Ebola’s Front Line
Kevin Fleming’s mission to serve prepared him for his greatest challenge—rebuilding Liberia, a nation devastated by disease
By the time he enters the Ebola treatment clinic in early October last year, Kevin Fleming has already gotten a feel for what’s happening to this West African nation and its capital, Monrovia. The rainy season is ending. The air is steamy and damp. At the airport, they took his temperature and made him wash his hands in bleach water. Driving up and down the dusty streets of the big city, he noticed the buckets of bleach water waiting outside the doorways of homes and offices. No one shakes hands. No one hugs. People keep their distance. The Ebola epidemic raging across the country has taken hold.
In the days to follow, he would meet with the president of Liberia and her minister of health and with officials from the United Nations, the Centers for Disease Control and the U.S. Agency for International Development. He would penetrate the rain forest on the back of a motorcycle and get dropped into a remote village by U.N. helicopter. But for the moment, as the interim director for the non-profit Last Mile Health, Fleming needs to see how the Ebola clinics are operating, how the patients are treated, how the health care workers do their jobs.
His tour of the Ebola Treatment Unit, opened by Doctors Without Borders in August when the Ebola crisis was escalating, begins in the area where new arrivals come in to be tested. They’re the ones showing active symptoms of the disease. They have fever. They’re weak and nauseous. They’ve been around people who’ve been sick with Ebola. They’re placed in a white tent used as a holding area for those suspected of being infected. Those who test positive are taken into the bowels of the clinic for treatment, an area known as the hot zone. A few survive and come back out. More than half do not.
In the midst of the activity, Fleming hears a young girl crying, “No, no.” He turns and sees a health care worker and a doctor, both in bulky yellow hazmat suits, their faces hidden by white head gear, reach for the girl. She’s around 12 years old. She cries as they pull her away from her family. There are three of them, crying and huddling together. They’re trying to say goodbye, but they don’t know how without wrapping their arms around her.
“It was hard to see a family left behind and sad, because they know the outcome is not good if you test positive for Ebola, and they can’t console each other, and I can’t go hug them and console them,” Fleming says. “It was like time stood still.”
They walk past the family and the doctors and the girl. “God bless,” says a person leading his group.
Fleming would never see the girl again. He doesn’t know what happened to her or if she even survived. But she becomes, for him, the face of Ebola, an image that seals for him the reason he is here, in Liberia, helping Last Mile Health combat the escalating Ebola epidemic. It’s also symbolic of why he’s embarked on this lifelong journey to improve other people’s lives through education and knowledge. He knows his work with Last Mile Health will be purposeful, but it will end in four months, and the next phase of his life will begin as he starts a new job as a Peace Corps Country Director. He hopes it’s in Liberia.
His impact on the ability of Last Mile Health to respond to the epidemic does not go unnoticed by Dr. Raj Pinjabi, its founder and CEO.
“One thing about Kevin is his courage,” Pinjabi says. “Being on the front lines of the world’s worst epidemic in the last century, and doing it with the good humor, charm and leadership he brings, and that courage he displays, is huge. His connection with Liberia has helped this country through this crisis, and it’s an invaluable perspective to bring to the Peace Corps.”
Being a Country Director is a long-held dream for Fleming. Now it’s coming true and all he can think about is how fortunate he is. It’s a feeling that began when he was a student at Xavier and discovered that helping others was an actual student activity and even a profession for some. Growing up on a farm in central Ohio, he knew about hogs and business and hard work and pitching in for his community, but this idea of intentional service work to benefit whole communities was entirely new. He was drawn to it like a magnet, and after graduating in 1994 with a degree in psychology, he went through a series of life-changing experiences with non-profit organizations from California to New York and eventually around the world.
Now, witnessing the stomach-churning separation of a child from her family, who no doubt wonder if they’ll ever see her again, if she’ll survive the virus, or if they’ll get sick, too, Fleming comes face to face with the reason he’s here, in this clinic in Monrovia so far from his Ohio home. He realizes it’s where he was always meant to be, that it’s his mission to bring knowledge to people wherever they are so they can make more informed decisions about their lives that in turn will help them to live—and live well.
He’s been preparing for it all his life.
