The crowd was waiting — and angry. The minute the Liberian Red Cross convoy pulled in to a tin-roof shantytown huddled at the base of Monrovia’s St. Paul Bridge on the morning of Sept. 24, residents crowded the lead vehicle, clamoring to be heard. The five-vehicle convoy was there to pick up the body of a man who had died the night before with symptoms of Ebola. “Where were you two weeks ago when we called when he had a fever?” demanded one resident. “I’ve been calling every day for an ambulance,” shouted another, brandishing the call log on his mobile phone for proof. He turned to face the crowd: “No one comes when we are sick, only when we are dead.” The residents roared in agreement. One teenager turned his back on the Red Cross team, bent over, and grabbed his buttocks in a sign of contempt. The team supervisor, Friday Kiyee, sighed as he launched into an explanation polished by countless repetitions. “We are the Red Cross Body Management Team. Our job is to pick up dead bodies. We are not responsible for picking up patients and taking them to the hospital. We are only here to pick up the body.” He clapped his hands sharply, a signal for the men on his team to suit up and get to work.
All of the health care workers and other people involved in combatting the Ebola epidemic in Liberia face great risks on the job and the workers on the Red Cross Dead Body Management Team are no exception. The disease is at its most contagious in the hours after death when unprotected contact with the body and its fluids all but guarantees transmission of the deadly virus. Proper disposal of Ebola’s victims is one of the most essential factors in stemming the course of an outbreak that is killing hundreds of people a day in West Africa and threatens to infect up to 1.4 million in Liberia and Sierra Leone by January, according to a worst-case scenario predicted by the United States’ Centers for Disease Control and Prevention. But instead of gratitude, the men tasked with handling the dead — acting as collectors, coroners and undertakers for the victims of Ebola — face fear and revulsion. In the course of their work they are yelled at, spat at and threatened with rocks. At home, after a long day climbing into and out of stifling biohazard suits, hauling bodies, and bathing in pungent chlorine solution, many of them also face isolation from their friends, family members and neighbors. “No one wants to be near me,” says 29-year-old Nelson Sayon, who has been with the Dead Body Management Team since Ebola came to Monrovia, in June. “They are afraid. They refuse even to take our money if we want to buy something in the store, or eat in a restaurant.”
Each team, of which there are six in Liberia, works six days a week, from nine in the morning to around six at night. They rarely have time for lunch. A typical day starts at a Liberian Red Cross center in downtown Monrovia, where the teams are given their assignments for the day. Early in the morning of Sept. 24 the center was bustling with activity. Workers were mixing buckets of chlorine solution to fill up the backpack sprayers used by disinfectant teams. Others were hauling sacks of Tyvek biohazard suits, rubber gloves, goggles and masks — the foundation of a Body Management Team member’s wardrobe. One man walked by with a cardboard box labeled bodybags.com balanced on his head. Kiyee gathered his team and read out the assignment for the day: district 16, one of the most Ebola-impacted areas of Montserrado County, home to the capital Monrovia, and the epicenter of the outbreak. Before starting their rounds “we pray,” said Sayon, a member of Kiyee’s team. “We pray for guidance, protection, and for God to make Ebola go away.” He also prays for the bodies he is about to collect, he said, because once he starts, he won’t have time to be thinking about the dead. He will be too busy trying to stay alive, making sure that he, and his teammates, are properly covered and routinely disinfected.
The first stop was Babama Junction, where a man named Paul Taylor had succumbed to a high fever the night before. Taylor’s wife, fearful for her own health and terrified of the Ebola stigma, swore that her husband had only been sick a day, and that he couldn’t possibly have had the virus. There was no vomit, she said, when describing his symptoms to Kiyee. No diarrhea, no blood in the mouth — typical signs of Ebola. She begged the team not to take her husband away. She wanted to bury him herself. But there is no rapid test for Ebola, and with every dead body a potential viral bomb, the team can’t take any chances. “We can’t say for sure if a person has Ebola or not,” said Kiyee. “Any person who dies right now is considered a suspected Ebola case, and we have to take the body.” Even if they don’t have proof, the teams have enough experience by now to know the signs. “The people don’t want to accept that their father or mother or wife has Ebola, so they lie [about the symptoms],” said Sayon. “But when we come back again and again to the same house, the same community, we know it’s Ebola, and not asthma or malaria.”
In the early days of the outbreak, the Dead Body Management Teams would help families bury their dead – laying the body six feet deep, under layers of dirt soaked with chlorine spray. But as the numbers of dead increased exponentially, fearful communities began to reject the burials, and the government mandated that all bodies, no matter the cause of death, be cremated.
There were 10 members of Kiyee’s team at the Taylor family home: four men to handle the body, two to disinfect the house before and after the pickup, one to oversee the proper protective gear, and three to run interference with the community. Even as the moon-suited and chlorine-drenched collectors wrestled Taylor’s body into a body bag, Kiyee was out in front of the house, placating the gathered crowd and explaining, once again, his responsibilities. The collectors heaved the body bag into the back of a navy blue pick up while the crowd erupted into a collective howl of grief. The collectors disrobed in ritualized steps: the first layer of gloves, then the hood, the goggles, the face mask, the body suit, and finally the last layer of gloves, all interspersed by liberal sprays of chlorine solution. The convoy reassembled and sped through the community’s mud-slicked roads, chased by residents alternately bidding the body farewell, and cursing the team that had taken a beloved father, brother and husband away.
So it went, a relentless cycle of dressing up, collecting a corpse and undressing, until the pickup was weighed down with 20 bodies in all. So full was the truck that it could not even stop to pick up the body of a man who had died in a roadside market. “We will come back tomorrow,” one of the drivers yelled to the crowd. Then, accompanied by a police escort, the convoy tore down the highway towards a crematorium on the outskirts of town. There, the collected bodies would be burned, unmarked and unmourned, along with the scores of other corpses collected by the Red Cross that day.