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How coronavirus hit Aden: A Yemeni doctor’s diary

‘I never thought I would write something like this, and I did not plan for it to be published. But I want to share this experience. Maybe some people care?’

(Adly Mirza/TNH)

 

 

How coronavirus hit Aden: A Yemeni doctor’s diary

 
 

As COVID-19 courses through Yemen, taking an unknown number of victims in a country already decimated by war, Dr Ammar Derwish, 32, has been documenting the toll on his community.

He lives in Aden, where one of his first jobs was treating trauma patients in the early months of the now more than five-year conflict, when the southern port city was besieged in the fight between the internationally recognised government and Houthi rebels. Now his home city has been hit so hard by coronavirus that the UN believes a quarter of its population may be infected, and hospitals have had to turn away patients with symptoms. So, between jobs and not associated with any hospital, caring for his own community has become Dr Derwish’s full-time unpaid occupation. Shortly after Aden’s first COVID-19 cases were announced in late April, he purchased supplies with his own money and began making house calls to sick neighbours and friends. As he fasted for Ramadan, he himself fell ill, and friends and relatives succumbed to the virus. But Dr Derwish continued to treat the sick, taking meticulous notes on his phone – notes that became this diary.

Illustrations by Adly Mirza

 
 
 

Notes from a pandemic

Click play below to hear from Dr Derwish

Since COVID-19 began in China and then went on to attack a lot of other countries, I remained in a state of denial, even though I took some minor precautionary measures. I’m not hiding that. Seeing all the other countries falling down when faced with it, when my country still had no cases, made me think “Oh, maybe it forgot about us, as always”, but this time it was a good thing for Yemen to be forgotten. I thought maybe Yemen’s isolation would save us. Or that perhaps we have better immune systems because we deal with lots of other diseases that people in Western countries have probably never even heard of.

One of the things that made me hesitant to believe what was happening around the world is that most of the information regarding the disease is coming from governments, both here and in the West. It was coming from governments that we in Yemen lost trust in a long time ago.

I never expected to see what is happening right now, here in Aden. The situation is insane. People are falling down, one by one, like dominoes. Especially the old and middle-aged. It starts with fever, then very quickly comes difficulty breathing, and then sudden death. People are still afraid, and they hate to hear the name of the virus. Even some medical staff won’t say it in public, like it’s cursed.

Many people in these notes died. Others survived, and said to death: “Stop. I still have a life to live.”

I never thought I would write something like this, and I did not plan for it to be published. I never thought that my notes would make a difference to anyone. I still believe they might not. But I want to share this experience. Maybe some people care?

Next section

Preparing for the pandemic

After his brother pays a visit to ‘Yemen’s Wuhan’ and falls ill, Dr Derwish stocks up on medical supplies.

 

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3 May 2020

On the tenth day of Ramadan, a Sunday, my younger brother Osama plays a match in the Ramadan football league, on the beach. The match ends around 6pm. Osama feels a little tired and has an intermittent light dry cough. He sleeps for a few hours and feels better, but I still think he should rest, so I go out to buy groceries – one of Osama’s chores in our family. 

While I’m out shopping, I see my neighbour and close family friend Hussain, who tells me his father, Wagdi, is feeling sick and needs help. I go over to their house. Inside, Wagdi has a big plastic bag full of medication another doctor has prescribed. I take a look at the results of some blood tests he has done, and everything looks normal. I conclude he probably has the flu, or maybe he’s exaggerating a bit: the “man flu”, as a friend of mine calls it.

To understand how we got here – before I started writing these notes – let’s go back in time a little bit.

It was on the fifth day of Ramadan, 28 April, the day before the first official cases of coronavirus were announced in Aden, that Wagdi began to feel unwell. He is 56 and has diabetes and high blood pressure. He saw a doctor, complaining of fever, fatigue, and some muscle aches in his lower limbs. The doctor thought Wagdi might have some sort of mosquito-borne infection, like chikungunya or dengue fever [both are fairly common in Yemen, and Aden has recently had flash floods so there are lots of mosquitoes around].

Then, on the eighth day of Ramadan, 1 May, Osama played football. After the game finished, he went to break his fast at his friend Ahmed’s house in al-Mansoura, a different district of Aden. While they were eating, Ahmed told the others he had been feeling sick for the first five to seven days of Ramadan, with general weakness, tiredness, and a fever. He said he was ok now, but that his dad wasn’t feeling well. 

When he got back, Osama described al-Mansoura, which is more crowded than Buraiqa, where we live in Aden. Al-Mansoura has lots of private hospitals and clinics. “It’s really scary,” he said. “I think it’s Yemen’s Wuhan. Everyone is walking around with IV lines in their arms. There’s water in the streets [from the floods] and sewage. The mosquitoes are the size of birds. It is a very infected city. It feels infected. It smells infected. It looks infected.”

The next day, Ahmed took his father to al-Amal Medical Centre, which is usually for cancer treatment. The government has turned it into a hospital for COVID-19 patients. 

Unfortunately, his father died a few hours later.

I think to myself that if in the coming days someone asks for help, then at least I will have some supplies ready.

4 May 2020

On the eleventh day of Ramadan, a Monday, three days after he met with Ahmed, Osama feels unwell again. He is completely exhausted, with pain in his knees, a mild fever, fatigue, and a very strong headache. The symptoms are a little bit confusing. It could be chikungunya, due to the severe knee pain. But it could also be COVID-19, as he was in Ahmed’s house, and his father just died with symptoms that look like COVID-19.

Osama does not break his Ramadan fast today. Instead, before dawn, he takes a painkiller and some vitamins and sleeps, and does not pray at the mosque. But I do.

At around 1pm, Hussain drives over to my house, saying that his father Wagdi is dying. I put on my N95 mask and meet Hussain at his car. Hussain asks me, laughing: “Why the mask? Is it for corona?” “No,” I tell him. “It is because Osama is sick and I probably have the disease that he has. Your father is already sick, and I don't want to transmit something else to him when he is very vulnerable.”

We drive to their house. Wagdi looks sick. He’s not eating or drinking. Usually, he would be joking and smiling and no doubt making fun of my mask. Instead, he keeps saying, “I am old, I am going to die. This is the end. This is my end.” I feel so sad for him. I tell Hussain what he should do, and how to give his father the medication he has already been prescribed. I tell him that he needs to measure his blood pressure and blood glucose levels before giving him any intravenous fluids. I give him some more medications for the fever and muscle ache. 

At 5pm, I take my camera to watch football at the beach, because I am one of the Ramadan tournament’s supervisors and we put pictures and videos of the matches on social media. My older brother Muaad says he is sort of tired, but he keeps playing anyway. When we arrive at home Muaad is really exhausted, and he has a fever and a severe headache. My mom and I decide he should take something to bring down his fever. 

In the evening, I take Osama for a blood test [blood tests and X-rays and other scans are easy to get here if you have the money to pay for them at private clinics and hospitals, and you don’t usually need a doctor to order them or look at them]. All the results are within normal range, which I was expecting.

5 May 2020

On the twelfth day of Ramadan, a Tuesday, Muaad is in a bad way. He has developed some new symptoms: loss of appetite and a sore throat. He breaks his fast with just fever suppressants and some water. Osama is sick too, but better than Muaad.

