Liberia undertakers still haunted by Ebola after outbreak declared over

Not one of the boiler-suited health workers who combed the streets collecting the bodies of suspected Ebola victims caught the virus, thanks to the proper implementation of safety procedures. But their masks, gloves and rubber boots were no protection against a contagion of a different sort

A Liberian woman throws a handful of soil towards the body of her sister as Ebola burial workers take her for cremation in 2014 in Monrovia, Liberia. John Moore / Getty

As undertaker-in-chief during Liberia's Ebola outbreak, Mark Korvayan's only sense of job satisfaction used to be coming home alive at the end of a day's work.

For 18 grim months, he ran what was arguably the world's bravest crew of undertakers — the teams of boiler-suited health workers who combed the streets of the capital, Monrovia, collecting the bodies of suspected Ebola victims.

Not only did they stand a high chance of catching the virus themselves, they also risked beatings from mobs of hostile locals, who either refused to believe the virus existed, or blamed the health workers for spreading it.

Now, three years after helping steer his country from apocalypse, Mr Korvayan has the lofty title of Knight Commander of the Humane Order of African Redemption, his country's top civilian honour.

His real reward, he says, is not the gong itself — a star-shaped medal normally dished out to government bigwigs — but the fact that all his 150 staff are still alive too.

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Thanks to his safety procedures — even the cuffs of his workers' boiler suits were sealed with masking tape — not one got the virus.

But the masks, gloves and rubber boots were no protection against a contagion of a different sort.

For many of his colleagues, the horrors they saw every day have stayed in their minds ever since, driving some towards madness and others to drink and depression.

"On some days, we would pick up anything up to 70 bodies a day and cremate them," Mr Korvayan told The National. "I had not seen anything like that since the day I was born, and you have to have a strong mind to cope.

"About 14 of my own staff have suffered from mental health problems as a result — they feel depressed and their general health is not good."

Mr Korvayan, 38, was speaking as Liberia's five million people were midway through a two-round election to choose a replacement for president Ellen Johnson Sirleaf, the former World Bank economist who is stepping down after two terms.

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Read more: Ellen Johnson Sirleaf leaves big shoes to fill for Liberia's next president

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A second-round run-off vote on November 7 will pitch Ms Sirleaf's former vice-president, Joseph Boakai, against footballer-turned-politician George Weah, a former Fifa world footballer of the year who played for Chelsea and Manchester City.

Both candidates have portrayed the elections as a chance to draw a line under the Ebola outbreak, which killed 11,300 people across West Africa, 4,810 of them Liberians.

Yet, eager as the country's politicians may be to move on, it is not proving so easy for many of those who helped halt the crisis in the first place.

Few played a more crucial role than Mr Korvayan, who was drafted in at the height of the outbreak back in autumn 2014, when bodies were piling up on the streets.

At that time, it looked like Liberia's politicians might not have a government to run much longer. The health service had all but collapsed because so many workers had become infected themselves, and most other public servants were afraid to turn up to work for the same reason.

Health workers load the body of a dead woman suspected of dying from Ebola onto the back of a truck in Jene-Wonde, Liberia. Wade Williams / AP

Mr Korvayan, a former environmental health worker, had little previous experience of dealing with bodies, and started out with just a line of photos on a wall that indicated how to pick up and disinfect a body safely.

The technical guidelines were not much help when it came to operating in Monrovia's tough shanty towns where the majority of cases were first detected.

Many locals assumed that an illness that had no known cure and such terrifying symptoms — victims would bleed, Zombie-like, from the eyeballs — had to be a phenomenon of witchcraft, not science.

Such was the fear and stigma surrounding it that very few people wanted Mr Korvayan's teams knocking at their doors. Often, he found himself arguing with mobs of angry relatives who refused to hand over bodies, many of whom might have caught the virus themselves.

On one occasion, a relative clambered onto one of his vans to retrieve a body, infecting himself in the process. Sometimes the teams were beaten or had rocks thrown at them, and eventually they had to be given police escorts.

Ultimately, though, it was the sheer level of exposure to trauma that hit the burial squads the hardest. Mr Korvayan, for example, remembers picking up dead toddlers at a time when his own youngest child was just two years old, and having some of his neighbours wanting him to leave his home because they assumed he was infected. “I am strong, but at times, only the prayers that my family said for me kept me sane,” he said.

Others were not so robust, and are now haunted by memories of piles of corpses and visits to Monrovia’s crematorium, a forbidding, blackened hulk in a marsh outside town where the ovens burnt day and night. The crematorium workers themselves — some of whom occasionally received body bags bearing the names of old school friends — suffered possibly even worse trauma, with many drowning their sorrows in cane wine, a powerful local spirit.

“A lot of the crematorium guys have gone crazy, and I fear some of my own people will go that way too,” Mr Korvayan added. “We’ve asked [the ministry of health] for counselling for them, but so far we’ve had nothing proper.”

Dr Janice Cooper, a Liberian who heads a mental health programme for the Carter Center, a US NGO, said their research had confirmed widespread problems with drug and alcohol addiction among burial workers and crematorium staff. Some spoke of being unable to eat certain cooked meats any more because the smell reminded them of the burning flesh at the crematorium.

She said mental health counselling had been made available via a slew of foreign aid grants and NGO funding which came in the wake of the Ebola outbreak, but that some of those in need occasionally slipped through the net.

"Some of the affected workers also felt that that their bravery wasn't really quite appreciated compared to that of, say, medical staff working in Ebola treatment units," she added.

Meanwhile, the main comfort for Mr Korvayan's undertaker teams is the knowledge that they saved thousands more people than they burnt or buried.

One study published in a tropical diseases journal calculated that body collection teams like those under Mr Korvayan's stewardship could have saved anything up to 10,000 lives during across West Africa as a whole.

Mr Korvayan, meanwhile, has become a victim of his own success. While work with Ebola may be finished, he continues to be in demand and still supervises the burial teams handling any potentially hazardous corpses.

New health regulations introduced after the Ebola outbreak mean that now includes the victims of violent murders, and any other death where a large amount of blood has been spilt.

His move from Grim Reaper of the Ebola years to clear-up man for CSI Monrovia is not one he particularly appreciates.

"Now I have to deal with stuff like this as well," he said, flicking through a database of grim crime scenes on his smartphone. "I'm exhausted and I could do with some proper rest, to be honest. But if I don't do this job, who else will?"