Monrovia is a city where ambulances rush back and forth and burial teams in white hazmat protective suits have become so commonplace as to arouse no more curiosity. As the clock struck midnight on 13 October, health workers planned to abandon their posts at hospitals and ebola treatment units in the Liberian capital in a pay protest. Patients infected with the deadly haemorrhagic fever and vomiting, those who were “toileting” and bleeding, would be left alone in bed without food or care.
With close to 500 infected people in treatment centres, and almost three times as many yet to access care, the strike threatened to derail efforts to contain the crisis in Monrovia, now the centre of the ebola outbreak in West Africa. Given the huge risks and sacrifices endured by local medical staff, it is not hard to understand their anger.
At least 200 health workers have been infected with ebola and 90 have died, according to the latest government figures. Yet pay is modest.
At Island Clinic, a recently refurbished hospital that had been converted by the World Health Organisation into an ebola clinic, workers said they did not have contracts and that the government was skimping on hazard pay. Nurses and other staff claimed they had been promised $750 a month, and that the government was now offering them $435.
Workers elsewhere told similar stories. “They [the patients] are our people – we have to save their lives – but the government is not treating us fair,” said Matilda Weah, a 30-year-old nurse who had worked at Redemption Hospital, a government facility where five nurses and a doctor died after being infected.
In the end, the industrial action was called off, but only after a last-minute appeal from President Ellen Johnson Sirleaf as well as desperate negotiations between the government and the workers’ union leadership. Nurse Weah said it was concern for the patients, many of whom would have died, that persuaded them not to strike.
“When you see how sick they are, you cannot leave them like that,” she said.
Monrovia has teetered on the edge of chaos in these past few months. Desperate families transported loved ones in yellow taxis to hospitals because none of the city’s dozen or so ambulances was able to pick them up. Some died in the streets outside treatment centres even before being admitted. Others were turned away, returning home to infect relatives.
Schools were shut. The economy ground to a halt. Work stalled on the Mount Coffee hydropower plant, slowly being reconstructed by Norwegians; one of the darkest cities in the world could remain so for years to come.
Chinese workers building roads across the country were suddenly nowhere to be seen. Other foreigners –NGO workers, oil and mining company staff – scrambled for flights out. Coming the other way were specialists from the Centres for Disease Control and Prevention and WHO and USAID’s disaster assistance response team, with their safari waistcoats and caps.
US troops and military personnel are also trickling in as part of Operation United Assistance, announced by President Barack Obama last month. Their mandate is to build 17 ebola treatment units across the country, though these will not be staffed by Americans.
Many people welcome the assistance but some are suspicious of the motives of the US, which is widely seen as pulling the political and economic strings in Liberia. At a recent press conference, the US ambassador, Deborah Malac, felt compelled to assure people that US troops were not here to overthrow the government.
“They are here to provide additional heft to the effort that is already ongoing to fight ebola, period,” she said.
That fight remains a big one. Outside a former cholera clinic that has been turned into an ebola treatment centre sat five people: three men in their thirties, a young woman and a five-year-old boy. They had survived the virus and were waiting to go home.
“It was hell in there,” said one man, who wished to go unnamed because of the stigma associated with the disease. “We are traumatised. People were dying all around us.”
A jolly nurse who brought food to them while they were sick arrived to greet them. This was the first time they had seen her face; before, she was merely a figure in a mask. They thanked her for her help.
Yet the boy, who had lost his parents to ebola, was not on his way home but off to a centre built to care for some of the thousands of orphans who are expected to be created by this deadly outbreak.