At around 2pm, Hussain comes by again, asking if I can visit his father Wagdi, who I saw yesterday. I put on my mask and drive over. Wagdi is not too bad. Tired, but not that different from the day before. I tell the family to encourage him to eat and drink more, and say that he shouldn’t fast for Ramadan. Wagdi looks at me, so close to crying that I can see the tears in his eyes. His brother-in-law died just a few hours earlier. He says: “I am very tired. I am very sick. I never stopped praying since I was a child. Now I can't even stand up to pray.” I can't forget his words. 

I tell Wagdi to not even think about going to his brother-in-law’s funeral, then I go back home and wash all my clothes. 

Later I stand around at the gate outside my house, waiting for the azaan, the call to prayer, that means it’s time to break the fast. While I wait, I see my best friend Emad, who lives nearby and is 32, like me. We talk about coronavirus, and I say that the football tournament should be cancelled. I tell him about Wagdi being sick. Then Anwar, another neighbour, passes by, and hears us talking. He tells me that people who have medical skills should be helping others right now. I don’t like the way he says it, like an order. But his words stick in my head.

After sunset, at around 7:30pm, I go to the mosque to pray Isha, the last of the five prayers in a day. But any slight cough inside the mosque distracts me from my focus, which is supposed to be prayer only. I am wearing a scarf over my face, but when I kneel down I am worried about the cleanliness of the rug I am praying on, so I don’t put my hands down. That’s when I decide to stop praying in the mosque. If a prayer is not done in tranquility and without fear, it is not a prayer.

Later, I go out and buy a lot of medical supplies like IV cannulas, fluids, and fever suppressors. I buy dozens of each [you can get drugs at pharmacies and equipment at medical supply shops in Aden, but they are expensive].

I think to myself that if in the coming days someone asks for help, then at least I will have some supplies ready. So I will do more than what Anwar said, and I will assist not just with advice, but also with supplies. I set up an IV line for my brother Muaad to give him fluids, because he still isn’t eating or drinking.

Wagdi’s mother died tonight.

Curious symptoms

Facing a deluge of callers seeking advice about new symptoms, Dr Derwish begins to feel sick.

Hear why artist Adly Mirza was excited to illustrate this diary from Aden.

 

Next section

If this is not COVID-19, then what does COVID-19 look like? I think it’s coronavirus. Only Allah knows.

6 May 2020

On the thirteenth day of Ramadan, a Wednesday, I play football but during the match I have a strange feeling that I will get sick later. I don't know why.

When I get home I examine Muaad's throat and notice some traces of inflammation and pus. We try to do blood tests at the laboratory nearby at around 9pm, but it is too crowded. I think people are getting lots of tests done because they are scared of coronavirus. [In my neighbourhood, which is fairly well-off, some people can afford to do this, and to see private doctors. In other parts of Aden, they probably can’t]. I start Muaad on antibiotics based on what I saw in his throat, and keep him on fluids and fever suppressants. He improves slightly.

I’m standing outside the gate to my house talking with some friends at night when my friend Sami comes over and asks if I can install an IV line for him, because his temperature is a little bit high, with fatigue and diarrhoea. I say to him, “just eat and drink, and if you feel unwell then call me at any time and I will come to your house in no time.” I give him some medication, and he goes home to rest. A few minutes later, Bassam, another neighbour, comes up to me. He has the same symptoms. I tell him the same thing.

I don't know what to say about this illness, COVID-19. The symptoms I’m seeing vary in a weird way. If there was no pandemic, I would say these people have different diseases. For example, Wagdi has had severe pain, fatigue, and fever since the beginning of Ramadan. Another neighbour is vomiting. I can't count how many people I know who have gotten sick in the past few days. My phone hasn’t stopped ringing with people asking for advice, or people wanting me to come and examine them. There are too many.

If this is not COVID-19, then what does COVID-19 look like? I think it’s coronavirus. Only Allah knows.

7 May 2020

On the fourteenth day of Ramadan, a Thursday, I start to feel exhausted: mild headache; muscle pain, but mild; some coughing that started last night; mild pain in my throat. I don’t break my fast. Otherwise, I try to continue as normal and resist the sickness. 

Osama is okay. Muaad is still sick. He has developed two new symptoms: loss of taste and loss of smell. Later that afternoon, Sami calls, asking for help. At around sunset, I put on my N95 mask, get my equipment, and drive over. 

When I get there, I find Sami lying on the couch in a room with no electricity. [Before the war started, and through around 2016, power was fairly regular in Aden. But infrastructure and governance has really collapsed in the city, and now power is completely unpredictable, and often scarce.] Sami says he has been throwing up, has a fever, and can’t eat. I start installing an IV line to give him fluids and, at the same time, his brother Ahmed puts out food behind me because it is time to break the fast. He keeps saying, “eat, eat, break your fast now then worry about the IV.” I tell him that I need to finish the IV first, but I am just procrastinating. I am not even thinking of eating with them, because I’m worried that I might have something I could transmit to them.

Sami’s grandmother comes in and asks me: “Does he have the thing?” She doesn’t want to say the name of the virus. I say: “You mean coronavirus. Don’t worry. It looks like it’s just food poisoning.” I don’t believe myself in that moment, I just don’t want to scare them.

I leave their house without eating and go to check on their Uncle Nadeem, who lives in a separate house in the same yard. He generally looks ok, but says he has some back pain, fatigue, and a fever that comes and goes. I tell him to not even think of fasting, and to call me if he gets worse.

I get home after 7pm, still fasting, even though the call to prayer was an hour ago. I take off all my clothes, put them in a small bucket full of soap and water, and wash everything.

Everyone at home, especially my mom, who is a microbiologist, insists that my sore throat is bacterial, and that I should take antibiotics. But I don't think taking antibiotics will help, because this disease, whatever it is, seems to be spreading very fast and it jumps from one person to another in no time. It doesn’t seem like bacteria or parasites, or something transmitted by mosquitoes. I opt not to take the antibiotics, just to eat and to try to rest and stop the fever when it shows up. So far, it hasn’t been too high, over 38 degrees Celsius but not more than 39.5.

8 May 2020

On the fifteenth day of Ramadan, a Friday, I am struggling to get even a few minutes of sleep. Maybe it’s because of the caffeine in the pain reliever I took at dawn, with the last meal we eat before fasting. Or maybe it is another weird symptom of this disease. I feel stupid, as a doctor, not knowing if this is a symptom or not. At around 10:30 in the morning I get out of bed, looking for anything to help me sleep. [During Ramadan lots of people go back to sleep after the first early morning meal when they begin their fast again, shops are open at night, and there’s generally lots of activity in the dark hours.] I can’t find anything in the house other than an antihistamine. I inject myself with it, but it doesn’t do much. 

Today is slow, very very slow. I am somewhere in between tiredness and being really alert. I don’t break my fast. My symptoms are the same. No better, no worse. 

At around 7:30pm, Hussain contacts me, asking me to come and see his brother Anas, who got sick two days ago, with milder symptoms compared to their father Wagdi. He asks me for some advice about his father too.

I tell him that it’s not a good idea for me to go over there, and that we should try to keep the treatment from a distance. I am not avoiding them, but right now I don't know if what I have is what Wagdi has, and if it’s COVID-19. I also don't want to give Wagdi or anyone else something new.

