Ebola turns loving care into deadly risk

Days after Kaizer Dour died of Ebola at the edge of a mangrove swamp, strangers carried his rotting corpse in a dugout canoe for a secret burial. Out on an uninhabited, bush-covered island, far from the national basketball court where Kaizer won acclaim as one of Liberia’s most valuable players last season, the strangers fulfilled one of the most important duties of a Liberian family – burying the young man.

One of the men stood knee-deep in a shallow grave, shovelling sand over Kaizer’s 6-foot-2-inch body. The other, having steeled himself with swigs of a local gin called Manpower, gave a speech to bid Kaizer farewell in the absence of mourners. “Your whole entire family, no one is here to represent you,” the man intones, captured in a cellphone video. “Your mother gave a rose that we should bury with you to remember her. She tried her best, but she was alone.”

The burial, one of countless unrecorded deaths in the deadliest Ebola outbreak in history, was an anonymous end for a middle-class young man on the cusp of celebrity. A rising star in Liberia’s top basketball league, Kaizer, 22, had dreamed of making it to the Los Angeles Lakers, the home of his idol and fellow shooting guard, Kobe Bryant. His Facebook profile, updated just three weeks before his death on August 9, shows him spinning a basketball, an overhead light beaming down on a face bearing a young man’s self-assuredness.

A proper burial surely would have drawn hundreds of people – teammates, friends, fans and members of his large family, for whom Kaizer was an enduring point of pride. But this strange, horrific disease called Ebola, new to this part of Africa, had already started dismantling his unusually tight family, bringing fear, anger and ultimately death to the people who cherished him.

Ebola is a family disease, Liberians are reminded continually in Sunday sermons. The more families pull together to fight the virus, the more they seem to fall apart. Kaizer’s extensive family had survived Liberia’s 14-year civil war, growing stronger as it united against poverty, rapacious rulers and indifferent governments. So when Kaizer got sick, his mother, Mamie Doryen, did what the Doryens had always done, turning to her family to care for her ailing son.

Kaizer, infected by his father, soon passed the virus to two aunts. In all, seven members from three generations died in quick succession. His mother, the family’s dominant figure, survived. But blamed for the calamity, she went into hiding, a pariah in her family’s hour of greatest need. The family’s center could not hold. “Ebola was like a bomb,” one of Kaizer’s uncles said.

This destruction of families is the central tragedy of the epidemic. On a continent with many weak states, the extended family is Africa’s most important institution by far. That is especially true in the nations ravaged by the disease – Liberia, Sierra Leone and Guinea -–three of Africa’s poorest and most fragile countries. Ebola’s effects on the region, in undermining the very institution that has kept its societies together, could be long-term and far-reaching.

For most West Africans infected during the outbreak, the virus was transmitted quietly, through tender acts of love and kindness, at home where the sick were taken care of, or at a funeral where the dead were tended to. But for Kaizer’s father, Edwin Dour, Ebola came violently on the night of June 25 after a gravely ill man – Patient Zero to the Doryen family – was brought to the government-run clinic where Kaizer’s father was the chief administrator.

Six of 29 employees at the clinic died within a month of Ebola’s arrival. Kaizer’s father, known for never turning away patients, became infected, too, passing the virus to his son in a pattern seen across the city. The sick brought Ebola to defenceless health centers that in turn often helped spread the virus.

Despite the money that the United States and other governments had funnelled into Liberia’s health care system in recent years, the health centres quickly crumpled. The 16-year-old girl who had brought the disease from Sierra Leone to Monrovia, died in the state-run Redemption Hospital on May 25. A doctor and five nurses there, working without gloves or the basics of infection control, died in rapid succession.

Though Redemption often did not have running water, it was one of the biggest medical centers in Liberia. So after it was closed in a panic in June, the sick scattered to nearby clinics, including the one managed by Kaizer’s father.

Arrival of Patient Zero
On June 25, a yellow taxi dropped off a young man in front of the clinic’s gate. The patient, a church caretaker, had apparently become infected when an old woman with Ebola was brought in for prayers. By the time the caretaker showed up at Kaizer’s father’s clinic, he was exhibiting the full-blown symptoms of late-stage Ebola: vomiting, diarrhoea and – a peculiar sign of Ebola – uncontrollable hiccups. Around 10 pm, the sick man became violent and confused. “He was fighting – unstable – he was just going up and down, coming down on the bed, turning this way, that way,” said the physician assistant on duty, Moses Safa. The guard held the man down. “Then he gave up the ghost,” Safa said.

Kaizer’s father tested positive for Ebola, but the government did not tell his family. In theory, workers are supposed to inform families of test results; in practice, few tests have been carried out and the results rarely provided. Kaizer’s father, who was in his mid-40s, died July 23. Because his parents had separated years before, Kaizer helped tend to his dying father. But as has been the case for thousands who have died during this epidemic, the natural inclination to care for a loved one would prove his undoing.

Overwhelmed by Kaizer’s illness, Mamie Doryen had brought him to her family’s home in Capitol Hill. As day broke, the neighbours learned that an ailing Kaizer had been carried in overnight.

It was early August, and the government, reeling from the deaths at Redemption and other health facilities, was paralysed. Many Liberians remained deeply skeptical of Ebola’s very existence, suspicious of government corruption. The government slogan – “Ebola Is Real,” written on billboards and posters – merely reinforced the popular belief that it was not. Still, enough deaths had occurred in the capital that any illness caused suspicion of Ebola.

So, Mamie denied that Ebola had killed her former husband, Edwin Dour, and sickened Kaizer. Instead, they had both been poisoned, she insisted. The Doryen family allowed Kaizer to stay, sharing one room with three family members – all of whom would die.

But when the Doryens’ neighbours stepped up demands that Kaizer leave Capitol Hill as soon as possible, the Doryens acquiesced. Kaizer died the next morning in his mother’s home next to the swamp. It happened just as his own father was being laid to rest. During the funeral service for Kaizer’s father, the scattered attendees learned that Kaizer had died as well.

The government was still incapable of responding in the most basic ways, including collecting the highly infectious bodies of the Ebola dead. So two days after Kaizer’s death, the stench of his corpse seeping out toward her neighbours, his mother asked one of them, Jerome Mombo, to bury her son.