Health workers make ultimate sacrifice to battle Ebola
Kailahun - Placed in a disinfected coffin and driven alongside two bagged bodies on a flatbed truck, Modupeh Cole is buried without ceremony, tribute or tears, far away from his loved-ones.
The eminent doctor, a specialist of some renoun at the Connaught Hospital in Sierra Leone's capital Freetown, had been exposed to the deadly Ebola virus less than two weeks earlier.
Examining a patient who, colleagues say, was probably the first Ebola case in the hospital's 102-year history, he had no idea of the danger he was in.
Cole, who was in his mid-fifties, began to complain of a fever and severe headaches shortly after seeing his patient.
Signs and symptoms
He was transferred to the specialist Ebola treatment centre run by global aid charity Medecins sans Frontieres (MSF) in the eastern town of Kailahun.
Despite benefiting from among the best care and expertise on Ebola available anywhere in the world, he was dead within a few days.
"[Connaught] is a place where they see general patients, patients with all sorts of conditions," says Samuel Patrick Massaquoi, a one-time protégé of Cole and now the medical superintendent at the Kailahun Government Hospital.
"And when we had the outbreak, especially adult patients, they will hide their signs and symptoms - they will not tell you how they feel.
"They will present to you in any one of these hospitals in the country saying 'I have malaria, I have typhoid'. That was how it happened."
The last days of an Ebola victim can be grim, with the most severe cases succumbing to agonising muscular pain, vomiting, diarrhoea and catastrophic haemorrhaging described as "bleeding out" as their organs break down.
Despite the best efforts of health professionals at MSF and elsewhere, there is little dignity for victims of Ebola, even in death.
Belongings must be burned and often burials are witnessed only by grave diggers.
"Families often stay away from burials with Ebola, but they can come later because we keep a list of who is buried and where," says the manager of the health ministry crew in charge of interring Cole.
"We contacted the doctor's family but they said to go ahead straight away."
Ebola, classified as one of the world's most virulent and contagious pathogens, spreads through contact with bodily fluids and victims are particularly contagious in the days after death.
The removal of Cole's body from the MSF centre on Thursday was carried out not in the company of family, with eulogies, coffin bearers and hymns in church - but in an operation orchestrated with surgical precision.
MSF staff in hazmat suits meticulously disinfected his bodybag and the trolley on which it was to be placed, from which it was moved into a pre-sprayed coffin on a bleached truck.
The doctor, a medical professional of some standing among colleagues, is among dozens of health care workers who have paid the ultimate price for their efforts to contain the disease.
'Hostility to health workers'
Sierra Leone disclosed on Thursday that 32 nurses died from the Ebola virus while performing their duties between 24 May and 13 August.
In parliament, the country's chief medical officer, Brima Kargbo, spoke of the difficulties health workers were facing in fighting the epidemic.
"There is a rejection among people of the existence of Ebola and hostility towards health workers," he said.
Saffa Kemoh, a member of the health ministry's Ebola burial team in Kailahun, said friends would no longer go near him since he joined up, while family were taking an even harder line.
"They say they will not allow me in the house. They have driven me away," the 22-year-old told AFP.
Kailahun is at the epicentre of the world's worst ever outbreak of Ebola and the city of around 30 000 and neighbouring Kenema account for the lion's share of Sierra Leone's almost 800 cases.
The 65-bed MSF facility in Kailahun has so far taken in some 200 confirmed cases and counts 52 survivors among its successes.
"Unfortunately most of our patients won't make it and we know that, and it's incredibly difficult emotionally to keep going every day knowing that," said Ella Watson-Stryker, 34, a health promoter for MSF.
Watson-Stryker, who began working on Ebola with the announcement of the outbreak in Guinea in March, said local staff often suffered stigma, despite saving lives.
"They have a lot of problems at home. I had one staff [member] working for me whose father refused to speak to him. I've had staff whose families told them they had to sleep outside and were excluded from family meals.
"It's really difficult for them in their communities. Over time people start to understand and the stigma reduces. But it's a very difficult situation."