Later on, I feel a little bit better, so I go to sit next to our gate to watch the guys playing volleyball, where there’s a net set up in the middle of the street. I cover most of my face with a scarf. I see my friend Emad, who is on the same football team as Muaad. Emad says that during their match today the sun felt really hot, and he felt like he was getting sick.

By the end of the day, swallowing is very, very painful. I hear that the older brother of my friend Badih died yesterday night. He was over 50, and the director of the school I went to for the ninth grade. He had heart problems, but who knows if that is connected to his death.

9 May 2020

On the sixteenth day of Ramadan, a Saturday, I am still sick, and my sore throat is getting worse. But I go out to buy a fingertip pulse oximeter, which was recommended to me as a tool to monitor the amount of oxygen carried in the human body. Low blood oxygen is a sign of severe COVID-19 I’m seeing a lot of.

At night, I go to see Wagdi at his house. His son Hussain opens the door, and says, “thank Allah you came, I wanted to call you.” He says that now his older brother Anas can’t breathe. 

Anas is in a guest room, lying on a mattress on the floor, connected to an oxygen tank by a mask. Four friends are sitting around him. From my examination, he looks ok, with some shortness of breath. I put the oximeter on his finger. It is high, 98 percent, as it should be, but then again being on oxygen would make the reading normal.

Then I go to see his dad, Wagdi. He is looking better, but he tells me that he still gets dizzy when he tries to walk or go to the bathroom. I put the oximeter on him, and his oxygen saturation is between 82-85 percent, which is very low. I get scared, and I tell Hussain to hurry up and bring the oxygen from Anas’ room. Their father needs it more. I change the mask, put him on oxygen, and stay for a few minutes until his levels increase.

10 May 2020

On the seventeenth day of Ramadan, a Sunday, I try to get some rest. I am feeling better. Muaad is too. At around 11pm, I see three missed calls from Muhammad Q, who I call my multi-talented friend. He’s the person I consult for all mechanical problems. When I call him back he says he is tired and his throat hurts, but he already went to a clinic nearby and they gave him some medication. No worries, he says. I tell him to let me know if there is anything I can do, but he says everything is completely fine now.

 

Like drinking razor blades

The death toll among friends and neighbours begins to rise, but there's still no lockdown in the hot Aden summer.

 

It is impossible for people in Yemen to be on lockdown in this heat, with no delivery services, government support or services, or even regular updates from the government. Who will bring them food? Who will provide an income for them if they are not allowed to work? How will they feed their families? Staying at home is not an option here.

 

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11 May 2020

On the eighteenth day of Ramadan, a Monday, I am supposed to play in a football match on the beach. I get home a little before 5pm after being out all day visiting patients at their homes, and there is still time to make it, but I am too exhausted. The team’s captain had sent a message to us saying, “whoever wants to go and play is free to do so, but I’m not going. I have a family: parents, sisters, and a wife. I don’t want to give them anything.”

As for me, I still have a sore throat. I’ve never felt this kind of pain before, despite a long history of throat infections. I can get food down, but I can't swallow fluids. Drinking a sip of anything is like drinking blades or pieces of glass.

While we are breaking our fast today, with the family all sitting together, I told my mom that I have the constant smell of something strange, like paint. Muaad says: “Oh really? I haven’t been able to smell or taste anything since all this started.” Then I tell them that sometimes I feel like I am drowning or there’s water in my nose, like when water gets in your nose when you’re swimming, and Muaad says: “Really? I feel that too!” So I guess maybe this water thing is a COVID-symptom, and not my imagination. Until now, I really thought I was hallucinating.

While we are eating, Muaad asks if we have heard about Abdul Rahman? He died, he says. He was one of the nicest people in the neighbourhood, a taxi driver who we used to ride with a lot. I’ll miss his smile. My last memory of him was seeing him at the market in the morning, standing next to his car, joking with the other taxi drivers, always teasing them. 

12 May 2020

On the nineteenth day of Ramadan, a Tuesday, I’m still sick. I try to rest most of the day. At around 7:30pm, Hussam, a 15-year-old neighbour, texts me saying he has fever and fatigue, asking what he should do. I give him some advice and then I go out to do some work, and the streets in the central district of Aden are crowded. Almost every shop is open, even though there is supposedly a curfew and a lockdown. It’s not being enforced, and is really in name only. 

Later that day, people are posting on social media that the imam of a well-known mosque in Aden, who was more than 60, was taken to the hospital with a fever. He died after he got there.

13 May 2020

On the twentieth day of Ramadan, a Wednesday, my throat still hurts. I can't believe this is not going away. It is now extremely painful and it doesn’t stop.

After breaking my fast, I put some alcohol spray in my pocket, put on my mask, and go to the market near my house. It is crowded and busy like it always is during Ramadan. I try to keep a distance from people, but it is hard. I try to avoid touching the doors in the shops, sometimes pushing them open with my elbow or foot.

Many people accept the pandemic is here now and that there is a disease spreading. But they have no options. It is impossible for people in Yemen to be on lockdown in this heat, with no delivery services, government support or services, or even regular updates from the government. Who will bring them food? Who will provide an income for them if they are not allowed to work? How will they feed their families? Staying at home is not an option here.

After the market, I go to check on Wagdi. He is feeling better, and I feel like I did a good job treating him, Alhamdulillah [praise be to God]. I sit with him for about 15 minutes, and he smiles and jokes like he did before he got sick. His kids are around him. It makes my heart happy. 

Later on, I hear that our neighbour Saleem, who was over 50, is dead. 

14 May 2020

On the twenty-first day of Ramadan, a Thursday, I sleep for a few hours after the dawn meal. I leave the house around 8am to do some work, but my throat still hurts. I can’t swallow at all now, not even my own saliva.

After about an hour and a half of work, I spend most of the day trying to rest and recover. But no day ends now without some tragic news. At around 9pm, I get news that my friend Hassan’s father, who was in his fifties, has died. Two hours later, another friend’s father, who had diabetes, dies too. This is so painful.

Dark days are getting darker

More people fall sick, including Dr Derwish's youngest brother, and others stop him on the street and ask for help.

In this stateless country, I’m not doing anything publicly. But, if someone asks for help, I’m here.

 

Next section

15 May 2020

On the twenty-second day of Ramadan, a Friday, I still feel the pain in my throat. It’s still intense, but it is not as continuous as it was before. It’s a strange symptom. Muaad’s pain is completely gone, but he still can’t taste or smell anything.

In the afternoon, Muaad tells me the old man who works as a guard at the telephone exchange near our house died. He used to love watching us play football. I already miss all the days when he would ask: “Where are the guys? Aren’t they playing today?” He won’t ever come watch again.

An hour later, I see a post on social media that my friend Muhammad Q’s father died. I can’t even go give my condolences. These dark days are getting darker.

At night, while I am at the corner shop buying some groceries, a neighbour stops me to ask for some help. He looks worried, and asks me to look at his wife’s lab tests. [It’s really easy to get tests done here if you can pay for them, but not everybody understands the results or can afford to have a doctor look at them.] She has been complaining of a rising body temperature, muscle ache, and some difficulty in breathing. Based on her history, symptoms, and the tests – which were all in the normal range – I am not too worried. I prescribe his wife some medication.

A few hours later, I see Emad, and now he has the same symptoms I had, especially the painful sore throat.

