“I will. Back away, please.”
Elim’s initial diagnosis was malaria. The disease was rampant in tropical and subtropical regions, especially impoverished areas like Mandera, which was only about two hundred and fifty miles from the equator. Worldwide, over two hundred million people were infected with malaria each year, and nearly half a million died from the disease. Ninety percent of those deaths took place in Africa, where a child died of malaria every minute. Westerners visiting Kenya frequently came down with malaria as well. It was treatable, and that gave Elim some hope as he snapped on a pair of blue gloves and began his exam.
The patient was barely conscious. His head tossed from side to side as he mumbled. When Elim pulled the man’s shirt up, his diagnosis changed immediately. A rash ran from his abdomen to his chest.
Typhoid fit these symptoms better. It was also endemic to the region, and was caused by bacteria—Salmonella typhi—that bred in open pools of water. Typhoid was manageable. Curable. Fluoroquinolones—one of the few antibiotics they had on hand—would treat it.
Elim’s hope vanished when the man’s eyelids parted. Yellow, jaundiced eyes stared up at him. Blood pooled at the corner of his left eye, then trickled down the man’s face.
“Get back,” Elim said, spreading his arms out, sweeping the nurses with him.
“What’s the matter with him?” the man’s friend asked.
“Clear the room,” Elim said.
The nurses evacuated immediately, but the young man stood his ground. “I’m not leaving him.”
“You must.”
“I won’t.”
Elim studied the young man. There was something off here. The camera, his demeanor, showing up here of all places.
“What’s your name?”
“Lucas. Turner.”
“Why are you here, Mr. Turner?”
“He’s sick—”
“No, why are you in Kenya? What are you doing here in Mandera?”
“Starting a business.”
“What?”
“CityForge. It’s like crowdfunding for startup city governments,” Lucas said, sounding rehearsed.
Elim shook his head. What’s he talking about?
“You know what’s wrong with him?” Lucas asked.
“Perhaps. You need to leave the room.”
“No way.”
“Listen to me. Your friend has a very dangerous disease. It is likely contagious. You are at great risk.”
“What’s he got?”
“I don’t—”
“You have to have an idea,” Lucas insisted.
Elim glanced around, confirming that the nurses had left the room. “Marburg,” he said quietly. When Lucas showed no reaction, he added, “Possibly Ebola.”
Color drained from Lucas’s sweaty face, making his dark, shaggy hair contrast even more with his his pale skin. He looked at his friend on the table, then trudged out of the room.
Elim walked over to the exam table and said, “I’m going to call for help. I will do everything I can for you, sir.”
He removed his gloves, tossed them in the waste bin, and drew out his smartphone. He took a photo of the rash, asked the man to open his eyes, and snapped another photo, then sent the images to the Kenyan Ministry of Health.
At the door, he instructed the nurse waiting outside to keep anyone but him from entering the room. He returned a few moments later wearing a protective gown, facemask, boot covers, and goggles. He also carried the only treatment he could provide his patient.
On a narrow wooden table in the dingy room, he lined up three plastic buckets. Each bucket had a piece of brown tape with a single word written on it: vomit, feces, urine. In the man’s condition, Elim wasn’t optimistic that he could segregate his exiting bodily fluids, but that was the standard protocol for Ebola and similar diseases, and Elim intended to follow it. Despite having few supplies and little staff, the African doctor was determined to provide the best care he possibly could. It was his duty.
He handed the man a small paper cup filled with pills—antibiotics, to treat any secondary infections—and a bottle labeled ORS: oral rehydration salts.
“Swallow these, please.”
With a shaky hand, the man downed the pills and took a small sip from the bottle. He winced at the taste of the mixture.
“I know. It tastes bad, but you must. You must stay hydrated.”
On average, Ebola killed half of those it infected. Even when the body’s immune system defeated the disease itself, the diarrhea during its acute phase was often fatal due to dehydration.
“I will return soon,” Elim said.
Outside the room, Elim carefully removed his PPE—personal protective equipment. He knew they didn’t have enough PPE in the hospital to protect all the staff who would need to care for the man. They desperately needed more equipment—and help. In the meantime, Elim would have to isolate the sick man and quarantine Lucas long enough to determine if he was infected too.
The middle-aged physician was weighing his next move when the nurse called out once again.
He raced to the hospital’s triage room, where he found yet another westerner, a tall white man, leaning against the door frame. He was older than the other two, but like the other sick man he was pale, sweaty, and smelled of diarrhea and vomit.
“Is he with the others?” Elim asked.
“I don’t know,” the nurse answered. “They sent him from the airport.”
“Sir, please lift your shirt up.”
The tall man lifted his shirt up, revealing a wide rash.
Elim took a photo to email to the Ministry of Health. To the triage nurse he said, “Escort him to Exam Two. Do not touch him. Keep your distance. Leave the room. No one enters.”
He dialed the Kenya Ministry of Health’s Emergency Operation Center. When the line connected, he said, “I’m calling from Mandera Referral Hospital. We have a problem here.”
Chapter 2