When James Harris rushed his wife, Salome Karwah, to a hospital at the edge of Monrovia on the night of February 19, he expected that she'd be treated as a priority case. Salome was a prominent Ebola survivor and ex-Doctors Without Borders employee who'd graced the cover of Time magazine in 2014 as one of the "Ebola Fighters" named persons of the year. And the hospital — run by an international Christian aid organization affiliated with the U.S.-based charity Samaritan's Purse — had earned a reputation for providing care to survivors.
In fact, Salome had just been discharged from the same hospital a few hours earlier. She'd given birth to her fourth child two days before, undergoing a Caeserean section despite a dangerously high spike in her blood pressure, which Harris says had periodically popped back up in the days after the procedure. Privately complaining to Harris that she was being neglected by hospital staff, Salome returned home on the 19th to tend to her newborn son. Not long after, Harris says, she collapsed, foaming at the mouth and wracked by convulsions.
But when Harris reached the hospital — known as ELWA, or Eternal Love Winning Africa — he says the doctor on duty refused to treat Salome. A doctor who specializes in treating Ebola survivors wasn't present, and Harris was told he'd have to take her to a different hospital. In anguish, Harris says he pleaded with the doctor, growing increasingly agitated as his wife convulsed in the front seat of his car outside.
"[The doctor] was checking Facebook," Harris says. "I had to rush into the emergency room myself to get a wheelchair, but I was struggling to take her from the car to put her in it. Other nurses came to help me, but the doctor told me that she would not touch her, and that if [Salome] stayed [at the hospital] she would die."
Harris called Dr. Mosoka Fallah, a prominent Liberian epidemiologist who works with Ebola survivors, begging him to intervene. After three hours Fallah arrived at ELWA. Salome was finally admitted and examined. Two days later, she died. She was 28 years old, leaving behind Harris and their four young children. No cause of death has been given.
Salome had lived through civil war, conquered Ebola and served as a global face of humanitarianism. But she could not survive giving birth in sub-Saharan Africa.
Cradling his new son, Jeremiah, in the soft dusk of a Liberian night, and surrounded by friends and family from the neighborhood — known as the "Obama community," after a local school that bears the former U.S. president's name — Harris speaks quietly, sadness etched on his young face.
"I feel crazy," says Harris, who's 32. "Salome was a friend of mine, not just my wife. I will never replace her."
Like Salome, Harris is an Ebola survivor. The two met in 2013 at a friend's house, consoling each other over recent breakups. Romance budded, and not long after they began seriously dating. Harris says he was drawn to her kindness and humor.
"She was caring with my people. When I was depressed, she was there to comfort me. When I was downhearted, she was there to reawaken me. And she was always smiling," he says.
A year after they started dating, the Ebola crisis hit Liberia. Salome and her family were among the first wave to become ill in the late summer months of 2014. Her father, a local doctor, passed away along with her mother and uncle. But she survived, along with her sister Josephine and Harris.
Josephine says that when the three of them were confined in the Doctors Without Borders treatment unit, Salome's priority was to care for her, even at the risk of her own health.
"I was worried about her, because I was pregnant at the time. There were nine other pregnant women in the unit and we watched all of them die. Salome's entire focus was on me, that at any time I would die."
Later, when Harris deteriorated and neared the edge of death, Salome cleaned body fluids off of him and changed his clothes. When her mother died of Ebola in a separate part of the unit, she hid the news from Josephine in fear that it would harm her chances of survival.
In early September 2014, Josephine and Salome were discharged. A few days late, Harris received the news that he was Ebola-free.
"I called Salome, and it was like she went crazy. She was shouting on the phone, so happy."
Doctors Without Borders staff noticed that Harris and Salome had shown an inclination to care for the other patients and hired the two of them to serve as psycho-social counselors to the sick.
"She was so caring," he remembers. "They told us we should only spend 30 minutes in [protective gear], but sometimes she would stay in the ward for 2 or 3 hours, just talking to patients and telling them to have hope."
Interviewed by NPR in 2014, Salome Karwah said, ""It was not hard to come back [to the Ebola treatment center]. Of course I lost my two parents here ... but if I can help someone survive, I will be very happy."
After the outbreak ended and the unit closed, Harris and Salome got engaged and were married in January 2016. In photographs, the two are smiling, elegantly dressed in white. Salome was pregnant with their third child at the time and delivered a few months later.
Later that summer, Salome discovered she was pregnant again. Already dealing with three young children, the newlyweds went so far as to contemplate having an abortion. But Salome was deeply religious and decided to keep the child. They both agreed it would be their last.
Now, in the wake of Salome's death, both Harris and Josephine are accusing staff from ELWA hospital of malpractice, saying that she was stigmatized and discriminated against because she was an Ebola survivor.
"We look at it as stigma," Harris says. "The doctor said that the other doctor who normally works on survivors wasn't around to treat the 'special' patient. I said because she's not around my wife will die? And [the doctor] told me yes."
ELWA hospital is managed by a Christian aid organization called Serving in Mission and is supported by Samaritan's Purse, which made headlines during the Ebola crisis when two American doctors working with the organization contracted the disease in 2014. It's considered to be among the best health facilities in Monrovia, operating a special clinic for Ebola survivors that treats secondary complications like vision loss and joint pain.
When NPR asked a doctor from ELWA to comment on Salome Karwah's case, he said that the hospital does not think the press is an "appropriate forum for the discussion."
More than a week after Salome's death, Harris says that ELWA still hasn't explained the cause of his wife's passing.
According to the World Bank, maternal mortality rates have declined sharply since 1990 in nearly every country, with the United States being a notable exception. Still, Liberia boasts the sad distinction of being among the ten most dangerous countries to give birth in, with a rate of 725 deaths per 100,000 live births. And while most of the reporters who descended upon Liberia in 2014 have long since moved on to new stories, the ongoing effects of the outbreak are still reverberating through the country, which lost nearly ten percent of its health-care workers to the disease.
Salome Karwah leaves behind her four children, all of them under the age of 6, and a family tortured by questions over what went wrong.
Josephine is bitter. She says that Salome cooperated with the government's mandate for survivors to go for routine checkups, including tests to ensure that her breast milk was safe. She believes that her sister deserved better care given her contributions to the country during the crisis.
"In fact, I'm not a survivor from today on. I will never go to a survivor clinic again, and I won't ever be part of another study," Josephine says. "If I'm sick, I'll disguise myself."
"I still don't believe she's dead," she says in a soft voice. "I was trying to call out to my daughter this morning for her to come for a bath, and I accidentally started calling Salome's name instead."
"Even if you never met Salome, I want you to picture her as a humanitarian," Harris adds. "That's the kind of person she was."
Ashoka Mukpo is a freelance writer and videographer who covers politics and culture, primarily in West Africa. Find him on Twitter @unkyoka