The 2014 West African Ebola outbreak killed 11,310 people. Liberian nursing assistant Salome Karwah was not one of them. The disease that tore through her town in August of that year took her mother, her father, her brother, aunts, uncles, cousins and a niece. But by some miracle, says a Time report, it left Karwah, her sister Josephine Manley and her fiancé James Harris still alive.
But, it says, just because Karwah escaped Ebola, it didn’t mean she was secure against the failures of Liberia’s broken medical system. She died on 21 February, 2017, from complications in childbirth and the lingering social stigma faced by many of Ebola’s survivors.
Karwah used to joke that survivors had “super powers” – because after overcoming the disease they were forever immune from it. Like any superhero, she often quipped, it was her moral duty to use those powers for the betterment of humankind. So, the report says, as soon as she recovered, she returned to the hospital where she had been treated – the Médecins Sans Frontières (MSF) Ebola treatment unit just outside of the capital, Monrovia – to help other patients. Not only did she understand what they were going through, she was one of the rare people who could comfort the sick with hands-on touch. She could spoon-feed elderly sufferers, and rock feverish babies to sleep.
The report says in November 2014, Karwah, her fiancée, and her sister were already planning to re-open the family medical clinic that had been forced to close when her father, the local doctor, succumbed to Ebola. She envisioned a kind of super-clinic, whose survivor nurses would able to go where other medical personnel feared to tread because of their immunity. “I can do things that other people can’t,” she said then. “If an Ebola patient is in his house, and his immediate relative cannot go to him, I can go to him. I can take (care of) him.”
The report says it was her determination to help Ebola patients when most of the world fled in fear that put her among the Ebola Fighters who were named TIME Magazine’s Person of the Year in 2014.
At the time, Karwah seemed invincible. When the outbreak in Liberia ended, and people could have a party without fear of catching the virus, she finally married her fiancé, changed her name to Salome Harris, and had her third child. She picked the name Destiny. Then she got pregnant again. On 17 February she delivered a healthy boy, Solomon, by caesarian section. She was discharged from hospital three days later. Within hours of coming home, Karwah lapsed into convulsions. Her husband and her sister rushed her back to the hospital, but no one would touch her. Her foaming mouth and violent seizures panicked the staff. “They said she was an Ebola survivor,” says her sister. “They didn’t want contact with her fluids. They all gave her distance. No one would give her an injection.”
The report says Karwah died the next day. “My heart is broken,” says Manley. “Salome loves her children, her James. The one-year-old, the newborn, they will grow up never remembering their mother’s face.”
Manley doesn’t know what caused the convulsions, but believes that something went wrong in the surgery. Still, she says, if her sister had been treated immediately, she might have had a chance. Instead, “she was stigmatized.”
The report says news of Karwah’s death rippled far beyond her small community in Liberia. Those who knew her for her tireless cheer in the MSF Ebola treatment clinic were devastated. “To survive Ebola and then die in the larger yet silent epidemic of health system failure… I have no words,” says Ella Watson-Stryker, a MSF health promoter who worked with Karwah in Liberia and was also among the Ebola Fighters on the 2014 cover.
Karwah’s death is being investigated after reports that health workers were afraid to treat her, the country’s health ministry said. Reuters Africa quotes the ministry’s chief medical officer Francis Kateh as saying: “It is tragic that one of our heroes, who survived Ebola, died from childbirth in a hospital. We are taking the death very seriously,” he said, adding that the authorities were investigating whether staff had refused to treat Karwah.
Liberia was hit hardest by the world’s worst outbreak of Ebola, losing more than 4,800 people in an epidemic which killed around 11,300 people across Guinea, Liberia and Sierra Leone between 2013 and 2016. Many survivors have been shunned by their families, communities, and even health workers.
The report says the virus can lie dormant and hide in parts of the body such as the eyes and testicles long after leaving the bloodstream – raising questions about whether it can ever be beaten, with West Africa’s 17,000 survivors acting as a potential human reservoir.
While health experts say the risk of Ebola re-emerging in survivors and being transmitted to others is low, some fear that the stigma surrounding the virus could lead to further preventable deaths of survivors in the three affected countries.
“Emergencies like these create lasting effects, partly because they can be so destructive to the social fabric of a country or community,” said Richard Mallett, research officer at the Overseas Development Institute, a UK-based think-tank in the report.
Medical charity The Alliance for International Medical Action (ALIMA) said many Ebola survivors were struggling to access healthcare in West Africa – but not as a result of being stigmatised by health workers. “Many survivors lost their jobs, or their spouse, and can no longer afford healthcare for themselves or their family,” said Ivonne Loua, head of ALIMA’s survivor care programme in Guinea.