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Chapter One

Swept Away

June 30, 2003

Unrestrained cargo lurched precariously behind my head, but I did my best to ignore it. Instead, I clutched at the frayed seat belt in my lap and focused my eyes out the helicopter window, past streaks of frenzied raindrops, toward a growing brightness in the distance. There's no point in looking back, I told myself—the only option is forward.

The cabin, filled with the whine of the antique turbines, shuddered violently when we flew over dry land. The lumbering transport bucked in stubborn protest as a lone light drew us down into flickering shadows. As the aircraft finally struck the ground with a jarring thud, we tilted dangerously to one side for a few nerve-racking seconds before settling.

After quickly gathering my few belongings, I filed out the cramped doorway to sway briefly under the downdraft of the chopper and the weight of my backpack. For a moment I searched for a familiar face in the surrounding undergrowth, but I knew there was none to find.

Out of the dim jungle a bear of a man steadily plodded toward me. "Merlin?" he yelled over the slowing chopper blades, naming the nongovernmental organization (NGO) that was providing my logistics.

I nodded my head in what I hoped was confident affirmation. "Ross," I shouted back as I shook his meaty hand.

"Mikhail," the big man answered in a gruff Eastern European accent. He paused to fan his sweat-soaked T-shirt. "Hope you're ready for the heat," he added.

The two of us abandoned the small refuge of light to step into darkness. Our driver, a man with midnight skin, materialized out of the shadows to assist me with my backpack. Then my two escorts ushered me down a dirt path to a beat-up Range Rover.

Stickers of AK-47 machine guns, crossed out by big red Xs, covered the car. Bold letters underneath proclaimed no arms. I slid into the passenger seat, trying not to second-guess my own intelligence: why had I voluntarily entered a place where vehicles needed to declare their lack of an arsenal?

Mikhail, clearly an assertive man, insisted on getting behind the wheel. Our chauffeur, rendered obsolete, climbed into the backseat and sulked there silently. "You don't mind, do you?" Mikhail asked me. "Just got here last week and I'm still getting my bearings," he explained. As we lurched forward, I shrugged to myself, content for the moment simply to be on the ground.

A hot breeze engulfed us as we headed into the heart of the city. Freetown, the capital of Sierra Leone, was pitch-dark at night. My two guides and I drove without conversation, listening only to the steady hum of the engine as enigmatic buildings passed by the window. I tried to reassure myself that I could handle whatever my new home might contain, but didn't feel all that convinced. Nothing seemed even vaguely familiar to me. Nothing looked like home.

Headlights suddenly materialized out of the darkness, followed by the frantic honking of an oncoming truck. For a few fearful seconds, I found myself pressing down hard at an imaginary brake pedal beneath my feet, my adrenaline surging as the oncoming vehicle swerved by, barely missing us. "Why did he do that?" Mikhail complained to our driver, after the road had again returned to the comfort of shadows. But while I tried to relax my legs, the backseat offered only indignant silence as an answer.

As we entered the sleeping city center, our car passed a sole lit sign, a plaque identifying the adjacent building as the Sierra Leone Reconciliation Court. The country had been at war since 1992, with the government in Freetown fighting the Rebel United Front (RUF). These two main combatants had raped, maimed, and murdered wantonly before finally signing a United Nation-brokered peace accord. The mandate of the court was to prosecute the worst of the prolonged conflict's many war criminals.

I watched the building pass, barely able to imagine the drama that had recently occurred within its walls. Just a week prior, judges there had issued an arrest warrant for Charles Taylor, the neighboring Liberian president. The magistrates accused the dictator of crimes against humanity, for creating the RUF and subsequently supporting the rebels by providing a conduit for the group's illegally mined diamonds to the international market. But no one knew what would come of the indictment. Charles Taylor was ensconced in nearby Liberia, safely out of the reach of international justice.

As the sign for the Reconciliation Court faded away in my sideview mirror, I recalled the many crimes with which Taylor was charged. More than two hundred thousand people had been killed and one million forced from their homes in a lengthy war punctuated by some of the worst human rights abuses known to the modern world. The atrocities were so extreme that they seemed almost unbelievable: arbitrary killings of civilians, widespread torture, systematic rape, deliberate amputation of limbs, and the forced recruitment of countless child soldiers, among others.

As I tried to come to terms with what it meant to have suddenly entered such a trauma-ridden land, Mikhail interrupted my uneasy thoughts. "Up for a drink before we hit the guesthouse?" he asked casually.

I wanted nothing more than to find a safe room in which to huddle, but I didn't want to seem overwhelmed. "Sure," I cautiously agreed.

We soon pulled off the road and parked next to a small porch, where an anemic light guarded a few empty tables. As we sat down, our driver greeted the waitress. "How dee body?" he said in a singsong timbre.

"Dee body fine," the woman replied with a welcoming smile. I tried to follow the pair's conversation in Krio, Sierra Leone's official language, but could identify only a few words of the English-based dialect that freed slaves had brought back to Africa.

Mikhail quickly ordered us a round of beers. When the waitress returned, she efficiently flipped off their caps, rubbed the open bottle tops with a used rag, and handed them to us. My large escort eyed his change in leones, unabashedly confirming the absence of fake bills before holding his beer up to the driver and me. "To peace and health," he said. The waitress encouraged us with a big pearl-white grin as we all three took a swig.

The driver continued to chat up the waitress, leaving Mikhail and me to ourselves. The burly Macedonian turned to stare openly at me for a few moments. "So," he finally blurted out, "you're the Lassa guy?" I was clearly a lot younger than he had expected.

