How Bureaucrats Let Ebola Spread to Nigeria

After Patrick Sawyer’s sister died of the virus, Liberia’s Ministry of Health instructed him not to travel. But he was allowed to fly to Lagos. Now he’s dead—and 10 more are infected.

The Daily Beast

From the hot zone come more chilling reports about the U.S. citizen who brought Ebola from his native Liberia to Nigeria and might well have brought it to America if he had been able to return to his wife and children in Minnesota this month as he planned.

We now learn that 42-year-old Patrick Sawyer was traveling to an economic conference as a representative of the Liberian Ministry of Finance even though the Liberian Ministry of Heath had instructed him not to travel because he might be infected with Ebola.

“I can confirm to you that he was advised by the Chief Medical Officer at the Ministry of Health not to leave the country because he was under observation,” a Liberian government spokesman was quoted telling a Lagos newspaper. “It was regrettable that he left the country while being observed.”

Ministry of Health protocols called for Sawyer to be to be monitored daily for 21 days. But as an official with the Ministry of Finance, Sawyer went ahead with plans to attend an economic development conference in Nigeria. The man who authorized the trip, then-Deputy Minister for the Budget Sebastian Muah, at first said he had authorized the trip and excused the decision by pleading a lack of medical expertise.

“I am a medical doctor?” he asked in an online posting. “Take me to the international court since I am guilty of approving a travel.”

On Wednesday, Muah suddenly denied all responsibility, telling the Liberian website FrontPageAfrica that Sawyer never got government approval for the trip and secured his ticket through the organization that sponsored the conference.

What is beyond dispute is that a man who was officially under observation as a possible Ebola carrier was permitted to board a plane for Lagos on July 20 even though he was manifestly ill. He is said to have been in such physical distress that surveillance camera footage shows him at one point sprawling facedown in the airport waiting area.

The footage, which has not been released but has been viewed by a reporter for The New Dawn, also reportedly shows a downcast and sick-looking Sawyer seeming to avoid physical contact with others, at one point declining to shake the outstretched hand of an immigration official—a suggestion that he harbored at least a suspicion that he might be carrying an infectious disease.

Sawyer vomited repeatedly during the two-stop flight and collapsed upon arriving at the Lagos airport. He was taken to First Consultant Hospital, where he reportedly told the medical staff that he had malaria.

He tested positive for Ebola and is said to have been in such deep and desperate denial that he insisted the doctors were wrong. He is described by FrontPageAfrica as having become so angry he ripped the IV lines from his arms. He also apparently sought the help of high-ranking Liberian officials, who reportedly pressured the hospital to release him, initially so he could attend the conference, then simply so he could go home.

On July 25, five days after he landed in Lagos, Sawyer died. At least 10 Nigerians were infected as a result of his apparently officially sanctioned travel, including a nursing mother who had given birth at the hospital before he arrived but returned afterward for her newborn’s vaccinations. She apparently was infected by a nurse who had become infected while treating Sawyer.

Another nurse who was working when Sawyer was brought to the hospital from the airport went on Facebook and reasoned that she had not been exposed enough to have caught the dread disease:

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“I never contacted his fluids. I checked his vitals, helped him with his food (he was too weak),” wrote the nurse, Obi Justina Ejelonu. “I basically touched where his hands touched and that’s the only contact. Not directly with his fluids. At a stage, he yanked off his infusion and we had blood everywhere on his bed…But the ward maids took care of that and changed his linens with great precaution.”

Ejelonu soon after tested positive and at last report was critically ill, deep in the horrors of Ebola. The chain of infection goes back to Sawyer’s 27-year-old sister, Princess Nyuennyue, who was bleeding heavily from her vagina when her husband brought her to St. Joseph’s Catholic Hospital in Monrovia in early July.

The medical staff were at first leery of treating her for fear of Ebola. The hospital’s chief administrator, Brother Patrick Nshamdze of the Hospitaller Order of Saint John of God, stepped in. He was from Cameroon and spoke French, as did the woman’s husband, who reportedly told him that she was suffering a miscarriage.

Nshamdze arranged for Sawyer’s sister to undergo a D&C and be admitted to a general ward. But she continued to bleed, and the staff became all the more alarmed. She was scheduled to be transferred to the isolation unit when her brother arrived.

Sawyer insisted that she be given a private room and plunked down $500 to secure it. He proceeded to personally change her gown and placed her in a wheelchair for the move. He was seen to get her blood on his own clothes as well as his shoes in the process. He is said to have been given a pair of slippers to wear.

On July 7, the sister died. Sawyer’s bloody shoes were still in the private room and were left there along with her belongings by hospital staff, who were fearful of the virus.

On July 9, Sawyer informed ArcelorMittal, a mining company where he worked as a part-time consultant, that his sister had died of Ebola. The company says it immediately notified the government.

“Having informed us of this news, Patrick was submitted to the Ministry of Health for a medical observation and isolation and requested not to return to work until he had passed through the incubation period,” a company newsletter reports.

