In Liberia’s capital, an Ebola outbreak like no other

MONROVIA, Liberia —
Some people are swimming in and out of the Ebola quarantine zone in the seaside capital of Monrovia. One man slips out every day to reach his job at a Western embassy. Another has turned his living room into a tollbooth, charging others to escape through his apartment at the edge of the cordoned-off area. Countless others have used a different method: bribing their way out with fees that soldiers determine according to a person's appearance, circumstances and gender.

Christian Verre, 26, a clothing salesman, sneaked out through an abandoned building with his girlfriend, Alice Washington, 21, and eight friends. “Go back! Go back!” soldiers and police officers yelled, he recalled, but the conversation quickly took a different turn: “What do you got?”

Those carrying goods handed over more than $8, Verre said. He was charged $4.25 for his girlfriend and about $6 for himself, “because I'm a man.” The couple now share a shack a few blocks outside West Point, the sprawling slum that was placed under an Ebola quarantine last week.

“I didn't want to stay in West Point for 21 days,” he said, referring to Ebola's maximum incubation period. “I wouldn't die of Ebola but of hunger.”

The Ebola outbreak in West Africa, already worse than all other Ebola epidemics combined, is for the first time spreading uncontrollably in a major city, one in which one-third of Liberia's 4.5 million people is estimated to rub shoulders, often uneasily. Though Ebola reached Monrovia three months after its appearance in the rural north, the city has become in a few weeks a focal point of the epidemic.

The outbreak has overwhelmed the government of President Ellen Johnson Sirleaf, who has won the Nobel Peace Prize and the admiration of leaders worldwide. But her management of Liberia has long drawn criticism at home, and her handling of the Ebola epidemic has presented her with a political crisis that is galvanizing her opposition.

“We suffering! No food, Ma, no eat. We beg you, Ma!” one man yelled at Johnson Sirleaf as she visited West Point this week, surrounded by circles of heavily armed guards, some linking arms and wearing surgical gloves. “We want to go out!” yet another pleaded. “We want to be free, Mama, please.”

International Ebola experts and her own health officials advised against imposing the quarantine in West Point, worried that it would antagonize a population whose cooperation the government needs to stop the epidemic. But Johnson Sirleaf sided with the army, which was the strongest proponent of the quarantine and took the lead in enforcing it, especially in the first two days.

“Putting the police and the army in charge of the quarantine was the worst thing you could do,” said Dr. Jean-Jacques Muyembe, a Congolese doctor who helped identify the Ebola virus in the 1970s, battled many outbreaks in Central Africa and has been visiting Monrovia to advise the government. “You must make the people inside the quarantine zone feel that they are being helped, not oppressed.”

Isolating communities has succeeded in some rural areas in past outbreaks in Central Africa. But the quarantine of an urban neighborhood, where 60,000 to 120,000 people are crammed into crumbling shacks, has proved to be more than just porous. It has led to deadly clashes with soldiers and may be helping spread the disease, experts say, forcing people to crowd together for basic humanitarian aid, such as food.

Men in West Point squeeze together in dense lines for rice and water, pushing and shoving, sweat mixing, saliva flying, blood sometimes spilling. One morning, a man in a wheelchair trying to cut to the front was beaten, stripped and left sprawled in the middle of the road, urinating on himself.

“The quarantine is going to worsen the spread of Ebola,” said Muyembe, the director of the National Institute for Biomedical Research in Kinshasa, Democratic Republic of Congo.

Lewis Brown, the Liberian minister of information, said the president made the decision based on health and security concerns. Though Ebola has been spreading throughout other parts of the city, he said, the government singled out West Point because of its dense population and its potential for political instability, as shown when residents recently stormed an Ebola holding center that they did not want in the neighborhood.

Johnson Sirleaf has made no public statement since the start of the quarantine and the fatal shooting of a West Point boy, Shakie Kamara, 15, who was caught in a battle between soldiers and men trying to break out of the quarantine zone.

During her visit to West Point, she apologized to his family and looked at those calling for help but said little. Walking several feet behind her, a man in a checked shirt pulled out Liberian dollar bills from a backpack with his gloved hand and tossed the money to the loudest protesters. The money silenced their criticism but set off fistfights.

A Toyota Land Cruiser took the president out of West Point. Her guards and entourage followed on foot, tossing their used gloves on the ground on their way out.

No one knows why Ebola has succeeded in spreading at such an alarming rate in Monrovia. The virus has reached the capital cities of Freetown, Sierra Leone, and Conakry, Guinea — the two other West African nations most affected by the current outbreak — but the disease has been more effectively contained in those cities.

The first cases in Monrovia were reported in June. Infections have multiplied quickly in recent weeks, illustrating the speed with which Ebola can spread in a major urban area. The county containing Monrovia quickly registered the nation's biggest death toll — now 274 deaths of a national total of 754, according to the Ministry of Health.

“The Conakry outbreaks have been very small, and they haven't exploded in Freetown,” said Dr. Armand Sprecher, an Ebola expert for Doctors Without Borders. “So something is different in Monrovia. It's something in the disease transmission behaviors in Monrovia that has done this. That's my guess. We've never seen this kind of explosion in an urban environment before.”

As the situation worsened in Monrovia in mid-August, the government established the city's first Ebola holding center in West Point. Locals ransacked and closed the center within days. On Aug. 20, under the president's orders, the army and police placed West Point under quarantine, the first time, some experts say, that a quarantine was attempted on such a scale.

A week into the quarantine of West Point, life has been getting harder for those without the means or connections to get out. The price of goods that arrive in the quarantine zone — rice, water, coal, prepaid cellphone cards, soap — has doubled.

“People are fighting for food to eat,” said Victor Nwanodu, who owns one of West Point's most popular public toilets and baths. Business has dropped, he said, as people can no longer afford to pay for a hot bath.

Johnson Sir leaf's handling of the crisis is drawing new political challenges and leading to defections. Political parties and newspapers are calling for her resignation. This week, Johnson Sir leaf said she had fired high-ranking government officials who refused to return to Liberia because of the Ebola outbreak. Though she inspired great hope among Liberians when she was first elected in 2005, becoming the first woman elected head of state in Africa, the crisis has fueled longstanding criticism that her reputation was inflated by foreigners with little knowledge of Liberia.

“This Ebola thing now has basically laid the thing out like this: the system is bad and the emperor has no clothes,” said Samuel Jackson, who served as an adviser to the president until the end of July but is now backing Benoni Urey, a businessman believed to be Liberia's richest man and a candidate in the next presidential election.

Urey said Johnson Sirleaf “must take the ultimate blame for everything.” One of the greatest sources of public anger, he pointed out, has been the government's inability to pick up the bodies of the Ebola dead, which have often been left in people's houses or dumped on public streets.

Jerolinmek Piah, the president's press secretary, said Johnson Sirleaf was no longer giving interviews.

source: http://seattletimes.com/