I see another post that says one of my professors from the faculty of medicine died. He was super smart. It is such a huge loss.

16 May 2020

On the twenty-third day of Ramadan, a Saturday, I sleep almost all day, and the pain in my throat suddenly disappears. I browse social media, which has become like an obituaries bulletin. Someone else has died, a nice man who worked at the oil refinery nearby.

There is no electricity for most of the day, and I go out at around 4:30pm to get some ice from the corner shop. People there say the refinery worker died at a private clinic. Some more neighbours came by, and they say that their driver is sick – lab tests indicate malaria but now he’s having trouble breathing. I think that doesn’t sound like malaria.

That evening, the driver dies. Then Emad calls, and says he is nauseous. Another neighbour comes over, and tells me that he is vomiting, coughing, feels weak, and has a sore throat. Then the guy who runs an internet cafe on our street texts, saying he has a fever and feels weak. I give everyone almost the same advice: to rest, take a fever suppressants, and isolate themselves. And of course not to fast. 

17 May 2020

On the twenty-fourth day of Ramadan, a Sunday, my youngest brother Ahmed gets sick. He has muscle fatigue, and can feel himself getting a fever. 

Ahmed thought he was immune from all this, and had been going out when the rest of us were home sick. I’m not too worried because he is 20 and strong. I put him on the same regime as the rest of us, and I try to scare him a little bit about the virus. 

At around 6:40pm, my neighbour Khader texts to say his mom is dizzy and has a fever. He says he is going to take her to the lab for some tests – they have already done two rounds of tests – and he is looking to buy an oximeter, but he can’t find one. I tell him not to take her to the lab. It is pretty obvious from the symptoms he describes that she probably has COVID-19.

So he brings her to my house, and I see her from outside the car. I check her oxygen and things look ok, at least for the moment. But they aren’t convinced, and go to do more blood tests. Later, he tells me she had an IV line put in, because she wasn’t eating.

At around 11pm, while I am watching the guys play volleyball, my friend Arabi drives by. He’s worried about his mom too. I tell him some of the things that could help protect her from this pandemic, just general advice. He asks why I don’t make a video with this advice and put it online. I’m sure many people don’t know the things I told him – many of them are new to me too – but I tell him that in this situation, in this stateless country, I’m not doing anything publicly. But, if someone asks for help, I’m here. And, if someone asks him, he knows where to find me.

Tonight, the brother of one of the owners of the local fish restaurant dies. He was in his fifties. According to the civil registry, the death rate in Aden today is the highest so far. There were 89 deaths, which is six or seven times higher than this time in previous years. 

Reading X-rays by moonlight

Dr Derwish notices a worrying trend in images of his patients' lungs, and he tries to scare a son into caring for his father.

“I will tell you three things, and you have to do them exactly as I say, otherwise, when the sun rises tomorrow morning, your father will not be alive.”

 

Next section

18 May 2020

On the twenty-fifth day of Ramadan, a Monday, at around one in the morning, I see multiple missed calls from a number I don't know. Then a text message comes. It is from my friend Arabi, who says to call. He says it is urgent.

When I call him back, Arabi tells me his neighbour, who is a deputy minister in the government, has had a fever and fatigue for a few days. His name is Ashal, he’s having trouble breathing, and his family is very worried. They took him for a CT-scan, but don’t know how to interpret it. I tell him to bring it to me, but he says he’s already outside my house.

I go outside and the guys are playing volleyball next to the gate like they always do during Ramadan nights. Arabi is waiting a few metres away in a new SUV with a guy I’ve never seen before in the driver’s seat. They give me a big envelope with the images and reports, which say: “Atypical pneumonia (COVID-19)?”

Arabi is sitting in the car with the other man, who I learn is Ashal’s son. So I say to him, “look, I’m not going to hide this from you… your father has coronavirus. It looks severe. You need to take him to al-Amal now,” where Médecins Sans Frontières is now in charge of the COVID-19 centre. 

“No, no, no, we can’t do that. He’ll die of fear,” he says. I stop for a few seconds, thinking quickly about what to say, and how to say it. I think I have to be firm and scare him, or he will not take me seriously.

“I will tell you three things, and you have to do them exactly as I say, otherwise, when the sun rises tomorrow morning, your father will not be alive.” I can see the fear and sadness in his eyes as I say this. I tell him that, first of all, I will give him my pulse oximeter, and he has to go right home and check his father’s readings, and send them to me. Second, he has to take the images and reports he already has to al-Amal and ask them for a treatment plan to follow at home. Third, find oxygen now, get it from anywhere. I give him the oximeter and say: “You have to take care of him. Do your best.” [You can buy oxygen canisters at medical supply shops, and then you have to pay extra to get them filled up.]

When the morning comes, Ahmed is still sick for the second day. He is tired, and his fever comes and goes. A friend sends me a message, asking me for advice about his wife, who has fatigue and a fever.

19 May 2020

On the twenty-sixth day of Ramadan, a Tuesday, Ahmed is sick for the third day. His fever and fatigue are gone, so he thought he could fast, and he did, but now he has a sore throat. That pattern seems typical, according to most of the people who’ve had this, including me.

I sleep almost until the afternoon, then I wake up and see lots of missed calls and a message from my friend Sami. “Please call me when you wake up,” the message says. “My father is crying because of the headache and the pain in his muscles.”

I contact Sami and he comes to pick me up, so I put on my N95 mask, put alcohol spray in my pocket, and take a digital blood pressure monitor with me. First, we stop by Arabi’s house to get my oximeter, and he tells me that they have found oxygen for Ashal, the deputy minister, and now he’s in a separate room from the rest of this family.

Arabi asks me: “Do you think I should stay away from him too? Because I just kissed him on his forehead.” I tell him to keep his distance from Ashal and his family. It’s likely he’s a carrier now. When I get the oximeter back, I cover it and the batteries with alcohol, rubbing it in my hands like a piece of soap.

Over at Sami’s house, his father looks exhausted. He’s in his fifties and is usually tough and funny. I talk with him for a while, and his vitals look normal. He has severe back pain, a headache, and he’s sleep-deprived. Not a high fever. I tell him not to fast, and I give him some advice and basic medication, as well as half a pill of medium strength anti-anxiety drugs.

A few hours later, Muhammad Q calls me, and says he is outside my door. He is holding an x-ray of his own chest, which he has done because he has been worried ever since his dad died.

The electricity and street lights are off, so I try to find any sort of light to see the film. From what I can see, his chest looks full of haze, which is alarming. He says he only has a cough, but the X-ray technician told him to see a doctor. Muhammad Q is a smoker, and he doesn’t have any real coronavirus symptoms, so I tell him not to worry and I write him a prescription for some cough syrup.

But I think about it all day, searching online. It could be that a viral infection like coronavirus looks similar on a chest X-ray to a heavy smoker. But what’s the point of scaring him? He’s been sick already. His father just died. All his family definitely had it already, or has it now. I’m not sure if I was right or wrong in reassuring him. 

20 May 2020

On the twenty-seventh day of Ramadan, a Wednesday, my youngest brother Ahmed is still sick, but is fasting, like he did yesterday. He is still complaining of a sore throat, but it looks better. 

