Salomé Karwah survived Ebola and helped turn the tide of the epidemic, winning international recognition. Tragically, she has now died from post-childbirth complications, but might have lived without the stigma against Ebola survivors. In combination with the lack of post-natal medical care in her homeland, these irrational fears cost the world a true hero.
When Ebola came to Liberia in 2014, Karwah was a nursing assistant. Her parents, brother and more distant family members died of the disease, but Karwah herself recovered, along with her sister and fiance. Subsequently, she went to work at the Médecins Sans Frontières (MSF) treatment unit that had helped her survive.
Since you can't catch Ebola twice, Karwah was able to touch the sick without wearing multiple layers of gloves. The combination of her medical knowledge, experience of the disease, empathy for the sick, and extraordinary energy helped save numerous lives. She worked as a mental health counselor giving people the will to live. When Time Magazine made the teams confronting Ebola their people of the year for 2014, she was one of those they highlighted.
On February 17 this year Karwah gave birth to her fourth child by cesarean section, and was discharged on the 20th. Within a few hours of coming home, she went into convulsions for reasons unknown. On being rushed to hospital she was denied treatment by panicked staff. “They said she was an Ebola survivor,” her sister told Time. “They didn’t want contact with her fluids. They all gave her distance. No one would give her an injection.” Karwah joins five of the authors of the original paper describing the outbreak in losing her life. While she did not die directly from Ebola, there is a high chance she would still be alive were it not for fear of her status as a survivor.
The tragedy serves as a reminder that the social context for diseases can be as important and disastrous as the medical conditions themselves. Although there is some uncertainty about how long after recovery people remain infectious, the chance that anyone could have caught the disease from someone who recovered almost three years ago is infinitesimal. The fear is not surprising, however. After all, at the height of the epidemic, there were demands for the wealthy world, the United States in particular, to ban travel from affected countries, lest the disease jump continents.
Even then it was easy to prove that there was very little risk to nations with advanced medical systems, and that such a ban would instead have greatly increased the death toll by preventing medical teams from helping bring it under control. With educated people safely clear of the outbreak refusing to listen to reason, the reaction of the staff who refused to assist Karwah is all too predictable.
The West African Ebola epidemic killed an estimated 11,000 people, with another 17,000 surviving the traumatic disease. The disruption and diversion of medical resources from other diseases almost certainly killed even more people. It could, however, have been far worse.
The world can thank a combination of astute aid from richer nations and the heroic efforts of people on the ground for saving hundreds of thousands of lives. The provision of beds that allowed doctors to treat patients in relative safety is thought to have prevented more than 50,000 cases in just one country, but it was primarily local medical teams like Karwah's who stopped transmission. Tragically, it will be a long time before medical facilities in the region recover from the strain, which may have played a part in Karwah's death.
