Crouching towards a dirt road strewn with pebbles, Emmanuel Boyah, a Liberian primary health care manager , grips a box of enormous yellow rubber boots with both hands.
Black shirt tucked into snug black pants, his role is made transparent by the bright yellow embroidery across his chest: “International Rescue Committee.” Stacks of clean brown boxes surrounding him hold bleach, latex gloves, and masks—weapons against Ebola. These supplies will be distributed to medical facilities across Lofa County, one of the hardest hit regions in Liberia, where reports show more than 624 deaths.
The supplies are reason for celebration, or at least a mini one, as evidenced by the half-smile on Boyah’s round face. But peering more closely at the photograph, taken this August, his weary brown eyes reveal a darker truth. In mere days these supplies will be gone, smeared with the contaminated blood, urine, semen, and saliva seeping out of Ebola victims, living and dead. More dangerous than useful, they will be sterilized. Burned. Discarded. Some lives will have been saved, but not enough. And there’s no way to know when the next shipment arrives.
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Underneath the yellow boots image of Boyah, posted on his personal Facebook, a friend says “thank you” for his efforts. “We are trying to fight for the survival of our people. Ebola is very dangerous,” Boyah writes in reply. “But we have to fight.”
According to a report released this week by the World Health Organization, an estimated 240 health-care workers have been infected with Ebola in West Africa. Of that number, at least 50 percent are already dead. For an international relief worker, contracting the virus likely means becoming the focus of headlines about high-tech aircrafts and secret serums. For a West African doctor in the same position, it means simply one less health-care worker on a continent in desperate need of more.
Up until last year, Boyah, a native of Liberia known to his people as “Doctor,” was working to resuscitate a health-care system destroyed by a bitter 14-year civil war that left Liberia in pieces. With the help of the global humanitarian aid group International Rescue Committee (IRC), Boyah had begun to reverse the narrative of hopelessness driving Liberia’s health-care system. With the support of IRC, he helped medical workers get training, better supplies, and actual salaries. He convinced women with high-risk pregnancies to deliver at the hospital, parents to make vaccinations a priority, and families to build dish racks to help stave off disease. “We made a lot of progress,” Abby McDaniel, the leader of the project in Liberia and Boyah’s direct supervisor at the time, says. “Real progress.”
The project was, admittedly, not without crises. When multiple cases of watery diarrhea spread through one village, doctors feared it was cholera. Efforts to rebuild the country’s health-care system in the face of a potential outbreak become a luxury they can no longer afford. Until now, however, these smaller scares merely delayed progress. The Ebola outbreak has halted it entirely. “Liberia is still working very hard to strengthen their health-care system,” says McDaniel. “There’s still a long way to go to make sure these health-care systems are prepared.”
Once the driving force behind a mission to infuse life into Liberia’s health-care system, Boyah must now devote his days to battling death. As the appointed leader of the International Rescue Committee’s response to the deadly outbreak in Lofa County, Liberia, he is at the forefront of the grassroots response to the Ebola crisis in West Africa. To some, the decision to help these patients may seem unfathomable—insane, even. Not to him. After paying his way through both elementary school and medical, witnessing a vicious civil war, and surviving as a refugee, for Boyah the Ebola crisis is merely the next step on a journey populated by pain.
“Some of our supported health facilities staff have died already,” he said recently in an email to McDaniel. “But the medical profession is a calling and we must respond at this time.”
It’s emails like this one that McDaniel says captures Boyah so perfectly. After a year and a half working together, the image of him that sticks in her mind is of one late night working on quarterly reports. Despite multiple shutdowns during the day to preserve energy, fuel for the generator (most of the country doesn’t have electricity) had run out. Struggling with the only battery-operated lamp, McDaniel glanced at Boyah. Perched upright in his chair with a cellphone clenched between his teeth, he was able to produce just enough light to see the keys.
He hardly moved until the day’s work was complete.