Around 8pm, Muhammad Q’s brother turns up outside my house, holding his own chest X-ray, just like his brother did yesterday. He says he felt sick a few days ago, and now he’s feeling ok, but he also had the X-ray done because his father died. I say, “don’t worry, your chest is perfectly ok”. But it isn’t. It looks exactly like his brother’s. It is like I am looking at the same image or a scene in a movie that is repeating itself. I think this must be what the X-ray of someone recovering from COVID-19 looks like.

Half an hour later, I hear that our neighbour, a nurse who I think was in her early fifties, has died. She lives in an apartment at the building on the main street, and everyone in the building is sad. One of her neighbours tells me, “the mom of our building has died.”

At around 10:30pm, while I am waiting for my turn in the pharmacy, two people are in front of me talking. One guy who I don’t know is saying you should never give in to illness, people should move and not rest. The other, a neighbour called Hamed, says, “all this talk about coronavirus is giving us a headache, but I’m just buying malaria treatment for my mom.” I say to myself: “His mom probably has coronavirus but he doesn’t believe in it. He thinks it’s malaria.” He took his medication and left the pharmacy.

The electricity cuts off at 3am, then comes back for 45 minutes at 11am, then again for another 45 minutes at 4:45pm, but then it cuts out when a sand storm comes at 5:30pm.

21 May 2020

On the twenty-eighth day of Ramadan, a Thursday, the guys start playing volleyball when the electricity comes on, a few minutes after midnight, and today I join them. [The power is so irregular that we never know when it will switch on or off.] Some people drive by in a big truck and tell us that our friend Hamed’s mom just died, and then I remember that a month ago someone at the mosque told me that Hamed’s older brother died of coronavirus in Saudi Arabia.

The electricity cuts off at 3am, then comes back for 45 minutes at 11am, then again for another 45 minutes at 4:45pm, but then it cuts out when a sand storm comes at 5:30pm. Ahmed can’t fast because of the heat and the pain in his throat. 

In the afternoon, Osama goes to help a friend prepare for the funeral of his uncle, who died in the hospital. Later, I hear that another of my professors from medical school, who had been my mom’s boss, has also died. 

Muhammad Q comes again in the evening, with more lab tests and an X-ray; this time they are his uncle’s. He says his uncle has been complaining of fever and fatigue for about a week. I look at the chest X-ray, which looks exactly the same as the other ones I have seen. I tell him that his uncle should get a CT-scan, if he can.

Long Ramadan nights

As the pandemic spreads, there's little of the usual joy in the last few days of Ramadan.

 

Next section

22 May 2020

On the twenty-ninth day of Ramadan, a Friday, the power has been off since the sandstorm started yesterday. My little old generator is making a lot of noise. When I bought it years ago, the salesman said, “don’t keep it on for more than six hours at a time, you have to give it at least two hours break.” But there is no mercy in our hearts for this beautiful small engine. We love it, but we can’t let it rest. I keep it on until the fuel tank is empty, then I stop to refill it again.

My brother Ahmed is feeling better. Today, he mentions the drowning sensation Muaad and I both had. He says that it’s super weird. “Yes, yes,” I tell him, and Muaad laughs and says it was crazy. My mom doesn’t get it, and I don’t think I would believe this symptom existed if I hadn’t had it myself.

After we break our fast, Ahmed goes out to get some chocolates and nuts for Eid al-Fitr, which starts the day after tomorrow. Maybe it’s a silly habit, buying these things, but at least it helps us feel the holiday. 

Muhammad Q comes back at night again, with an envelope in his hand, containing his uncle’s CT-scans and the report. I put the report aside and look at the images of his uncle’s lungs. “Look, I already knew this, but now there is further confirmation,” I tell him. “Your uncle had, or has, COVID-19.” He says his uncle is doing ok now, but I tell him to get some oxygen ready just as a precaution. He looks worried.

Later, I see some lights on our street. It is a gathering of technicians and engineers working on our electricity cable. A lot of the neighbours are outside watching them. I think they are mostly just outside because of the unbearable heat inside their houses.

Near the cable I see two brothers who I know, Nawar and Majed, and they say they have both been sick. They are 44 and 38. Nawar says he thinks his mom is going to die. They also tell me that they’ve heard my friend Emad’s mom is sick.

23 May 2020

On the last day of Ramadan, a Saturday, the electricity comes on around 2am, for just two hours. 

After breaking the fast, I go to buy some lamb for Eid. My father loves to have lamb on Eid. At the market I ask for half a lamb, but the butcher asks, “Why, your father always takes a whole lamb!” I tell him half is enough. Without electricity, a whole one will go bad in our fridge, which is basically just a cupboard now. 

On the way home, I see Aref, the computer technician who has a shop next to the internet café on our street. He tells me Emad's mom is very sick. Until then I thought her sickness was pretty mild.

At around 11pm, Muhammad Q comes back to my house, and this time he is shaking. He says he couldn’t sleep last night, because now he is worried about his wife and family, all of whom had contact with his sick uncle, the one whose chest scan I looked at last night. “What should we do?” he asks.

I tell him to calm down, and that there is nothing to worry about. “Just take precautions,” I say. “Wash your hands, and your wife should do the same. And don’t make contact with your uncle, unless you are careful. Don’t worry,” I say. He leaves, but I can see he is scared.

A few minutes later, I speak with Arabi, whose neighbour Ashal is now getting better. He thanks me for what I did, for when I scared Ashal’s son into getting his father to the hospital immediately, because when they came by my house the other night they were planning to go sit at the beach and play some games online. They were going to wait and take Ashal to see a doctor the next day.

“I guess if we did that he would be dead by now,” he says.

The power comes back on at midnight.

A holiday like no other

Dr Derwish's family survives to see the holiday of Eid al-Fitr, but others are not so lucky.

 

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24 May 2020

On the first Day of Eid al-Fitr, a Sunday, finally this Ramadan is over. In the past month, I have heard so many people saying that they wish it would end. Usually everybody loves Ramadan, but it’s different with everything that is happening this year: it has been scary and missing the usual socialising and fun.

Now it’s the morning of the Eid holiday, and for the first time in a long time we’ve had electricity for six straight hours. Now that is a happy Eid. I go to pray at the mosque with Osama and Muaad. At first I wasn’t planning on going, but then I saw Osama getting ready and then Muaad saw us, and we all got excited. I take a scarf with me to put on the floor over the carpet, and of course my alcohol spray. 

But when I get there, my God, the mosque feels like a big contaminated container. The carpet looks clean, but I know it’s the same old carpet. There are lots of people, almost all wearing masks. But they are sitting very close to each other, and still shaking hands and hugging and kissing like this is a normal Eid. But it is not normal. When people come up to greet me, I raise my elbow. When I do, this one guy says to me, “really, are you serious?”

On the way home, we stop for a second to get some bread from the bakery, and then gather for a happy breakfast. Thank Allah we are all still here, a complete family.

While we sit in front of the TV to watch some comedy shows, I send messages of holiday greetings to everyone I know. I send one to Emad, and he sends me best wishes back, but also asks me for instructions on how to use oxygen for his mom.

I go to the beach to swim at 5:45pm, and it is full of people. I put on my goggles and my swimming cap and jump in, despite all the tourist boats going really fast around the area where people are swimming. I go a few hundred metres deep into the sea. I feel really good after that, especially with everything that is going on, all the stress. I don't make any contact with people while I am swimming, so I don’t think I put anyone’s life at risk.

