After a busy night shift at the hospital, there was nothing the nurse Josiane Ekoli liked to do more than come home and wake up her sleeping children. Her 22-year-old son, Kenan, a finance worker, got the worst of it, because his bedroom was the closest to the front door. “Oh my days,” Kenan groans. “Every day, I’m hearing my name, without a doubt. She’s screaming my name. Kenan! Kenan! She knew I hated being woken up.”
On Saturday mornings, when Josiane had not come off a night shift, she had a routine: at about 9am, she would blast gospel music through the house. If that did not get her children up – she had five, but two of her sons had moved out – she would go into their rooms and start talking to them. At them, really. “Sometimes, she woke me up just to talk,” says Kenan. “I’d say: ‘Mum, couldn’t you wait until I was awake to have this conversation?’”
Once the children were up, Josiane would often spend the day in the kitchen with her 26-year-old daughter, Naomie, a student. Josiane would teach her how to make traditional Congolese food, such as madesu, a cooked bean dish, or mikila, an oxtail stew. “You’d watch her do it,” says Naomie, “and taste it with her. She’d teach you one or two times and then the third time she’d say: ‘Right, let me see you do it yourself.’ And you’d better get it right, because she would in-your-face laugh at you if you didn’t know how to do it!”
Josiane does not blare gospel music around the house any more, or wake up her kids early. She does not spend Saturday mornings in the kitchen with Naomie, laughing and tasting food. She died of Covid-19 on 13 April. She was 55.
Josiane was born in Kindu, a city in the Democratic Republic of the Congo. Her father was a prominent politician who married several times; her network of sisters and half-sisters, brothers and half-brothers spread out across the DRC, as well as in Cameroon, to the north-west, and South Africa. In Congolese culture, you pray for your firstborn to be a boy, to look after the family, but Josiane was the eldest.
“When you are born a woman, people think: ‘She’s going to rely on the family,’” says Josiane’s sister, Solange Kathanga, 45, a healthcare assistant from Leeds, where Josiane also lived. “But Josiane was never like that. Whenever you needed help or money, Josiane was always there.” When they were kids, her sister was strict. “Don’t do this! Do this! If you don’t wash the plates, you are not eating today!” Solange says, mimicking her sister. “It was like being in the military.” Josiane mellowed in her 20s. “She became more patient, more open,” says Solange. But the organising principle of her life remained the same. “She always said to me: ‘Don’t put your hope in others, don’t rely on people, you have to work for yourself,’” Solange says.
The maternal instinct never left her. “She was the most kind-hearted, no-nonsense woman I know,” Naomie says. “As soon as you walked into her house, there was no difference between her kids or one of my brother’s friends.” Two of Kenan’s schoolfriends moved in with the family for more than two years. “She put them in my room and they would go to school from my house,” says Kenan. “That’s the kind of woman she was. She’d treat my friends like her own.”
Josiane studied nursing at the University of Kinshasa, before moving to Germany in her early 20s, to work in care homes. Her family saw her as a bit of a test case: they would send Josiane to Europe and, if it all worked out, she would help her siblings relocate. “She got all her younger siblings, especially the females, to come to Europe,” Naomie says. There were always relatives sleeping on their sofa. “All my life, we’ve always had family members staying with us,” says Kenan.
Those early years in Germany were not easy. Josiane met and married Jean-Claude, an IT consultant, who was also from the DRC. “It was difficult being black at that time,” remembers Josiane’s eldest son, Jean-Claude, 32, a business developer. “It was hard for my dad to find work.” Josiane considered retraining as a doctor and even enrolled in medical school, completing her first year of study before dropping out. “I asked her: ‘Why didn’t you finish your medical degree?’” says her friend Oyenike Ola, a 58-year-old healthcare assistant and trainee nurse from Leeds. “She said that all the racism compelled her to move to England.”
