In 2014 Salome Karwah was Time’s person of the year for nursing Ebola victims after surviving the disease herself. On February 21, 2017, Salome died of childbirth complications, but also of Ebola complications. Well, sort of.

You see, Salome’s “Ebola complications” were likely not physical in nature. When her family rushed her to the hospital, she was convulsing and foaming at the mouth likely due to a severe infection from her recent caesarian section. She was not experiencing Ebola. And yet, in that moment, her status as an Ebola survivor was what determined the care she received, or rather, did not receive. Hospital staff were too afraid, likely too traumatized from their experiences with Ebola, to treat an Ebola survivor. 

I heard this story on my drive to work and my head was flooded. I tried to unpack everything I just heard. The reporter concluded that this was a story about an insanely infectious and diabolically devastating disease slamming an already crippled health infrastructure. This story is not new in international public health, and not even necessarily to the mainstream American public post the 2010 earthquake in Haiti. There are always chronic vs. acute needs, and we’re relatively good at responding to the acute ones, but the chronic ones are chronic for a reason. 

But a crippled healthcare system is only the tip of the iceberg of chronic issues in this case. The reporter incredibly briefly touched on another: the fear and legacy of Ebola. That’s the story for me here. To me, this story said more about how a community deals with trauma and stigma, and particularly, how women factor in. It’s about the aftermath of disease long after the aid workers have gone home and the acute fear of infection has dissipated. How do you rebuild a community where not long ago everyone was an infection risk and you lost loved ones left and right with no time to grieve in between? 

I first became involved with COHI after the Haiti earthquake to help with these lingering issues of community building and healing through the lens of gender-based violence. We know that violence increases after disasters: people are vulnerable, tensions are high. This is the work that needs to be done after the acute trauma. Not just because the health infrastructure is even more crippled post-disaster, but because the healing and grieving hasn’t even begun. This is why COHI emphasizes vicarious trauma trainings for health workers and caretakers, and this is why COHI focuses on women: because while women are often the most vulnerable during and after disasters, they’re also often the caretakers and the glue that bind up the holes a disaster leaves. Just look at Salome. 

And there’s also the stigma that accompanies trauma. Trauma breeds fear and distrust, both of which were at play here. In some ways, Salome’s story is not unlike women who sustain other childbirth injuries like fistula: a traumatic childbirth begets social stigma, much like surviving Ebola. 

When COHI partners with midwives and communities, this is what we focus on. Because while preparing for obstetric emergencies and neonatal resuscitation is lifesaving, we know that so is dealing with trauma, fear, and stigma.

-Molly Ryan

COHI Global Coordinator Volunteer