In January 2016, I spent four hours on a Wednesday afternoon wondering if maybe I had Ebola. I was a week into a reporting trip in Freetown, Sierra Leone, and that morning, I had woken up with a pounding headache, aching joints, and chills in 96-degree mugginess. That week, I had walked through several Ebola treatment units, two with suspected active cases, and touched dozens of potential carriers. Yet in spite of my trip's mission to uncover how dormant Ebola is still seeking fresh, vulnerable hosts—like me—I didn't think much of the symptoms. Jet lag?
Then, during interviews with Ebola survivors at a nearby clinic, dizziness set in. I uncrossed my legs for balance and looked one survivor in the eye as she recounted the wailing in the treatment unit, the stench of lying in her own vomit, the moment her three infected children were zipped into body bags. I asked her to think back before then, to day one, to what each of their initial Ebola symptoms had been.
"Headache," she said, "then, aching joints, terrible chills. Dizziness."
I laughed out loud, and then bit my tongue. Sounds familiar, I thought. The room spun as I ran the interview longer than normal, delaying my predicament: This survivor was equipped with Ebola antibodies—even if I was carrying Ebola, she was safe from it—but most patients and staff outside the room were not.
"After you," I gestured, smiling, ensuring she'd be the one to touch the doorknob on the way out. It took almost an hour and several white lies to secure a thermometer without alarming anyone. I sneaked out behind the borehole and checked my temperature three times. 103 degrees Fahrenheit. 103 degrees Fahrenheit. Then, almost 104. I clutched my knees, barely standing. Get out, Em, I thought. Get. Out.
Odd, wasn't it? I had hidden from healthcare workers with fine-tuned knowledge of the virus. I had avoided the clinic's rehearsed suspected-case protocols, and, at peak suspicion, had fled the health facility grounds instead of running toward it. In a society just beginning to emerge from the terror of an epidemic, I had been more afraid of triggering the Ebola alarm than of Ebola itself.
I isolated myself in my motel room, vomiting stringy pulp of an orange through my nostrils and shivering on the floor.
* * *
Official counts estimate that since early 2014, more than 28,000 people have been infected by Ebola in West Africa, though most experts believe it might have been almost double. Records show more than 11,000 deaths across Liberia, Guinea, and Sierra Leone. For decades before the outbreak, West Africa's diarrheal disease rates had been among the highest in the world, in part due to a complete lack of hand washing. But when I arrived in January of 2016, three months after the country had first been declared Ebola-free, signs of a culture shift were evident from the tarmac.
We were sanitized at the bottom of the plane's stairs at the Freetown airport, again at the Immigration desk, and a third time by the baggage claim. I filled out two health forms and had a temperature screening every 30 steps. In taxis downtown, I was pulled over at least once per day, the military personnel demanding proof of hand sanitizer packets on our persons. Buckets of chlorine guarded the thresholds of cafes and shops, endorsing a new cultural expectation to sanitize before entering.
Precautions were heightened at health facilities, where, upon several occasions, a single suspected Ebola case (ultimately malaria, typhoid, or both) would trigger an eerie hush across the property: Staff would murmur through the day, no one touching, the cases' providers cloaked in protective gear and boots soaked in chlorine. That particular day in January that I fell ill, charity vans had brought patients from the provinces for their once-in-a-lifetime shot at cataract surgery. Reporting my Ebola symptoms would have evacuated them all.
During the trip, I asked locals about how fear of the disease affected life in their communities. Malcolm Albert, a baritone in the church choir, ruminated on it as we sipped cherry sodas in the back of a gas station. As the initial vision screener at the eye clinic where I interviewed survivors, Malcolm said the post-traumatic stress wasn't just institutional; it was personal. Since losing close friends to Ebola, Malcolm has had trouble sleeping and eating, anxious that Ebola is hiding in every patient he screens. "[The outbreak] was scary, very scary. Military guys, police, ambulances were going up and down the street like chickens without heads—every day, every second, 15 or 16 times," he says. "Still now, there is no trust among us because everybody is … a threat."
Ann Marie Kamara has seen fear take root in harsh stigmatization. At 22, she's the sole survivor in a house of 10. Her extended family refuses to interact with her, so she has dropped out of her university and has been temporarily employed by Partners in Health. Like most other survivors, Ann Marie has post-Ebola eye complications, so once the position ends this month, she doesn't know how she will feed herself. Even with the finances to return to school, she expects her blurred vision will inhibit her graduation.
"I understand why they fear us," she said. "No one comes near me, not even my family, but I understand. It's because of the fear of the outbreak. Without Ebola, my family would be glad to see me. But it is because of this villain that they fear I will transfer to them."