Later on, Yasser, who is in his late thirties, dies. He’s the brother of Abdul Rahman, the taxi driver, who died earlier this month. And Sameer, the other brother of the fish restaurant’s owner – he dies too.

25 May 2020

On the second day of Eid al-Fitr, a Monday, the electricity is as bad as it was before, maybe two and a half hours on, then three and a half hours off. We all wake up early, and have the second Eid breakfast together.

Ever since I was a little kid, the second day of Eid was when we went to my grandmother’s house (my mom’s mom), but this year we can’t because she is in her early eighties and has asthma. I had already told my mom to warn my grandmother that we would not be coming, but it’s hard because she lives on her own, and she is lonely since her daughters have stopped their weekly Thursday gathering because of coronavirus. 

I drive my mom to see my grandmother, but I tell my mom that they can’t hug or kiss, she can just shake her mom’s hand and maybe kiss it, and then everyone has to wash their hands. I stay in a separate room and say hi to my grandma from a distance, which is odd. The spirit of Eid is really missing this year.

At around 8pm, Khader starts messaging me asking about some medication that a doctor prescribed for his mom, who has been having problems breathing. He comes to my house with her chest X-ray, and it looks familiar. “This is not good,” I say to myself. Khader says he has been trying to buy a pulse oximeter for days, but it’s too expensive. 

I tell him that I suspect his mom has COVID-19, and he can use my oximeter. I tell him that he might also need oxygen, but at least that’s easy to get from anyone in the neighbourhood who has recovered.

Me, Muaad, Osama, and some other friends go to play football. Muaad wears a mask when we play. I don’t.

Later that night, I hear that the mother of two brothers who both passed away this month, Yasser and Abdul Rahman (the taxi driver), has now died too. I think that if I think my Eid is bad, how bad must it be for their family? And there are still some people here who do not believe in this disease. What needs to happen for people to believe?

26 May 2020

On the third day of Eid al-Fitr, a Tuesday, Khader calls and asks me to come to his house to explain how to give his mom her medication. I don’t want to go, because they really don’t need the physical presence of a doctor, but he seems really worried and confused.

So I tell him that I will go, but that we have to take separate cars. I don’t want to go in his car. I put on my hazmat suit for the first time, and my N95, and take my alcohol spray, and go to their house. I don’t put gloves on because I have the spray. 

Inside the house, I see Khader’s uncle, and five plastic bags full of IV fluids, and injections, and antibiotics, medication for malaria and asthma, fever suppressants, vitamins, and pills for anaemia. All of this had been prescribed by a private doctor. [People who can afford it are going to see them, but it’s expensive and they aren’t necessarily trained to deal with COVID-19]. I think this is too much, and tell them they should go to the MSF centre and seek out their advice. “Don’t admit her,” I say. “Just ask about a treatment regime, because this medication is a lot.” [Right now, the MSF-run al-Amal is one of two hospitals dedicated to COVID-19, in all of Aden, which had 900,000 people before the war and now has a much bigger population. The other is al-Jamhouria, run by the government. If people can’t go to these hospitals, which are already full, they have to go to private clinics and hospital emergency rooms, which are extremely expensive and too expensive for most people.]

They insist that I sit down, but I refuse. I stay standing up, and don’t touch anything. Khader’s father asks why I’m being so rigid, and I tell him it’s for their safety. 

I leave after about an hour. I take my hazmat suit off outside the car, flip it inside out, and put it in a plastic bag in the trunk. I spray my hands with alcohol, and at home I put all my clothes in a bucket of water with soap. I hang them, along with the suit and mask, on a laundry line outside to wait for the morning sun.

Desperate messages from a remote village

Family members are often caring for their relatives with no help, and Dr Derwish wonders when – and if – he should tell them the truth.

I think the best way to help the patient is to not tell him what I’m really thinking, which is that his dad has COVID-19.

 

Next section

27 May 2020

On the fourth day of Shawwal, a Wednesday, I spend most of the day repeating what I already told Khader and his uncle by phone. They call and message every two hours or so. 

28 May 2020

On the fifth of Shawwal, a Thursday, Khader’s youngest brother messages me at 12:20am with more questions about his mother’s medications. In the evening, Khader brings back my pulse oximeter. He says he got one from another patient who has recovered.

29 May 2020

On the sixth day of Shawwal, a Friday, the morning is calm. Khader comes over, asking for the pulse oximeter back, because the one he got doesn’t work. I play some football later and, at around 10pm, I go out to buy fruit. I see Alwai, who is driving by, and he stops to talk. He asks me about his father, who he says has a low-grade fever, fatigue, and has lost his sense of smell and taste. I give him some advice, and tell him to ban his father from going out, especially from going to see Alwai’s grandfather.

30 May 2020

On the seventh day of Shawwal, a Saturday, around two hours after midnight, a woman who I know sends me a message from Sana’a, asking for urgent help. She works for an international media organisation and I’m not sure why she has contacted me – maybe I’m the only doctor that came to her mind at that moment – but she says that her brother-in-law is in a remote village in Ibb province, has been sick for five days, and is coughing and having trouble breathing. He went to the village for Eid, got sick there, and all the clinics and hospitals are closed. I tell them to try to do some lab tests, and say that I will follow the patient’s condition remotely. 

Later, the man’s son, who is named Rabih, contacts me, and I explain to him how to take care of his father. Almost all of his lab tests are normal, but from my perspective, with this outbreak and all these different symptoms, it’s better to assume the patient has COVID-19, especially when we’ve ruled everything else out. Rabih says his father hasn’t eaten for three days. I give him a list of IV fluids and medications and vitamins that should help, but he says they don’t have any pharmacies in the village or the nearby town. He says there is one nurse there, who can check blood pressure.

Later that night, I see a neighbour, who tells me that his older brother is sick and isolating at home. He also says our neighbour Hamed and his brother, who lost their mom ten days ago to COVID-19, are both at the MSF isolation centre. 

I spend all night responding to messages from Rabih in Ibb. He is worried about his father, and is all alone with him. 

31 May 2020

On the eighth day of Shawwal, a Sunday, I spend much of the night, until around 4:30 in the morning, on the phone with Rabih in Ibb, talking everything over with him and trying to control his father’s fever. He keeps asking me, “what do you think my father has?” I say it’s probably just the flu. Rabih is only 21, he’s in a remote village, and I don’t want to scare him or make him lose his focus. So I think the best way to help the patient is to not tell him what I’m really thinking, which is that his dad has COVID-19. Maybe I’ll tell him later, when he’s better prepared.

In the afternoon, he sends me a message saying his father is feeling a bit better and is drinking liquids.

At around 11:30pm, I see a missed call from a friend in the neighbourhood, Muhammad O, who is looking for a pulse oximeter for his father, who he says is sick. He eventually finds one. 

The dancing pallbearers

Dr Derwish worries that one of his patients won't pull through, and his friends and brothers are called upon to dig graves.

 

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1 June 2020

On the ninth day of Shawwal, a Monday, at 12:30 in the morning, Muhammad O messages me, explaining that both his father and grandmother are now sick. His grandmother has stopped eating and has lost her sense of smell and taste. They had seen a specialist physician, who prescribed medication that I have seen some other patients be given for what looks like COVID-19 symptoms.

