“You’re an imbecile.” Dr. Giovanni sounded like a father who’d lost all his patience with a child who didn’t want to learn. “You are going to kill everyone in this town.”
Dr. Littlefield’s immediate impulse was to lash back, but he didn’t have the energy for it. Too many twenty-hour days had worn all the fight out of him.
“I’ve only been here a half hour, and I can already see this is Ebola—or maybe Marburg—if you’re lucky. And what have you done? Your nurses wear plastic aprons they’ve been reusing for days. They clean the aprons in a common bucket instead of burning them. They are not protected from this outbreak. You’re going to kill them and yourself. You don’t have a containment area. You let people walk out of the hospital and into the street, carrying the virus with them. You’ve made this whole town a hot zone. How can you be a doctor in this country and not have the good sense to take the proper steps to contain this?”
Dr. Giovanni was on the edge of the porch by then, Littlefield having backed down a few steps in the face of the scolding.
But Giovanni’s rebuke found a quick end. “Have you nothing to say for yourself?”
“Yes. Are you ready to listen?” Littlefield replied.
“Of course.” It sounded like a platitude.
“I’ll skip right over the part where I tell you I’ve been on the radio, and you’re the first person to show up.” Littlefield retreated down the last few steps and put himself on level ground. The Italian could come down and talk to him face-to-face.
Dr. Giovanni proceeded down the steps and took up a position on the dirt road in front of Littlefield, towering over him anyway. “I came to investigate as fast as I could.”
“When were you told to come?” Littlefield was not impressed, and his tone made that very clear.
“Yesterday morning?”
“Why so long?”
“West Africa.” That was the simple answer, and both Littlefield and Giovanni knew that. West Africa was experiencing the largest Ebola outbreak in history, and it was accelerating. “Whoever is not there is running around the rest of Africa chasing rumors of more outbreaks. Most of them are just fear.”
Littlefield nodded to the hospital. “But this one isn’t, is it?”
“No. But if you know it’s Ebola, why haven’t you taken the steps to contain the disease?”
Dr. Littlefield laughed harshly. “It’s so easy to judge, isn’t it?”
Dr. Giovanni took a moment to pull himself back from the edge of losing his temper. “Tell me, then. What happened here?”
“As far as containment goes, well, you can see the outbreak is bad. It’s already everywhere in the town.”
“When did it start?”
Littlefield did some mental math. “People started showing up with symptoms a week ago.”
Dr. Giovanni asked, “How many?”
“A lot more than there should have been for a normal outbreak. Nearly two dozen that first day.” The fog of missed sleep clouded his memory.
“Twenty-four?”
“Yes.” Littlefield looked down, nodding for emphasis. “Twice that number, the next. On the third day, when I started pleading for help, we had around a hundred. That is a lot for a town this size.”
“And you’re the only doctor?”
Littlefield gestured down the street. “This is not a large town. Even so, maybe a hundred thousand live in the district. There are two other small clinics in the area, but this is the only one that passes for a hospital. There were two of us, but Dr. Ruhindi is inside. He fainted last night. He has the virus, and can’t even stand now. Two of our nurses went to Sierra Leone two months ago to help. Some of the college students teaching at the free school volunteered to help. All but one is sick. We have Nurse Mary-Margaret and a couple of girls from the town who help us.”
“When did you first suspect Ebola?”
Littlefield thought for a moment. “The third day. Before that, patients had the usual headaches, fever, nausea, and diarrhea that accompany just about any common outbreak. However, this outbreak was so widespread and sudden, I initially suspected typhoid. I drew blood samples and sent them to the lab in Kampala.”
“What came back?”
“Nothing.”
Putting the pieces of the puzzle together, Giovanni replied, “You didn’t receive the results?”
“I’m still waiting.”
“You may not ever get the results. Rumors of Ebola and fear of the disease have caused the government to blockade the roads in most of the eastern districts.”
“Great.” Dr. Littlefield stepped over to lean against the side of the porch’s foundation, and put himself under the shade of the roof that slanted out in front of it. “On the third day, maybe twenty of the people who’d come in over the previous days with other symptoms came back with blood-red eyes. Others followed. The rashes started showing up, and that’s when I knew.”
“But all at once? How do you explain it?”
Dr. Littlefield shook his head. “It didn’t make any sense. You obviously see that, too. Ebola has a death chain. Usually you can trace it back one person at a time. Perhaps a man comes in with symptoms, but you know he got it from his wife, who was in two weeks ago, who got it from their child, who contracted the disease a week or two before. And maybe that child got it from a childhood friend. Ebola is a nightmare—a slow-motion nightmare that grows through personal contact. It thrives in this culture because they feel a social need to touch. They even touch the bare skin of the dead in their funeral rituals.”
“Not that different than us in the West,” Dr. Giovanni said.
“I guess not.” Dr. Littlefield took a moment to collect his thoughts and get himself back on track. “We didn’t have a death chain here. That’s the reason I didn’t even suspect Ebola at first.”
“Because it exploded across the population rather than growing in it?” Dr. Giovanni asked.
“Yes. That’s exactly what happened. It exploded for no apparent reason. People were getting infected by the dozens, with no apparent link. Of course, that was at first. By now, everybody in town who didn’t flee is in some stage of the disease. The hospital is overflowing.” Dr. Littlefield pointed to a cluster of three rectangular buildings a short distance across the mountain slope. “The school buildings are full.”
“Everybody is infected?”
“I don’t know that for sure.” Dr. Littlefield pointed down the road in both directions. “Two days ago I walked through town and tried to get people to come out of their houses and talk to me.”
“And?”
“Most wouldn’t come out. The ones who did kept their distance, which was smart. A few admitted that at least someone inside was sick. In some houses, everyone is sick. Everyone. But they were afraid to come to the hospital.”
“Do you blame them?” Dr. Giovanni asked.
“No. There’s little we can do for them. Most of our protective equipment was stolen early on.”
“That’s what happened to it?”
Dr. Littlefield nodded sadly. “What you see is what we have.”
Dr. Giovanni started to raise his hand to shake, but quickly put it back down. “I’m sorry. I owe you an apology.”
“You do,” Littlefield agreed. Giovanni had been unnecessarily harsh.
“I admire your dedication and bravery.”
Dr. Littlefield glanced at the hospital doors over his shoulder. “I’m just trying to help.”
“Are you symptomatic yet?”
“I have a headache and a fever,” Dr. Littlefield admitted.
“I’m sorry.”
Littlefield shook his head. “It was inevitable.” And for so many caregivers in Africa that was indeed the case. He walked around Dr. Giovanni, climbed the six stairs up to the hospital’s porch, and went to his favorite spot to lean and look at the small farming community. “I’m afraid.”