Josiane told Oyenike about an incident that took place at one of the care homes where she worked. Her colleagues did not like Josiane because she came in early and stayed late, which made them look bad. One day, they ganged up on her. They refused to enter the building where they worked until Josiane was fired. “They said: ‘This black girl must go. We can’t work with her,’” says Oyenike. The manager backed Josiane. “She said: ‘This girl is going nowhere.’”
The family moved to England in 2002, initially living in London, before settling in Wolverton in Milton Keynes. The family had expanded: by now, in addition to Jean-Claude, there was Naomie, Kenan and Aaron, who is now 19. Aalijah, who is 16 and the youngest of Josiane’s children, came along after they moved to the UK. Josiane worked as an agency nurse. She preferred agency work, because it gave her more control over her shifts. Also, it meant she never had to work on Sundays – and Sundays were for church. “She was very God-fearing,” says Naomie. “She went to church every Sunday. That was her thing. Church was her happy place.”
Josiane’s children went to church with her, because they could see how much it meant to her. “It made her so happy, seeing us all there together,” says Naomie. Josiane always dressed up for church, usually wearing African fabrics. Dutch wax prints were her favourite. “Every outfit had a special shoe or handbag to go with it,” says Naomie. “Say she had a black shoe: she’d wear that with, like, two specific outfits. One pair of shoes, two outfits maximum!”
Josiane separated from her husband in about 2009, although it was amicable. “She never held grudges,” says Kenan. “Even against my dad! She was cool with him.” The family moved again, to Chapeltown in Leeds. As a single mother to five children, four of whom were still living with her at this point, Josiane knew that she had to be firm. “If you wanted to go out, you had to make sure that your room was clean, that you had done your chores,” says Naomie.
When Kenan was 16, he started staying out late, hanging around with a bad crowd, the usual stuff. Josiane suggested that the two of them go on holiday, to visit her brother in Cameroon. “One morning [in Cameroon], I wake up and I’m trying to find out where my mum is,” Kenan says. “They say she’s gone out to get breakfast. It gets to 8pm and I’m like, how has she been gone all day getting breakfast? I call her and she’s not picking up.” Eventually, Josiane answered the phone – from the UK.
“She said: ‘You’re going to learn to behave and then you can come home,’” Kenan says, laughing. Kenan spent four months living with his uncle in Cameroon. When he came home, he no longer misbehaved. “The way she went about it, to keep me out of trouble, I respect that,” he says. “I thanked her for it. When I was in Africa, a lot of my friends who were in England, who I was around every day, were getting in trouble with the law. The way she did it was a bit mad. But it was all for a good reason.” He bursts out laughing. “And it was so funny.”
Spending that time in Cameroon also helped Kenan to see the sacrifices that Josiane had made to give her children a more prosperous future. Josiane regularly sent money back to the DRC to support her family. “Seeing how people live out there, how they struggle, it really changed my perspective on everything,” Kenan says. “When I came back to the UK, I started working. As African kids, you don’t realise the sacrifices your parents have made. It’s only when you go back that you really understand.”
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Jean-Claude does not like to think of his mother as dead, because that would be to contemplate the enormous crater her loss has left in his life. “Even though she’s not here now,” says Jean-Claude, “it actually feels like she’s at work. Because she was always working.”
Josiane worked hard. “She hardly sat down,” says Oyenike. She and Oyenike often worked at the same hospitals. “You’d see her constantly pushing the drug trolley from one bay to the other. I’d say: ‘Josiane, let’s go and get some food.’ She’d say: ‘Let me quickly finish this round.’”
One day, Josiane and Oyenike were in the staff kitchen, on their lunch break. A ward sister asked Josiane to go back to the nurse’s station, even though she was eating lunch. “She just looked at her and dropped the food and went to the nurse’s station,” Oyenike says. “I felt bad for her. I said to Josiane: ‘Why did you do that? You could have told her it was your break.’” Sometimes, during handover, staff would pull faces at Josiane’s African accent. “She didn’t care,” Oyenike says. “She delivered whatever she had to do and handed over to them.”