He asks for my opinion on the medications, and I tell him that the doctor who prescribed them is more senior than me, so even if I’m not comfortable with them he’s still the expert. But I am worried about how his father’s and grandmother’s bodies will handle all those medications, which include some antimalarials. 

I ask Muhammad O to describe how it all began with his father, who is 56. He says it started with a fever on the last day of Ramadan, and then on the fifth day after Eid it got stronger, and now he is fatigued and can’t smell or taste food. He already has heart problems. Muhammad O tells me he is afraid. 

“Look, I’ll tell you the truth,” I say. “It’s possible that your father has coronavirus. It’s likely. So let’s assume he has it, try to support his body and his immune system, and watch him very closely.” I tell him to get oxygen, or try to find a tank that will be ready if it’s needed. We spend almost two hours talking. The conversation ends with me saying: “Do your best. Everything will be fine. Call me anytime.” 

By noon, his father’s oxygen levels are not good [Muhammad O had a pulse oximeter so he could check], but he has an oxygen tank ready and I tell him now is the time to put it on. His father falls asleep, and I ask him to take a video of him so I can count his breathing. I count: it is 48 breaths per minute. That’s not good. I won’t hide it: I felt scared. 

That afternoon, I sit with my mom, and I tell her what is going on with Muhammad O’s father. With these signs, he should be in intensive care, I tell her. I’m really worried he won’t survive.

During the day, I keep in touch with Rabih in Ibb about his father, and Khader about his mother. Both are improving. But I also hear about another man, a close family friend of Khader’s, who was taken to the hospital.

I go with Osama and Muaad and some other friends to play football at our old school, but we haven’t even begun when Khader comes climbing over the wall asking for help digging a grave for his family friend, who has just died. I remember the look on everyone’s faces. They came to play football, but they couldn’t say no.

I see Emad on the street, and we talk about his mom, who is better now, and about how I’m worried about Muhammad O’s father. I tell him that the disease hits you hard, you get really sick fast, and then there are two or three critical days. If you get good care during that time, a patient can survive. If not, the chances are low.

Later, in the evening, Osama tells me that another friend’s grandfather has died, and they need help digging him a grave too.

2nd June 2020

On the tenth day of Shawwal, a Tuesday, Muhammad O tells me his father was better today. I take a deep breath in and say “thank God” to myself. But his grandmother is worse. I give him some instructions, and tell him to keep his grandmother away from his father. 

I continue to follow up with Rabih out in Ibb. His father is becoming uncooperative with treatment, which is normal. I try to encourage him to be gentle, and tell him that these few days will be hard, but then it will get better. I tell him to get a pulse oximeter from anywhere, and he sends me some chest X-rays that apparently he took his father to get. Someone at the health centre they went to told them the X-rays show the beginning of coronavirus.

I tell him to try and calm down, because he seems like he is losing his mind. He didn’t respond to my last message at 7pm. Later that night, the son of our neighbour dies in a car accident, and Khaled calls Osama and Sabri and the others to come and help dig his grave. 

Osama says we are becoming like the guys in the dancing coffin meme, the pallbearers from Ghana who dance at funerals. Everyone shares their videos on social media now – it’s a dark joke about how coronavirus is coming for all of us.

3 June 2020

On the eleventh day of Shawwal, a Wednesday, Muhammad O tells me his father is good now, but his grandmother is so dehydrated she can’t give blood for lab tests. She refuses to drink, and he even had his uncle call from overseas to encourage her to cooperate. That seems to have helped a bit.

In Ibb, Rabih takes his father to a hospital that is treating COVID-19 where they did more tests and scans. I wouldn’t have advised him to go there because it’s already clear his father has coronavirus. He sends me a picture of the medications they gave him, including two types of antibiotics, which would make sense if he had a bacterial chest infection. I don’t think he does. I tell him once again that he should try to find a pulse oximeter so he can monitor his father, and that right now the best treatment is rest.

At around 5pm, the captain of our Ramadan football team sends me lab results from his father, and a report from a chest X-ray the captain has done. So many people are coming to me with these sorts of images and test results because doctors are doing tests without first listening to their patients, or hearing their stories. Doctors should use these tools as one way to interpret what a patient has, not the only one.

I ask the captain to send me what he has anyway, and even though someone at the hospital told him his father might have malaria, I suspect coronavirus. He drives to my house and asks me to get into his car because he has the AC on and it’s hot outside, but I tell him it isn’t a good idea. It’s better that I not get in a car that his father may have used, because I could infect many people.

He insists on hearing what I think, so I tell him directly what I suspect. I give him my pulse oximeter, and ask him to use his phone to take a picture of it on his father’s finger, and text it to me. I write a prescription for his father’s cough, order more tests, and tell him to be in touch.

4 June 2020

On the twelfth day of Shawwal, a Thursday, a few minutes after midnight I am talking to Rabih in Ibb and trying to encourage him. I tell him to hang on and try to be patient for his father, for just a day or two more.

It starts raining at 2am, starting with a few drops and then heavier, like I’ve never seen before. I go out on the roof of our guest room, which is separate from the main house, because I want to make sure the water won’t get in the window. I stand up there, sweeping water off the roof, while my mom calls me to come in. I keep sweeping, but the water doesn’t stop. The electricity cuts off, and I am still sweeping while the sky flashes with lightning and thunder and I can see the whole neighbourhood. I’m tired, and it is cold.

I come inside at 3am and see a message from Rabih. It says, “by Allah, I owe you a life”. His father is feeling better. I tell him he doesn’t owe me anything, don’t ever say that.

I talk to Muhammad O. He says his father and grandmother are now doing fine, but someone else we know, a man called Yasser, is sick. He’s in his fifties, and has had fever for a week that comes and goes. He’s dizzy, and can’t taste food. He’s tired. I give him some advice and order lab tests. Later, he sends me his grandmother’s ultrasound, which shows a lot of problems in her kidneys. I tell him he needs to see a specialist for this.

5 June 2020

On the thirteenth day of Shawwal, a Friday, at around 1am, Muhammad O sends me Yasser’s test results. They are all normal, except for high glucose. It could be that he has diabetes and doesn’t know, or maybe the levels are high because of stress. I tell Muhammad O to put Yasser on the same regime we had done for his father. Yasser’s family wants him to have X-rays, but I advise them against it. I say that we are likely dealing with coronavirus, and any movement or extra exertion could put him in danger. 

Later in the morning, someone else texts me asking for advice on what to do about his wife, who is not eating, has a headache, fatigue, and feels dizzy all the time. We talk for around 30 minutes.

A around 5:30pm, Muhammad O sends me a message saying his grandmother is very sick again, and he thinks she may pass away. He sends me her pulse oximeter readings, and I tell him to keep her on oxygen at all times. I try to call him back more than 20 times, because the readings indicate she is dying. He doesn’t answer. Two and a half hours later he sends me a message saying that he thinks she has passed away. I ask him if he wants me to come and check. But he doesn’t respond until around 11pm, when he just says, “it’s done”. I think he means they already buried her. 

My Uncle Salem

The Derwish family mourns the death of a beloved uncle.

I’m screaming and I’m angry and my mom has tears in her eyes.

6 June 2020

On the fourteenth day of Shawwal, a Saturday, around 30 minutes after midnight, I see a message from my Aunt Eman, my mom’s sister, who is a professor of pathology. She says her husband, my Uncle Salem, is sick, and she doesn’t know if it is a kidney problem [he’s had one for years], dengue, or what. Salem is 68, and a professor of internal medicine since the seventies. He taught my father, my mom, and me.