I paused for a few seconds before answering. "Yeah," I finally grunted, doing my best to imitate my guide's gruff demeanor. Although it was hard to feign comfort with my brand-new title, I didn't want Mikhail to know how lacking I was in field experience. I had finished three years of medical school and a year of public heath, in addition to studying extensively before leaving. That would be enough, I silently hoped, to handle whatever challenges lay ahead.

"A doctor died of that here last year," Mikhail continued with a knowing shake of his head, as if to say he was new to the country but was aware of that much already.

I was also well acquainted with the story of the fated Freetown physician. He had died from Lassa fever, a viral hemorrhagic fever (VHF) limited to West Africa. His horrific demise was just one of the many details I had conveniently failed to mention to those close to me before I left for my trip. My dad and brother had told me I was crazy, while my mom had sighed deeply—her heart torn between needing to protect me and not wanting to stand between me and something I was passionate about. With worry already clearly evident in their voices, I had held my tongue. There was no need to burden my loved ones any more than I had already.

From the moment I had first heard about the dreaded Lassa virus, during my second year of medical school in a sterile California classroom that now felt very far away, I had been drawn to the illness. The disease is one of four famed VHFs (including Ebola, Marburg, and Crimean-Congo hemorrhagic fever) that share a terrifying tendency to spread from person to person, as well as a gruesome clinical picture of massive bleeding frequently leading to death.

Although there are countless TV shows and movies focused on the more riveting aspects of medicine, the extended study needed to enter the field is almost exactly the opposite of dramatic. Medical school is hour after hour of monotonous rote learning, memorizing a neverending series of facts that can seem completely disconnected from the act of caring for actual human beings.

Years of exams merge together until you almost forget why you choose to go into medicine in the first place. Surrounded by highly competitive people, you can easily become distracted by which specialties are the most prestigious or the most lucrative. During that time, Lassa became a symbol to me of something different, of foreign adventure and unquestionable need.

I knew that my trip was risky, some had told me even foolish, but the mix of danger and adventure surrounding the mysterious virus compelled me toward it. I had studied for years to swear an oath to care for the sick. In my eyes, confronting Lassa seemed to be the ultimate test of such moral fortitude. It meant that I had not yet lost a few threads of idealism, to which I so desperately clutched throughout my training.

As I had researched the trip, I learned that the Freetown physician to whom Mikhail referred had contracted Lassa from a patient returning from southern Sierra Leone, where the disease is endemic. The doctor's and his patient's horrific deaths, their bodily fluids pouring like flowing tap water from every orifice of their swollen corpses, had caused panicked patients and staff to flee the Freetown hospital.

Admittedly, Mikhail's comment disarmed me for a moment. I didn't want to be reminded about the past physician's death. To me, at that time, medicine was supposed to be about tales of human triumph. I thrived on stories of success, tumors removed and lives saved, not failure.

I did my best to turn the topic to a more pleasant subject. "So, what do you do for Merlin?" I asked Mikhail.

"Fix problems," the big man answered. "I'm in charge of logistics for Sierra Leone, moving stuff and people around the country."

"You just got here?" I said.

"Yeah, last week. The post has been open for several months, and they were pretty anxious to fill it, given the fighting in Liberia."

"And before?"

"I was back in Kosovo, where my wife and twin girls are. I worked for Merlin there, transporting medical supplies. But the pay is higher here as an expat."

"It's a move up, then?"

"Yep. And I'm already looking forward to buying my girls matching tricycles for their birthday," Mikhail answered, with a twinkle in his eyes.

Then, just as quickly, that glimmer disappeared. With a sharp grunt, the Macedonian slammed down his empty beer bottle. "Time to go," he said, before herding the driver and me into the Range Rover. Assuming the wheel, my temporary guide proceeded to drive us a short distance down the dark Freetown streets to the Merlin guesthouse. As we approached, a growing glow from the building illuminated high walls—broken bottles, cemented on top, glinted beneath rolls of barbed wire.

A group of more than fifteen armed security guards soon unlocked the gates to let us enter the compound. The African men wore winter hats and thick jackets, along with threadbare pants and sandals. "They think it's cold at night," Mikhail whispered to me, perspiration clearly beaded on his own forehead.

As I greeted the near battalion of guards, the nearest man cheerfully grabbed my arm and proceeded to teach me the Sierra Leone handshake. We began with the normal Western grasp, then spun to clutch each other's thumb, and then back to the ordinary grip. I bit back a smile as each guard shook my hand the same way, the eldest with methodical dignity.

Mikhail eventually led me through the small, dark house to my room for the night. "We should have a ride for you in a couple of days," he informed me. My final destination was Kenema, a southern town close to the border of warring Liberia. Merlin sponsored a ward there, the only one in the world solely dedicated to treating Lassa fever.

I unpacked a few things and got into bed, but sleep eluded me. My comfortable mattress, where I had last laid my head in one of London's towering high-rises, seemed a distant memory. More than space and time separated me from that place—in between sped a river of differences. Concealed under the cover of night, I clung tightly to my makeshift pillow and silently hoped that the rising torrent wouldn't sweep me away.

Excerpted from THE LASSA WARD by Ross I. Donaldson, M.D., M.P.H.

Copyright © 2009 by Ross I. Donaldson

Published in May 2009 by St. Martin's Press

All rights reserved. This work is protected under copyright laws and reproduction is strictly prohibited. Permission to reproduce the material in any manner or medium must be secured from the Publisher.