So on a December afternoon, aid workers who had hiked to Quewein to help stanchan outbreak led Darius out, an arduous two-hour journey that might mean the difference between life and death. For their own protection, the workers instructed the little boy to clutch the end of a long stick.
Rural Ebola flareups in places such as Quewein have become a focus for rapid-response teams of doctors, health officials and other workers who hope to prevent these cases from reigniting Liberia’s epidemic.
But the fight for Quewein — and the fight to save Darius — illustrates exactly how hard that task will be. The village of 55 mud-brick homes with thatched roofs, several hours northeast of the capital, Monrovia, is so remote that health officials didn’t learn of the outbreak until a month after it started. Quewein has no electricity, no clean water and no access to medical facilities.
“We’ve managed to bend the curve on this epidemic, but it’s not over yet,” said Sheldon Yett, head of UNICEF’s mission in Liberia. “We are at a stage in the epidemic where we have to go to every village. We have to hunt down every case.”
For Darius, being found was the first step.
Holding on to the stick, he was led by a worker from Concern Worldwide deep into the sweltering rain forest, over rocks and hills and across treacherous river crossings made of logs and bamboo.
A second worker trailed the boy in the oversized shirt, carrying a chlorine tank and spraying the path to kill any infectious material that Darius left behind. The acrid smell of the chemical mixed with the lush scent of tropical flowers.
‘Tearing the village apart’
Ebola came to Quewein in late October, probably traveling up the same red-dirt trail that Darius followed to the ambulance.
Liberian health authorities and international aid workers suspect the outbreak began with a woman named Batime Garway. The sickly 89-year-old arrived in Quewein on a Friday night, carried on a stretcher by local youths. Her son, Joe Garway, said that she had fallen sick in Monrovia and that he wanted to bring her home to die.
By Saturday morning, she was gone.
Ebola preys on care and kindness. The virus quickly tore through Batime Garway’s friends and family. A friend who had washed her body for burial was dead by early November. Then Joe Garway said his father was stricken. An older brother succumbed. His brother’s wife, who had nursed him, died, too. So did their child.
Five members of Garway’s family had died in a month, but still he questioned whether Ebola was the cause. He said that his mother had suffered from hypertension and that his older brother was probably poisoned with bad alcohol — a common theory about Ebola deaths. Garway pointed to his own chest and asked: “Why have I not gotten sick?”
“I can say Ebola killed my mother,” he said, “but I have doubts.”
Aid groups said the path of the virus from the capital to Quewein is probably how many rural outbreaks begin. The disbelief among some of Quewein’s 350 residents is common, too. The “Ebola is real” messages that plaster billboards across Monrovia have not fully reached the countryside.
Health officials from Grand Bassa County finally heard of the unusual number of deaths in Quewein and came to investigate on Nov. 26. One of them, Gabriel B. Kassay, said that Joe Garway tried to incite the village to expel the group but that the officials managed to persuade some of the sick to give blood samples for Ebola tests.
It was a start, but the virus was primed to explode.
Over the next three days, seven people died of suspected cases of Ebola and two others became sick, Kassay said.
Fear and hunger spread as quickly as the virus. Quewein’s residents said people tossed clothes and mattresses out of their homes and burned them, choosing to sleep on dirt floors rather than risk infection. Word of the outbreak spread quickly to surrounding villages, who banned Quewein’s residents from local markets. Residents said a party sent to one of those villages was beaten and chased out.
“Ebola is tearing the village apart,” said David Korn, the town chief of Quewein.
Doctors Without Borders deployed a rapid- response team Dec. 1. A helicopter thundered over the rain forest and landed on Quewein’s dusty soccer field. Team members unloaded materials and erected white tents to house a makeshift Ebola treatment unit. They fired up a generator. Bottles of drinking water were carried up the forest trail balanced on the heads of residents, since Quewein’s well was contaminated.
A large section of homes was cordoned off with bright yellow caution tape to quarantine the infected. Teams in yellow moonsuits buried the dead and disinfected homes with chlorine spray. On a recent day, they were seen dousing a Bible, a purse and two tables outside the home of a sick woman.
Teams dispatched by the county, known as contact tracers, began documenting everyone who had come in contact with the sick so that they could be isolated to stop the spread of the disease. The task was daunting: There were 10 other remote villages in the rain forest that might have to be visited.
“For such a small community, this is a huge outbreak,” said Jonas Ohlsen, the physician who led the Doctors Without Borders team. “The work is much more challenging than putting up an ETU [Ebola treatment unit] in Monrovia in some ways. There, you have staff nearby. You have roads.”
On the day of Darius’s journey, Ohlsen said that he himself had already walked blood samples from a suspected Ebola patient down the forest trail to a vehicle that could carry them to a laboratory hours away. .
Doctors Without Borders has reported 43 confirmed or suspected cases — roughly 12 percent of Quewein’s population. Of those, at least 14 have died, and the fate of many who hiked out through the forest could not be traced. But the response team had made progress; only one patient remains in the village treatment center.
As with Darius, most of the presumed sick had no option but to walk their way to care, en route to a more comprehensive Ebola treatment unit in a neighboring country. Few pilots are willing to airlift Ebola patients, the aid organization said, and in those rare cases patients must be transferred one at a time in special isolation bubbles.
Some say that what has happened in Quewein speaks to a larger problem. While the international response to Ebola has helped provide hundreds of treatment beds and trained staff in urban epicenters of the outbreak, few resources have flowed to provinces where outbreaks have recently flared.
In Grand Bassa County, home to Quewein, the first Ebola treatment unit is scheduled to open this week. There was just one lab technician trained to handle Ebola specimens through November, according to a CDC report released last week.
Doctors Without Borders has documented similar problems, saying that contact tracers in rugged River Cess County did not have cars or SIM cards for their cellphones. There are 580 treatment beds in Monrovia, but only 178 in the rest of the country, according to the aid group.
In Quewein, one of those being treated in the isolation unit was T-Girl Bondo, Darius’s mother. The 25-year-old said she had gotten sick caring for her older sister, who had died of Ebola. The virus had also taken her sister-in-law and Darius’s brother. When asked if she was afraid that Ebola would take her life, Bondo registered no flicker of emotion.
“No, she said. “People are dying. Everyone has seen people dying.”
But she grew more animated when talking about her only surviving child.
“I feel so sorry for my son,” Bondo said after Darius left the village. “Walking that long road, I put [Darius] in God’s hands.”
Out in the rain forest, the boy had managed to walk for miles, scrambling across one river on a bridge of logs, aid workers said. When the boy got to the second river, he slipped off a crossing made of bamboo and plunged into the water. Aid workers said they had to snatch him out. Darius kept going.
Roughly two hours into the hike, a single river stood between the boy and the ambulance, but the crossing was the most precarious yet — a rickety scaffolding of bamboo poles lashed together. It was about 10 to 15 feet above the water and had a single handrail. With each step, the bamboo creaked and bowed.
Darius could not make it across alone.
An aid worker donned a full protective suit and scooped up the boy in his arms, the workers said. The pair inched across the bridge step-by-step to the far bank. Darius was loaded in the back of the ambulance, which bounced down a rutted dirt road. But there remained a two-hour trip to reach the Ebola treatment unit run by the International Medical Corps.
Darius finished the journey. At the Ebola treatment unit, he was given a test for the virus. It came back negative.
Death was all around Darius, but somehow he had been spared.
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