Oyenike does not drive, so Josiane would often drop her off and pick her up from work. Even if Josiane’s shift finished earlier than Oyenike’s, and she was tired, she would wait in the car park until her friend finished. Once, Josiane lent Oyenike money. When Oyenike texted her, asking for her bank details so she could repay her, Josiane ignored her message.
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A list at the reception of Harrogate district hospital, where Josiane worked, tells agency nurses to which wards they are assigned. “Josiane would never refuse wards, even if they weren’t good wards,” says Oyenike. She was willing to work anywhere. As coronavirus swept the UK in March, Oyenike counselled Josiane not to work on the Covid-19 wards. “I told her: ‘Choose where you work.’ But she would tell me: ‘What can we do? We have to do the work.’” So when Josiane was assigned to work on the the Harlow and Farndale wards, which were being used to treat Covid-19 patients, she uncomplainingly took up her post.
Josiane tended to work Mondays to Thursdays. If she was on night shifts, Naomie would wait for her to get home, so that she could make her mum breakfast – porridge usually, or avocado on toast with tomatoes. Before Josiane went to sleep, they would talk about her shift. It was during one of these breakfasts that Naomie realised her mother was being given limited personal protective equipment (PPE). “But she would say: ‘If I don’t work, who else is going to do it?” Naomie says. Oyenike observed the PPE that was being distributed to staff on the Covid-19 wards. “It was just the normal PPE you get when you do personal care or want to enter the bay,” she says. “Just an apron and gloves. Initially, there were no face masks, but later they brought surgical masks.”
World Health Organization guidelines for the treatment of Covid-19 patients state that healthcare practitioners should wear heavy-duty aprons, an N95 or FFP2 respirator mask, eye goggles, gloves and single-use gowns when performing aerosol-generating procedures such as intubating or resuscitating a patient. But during the pandemic, Public Health England changed its guidance on PPE provision repeatedly. “Certain elements were watered down,” says Dr Rinesh Parmar of the Doctors’ Association UK. (The Royal College of Nursing was unavailable for comment.) “The official line from the government was that the changes were based on the science. But most frontline staff were concerned that the guidance was being watered down due to a lack of supply of PPE.”
It was clear by mid-March that the government was struggling to get PPE to NHS workers. On 22 March, Parmar appeared on BBC One’s Andrew Marr show. Still wearing his scrubs and looking tired after a night shift, he told Marr that he had been inundated with emails from concerned medics, warning of PPE shortages. “They feel like lambs to the slaughter … like cannon fodder,” he said. By 24 March, the Royal College of Nursing was warning of shortages. “Nursing staff should never be forced to choose between their safety and their livelihood,” a spokesperson said. On 3 April, the British Medical Association warned of a “scandalous lack of personal protective equipment”.
On social media, NHS staff complained of PPE shortages, only to be threatened with disciplinary action by hospital bosses. Desperate, they began to improvise. Nurses tied bin-liners around their legs and plastic aprons around their heads. A survey in April by the Royal College of Nursing of its members found that, of the 13,605 who responded, 50% felt pressured to care for patients without adequate PPE and 27% had to use PPE that was donated or which they had bought or made themselves. As anger mounted over the lack of equipment, the public stepped in. Schools donated their science laboratory goggles. DIY stores donated masks. A crowdfunding page set up by NHS medics raised £2.3m in public donations for PPE, including a £275,000 donation from the X-Men actor James McAvoy. In desperation, some healthcare trusts even began relabelling expired PPE, because new stocks of in-date PPE were not available.
All the while, government ministers obfuscated, blustered and stonewalled. On 10 April, the health secretary, Matt Hancock, implied that NHS staff were to blame, for overusing PPE. “There’s enough PPE to go around, but only if it’s used in line with our guidance,” Hancock said. By the following day, he had pivoted to blaming shortages on a “distribution issue”. Fielding questions later that day at the government press conference, the home secretary, Priti Patel, offered up a feeble almost-apology. “I’m sorry if people feel that there have been failings,” she said. “But … it is inevitable that the demand and the pressures on PPE and demand for PPE are going to be exponential.”
