The terrorist, as some have recently labeled her, is wearing librarian glasses, a formless black ankle-length dress, and sensible clogs.
It’s early November in Spokane, Washington, where she’s visiting family whom, just a few months ago, she feared she might never see again. A grandson is loudly pushing a toy truck toward her. She smiles at the boy, sending him scuttling away. Hunched over, hands folded in her lap, she is tiny but not timid. Like the virus that nearly killed her, she is resilient and misunderstood.
To be clear, Nancy Writebol, a 59-year-old former housewife and part-time high school registrar, is not a terrorist. She is zealous in the opposite way—for good. Nancy has spent the past 15 years traveling to some of the most despairing places in the world as a Christian missionary. Along with her husband, David—a retired financial software manager, whom she met when they were growing up in Evergreen, Colorado—she has helped build churches, hospitals, and schools in countries such as Zambia. Since 2013, they’ve worked under the aegis of a Charlotte-based missionary group called SIM, short for Serving in Mission. Nancy and David chose long ago not to keep a conventional home: “It’s wherever we are,” David says. And from August of 2013 until a year later, when Nancy was flown to Atlanta with a supposed threat to the human race growing inside her—prompting the terrorist claims—they lived and worked in Liberia, a country just a decade out of civil war where SIM has operated for 60 years. Liberia quickly became one of three West African countries plagued by what has been called “the most dangerous outbreak of an emerging infectious disease since the appearance of HIV.”
This was either good timing or bad, depending on your humanitarian spirit and your instinct for self-preservation. Nancy and David Writebol dug in.
On June 11, 2014, an ambulance pulled up to the tiny missionary hospital in Monrovia where the Writebols worked. Nancy was the personnel coordinator for SIM, and Liberia’s ministry of health had called to say the ambulance was on its way with dangerous cargo: Ebola patients. Walking toward the car, she saw that there were three passengers inside—two adults and a child. The oldest, a man, had died on the way over. His grown-up niece got out and said in Liberian-accented English, “I don’t want to be in an ambulance with a dead person.” Then she lay down on the ground outside the hospital. It began to rain. The child disappeared with the driver.
Before taking the woman into their jury-rigged isolation unit on a stretcher, doctors suited up in PPE—personal protective equipment, which included a full-body suit made from white Tyvek fabric, a plastic face shield and breathing mask, goggles, latex and rubber gloves, rubber boots, and a plastic apron—as Nancy watched to make sure it was done correctly. This could take half an hour. “Normally, Liberians didn’t care how long things took,” she says. “But when it came to the hospital, families got very angry if you didn’t wait on them immediately.”
During the coming weeks, ambulances and taxis would arrive with confirmed Ebola patients and then leave with them when they weren’t cared for fast enough. The infected would go back to their villages, where the disease would spread.
Like all but one of the 34 Ebola patients the little hospital saw from June 11 until July 22 of 2014, the woman in that first ambulance died—despite receiving the best improvised care SIM could muster. There were no tears of blood or melting organs, as described in The Hot Zone, Richard Preston’s riveting but at times hyperbolic 1994 narrative of the disease’s emergence in central Africa. But the reality was nightmarish enough: zombie-like humans covered in strange rashes, vomiting, excreting black diarrhea, moaning in excruciating pain, and dying at a rate beyond 90 percent.
Discovered in 1976, Ebola is an ancient filovirus that at first resembles less serious fevers, like malaria and typhoid. But it can soon cause rapid deterioration of organ function and ultimately death. Ebola, named after a river near where the virus was first isolated, is infectious and, to a degree, contagious: Though a tiny amount of the virus can kill, it isn’t as transmissible as the flu. It can’t travel through the air.
The current outbreak is believed to have begun in December 2013, in the village of Meliandou in the West African country of Guinea. The suspected first case: a two-year-old boy who had contact with a nonhuman Ebola host—possibly a fruit bat. The virus spread to his family and eventually other humans in Guinea, Sierra Leone, Liberia, and, by importation, Nigeria, Senegal, Mali, Spain, and the United States. (As of late November, there had been 10 cases of Ebola in the U.S., four of whom were diagnosed here, and two deaths.)