On a Sunday night during his early years at Xavier, Fleming sat in a pew in Bellarmine Chapel listening to a sermon by Michael Graham, SJ, who was then a member of the faculty. He was talking about a moment when he’d made one of the most important decisions of his life—how he weighed his love for God and the Church against his desire for marriage and family and how in the end he chose the priesthood. The sermon made a huge impact on Fleming because of the gravity of the decision Graham had to make.
“What I remember was him making a huge leap of faith based on something he believed in, and he believed this was the path he needed to follow,” Fleming recalls. “It made an impression on me because of the way he verbalized the decision-making process in his life.”
Graham’s words resonated with Fleming because he was trying to make a decision about what to do with his own life. He’d planned to join the family business back in Baltimore, Ohio, and was studying psychology and business in preparation. Growing up on the farm was great training. It was fun but it was also hard work, and when the recession hit in the 1980s, it didn’t pay so well. But Fleming and his two sisters didn’t know how tough it had become. They were too busy helping with the hogs, cows, corn, beans and hay, pitching in from the time they could walk. He also was in 4-H, raising pigs named Moe and Dave to show at the fair. But when everyone else started losing their farms, Fleming’s parents converted from farming to landscaping. Fleming switched from caring for animals to riding lawn tractors in the summer and selling Christmas trees in the winter. It was an important lesson about resilience and entrepreneurship.
“One of my first memories is bringing all the money home at night and breaking it up into notes and then putting it in the bank the next day, and figuring out how much it cost for each semi-truck load of trees and how much to spend,” he says. “I remember counting money on the floor every night of the Christmas season to see if we broke even or not.”
But when he came to Xavier, he discovered the Dorothy Day House and its mission of service. It was a whole new world for him where people did amazing things for other people both within Cincinnati’s poorest neighborhoods and in rural areas considered “off the grid.” He signed up for one of their trips and the next year was sleeping in the attic of a farmhouse in rural Appalachia, where he and other students worked over a weekend to help teach and learn about sustainable agricultural practices.
The experience triggered in him a desire to do more, and it dogged him, even after graduating and returning home to work in the family business as the operations and human resources manager for Keller Farms. But the seed for wanting to help others had been planted and there was no turning back. “I was inching into this,” he says. “Xavier gave me a playground to dip my toe into and try different things and it had its impact on me, but I didn’t know how to turn it into a full-time job, and I was afraid to because I didn’t know people who did it.”
Thinking back on Graham’s difficult life-changing decision, Fleming mustered up his own courage and applied to Teach for America, and got in. “I wanted to be part of a movement, to be around people who wanted to make a statement and change in the world,” he says.
In August 1996, Fleming left for Compton, Cal., and never looked back.
Usually, after school got out for the day, the kids would hang around outside and kick soccer balls to each other. Fleming would be in his classroom cleaning up and getting lesson plans ready for the next day, and he’d hear the soccer ball—thunk, thunk, thunk—against the side of the building. It was almost as if the kids were letting him know they were still there, still safe, which in this part of South Central Los Angeles, was a constant worry. Gangs of young Latinos and blacks roamed the neighborhoods, and gang shootings were not uncommon.
Fleming was totally and culturally out of place, a white college-educated farm boy from the Midwest, plopped down in the middle of Compton, a working-class community known for hip-hop, rap groups and gang activity. He had nothing in common with his middle school-age students, half of whom spoke Spanish or broken English. He had 36 very-needy kids and few textbooks. The situation was challenging, but he took night classes, learning Spanish and how to be a better teacher. “I was not the most effective teacher, but my kids challenged me to be better, and they actually learned,” he says.
The day the soccer ball stopped thunking against the wall, however, was a different kind of lesson for Fleming. He heard a gunshot and ran outside. The janitor told him to stay back as a group of students carried an injured boy away. It was a gang shooting. The boy didn’t die, but it dawned on Fleming that it was after school “and these kids are shooting each other.” He had to do something, so he and some other teachers created an after-school program of sports and theater to give them something constructive to do.
It helped, but the shootings didn’t stop. In Fleming’s second year, a third-grade boy from his school was caught in the crossfire of a gang shooting while waiting at his bus stop. The boy died. Fleming was traumatized, but he didn’t realize just how much until after they planted a tree in the boy’s memory and he stood up in front of his class to teach them something—anything—about what had happened. He remembers standing there, unable to speak, thinking about how fast these kids had to grow up, and the tears began to flow. A little girl named Blanca, a third-grader, walked up to him and put her arms around him.