Kamara's understanding underscores this fear's double edge. While fear has bred stigma and distrust, it also appears to be what allowed Sierra Leone to overcome the epidemic in the first place. When the outbreak began, many people in the country didn't believe it even existed, because rumors spread that the virus was a hoax used to draw diamonds and oil out of the region.
"The dropping case number—in many ways, those came from the people," said Mauricio Calderon, the leader the World Health Organization's Ebola survivor research team in Sierra Leone. "You wouldn't believe what a difference it made for everyone to admit that Ebola was real and no one was positively safe. We came to a point when the loss was too great, and people were too afraid not to change habits."
"Ebola, at its cruelest, spreads by love," said Megan Coffee, an infectious disease doctor who advised the International Rescue Committee's Ebola response. "It spreads when someone holds a sick child or buries their mother as they believe they should. It was communities that had to make hard choices and stop these transmission chains. … We saw case after case come in and then the cases would suddenly stop. Families were calling for help for sick patients, calling for safe burials, and not reaching out and touching those they loved, no matter how hard it was."
In the disease's wake, I seemed to prefer to die of undiagnosed Ebola than of the humiliation of making a stink of symptoms and wreaking havoc in a slowly healing society. After forcing myself out of my motel room while sick, I slogged my way to a private provider, who conducted eight blood tests and concluded, "Jeez, this is one hell of a case of tonsillitis."
Back in my room again, I balanced a jar on a chair in front of my door for security and spent three days under a bed-net, eating canned beans and rationing my bottled water to take antibiotics, since the tap had tadpoles. Then, I went back out reporting.
* * *
At the end of my reporting trip, I had expected to go through hell—or at least extensive screenings—trying to get past the immigration desk in the U.S. using "West Africa" and "104 fever" in the same sentence, but instead, no one paused.
"Coming from Sierra Leone, huh?" the desk worker asked. "Say, do they still have that Ebola?"
I blinked. "One confirmed new case, yeah."
He nodded. "Go ahead on through, ma'am!"
I knew from CDC instructions that I was to take my own temperature twice per day for the full 21-day Ebola incubation period—and I did. But on day 20 of self-surveillance, once I was settled back home in Washington, D.C., I woke up with those same symptoms, plus a sore throat. You idiot, I thought, realizing that in the flurry of unpacking, transcribing interviews, and getting back to the office, I'd forgotten to take my last two penicillin tablets. The tonsillitis was probably reemerging.
In keeping with formality, I made my obligatory call to the CDC to report the symptoms, dreading the frenzy, but was instead confronted by the phone line's new recording: "Press 1 for information on Zika virus." In fact, in light of Zika's recent hold on dozens of South and Central American countries, no one seemed to remember what Ebola was. I was twice mistakenly transferred to Zika specialists, assumed to be reporting Zika symptoms, and once properly directed, received some bizarre questions from phone agents, like, "I understand you've been in West Africa and you're reporting Ebola symptoms. But only the symptoms, though, right?" as if I had probably run a negative lab test in my own apartment.
The scene in the Emergency Room—where I was required to visit after the call—mirrored the scene I'd avoided in the Sierra Leone clinic. The receptionist asked where I'd been, took three steps back from the table and removed the pens from the clipboard, asking me to please use my own. A nurse asked me to recount approximate hours spent in survivors' homes, clinics, and treatment hospitals; it had been many. Each answer provoked a blink of silence.
"Are you freaking out right now?"
I tell her no, that I really just have tonsillitis.
More silence. "I wish you the best, baby girl."
I was immediately masked, isolated, and ordered to give blood and urine tests, throat, and sinus cultures. By mid-afternoon, the drama wiggled its way into my psyche. Asked about weakness and irritability, my mind battled itself: You're dying! No, no, you're just hungry.
Still, there were constant reminders that we weren't in Freetown, that none of my providers had lost a husband, child, or sibling to Ebola. There were no chlorine buckets, no protective gear, no sinister silence in the Emergency Room as we awaited test results. The nurses who strung the sinus culture wire through my nose joked about Ebola when I winced.
"Come on, honey, you've been sick in Africa before, you're fine."
"She ain't fine. Child, I can't believe your mama didn't kill you, going over there during Ebola." She shook her head. "I don't even let my daughter go up to New York for New Year's Eve."
No fellow patients were evacuated out of the facility—in fact, a friend was allowed to deliver me a snack.
In the wake of Ebola, America had the luxury of choosing Zika as the new villain worth trembling over. When the same test results came back, my stateside tonsillitis had been more of a nuisance than an upheaval. I spent the afternoon breathing into a mask that fogged my glasses every time I exhaled, peeved that I was missing a day at the office just to get poked and prodded. I avoided an expensive butt injection by pinky-swearing to the ER doc that I'd finish my oral antibiotic regiment this time. And, upon discharge, I was ordered to spend the next 24 hours lounging in the den of my high-rise D.C. apartment, the closest I'd ever been to quarantine.