On August 8, 2014, the director-general of the World Health Organization declared the outbreak a “Public Health Emergency of International Concern.” By the end of November, the WHO reported more than 5,900 Ebola deaths worldwide—confirmed, probable, and suspected—and more than 16,000 cases. It’s the largest Ebola outbreak in history.
The Writebols, of course, didn’t know any of this when they arrived in 2013; Ebola wasn’t even a remote concern at the time. But by April, when word of the disease and its effects began to filter around them in Liberia—a sick woman vomiting from a motorcycle taxi across Monrovia; doctors attacked by paranoid locals in nearby Guinea—they grew concerned enough to take action.
Isolation is the best way to contain Ebola, which spreads through the exchange of bodily fluids, so they helped create an isolation unit using SIM’s stand-alone chapel on the 130-acre campus. It’s a small, concrete-block structure with doors on each side. Using curtained partitions, they created six bedded areas. They had electricity, but garden hoses were run inside for water. Medical supplies—decontamination solutions, for instance—were stored in a dressing room. Traffic flow was marked out. Latrines were cordoned off for disposing of infectious waste. And vision barriers were erected so people outside wouldn’t have to see the dying.
As demand for isolation increased, Nancy began training locals to help out at the unit. A young man named Bobby showed up in mid-July to become a hygienist; he helped with the donning and doffing of doctor and nurse PPEs, mixing bleach, and decontaminating and disposing of dangerous items. But it soon became apparent something was wrong with Bobby. Admitted to the isolation unit on July 26, he died days later, a frightening glimpse of what possibly lay in store for Nancy.
“I knew what malaria felt like,” she says, recalling her first symptoms. “So I just thought that’s what it was.” She took a malaria test on July 22: positive. A SIM doctor named Debbie Eisenhut thought Nancy wasn’t responding well to the prescribed medication, though—still feverish, feeling bad—so Nancy took another malaria test on the 25th: negative. The next morning, to be safe, she tried an Ebola test. Her blood sample was transported to the National Reference Laboratory of Liberia, an hour from the capital, near the airport. Lab workers processed the samples in a biohazard level four laboratory wearing full PPE. Testing took five hours.
That same day, David, SIM’s director of technical services, had his hands full attempting to fix water, sewage, and electricity problems that had arisen as they tried to ramp up capacity for more patients. He also started preparing to evacuate nonessential SIM personnel, all the while contending with local protests. Another missionary group, Samaritan’s Purse, was trying to build a 60-bed isolation unit nearby, but demonstrators were fighting it: Don’t bring more Ebola here!
Nancy was the least of his worries. “I was busy,” David says, “not even thinking about her. She was at home, comfortable, resting. It was just a fever.”
That night, he prepared fettuccine Alfredo for his wife and Eisenhut. The three ate together at a small table in the Writebols’ two-bedroom, cinder-block home, built in the 1950s to house missionaries. Afterward, David and Eisenhut went to a special meeting for all the missionaries on the campus. But before the meeting began, Eisenhut returned a call from a Samaritan’s Purse doctor. She then pulled David aside: Kent Brantly has Ebola. And Nancy does too. I’m so sorry.
David walked across the yard back to the house: How am I going to tell her? And our sons? Nancy was in bed. First, he told her that their friend and colleague, Dr. Kent Brantly, 33, had Ebola. “And so do you.”
“Both of us knew the trajectory of the disease,” David says. “At that point, there wasn’t much else to say.”
David reached out to hold his wife, but she stopped him. “Don’t,” she said.
He moved into a nearby apartment, where he was monitored for symptoms. None of his things—pillow, clothes, Bible—could come with him. They were all potentially contaminated.