In the time she spent working with Boyah, McDaniel never once heard him complain, though there were reasons to. One medical facility in Liberia, she tells me as an example, is accessible only after a three-hour drive down a narrow dirt road, a precarious walk over a swinging rope made of “local materials,” and a three-hour hike through the woods. “Supplying a health facility like that with drugs and medication—all of that has to get transported by foot the entire way,” says McDaniel. Carrying anything from anti-malaria medication to bags of cement, Boyah and other community members must carry the supplies the entire way.
Part of this tenacity, says McDaniel, seems born of his own struggle. “Coming from a small village, having to completely support himself, things were not handed to him,” she says. But just as strong is his passion for making people well. Without thinking twice, she remembers, Boyah would agree to work a weekend, pull an all-nighter, or travel a great distance. If an emergency arose while he was away, one that necessitated his presence, he’d arrive before McDaniel even had time to dial his number. “He would just show up,” she says. “‘It’s OK, I’m coming. I’m back,’” he would say.
In emails we exchanged, Boyah was humble, modest, respectful—apologizing for a slight delay in responding (as if, imagining his situation, it could possible warrant one). His love of caring for the sick, he tells me, dates to childhood. As an adulthood now living out his passion, his dedication sometimes borders on obsession. “He’s so passionate you hear him talking almost to the point of it being a weakness,” says McDaniel. “He cares so much, he’s so emotionally invested in serving people.” It’s a positive spirit so full McDaniel has watched it “shine through,” and influence those around him. “He maintains a compassionate outlook for everyone in the community. He tells them they are his Liberian brothers and sisters.”
It’s this built-in trust with the community that makes Boyah such a critical figure in the country’s fight against Ebola—and the most susceptible to harm. One of Boyah’s main jobs, perhaps the most dangerous, is going into the communities themselves. There, he “sensitizes” the residents, which entails explaining what the virus is, how they can avoid it, and what to do if they feel symptoms. If residents’ conditions align with the criteria for Ebola, he helps them get to the hospital.
Given the fact that Ebola is contagious once symptoms are present, by the time Boyah determines if someone is carrying Ebola, he could very well be carrying it himself. This truth is not lost on him. “The fact is, once you are providing service of any kind to an Ebola patient, you are likely to contract the disease anytime possible,” he writes to me. “Knowing this fact and getting involve with such activities, it is a very strong thing or decision for anyone to take or do. But, I feel good doing that because it involved saving people lives and that is my call.” At least two IRC-supported health workers have already been infected with Ebola and died.
That’s not to say talking with these patients, touching them, sitting with them, doesn’t make him anxious. “At some points after taking some actions or entering some highly affected communities, I can sometimes feel threatened and sometimes it can be very difficult to overcome the strong feelings from the threats the Virus post on people,” Boyah writes.
It’s Boyah’s ability to perservere, in spite of this knowledge, that speaks to his capacity for hope.
“This is not the first crisis they’ve gone through,” says McDaniel. “They have been refugees, seen things most people won’t see in a lifetime. There is a strength and resilience there that is remarkable and so inspirational.” The decision whether or not to fight for these people isn’t so much a decision for people like Boyah, but a calling. “People like Emmanuel, this is their home,” she says.
Assisting patients, distributing supplies, and coordinating treatment with the knowledge that doing so could lead to death can’t be easy. But Boyah insists he is not fearful. “I’m concerned about my own safety, but not really afraid,” he says. “It takes real committed staffs who are devoted to their professions to work under such situation, most especially at the front line.”
In a recent email to Boyah, McDaniel expressed her concern for him and the team. “My Sister! Bringing tears to my eyes to think you are thinking of me and supporting me,” he wrote back. “We are all Liberian,” he told another at IRC. “We want to protect the lives of our people.”
Editor's Note: An earlier version of this article misstated the length of Liberia's civil war. With the country's first and second civil wars combined, the total is estimated to be closer to 14 years.
