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Story Publication logo February 28, 2017

A Woman Survives Ebola but Not Pregnancy in Africa


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As Liberia grapples to care for thousands of Ebola survivors, scientists strive to understand post...

Salome Karwah, Ebola survivor and Ebola nurse, waits in her sister's bedroom on her wedding day as her aunts ask the groom's family for money, in a Liberian tradition known as Bride Price. In February 2017 she died from complications during childbirth. Image by Seema Yasmin. Liberia, 2015.
Salome Karwah, Ebola survivor and Ebola nurse, waits in her sister's bedroom on her wedding day as her aunts ask the groom's family for money, in a Liberian tradition known as Bride Price. In February 2017 she died from complications during childbirth. Image by Seema Yasmin. Liberia, 2015.

By the time she was 26, Salome Karwah had defied death at least three times. She had survived the longest, deadliest Ebola epidemic in history, which swept across west Africa recently, killing more than 11,000 people including her mother, father and uncle. Previously, Salome had fled gunfire to live through two civil wars that took the lives of more than half a million Liberians.

I met this strong woman over a year ago when I wrote a story about her sister Josephine's struggle with post-Ebola syndrome for Scientific American. And I have just learned Salome is dead, passing away on February 22 from complications during the birth of her fourth child. She was 28-years-old. It's unclear at this time if her baby survived.

Childbirth complications, known in medical terms as maternal mortality, kill more than 800 women globally each day, according to the World Health Organization. Salome's death is a reminder that a woman can survive conflicts and crises of historic proportions yet die giving birth.

When I first met Salome, it was December 2015 and a week before her wedding. She was seven months pregnant and feeding her four-year-old son, Favor, and her two-year-old daughter, Success, while waving off her sister's concerns about last-minute wedding arrangements.

A year earlier, in December 2014, Salome had been on the cover of TIME, one of five Ebola fighters who were honored as the magazine's Person of the Year. After she fought Ebola and won, Salome had walked back into the same Ebola treatment unit where she had watched her mother die. This time she went to work as a mental health counselor.

Salome wasn't the first to get sick in her family. Her father began spiking a fever in August 2014. Salome, who worked as a nurse's aide in a family clinic, poured her energy into a daily routine of dampening her father's fevers and injecting him with the twice daily insulin shots that kept his diabetes in check.

The deep ache in Salome's bones began four days after her father fell sick. When the headaches arrived, she would steady herself against the cool, green bathroom wall and squeeze her eyes shut against the beat of her pounding head. She kept her pain a secret from the 10 family members she shared a home with in the town of Smell No Taste, an hour's drive from the capital, Monrovia. Ebola felt like an ax to the head. "It was the worst headache of my life. The worst pain I have suffered—ever, ever. Like someone hitting me in my head over and over," she told me. Salome's older sister, Josephine, said Salome powered through the pain. Cooking potato greens and rice in their small kitchen, Josephine would notice her sister wincing while stirring the pot. "I would ask her, 'Salome, what is wrong?' And she would say 'nothing, nothing,'" Josephine said.

The day their father died from the infection, the sisters took their mother to an Ebola treatment unit in Monrovia. The three women were tested for the disease, and they all were positive. Three weeks later, only two of them walked out of the white tent.

Josephine was seven months pregnant the day she returned home to Smell No Taste. Three days later, she gave birth to a stillborn baby boy outside the family house. An ambulance would not come to her aid. Neighbors came out of their houses and stared at the screaming woman squatting in the street. Nobody would touch the Ebola survivor.

Salome moved to a different town. She couldn't bear to live in her parents' home without her parents. But she was run out of her new house after her neighbors learned she was an Ebola survivor. A nearby family was quarantined for 21 days when their bosses found out they lived near Salome. Still, at her wedding, Salome praised the Lord for them. "Thank God! Praise be to God for the people who were quarantined for 21 days and who did not get sick!" she said to a crowd of a few dozen relatives squeezed into white plastic chairs beneath a plastic awning. The groom, James Harris, stood in the corner and smiled. He was an Ebola survivor, too.

Salome struggled to make sense of her survival in the face of so much loss. "But I realized I had survived for a reason," she said. "And that reason was to help other people." Six days a week she traveled to Monrovia and encouraged Ebola patients to eat spoonfuls of rice and take sips of water. The work gave her life purpose, she said.

Ebola targeted Liberia's precious health care workers, people like Salome who dared to care for the sick. Nearly 200 doctors, nurses and auxiliary staff died during the outbreak, and with that the maternal death rate spiked 111 percent. Liberia already had one of the highest maternal mortality rates in the world. Data from the Liberian Ministry of Health and Social Welfare show that in 2015, 1,072 women died during pregnancy or childbirth for every 100,000 babies born alive. Hemorrhage was the leading cause of death followed by prolonged labor, eclampsia and unsafe abortions.

On the TIME cover, Salome stands with her arms crossed, her face staring down either Ebola or the reader or both. The headline, in white letters, reads: "The Ebola Fighters."

And she was a fighter. Salome fought a pain so deep she thought her bones were splintering. She also fought the cold stares of her neighbors, the crossed arms of the market vendor who refused to touch her money. She fought a disease that killed more than 11,000 west Africans, first as a patient and then as a caregiver. She survived all of those things and war—but it was becoming a mother that killed her.


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