By July 28, two days after her diagnosis was confirmed, the virus had made Nancy “weaker and weaker,” she says. “There was diarrhea, constantly. Paralyzing fatigue.” It was moving quickly through her organs. It’s said that Ebola takes longer to cure than it does to die from. One night, David came into what had been their home, wearing PPE, and placed his hand on her leg. The pain from the mere touch was so intense, she moaned.
One of the first things David did, after calling their two sons with the news, was reach out to Bruce Johnson, the head of SIM, in Charlotte. Johnson immediately went to Samaritan’s Purse headquarters in Boone, North Carolina, so that the two groups could coordinate plans. “In the early stages, we didn’t know a way that we could get them out safely,” Johnson says. “We didn’t even know if they’d be healthy enough to travel.” No charter company would take these passengers on. Commercial was out. So was military.
So how do we take care of them here? David thought. And, in the event that they don’t survive, what will we do with their bodies? They couldn’t be brought back to the U.S., he was told, unless they were cremated.
On Thursday, July 31, Brantly was given an experimental Ebola drug called ZMapp, a combination of three mouse-human antibodies grown in tobacco plants that seemed effective in killing Ebola in monkeys, though the drug had never been tested on humans before. Three plastic bottles of the stuff happened to be sitting in a medical freezer in Sierra Leone, left there the previous month by a Canadian researcher who wanted to see if ZMapp held up in tropical climes. Africans who’d since contracted Ebola—including a prominent Sierra Leone doctor—had not been given the untested Western drug; if it had killed the doctor, the thinking went, the local population might have claimed it was a sinister Western plot.
In any case, the medical director at Samaritan’s Purse, stationed in Liberia, had sent for the drug after long discussions with Brantly about his options. Brantly was willing to give it a try because it had worked on monkeys. So was Nancy. The next day, she took the cocktail. Two days later, she took another dose. That was all there was.
Meanwhile, the two missionary groups had cobbled together an exit plan, which involved the participation or consent of: the U.S. State Department, the CDC, local departments of health in the U.S., a specialized American charter company, the Liberian government, the governments of neighboring countries (“some were not warm and fuzzy about Ebola flying over,” David says), and Atlanta’s Emory University Hospital, where they’d be flown separately.
Brantly flew to Atlanta on August 2. Three days later, Nancy Writebol was placed on a baggage conveyor belt and raised, wearing full PPE, into a one-of-a-kind airplane operated by Cartersville-based Phoenix Air Group. Phoenix is the only air carrier in the world with an airborne biological containment system—a plastic tent, essentially—that allows the company to transport patients with highly contagious diseases.
“I remember when they took me to the airport,” Nancy says. “I couldn’t walk. The medic who was putting me on the conveyor belt stopped it, put his hands around my face, and said, ‘Nancy, we’re taking you home. We’re gonna take really good care of you.’” At the top of the belt, Nancy put her feet on the medic’s feet, and he walked her like a child into the isolation pod. That’s the last thing, other than extreme thirst, that Nancy remembers from her 15-hour flight back to the U.S.
Touching down at Dobbins Air Reserve Base, they rushed Nancy to Emory. It was August 5. She and Brantly were now the first ever Ebola patients to be treated in the United States.
The call to Dr. Bruce Ribner came on July 30, but it wasn’t from the U.S. State Department, who had visited—without once mentioning Ebola—just two days prior. It was from a physician with Phoenix Air: I don’t know if you’ve been told this, but we’re sending our plane over to West Africa to pick up two missionary healthcare workers infected with Ebola. They’re coming to Emory.
As director of the Serious Communicable Disease Unit (SCDU) at Emory University Hospital, Ribner had received plenty of unexpected calls in his day. But this was a bit of a shocker, even for him. The Ebola patients would require the hospital’s special isolation unit for serious communicable diseases, which he’d helped create a dozen years earlier. This would be the unit’s greatest test yet, and he welcomed it.