All of my uncle’s lab results look normal, except for his kidneys. I ask Eman some questions about Salem’s medical history, and she says he is eating and drinking water. Eman tells me she has a pulse oximeter but it is with her son Salah because he thinks he has coronavirus. She’s worried about Salah, but I’m not, because he’s only 30. I tell her to put some cold compresses on my uncle to bring his fever down, and to get the oximeter back from her son so she can keep an eye on his oxygen.

A little before 9pm, Muhammad O sends Yasser’s lab results. A specialist has given him lots of different medications that I have seen other people take, including antibiotics and anticoagulants, after which their health has deteriorated. I don’t like the regime, but at the end of the day, I’m a general practitioner, not a specialist. I instruct Yasser to rest, and maybe walk once a day inside his room to keep the blood flowing. 

At 10:30pm my aunt says my Uncle Salem suddenly became tired so they got a nurse who put him on IV fluids. She says the nurse readied an oxygen tank but said not to use it, and to just keep it there as a back-up. Now, Salem is sleeping, but he’s making noises like he is in pain.

I ask her to send me a picture of the oximeter on his finger, which is at 72 percent for oxygen, and 102 for pulse. That tells me he is suffering, and that his heart is trying to cope with a decrease of oxygen by trying to pump faster. I ask her to try and count how many breaths he is taking each minute, but he refuses and says he wants to sleep.

7 June 2020

On the fifteenth day of Shawwal, a Sunday, at around 1am, I check in with Muhammad O about his father and Yasser. His father is ok but still has a cough, and his neighbour Yasser has low readings on the oximeter, so I tell Muhammad O to bring the oxygen tank he has from his house to Yasser’s, and I teach him how to use the tank. I tell him he has to encourage Yasser to breathe deeply and slowly.

The electricity cuts off at 3am, so we keep the generator on. Its noise has become like the most beautiful symphony to me. All the fans are on, thanks to the generator, but the house is still boiling; it’s like a sauna inside. 

I sit with my mom, Osama, and Ahmed outside in the yard, and we talk about what’s going on with my Uncle Salem. I tell my mom not to cook anything, it is too unbelievably hot. So I go out to buy us lunch and when I’m coming back with the food, a little before 2pm, my neighbour Hani stops me and says his wife is sick and has mukarfes, which is a local name for chikungunya. I try to explain to him that’s probably not what it is, and he is shocked. 

Another neighbour passes by in his car and I can see the moisture on the windows with the AC on. He offers me a ride, but I say, “no worries, I can walk, it is close.” It isn’t close and the heat is unbearable, but I can’t be in other people’s cars right now. What if I give them something? 

At around 4:30pm, my mom tells me that my aunt says they are thinking of taking my Uncle Salem to get some blood tests and a CT-scan, but I am worried that any movement could kill him if there isn’t oxygen in the car. I tell my mom that I think he’s going to die. 

Later, a doctor I know calls, and he says that lots of doctors know my Uncle Salem, and they have readied a place for him at the intensive care unit at al-Jamhouria, one of the biggest government hospitals in Aden, which MSF is now running. But we can’t get hold of my aunt or uncle to tell them that, so I go out to buy dinner, and while I’m laying the food out for us to eat, at around 10pm or so, my mom receives a message saying Salem has passed away. 

My Uncle Salem has died, the man who taught me medicine, the man who I never saw grumpy. The man who was always smiling, punching me on the shoulder and laughing. Salem, who knows so much about medicine that when he talks I cannot take it all in. He has died. I’m screaming and I’m angry and my mom has tears in her eyes.

Khader checks in a few times throughout the day about his wife, who now has diarrhoea and a fever, and he gets in touch about an hour after Salem dies to say he has checked her blood pressure as I requested, and that it is low. So I ask him to give her fluids.

8 June 2020

On the sixteenth day of Shawwal, a Monday it is midnight and two hours since we heard that my Uncle Salem died. 

Just a few minutes after midnight, Muaad gets in, and says our neighbour Hamed has also died. He was 37. His mom died less than three weeks ago. An hour later Muaad tells me that Dr. Ahmed, who is my friend, and the same age as Hamed, is now in critical condition and at MSF’s al-Amal centre.

I haven’t slept since the news of the death of my uncle. It is 3:30am. My brother Ahmed says he is planning to go to the cemetery. “Ok, I’m going with you,” I tell him. “What’s the plan for praying?” We want to avoid going to Aden’s Grand Mosque to pray, because it’s huge and lots of people have been going there to pray for the dead. Ahmed says he will pray at the mosque here in our neighbourhood. “What about you?” he asks. I tell him that I will pray at home and get ready here, and when he finishes at the mosque he can pick me up and we’ll go together to the cemetery. We can pray for the dead together there, and it will be ok because we don’t need to kneel or get close to the ground like you do with other prayers.

[If possible, burial always happens right after the most recent prayer.] So we drive to the cemetery at 4:45 in the morning, me, Ahmad, and our friend Sabri. At first, there is no one else there, but after about 20 minutes we see the headlights of cars coming. The cars stop, and people come out carrying my Uncle Salem’s coffin.

I see Salem’s son, my cousin Marwan, who is a 36-year-old dentist, wearing a mask and standing near the hole in the ground. He is watching as people try to get it into the right shape before they put his father, my uncle, inside. 

There are lots of people there, so I try to keep my distance. Most people are wearing masks, some gloves, but Ahmed and I are not. Despite everything, people are kissing, hugging, and shaking hands. I gently tap Marwan on the back of his shoulder to give him my condolences.

While we are still there, my friend Hamed’s funeral procession arrives. I see some people who I know, and I greet them from a distance too. Then I go to give Hamed’s older brother my condolences, and he tries to shake my hand, but I tell him it is better for both of us not to. He nods his head in agreement. A few minutes later we pray together: me, Ahmed and Sabri, and a few other guys. Then I go home.

I sleep for a few hours, and when I wake up a little bit after noon my mom is already wearing black, getting ready to visit her sister Eman, Salem’s wife. I start the car and drive my mom to her sister’s house, which is in the middle of nowhere, in a residential compound south of Aden, close to the coast. I stop the engine and we walk to the gate together, but I decide to return to the car. Why would I go inside anyway? My mom wants a moment alone with her sister. 

Five minutes later, while I am writing these notes on my phone, my cousin Marwan comes knocking on the car window. He tells me to take all precautions possible with my mom, to tell her to wash her hands and not touch her face. 

When my mom comes out two hours later, I spray the car down with alcohol and then ask her to open her hands and put some of it on her. And then I ask my mom to take off her abaya, an overdress Muslim women in Yemen wear to cover their clothes for modesty. I tell her to flip it inside out. “Here, in the street?” she asks. The street is empty, so I say, “yes”. Doing this is one of the taxes of visiting people during the pandemic. She does it, puts her abaya in the back of the car, and gets in. When we get home, my mom cleans everything, even her purse.

I change my clothes too, and run to the beach for a swim. I think I need some exercise or I will go crazy. I only swim for 30 minutes, but I do feel a little bit better.

Ammar Derwish is a physician based in Aden

Adly Mirza is an artist and professor of Arabic based in Hawaii

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