Gueckedou, Sierra Leone: A team of emergency workers, faceless in their biological protective suits, works at the epicentre of an apocalyptic death zone. Amid scenes chillingly reminiscent of the Hollywood movie Outbreak, they are doing battle against the deadliest disease the world has ever known.
Ebola starts with symptoms of a common cold. It ends with excruciating death — massive organ failure and bleeding from every orifice — and kills up to nine out of ten of its victims. And crucially, it incubates for up to three weeks: enough for a carrier to unwittingly travel far from its cradle in central Africa to infect new populations.
Until recently, affected areas have been so remote, the risk of it travelling to Europe has been implausible. Suddenly, a new, vast epidemic in Sierra Leone and its bordering states has made that risk grave indeed. It is the first major epidemic outside central Africa and is already twice the size of the next largest recorded outbreak, which ripped through Uganda in 2000 and 2001.
In the UK, sea and air ports have been put on alert. GPs have been warned to look out for symptoms in patients returning from the danger zone. Questions have been raised over the health risk posed by the Sierra Leone team attending the Commonwealth Games in Glasgow, which open on Wednesday.
Among those struggling to contain this deadly outbreak is one rather surprising figure.
Beneath a plastic protective hood and full body suit, goggles, wellingtons, two pairs of gloves and a breathing mask is Cokie van der Velde, a 54-year-old English woman who has left her family and beloved allotment behind in Yorkshire to save lives in a frontline Ebola unit.
A sanitation expert with the charity Medecins Sans Frontieres (MSF), Cokie is a veteran of 12 years’ service with the charity. But she says nothing could have prepared her for what she has witnessed in Guinea and Liberia.
“This outbreak is totally, scarily out of control. Right now we are only firefighting,” the British aid worker says. “The situation is deteriorating and there is much resistance from the population who are hiding the sick.
“I have the awful feeling that we are just seeing the tip of the iceberg and it’s going to get exponentially worse in the coming month.”
A grim but essential part of her job is to bury the dead safely. Tradition dictates the dead are washed by family in preparation for burial — tragically leading to others catching the killer virus. Cokie has had to persuade locals to sacrifice the rites of the dead for the sake of the living.
She says: “Dead children have been the toughest part of the job. A dead adult is one thing but a child is another. I don’t let my emotions get the better of me and I try to make the end the best I can. I give families plastic flowers to bury with their loved ones, or a little toy for a child.
“It’s their final moments together, you have to acknowledge that, no matter what else is going on around you.”
Her all-consuming mission comes with 16-hour days and an all-too-often hostile reception from the very people she is trying to help. “When we get a call we have to go out into the field to collect the patients. It can be tough to persuade them to come in because of course they see sick people entering the unit and not coming out. This just adds to the myth of Ebola.
“Locally there have been rumours that it’s a cover for us to kill people and harvest their organs and that’s why families are not allowed to look inside the body bags of victims.
“It’s illogical but fear and suspicion do terrible things to communities. Think about it. Someone gets ill. We turn up in our plastic protection suits looking like we’ve just arrived from outer space and the sick person disappears for good.
“Our vehicles have been stoned and I’ve just been refused entry to a house which I was supposed to disinfect. There’s a lot of room for misunderstanding when you cannot save a life or even hand back a body to be washed and dressed for burial as ancient tradition dictates.
“I sometimes ask myself, ‘What would happen if Ebola broke out in Europe?’ And you know what? I think it would be the same. The fear of it is primal.”
In the midst of this maelstrom, Cokie is already on her second mission against Ebola this year.
She first left Whixley, West Yorkshire, in April to go into the “death zone”, returning home in May.
But she had just six weeks respite before MSF asked her to head back to the isolation unit in Gueckedou, Guinea.
“The unit’s in three parts,” she explains. “There’s a neutral zone where you change into scrubs, a low-risk area where there’s no eating, drinking or smoking and where you have to be in boots and scrubs, and then the totally protected area which you can only enter fully suited up.
“Getting into the suits takes ten minutes and the help of another person. There’s your scrubs, then a plastic boiler suit with non-breathable zips, a plastic hood which hides everything except your eyes, large goggles over them, two pairs of gloves in case one pair is breached and a breathing mask which does not transmit particles.
“It makes you look like an extra from Contagion or Outbreak.
“On top of that goes a plastic pinny and then there’s your wellies. After half an hour in the heat of Guinea I can pour the sweat out of my boots when I take them off.
“But it’s all crucial. Ebola is so virulent it can be passed in blood, sweat, tears or even by the fluid which coats your eyeballs.”
Even the smallest rip in Cokie’s protective suit could let in the virus but she is coolly aware of the danger. “It’s critical that not a millimetre of skin is showing, especially on your face.
“People always ask if I am scared confronting a virus as deadly as Ebola but I’m the one in charge of infection control so if I’m not confident that’s really bad news for everyone.
“You have to have faith in your systems such as never, ever, touching your colleagues — there’s no hugging or handshakes for the entire time we are out here. I don’t think about catching it, that’s the best policy.’
Beneath the suit, divorcee Cokie — it’s a childhood nickname coined by her sister, a shortening of her Christian names Agnes Caroline — holds on to the home comforts which help her endure life in this most extreme and terrifying environment.
She has an electric toothbrush which she can charge from her computer and Jo Malone mandarin, lime and basil moisturiser.
She keeps up her spirits by listening to Radio 4’s The Archers and The News Quiz, and by keeping in touch with her grandchildren Isaac, eight, Joseph, five, and one-year-old Suzannah, who are in Harrogate.
But these moments are just a brief respite from a burden which now casts a shadow beyond Africa.
It is only border controls and First World medicine that make an outbreak of the tropical disease unlikely in the UK. And while the threat of Ebola might seem remote from British shores, the authorities here are taking no chances.
Dr Mariano Lugli, deputy director of operations at MSF, said this year’s outbreak — the first major epidemic outside central Africa — was “unprecedented”.
“Until now, we have only faced relatively localised outbreaks in central African populations that do not move around that much,” he said. “West Africa is very different, because the people move around so much. The geographical spread is so huge. It’s unprecedented.”
Between Cokie’s missions to the Ebola zone she spent time in Yorkshire tending to the strawberries and peas in her allotment. Now she thinks longingly of her family back home but feels she cannot return while there is life-saving work to do.
“I miss my three grandchildren a great deal. But I do believe in the principle of humanitarian aid and that when poor nations need health care the rich should rise to the challenge. When the call comes, I go.”