“There were lots of feelings,” Ribner says. “You know, Gee, this is gonna be neat. We’ve had this unit here for 12 years now, and people were having serious doubts about whether there was a role for it. So I felt vindicated; it was a good thing we have this here. And part of it also was, I know we have all this planning, but it’ll be interesting to see if anything changes over the next two days. Because sometimes when reality hits, people change the algorithms.”
The first thing he did was send emails to his five-person physician team, three key nurses who oversaw a group of 21 nurses, and a few higher-ups at the hospital. The subject line was something like “Activation of Unit.” The message, in essence: I’ve just been notified that we’re getting patients with Ebola virus disease. The patients are estimated to arrive here Friday or Saturday. We need to activate the unit.
Twelve years ago, there was some hesitancy when Ribner proposed opening this unit, which charges two dozen doctors and nurses with the treatment of diseases like avian influenza, SARS, and anthrax: Would it be useful? Would it be safe? Twice a year for the past several years, they’ve trained, learning about modes of transmission, transportation, screening protocols, supplies, PPE protocols, waste management, treatment options, and how to communicate with other agencies. The Department of Defense has conducted field exercises at the unit, and Emory has twice activated the unit for what turned out to be false alarms: a CDC worker with suspected SARS and another with suspected Marburg virus.
“Everyone was ready and fully on board with the plan,” Ribner says.
When the SCDU is activated, all the unit’s doctors and nurses convene to review the disease in question. With Ebola, they had three days. “Obviously,” Ribner says, “I don’t expect our nurses to be very knowledgeable about a disease they’ve never treated or frankly thought much about, beyond the movie Outbreak.” They went over the infection—how it’s transmitted, what interventions can make the patient better. They reviewed PPE protocols, too, which took most of one day.
Unlike medical workers in Liberia, the suits worn by SCDU personnel included a fan inside a helmet, known as a “papper” (from PAPR, powered air purifying respirator). “We trained on that outfit for eight hours,” says Haley Durr. “It was very rigorous. There were people who didn’t make the cut. If you can’t keep yourself safe, you’re a risk to others.” (At Texas Health Presbyterian in Dallas, two nurses wearing PPE contracted Ebola in September from a Liberian patient who died there. Both nurses survived.)
Meanwhile, Ribner oversaw a review of the SCDU’s waste management system—there would be concerns from county authorities and citizens alike about contamination—while simultaneously taking part in administrative meetings, media communication meetings, “all sorts of meetings,” he says, “to figure out how we were going to deal with this episode as an institution.” Keeping the virus from spreading was, obviously, a major concern. Anything contaminated with Ebola would be disinfected, autoclaved with high-pressure steam, incinerated, and—in the case of actual human waste, after disinfection—simply flushed down the toilet.
He says he slept plenty, despite all this and the hate mail he received once the story of Emory’s involvement with Ebola broke. “Nothing that was personally threatening,” Ribner says, “beyond accusing me of being a mass murderer.”
A nurse cut off Nancy’s clothes, the only ones she had; everything else had been left in Liberia. The nurse asked Nancy to say her name and where she thought she was. All Nancy could muster: I’m in a hospital somewhere.
Kent Brantly, who had walked in on his own three days earlier, watched the medics wheel Nancy into an isolation room facing his. He was still suffering badly, but he could tell that she was in perhaps even worse shape; she looked at him without a seeming glimmer of recognition.
Lifted onto a bed, she looked around, dazed; this seemed just like any first-world hospital room, maybe more isolated. There was all the standard equipment: heart rate monitors, respirators, and a TV, too, which she didn’t watch for a week. She slept, vaguely aware of time passing, complaining of bad dreams.
“Every organ system in her body was being ravaged,” Ribner says.
From the moment she arrived, Nancy was under constant supervision. One nurse wearing PPE stayed in the room with her—they took four- to six-hour shifts—while another observed from behind the protective glass of the attached anteroom: charting vitals on a computer, calling for medications, making assessments. Nancy’s electrolyte levels were low, bordering on life-threatening. Nurses administered sodium, potassium, magnesium, and calcium immediately. Her veins had begun to collapse from dehydration, so fluids were pumped in through an IV. Her blood platelets were replaced by transfusion. She had high fever and irregular heart rhythms, too. Individually these were not all major concerns, but collectively they could be fatal.