“She hugs me in front of the class, and she said, ‘We all know someone who’s been shot in our lives.’ And each child in the classroom said who they knew who’d been shot. I realized they were consoling me.”
He also realized that as a teacher, it was his job to be counselor, doctor, nurse and pediatrician for his students, that he was responsible for their mental well-being as well. Fleming’s philosophy for his life’s work was starting to take shape, but he knew to accomplish it, he had to focus on changing the system, which meant leaving the classroom. At the end of the school year, he moved to Boston to work for an organization that focuses on creating after-school programs.
“My mantra became wherever I work, the job has to be providing access to information to people so they can make informed decisions about their lives,” Fleming says.
Fleming honed his philosophy over the next two years while working for Citizen Schools as a senior campus director, developing and managing after-school programs but also gaining experience managing paid and volunteer staff, budgets and fundraising. But as much as he was learning, something was still missing. So when he was offered a ticket to Harvard’s graduation ceremony, he knew he had to go. Nelson Mandela was speaking, and he thought he might learn something important from the man who had stopped apartheid. Fleming stood on the concrete steps 50 yards away, and it was as if Mandela was speaking to him. His personal mission began to come into focus.
“Mandela said, ‘We live in this world and you have this country with lots of power, and so be involved, act,’ and I thought, am I doing enough?” Fleming says. “I’m thinking I could go overseas and expand my perspective on the world, and then I hear him speak and I think, hell yes, I’m going. It confirmed in me I can live this mission-driven life and do something to help humanity. I left the speech wanting to go overseas.”
A year later, he applied to the Peace Corps and was accepted for a two-year term.
One afternoon in Lesotho, a land-locked country within the Republic of South Africa, the village chief told Fleming to follow him. They were going for a walk up the mountain.
“Thabang,” he said, using the African name they gave Fleming when he got to Haratema. “Come with me.”
Since Fleming had arrived in 2002 as the Peace Corps’ community health and permaculture manager, he’d focused on helping the rural area build agricultural trading centers. The village chief, however, had told him they wanted pipes. Fleming ignored him. He knew better, he thought, because he was trained and had done his homework. “He said, ‘We want the pipes,’ but I didn’t understand. I told him we’re not doing pipes, we’re doing agriculture, and we don’t need pipes for sustainable agriculture.”
But the villagers had been living through a drought, and finally it rained. Fleming and the chief marched up the mountainside, and when they were about halfway up, Fleming looked out over the countryside and noted how beautiful it was.
“Look down,” the chief said. Fleming looked and saw water bubbling up around his feet. It was a natural spring, and the water was flowing up out of the ground in an area where the earth was flat. The chief told him it only shows up when it rains.
“My heart sank,” Fleming says, “because they’d been telling me all along they wanted pipes to take water from the spring to the village. They’d been getting water from the river, which was contaminated. But it wasn’t him, it was me. I wasn’t listening.”
A true leader takes time to analyze all the needs of the village, he says, and learn from the people who’ve lived there for centuries. It was one of the most difficult lessons Fleming learned in his experiences in mission-driven work. He was humbled, but he realized his mistake and changed the project. They would build a gravity flow water system to bring the water by pipe from the spring to the village. He read books on gravity flow water systems and arranged for an engineer to train the villagers and also for a year’s worth of food so they could come out of the fields to work on the project. It was finished in 2004. The chief and the villagers were overjoyed.
“They all worked on it every day for one year and when it was done, I was happy. And I had learned something,” Fleming says. “I’m not an engineer, but it’s one of my proudest achievements.”
Fleming was sitting on a beach in Costa Rica last September, enjoying the warmth, the sand, the rain forest scenery contrasted against crystal blue water. He was finally taking a break. Since his Peace Corps stint in Lesotho, he’d had several more jobs, including co-founding a non-profit organization that helped create a shelter for children who’d lost families in the Indian tsunami, helping build the Teach South Africa organization, and being senior vice president for Operation Hope, setting up financial literacy programs in Haiti to help earthquake victims get back on their feet.
But while he was in Lesotho, he’d been told that he had the leadership qualities to be a Peace Corps Country Director. The idea had stuck with him, and in 2013, he applied for a position. When he got the call—and eventually the job—he decided to take a break because soon enough, he’d be entrenched in the management of Peace Corps’ operations in a country that had yet to be determined.