The Ministry of Heath is said to have ordered Sawyer not to travel. The Ministry of Finance nonetheless apparently authorized him to attend the conference in Nigeria. Finance officials there might have been worried about the repercussions among the other participants if it became known that a prominent Liberian had canceled because he might be infected with Ebola. Or the officials might not have been aware of the medical cause for concern.

“It’s possible the health ministry was monitoring him, but the finance ministry did not know,” a Liberian government spokesman later said.

Sawyer’s widow has since suggested in a Facebook post that his real reason for going to Nigeria was to seek better health care than was available in Liberia. Decontee Sawyer wrote: “He has expressed to me many times in the past that he felt passionately about helping to be a part of strengthening Liberia’s healthcare system, but he knew it wasn’t there yet, and he wouldn’t want to take a chance with his life because a lot of people depended on him.”

She went on, “Patrick had a passion for life, and he wouldn’t have wanted his to end. So, I bet anything he was thinking, ‘If I could only get to Nigeria, a way more developed country than Liberia, I would be able to get some help.’”

Unfortunately, none of his reported behavior following his arrival in Nigeria supports those contentions. He seemed, if anything, to resist the efforts to help him. And if he really accepted his life might be at stake and truly was seeking superior medical care, he could have returned to his family in the United States a month early. The truth is likely closer to what the widow told The Daily Beast in late July.

“I think he might have been in a state of denial,” she said.

In the meantime, at St. Joseph’s Catholic Hospital in Liberia, Brother Patrick Nshamdze, the administrator who had assisted Sawyer’s sister, fell ill. A first test for Ebola was negative.

“Based on this result, the other sisters and brothers decided to nurse him back to health,” an Ebola control worker who is identified only as Mosoka wrote in a letter that was posted on Facebook. “Despite their treatment he progressively began to show signs and symptoms that were typical of Ebola. He decided that he would leave for his home country, but the airline recognizing the signs and symptoms ask for a repeat of the test. Behold! This came back positive.”

The other health-care workers were stunned. And terrified.

“Brother Patrick was kept in one room of the hospital for treatment,” the letter continues. “The confidence of the brothers and sisters in our Ebola response system was seriously corroded. Brother Patrick became weaker and weaker and others stop coming around as they pondered over their own status. Then Brother Patrick died. His body was among the 52 bodies that were buried in a mass grave.”

That was on August 7. Seven other staff members then fell ill.

“One of them, a Nigerian Medical doctor, was told he was negative,” the letter reports. “However, he told us that every symptom in his body indicated to him that he too had contacted the disease. We then ordered for a new result. We are awaiting this result, but he is getting sicker and sicker each day.”

Others who had become infected included a technician from the lab that had been returning mistaken results.

“I have investigated the laboratory procedure and I noted several sources for potential errors,” the letter by Mosoka reports. “There is a single team of laboratory technicians that are working over ten hours a day and seven days a week without any time to rest. This would lead to lapses and increased risk for errors. One of the technicians told me sadly that they worked these very long hours and no one provides them with food. They begged for food and were given a 100-pound bag of rice with no soup kind and no one to cook for them. Many of them had not being paid for three months. How could we trust our lives in the hands of people that are overworked, starved and not given their just compensation? Are we winning this war against Ebola?”

The infected staff also included a social worker who now fled rather than be transferred to an Ebola treatment center, the very same one where Americans Dr. Kent Brantly and Nancy Writebol were working when they fell ill.

“Her daughter came and took her away, when she heard we were moving them to the treatment unit,” the letter reports. “This is worrisome as she could be a source of new transmissions in the community. Are we really winning this war against Ebola? I would say NO!!!”

Also among the ill was a 75-year-old Spanish priest, Father Miguel Pajares. He was evacuated to a hospital in Spain and given a dose of the experimental serum ZMapp that had been administered to the two American health-care workers. The Americans seem to be on the mend in Atlanta, but the priest died on Tuesday.

Back in Liberia, Mosoka was summoned when an emergency arose at an outpatient clinic.

“A man had started vomiting and toileting blood,” the letter reports. “I was called to intervene. I call the ambulance team but no one responded. I called those of my colleagues in authority at the Health Ministry, but they too were powerless as the system and the logistics were not in place to respond to such a call. The treatment unit was overflowing with sick people. They just could not pick any one up in the community because there were no beds available in the unit. Then the man died. His body stayed in the house for two days, while his poor wife and children slept in the open. No one wants to come closer to them. After two whole days of begging every authority I knew, they finally removed the body today.”

But the house had not been disinfected.

“The home was never spread. The poor woman and her children are again sleeping outside today. I have tried to call the guy on spraying but his phone is off. But, I will press on and will call again tomorrow.”

As the Ebola treatment center overflowed, St. Joseph’s Hospital, the oldest in Liberia, was shut down, it too waiting to be disinfected.

“The hospital is a ghost town,” Mosoka writes.

The letter closes with noble words of faith and hope from the hot zone where screw-ups are met each day with selfless courage.

“Maybe, as some of us fight each day to make some kind of difference, it will at least amend for all of our mistakes and failures in the Ebola Response. May God save our country and those countries affected!!!!”