The rotating team of five doctors and 21 nurses did more than simply stick needles and tubes in her arms. Durr recalls long conversations and gloved foot massages: “Her feet were very hot and swollen,” Durr says. “We rubbed them for hours using lotion, wrapping them with cold washcloths and ice. She told us about working in Africa.”
The nurses saw themselves as pioneers. “We were trailblazers, innovators with this disease,” says Carolyn Hill, the SCDU nursing director. “To do that and do it well, that was exciting.”
“We’d gone through rigorous training,” says Josiah Mamora, “and were ready to treat actual Ebola patients. In West Africa, they were in very deep isolation, and we became their first contact. It was a once-in-a-lifetime opportunity.”
David had stayed back in Liberia and isolated himself. He and Nancy spoke on the phone daily. She told him she didn’t feel alone. She had the nurses, her two visiting sons, the prayers of strangers, and the Lord. She felt God often, and two Bible verses in particular comforted her: “Yea though I walk through the valley of the shadow of death, I will fear no evil,” and “I give them eternal life, and they shall never perish; no one will snatch them out of my hand.”
God is good all the time, she told herself. He is good if I live, and good if I die.
One of the doctors came into Nancy’s room and said as she lay there, Why do you think we brought you here?
To be nice?
So do you think you’ll live?
I don’t think so. I don’t know.
You’re not dying on my watch, he replied.
Brantly and Nancy helped keep each other alive, too. “We talked about our symptoms, the diarrhea,” she says. “We’d laugh and say, ‘No one else can talk about this.’ It was good to be able to debrief with him. I could share about being angry at someone in the hospital. We could be really frank with one another.”
That included occasional griping about the food. The typical ICU diet, which they were given, began with clear liquids upon admission, graduated to soft pureed foods, and then on to more standard fare. The tipping point in Nancy’s recovery, it seemed to Mamora, “was when she wanted Sun Chips.”
For Nancy, it was maybe 10 days into treatment, when she decided to take a shower. “That’s when I knew life was returning,” she says.
Toward the end of their stay, the mother of one doctor in the unit made Brantly and Nancy homemade Indian: a curry dish, spiced cauliflower, naan, chapati. Nancy ate it for lunch and then dinner.
Ribner admits he wasn’t sure either patient would make it when they arrived. He attributes their survival to something we all take for granted: simple first-world care. “Every Ebola patient treated in the U.S. and Western Europe received magic potions. But at the end of the day, it’s just good supportive care, no different than what you give someone with influenza: monitoring body functions closely and correcting abnormalities as they occur.”
In the end, SIM and Samaritan’s Purse paid more than $2 million in healthcare and travel costs for the treatment of Nancy Writebol and Kent Brantly, who have, after a brief medical recess, returned to lives of missionary work.
Nancy Writebol had Ebola, which is much different from having Ebola. But that distinction has been lost on the American public in recent months. And so it is that Nancy’s harrowing journey from missionary to American medical anomaly has ended with her being dubbed a terrorist by some, treated like a leper by others.
In early November, a Denver TV station asked to interview the Writebols, who were in town visiting David’s relatives, about Nancy’s experience with the virus. The couple agreed to the interview but quickly regretted it. “The anchor came down to greet us in the lobby,” Nancy says. “He walked in and said, ‘I’ve been asked not to shake your hand or give you a hug. Furthermore, we’re going to do this interview in the park.’”
Even at their church back in Charlotte, where they’ve worshiped on and off for years, people have been frightened. “I went to greet someone,” Nancy says, “and she put her hands up. I was so dumb about the whole thing; I wasn’t even thinking this means ‘Stay away!’” Now she lets people offer their own hands first. It seems easier. “But it’s still very awkward for me. Because that’s not the kind of person I am.”
This story originally appeared in our January 2015 issue.