His cell phone dinged. The sound of the waves, the warmth of the breeze, the smell of the salt air quickly receded as he pulled up his email and saw a message from a close friend in the world of non-profits. His friend was on the board of a healthcare training organization in Liberia that needed someone with skills in organizational management to lead its efforts to scale up operations in response to the Ebola crisis. And do it fast. That organization was Last Mile Health. Fleming said yes, and a week later was in New York meeting with Pinjabi, the CEO, and by early October, he was on the ground in Monrovia, the capital of Liberia and the poorest city in the world.
His job: Grow Last Mile Health to respond to the disease. His first stop is the Doctors Without Borders Ebola clinic.
Fleming’s tour group moves on to a part of the clinic where he sees another side of the Ebola crisis that catches him off guard. Already reeling from his reaction to the little girl being taken from her family, he watches spellbound as a hazmat-clad doctor goes through the nerve-wracking process of undressing without also infecting himself. The tedious process takes 20 minutes and involves 32 steps. Another worker talks him through each one: undo the glove on your left hand, dip it three times in bleach water, throw it away, undo the glove on your right hand, one by one, step by step.
“I was so taken aback by the focus and dedication the doctors had to show under such extreme circumstances, and this was just as emotional as seeing the young girl taken away,” he says.
Next, Fleming needs to meet his staff on the front lines of the epidemic—those tasked with educating people in the hope they’ll never have to see the inside of an Ebola clinic. But they’re not easy to reach, since so many live in remote areas of the country’s rain forests. Last Mile Health, founded in 2007, sends people into villages to train workers how to recognize signs of disease. Before Ebola, they focused on diseases like malaria, tuberculosis and HIV/AIDS. When Ebola started re-emergeing beginning in spring 2014, the training shifted to teaching workers how to identify the signs of Ebola and, most important, how to handle suspected cases. Village culture had to change—wash hands in bleach water, no shaking hands, no hugging, no touching those who die.
Knowing that Liberia is experiencing 500 new cases of Ebola per week, Fleming recognizes the urgency and importance of his agency’s contribution to the country’s response to the disease. He hops aboard a 1960s-era UN helicopter ferrying his team and others, including a UN peacekeeping force, into remote regions of the rain forest and is dropped off in the town of Zwedru, otherwise a 10-hour drive by Land Rover. He spends five days there, getting to know his team members and how they do their jobs. He learns how they not only train health care workers in Zwedru, a town of orange dirt roads and traditional grass-roofed huts. They also go out to even more remote settlements to teach residents about the disease. In one village of about 50 people, he finds they have made their own version of chlorinated water and a sign: “All strangers you are welcome and please wash your hands.” He’s encouraged by how seriously they are taking the situation.
“I felt a sense of pride that Last Mile Health village health workers were training people who would know what to do so the disease wouldn’t spread to other people,” he says. “That is amazing. We’ve given people access to information to improve their lives at a fundamental level in a village, and it was working.”
In his four months as executive managing director of Last Mile Health, the agency’s annual budget triples and its staff doubles to 250. Fleming ensures that safety and security procedures are in place, as well as an emergency evacuation plan should any worker get sick, and he hires more staff to support the health care workers in the field. By the end of December, the agency is functioning at a new, heightened level, and the Ebola crisis, which has killed over 4,000 Liberians, is beginning to ebb.
On Dec. 31, Fleming leaves Last Mile Health to begin training with the Peace Corps, which, he finally learns, has assigned him to Liberia. He’s ecstatic, even though it’s hard to say goodbye. But he knows that what he learned at Last Mile Health will help him in his next job, part of which is training volunteer teachers to spot the signs of infectious disease. Pinjabi thinks he’s ready.
“I remember writing Kevin when he was leaving us to articulate in words what he has meant to us,” Pinjabi says. “I said he’s the kind of leader that makes leaders out of other people, and having someone who can live up to their own potential is one thing, but someone who can help others live up to their potential is another level of leadership.”
Fleming returned to Monrovia in early March. As Country Director for Liberia, he’s now focused on rebuilding a nation that’s been ravaged by the Ebola epidemic. Working in partnership with agencies still operating in the country, including Last Mile Health, he’ll be doing the same kind of work—managing staff and volunteers—only on a national scale. He’s amazed that he is here, but with the little girl’s face etched in his memory, he wouldn’t want to be anywhere else. He hopes he can help other little girls like her to live better lives, a goal that really began in college. “My time at Xavier is what put me on that path,” he says.