Around the time that the World Health Organization (WHO) finally declared the Ebola epidemic in West Africa an international public health emergency, a young woman named Adama Kargbo learned she was pregnant. A few months later, she contracted the virus and was admitted to an Ebola treatment center in Kissy, a suburb of Sierra Leone’s capital, Freetown. She lost her baby, but against all odds, she survived, overcoming the hemorrhagic fever which has killed more than 8,600 people in west Africa.
On the day Adama was to be discharged, MSF nurse Marisa Litster prepared to enter the high-risk area, where the patients are. “Adama is a special case,” Litser said as she puts on the yellow personal protective equipment. “She was our first patient” at this facility, admitted January 8, the day the center opened its doors.
“I’m excited for her, but also a little bit nervous, because I can see that there is lot of fear,” Litser continued. “This is just one part of the journey, but a big step will be going home and dealing with the aftermath of everything that comes with Ebola.”
In the patient area, Adama was sitting on a plastic chair, waiting. When the medical staff entered, she got up and walked towards the chlorine disinfectant shower. She was herself no longer infectious, but her clothes and personal items might be; all traces of the virus need to be liquidated.
When Adama left the patient area for good, MSF health promotion manager Roberto Wright Reis, who has been providing Adama with psychosocial support for the past two weeks, and Javiera Puentes, the medical team leader, were waiting for her. As others applauded, they embraced her, then walked with her towards the exit of the compound.
As Adama smiled and the cheers grew louder, Roberto raised her hand in the air in a gesture of victory. She then left a handprint—the first here—on the “survivors’ wall”, a symbol rendered in blue paint of her fight to get healthy once again.
“Ebola gets into you and sucks all your energy, all your vitamins,” Puentes told Adama. “Now that the virus is gone, you will feel weak for one or two months. This is normal. Don’t think that you are not better; all Ebola survivors feel weak for weeks.” She should avoid sex without protection for three months, however, because the virus remains active for a while in vaginal and seminal fluids and she is too weak to become pregnant again.
“A new chapter of your life is opening in which you will need to take care of yourself,” Puentes cautions. “Sleep and eat well.”
Ebola and Pregnant Women
The death rate for pregnant women infected with Ebola is not known exactly, but it is very high, and the prognosis for the fetus is much worse, in part because the virus appears to concentrate itself in the fetus. Pregnant woman with Ebola pose challenges in other ways as well. Medical staff in the newly opened MSF maternity in Kissy cannot do routine procedures because of the risk presented by exposure to body fluids, but they do use intravenous therapy, oral medication and, most importantly, they try to minimize the mother’s bleeding while in labor and after the delivery, to prevent the risk of her hemorrhaging and dying from blood loss.
When Puentes finished giving Adama medical advice, other staff members crowded around, keen to find out how Adama felt. “I’m feeling fine,” she said. “I’m happy because I’m discharged, so I pray to God for the others to be discharged.”
Adama wore a green T-shirt and skirt. She combed her hair and got ready to leave for home. How will your new life be? “I imagine it to be good,” she said. “When I get better, I want to go to university, study accounting and work in a bank.”
“I like being outside to take fresh air,” Adama whispered.
Life after Ebola
Adama can’t go home yet, because her home is still under quarantine, surrounded by tape. Most of her family came down with Ebola, and her mother, sister and brother are currently in a holding center. Adama is going to stay with one of her aunts in Waterloo, half an hour’s drive from the treatment center. Stigma will be the first hurdle that Adama will need to face.
Accompanying Adama will be Hawa Turay, one of her former teachers who happens to work with MSF as a health promotion officer. “When I met Adama in the center, I couldn’t believe she was the one, with a pregnancy of several months,” Hawa said, as she rode with her over the potholed roads of Sierra Leone. “I didn’t think she was going to survive, so I was very sad when I saw her. The time she got here she was weak, unable to talk. Now she is the first pregnant woman to survive in our center. She looks good, she’s happy, but she has lost many things.”
When they arrive in Waterloo, neighbors look on, unfazed. The MSF staff members hug Adama to demonstrate to the community that she is not longer infectious, but nobody pays much attention. Soon Adama’s brother, Abu Bakar, arrives on a motorbike. In the coming days, he hopes she can come and stay with him. “I’m happy for my sister. As of now she’s going to stay here,” he says.