MONROVIA, Liberia — In a country where public services have virtually collapsed, where about a dozen ambulances are normally available for 4 million people, saving an Ebola patient often comes down to this: phoning a barrel-chested politician with a taste for Hummers.
Saah Joseph didn’t intend to become the lifeline for victims of the worst Ebola outbreak in history. In February, weeks before the disease hit, the lawmaker imported six shiny ambulances from central California. His goal was modest — to serve his constituents suffering everyday ailments, and to burnish his reputation in the process.
But now, his personal cellphone number is announced on the radio and exchanged by friends in crisis. It is pasted on his six ambulances, near his smiling face. He estimates that he has transported 3,000 patients since April, at least half with Ebola.
While the United States and other donors channel more than a billion dollars into impoverished Liberia, Joseph, 38, has created one of the most vital services in this disease-stricken land: his own emergency medical team. He has six more ambulances on the way from California.
The reliance on his fleet is a sign of how poorly prepared Liberians are as the epidemic grows. Everything from plastic buckets to protective suits for health workers are in short supply. The country has only 4,901 body bags; it needs 84,841 in the next six months, according to the Health Ministry.
“The government never considered health a priority. I had people begging me for ambulances, and I found a way to get them,” Joseph said, reclining on his couch at home, his phone buzzing once again.
Aside from Joseph’s fleet, there are only about a dozen private and government ambulances in all of Liberia, and most of them are just cars or trucks with makeshift sirens and lights. Many Ebola victims take taxis to the hospital — posing a huge risk of infection for the vehicles’ next passengers. The cabs are typically not cleaned properly.
“It’s a problem they’ve been working on from day one,” said Bill Berger, leader of the U.S. Agency for International Development’s disaster assistance response team. “This is a crisis that highlights the weaknesses in the system.”
When Mulbah Dukuly’s best friend fell ill with Ebola-like symptoms, he called for a government ambulance. It never came. Then he called Joseph, and his crew arrived within an hour at the small apartment in central Monrovia. Wearing full protective gear, they lifted the old man into the ambulance, now dented and scratched from use. Dukuly watched, glassy-eyed. The crew turned on the siren and raced to the closest treatment center.
Boys cheered “Saah!” as the ambulance tore through the streets, craning their necks to see if the politician was at the wheel.
“The government isn’t doing this, so I called someone who would,” Dukuly said after the ambulance left.
Joseph has outfitted his team with boxes of protective gear and gallons of disinfectant. They clean the vehicles with chlorinated water. Sometimes he drives the ambulance himself, the protective suit tight against his protruding belly.
The team has picked up babies with Ebola and men bleeding from their eyes. The workers have picked up their own friends. When the ambulance supervisor fell ill with Ebola, they carried him to a treatment center in the same vehicle he once operated. He died days later.
“It’s all we think about. It’s all we talk about — that all of our people are dying,” said Sam Dropleh, 35, an ambulance driver.
The fleet wasn’t supposed to be used this way. For years, residents of Joseph’s electoral district, New Georgia, died of acute injuries or complications from pregnancy as they waited for a rare government ambulance, or got stuck in Monrovia’s painstakingly slow traffic on the way to the hospital.
So, Joseph reached out to an American man he had met through church who worked for the emergency response team in Chico, Calif. The ambulances would be donated if Joseph could pay for them to be shipped to Liberia. He paid $10,000 for the delivery of the first two and collected $20,000, mostly from another lawmaker, for the rest. Joseph made a point of not replacing the California plates with Liberian ones — proof that they were not the government’s property.
But Joseph is a politician, and the ambulances weren’t just about saving lives. Liberian politics is a cutthroat sport, and Joseph’s private fleet was a shrewd advertising campaign that he knew would impress his constituents. There’s a reason his photo is on the side of the vehicles.
Members of Liberia’s parliament make $96,000 a year in a country with an average per-capita income of $400.
“Every time I hear those sirens, I hear him making another dollar,” said one man from New Georgia, who walked away smiling when asked for his name.
Liberia has always been a vastly unequal country, where a few people have become wealthy, with access to foreign medical care and overseas universities, while the rest are stuck with a dysfunctional public sector. Sometimes, though, the rich step in to fill the void.
In March, the Ebola crisis and Saah Joseph’s political ambitions intersected.
Joseph grew up in a refugee camp in Sierra Leone, after fleeing his country’s civil war as a child. When Sierra Leone erupted in violence, he fled again, this time to Guinea. And when conflict broke out there, he left for Senegal.
When he finally returned to Liberia, it was 2006. He was 30. He went searching for his father, who had stayed in the country, and learned that he had been killed.
Joseph turned to the church. He had met American missionaries in the refugee camp, and his faith grew after he returned home. He convinced his American contacts at Jefferson Baptist Church in Oregon to donate school buses and books to his district in Monrovia. They eventually helped him start a school.
By 2011, Joseph had become prominent enough to run for a seat in the lower house of parliament. He won by a wide margin. Over the years, the onetime refugee child developed a taste for the finer things in life; he now owns two imported Hummers of his own.
During his political career, one of his greatest assets has been his generous American contacts.
On a church trip to California last year, he met Bob Hall, the assistant chief of First Responder EMS, based in Chico, and a career paramedic. Joseph told Hall about the shortage of ambulances in Liberia, how he once watched someone with a critical injury being taken to the hospital in a wheelbarrow.
“In a matter of five minutes we had an understanding that these ambulances were going to go to Liberia,” Hall said in a telephone interview.
Hall visited Liberia before the ambulances arrived and saw an emergency medical system “right on the cusp of chaos.” Months later, he heard news of the Ebola outbreak.
“I couldn’t believe the timing. It just couldn’t have been better,” he said.
By February, the ambulances were on the streets of Monrovia. By August, each one was carrying dozens of Ebola patients a day.
The United States and other foreign donors have helped the Liberian government develop a call center to dispatch vehicles to the homes of suspected Ebola victims. But with so many people contracting the disease and so few vehicles, the system often fails.
Even Joseph’s system hasn’t been as responsive as some hoped, largely because of the disastrous state of the country’s hospitals. This week, one of his ambulances spent nearly an entire day transporting two people with non-Ebola illnesses — a man with tuberculosis and a woman who had miscarried and was in need of a blood transfusion.
Not a single hospital would accept the patients, worried that they might have Ebola. The vehicle drove across Liberia to clinics and hospitals. Meanwhile, the crew’s phones lit up with Ebola calls that it couldn’t respond to. Eventually, the patients were driven back to their homes.
“What’s happening to this country when we treat our own people like this?” said Quiah Augustus Garlet, a doctor from the Health Ministry who was trying to help Joseph’s crew find a place for the patients.
As it grew dark, the ambulances finally returned to their assigned parking spots, in front of Joseph’s office.
Outside, in big block letters, was the slogan that had landed him in office.