But were these shortages inevitable? The government had been warned of the need to stockpile adequate PPE in the 2017 Exercise Cygnus report, which highlighted the government’s ill-preparedness for an influenza pandemic. The 2019 National Security Risk Assessment planning document determined that an “influenza-type pandemic” was the one of main risks facing the UK, alongside coastal flooding and a terrorist attack. The same year, the government advisory body the New and Emerging Respiratory Virus Threats Advisory Group recommended purchasing more protective gowns.
The government did not stockpile PPE then, nor when Covid-19 started sweeping across Europe in February 2020. It opted out of an EU-wide scheme to bulk-buy PPE in March. In April, the government belatedly purchased 400,000 gowns from Turkey, but, in an embarrassing volte-face, had to return them all in May, because they failed to meet medical standards. “It was an utter shambles,” says Parmar.
As the government scrambled to distribute PPE, hand-drawn rainbows appeared on windows. Every Thursday, the sound of clapping filled the streets. Ministers started to talk about healthcare workers in the language of patriotic sacrifice: they were heroes, on the frontline of a battle against the Covid-19 virus. Then NHS staff started dying of Covid-19: on 25 March, the first GP and the first working surgeon died; on 3 April, the first nurse died. In May, as the scale of loss of life to NHS workers became clear, the government upped the jingoism. “Our modern army of doctors and nurses … have fought this virus with irrepressible courage, compassion and care,” wrote Boris Johnson in a column published in the Sun. “They have risked their lives for us.”
Kenan dislikes this narrative. “You don’t sign up to be a nurse to be called a soldier,” he points out. “And even soldiers who do go out to battle are given helmets and protection.” Parmar perceives a more cynical motivation for this discourse of soldierly sacrifice. “By giving it a military, battlefield context, you’re making it OK for people to die … it normalises the fact that people are going to die in the public’s mind … But healthcare workers shouldn’t be dying of exposure to Covid. They should be safe at work.”
While the PPE furore was raging, Josiane kept working, treating her patients, doing her rounds, eating breakfast with Naomie. But she was now getting really concerned about PPE at work. She told her children that she had been issued only with a surgical mask, an apron and gloves, rather than full PPE, despite the fact that she was working on a ward treating Covid-19 patients.
The last time Oyenike saw Josiane was an afternoon at the end of March, when Josiane gave her a lift to work. Arriving at reception, Oyenike was told she was being sent to the Harlow ward, one of the two Covid-19 wards in which Josiane regularly worked. During the handover, Oyenike was told that two patients were Covid-positive and that she would have to move them – a high-risk procedure. “There were gloves and an apron and a surgical mask provided,” Oyenike says. “I turned to them and said: ‘Where is the PPE?’ They said: ‘This is it.’” Oyenike asked if she could at least change into surgical scrubs. The ward sister told her that, no, they did not have spare scrubs.
Oyenike has diabetes and hypertension, putting her in the at-risk group for Covid-19. She asked if she could be moved to a different ward. The only other ward her manager would send her to was the Farndale ward, also a Covid-19 ward. “I was crying,” she says. “Because I really wanted to work that day. I even showed them the medication I have, to show them I wasn’t lying. The manager just kept saying: ‘If you go, no one will pay you.’” Oyenike told her that she could not work without adequate PPE.
It took Oyenike nearly three hours to get home from Harrogate to Leeds, because it was late, she could not afford the cab fare and had to get three buses. She sobbed all the way home.
A Harrogate and District NHS foundation trust spokesperson said: “Josiane was a kind, caring and compassionate colleague and her death is a devastating loss for her family, and her friends and colleagues at Harrogate district hospital. She worked in a number of wards over a couple of years through her agency, and continued to do so during the Covid-19 pandemic.
“Different types of PPE were required for different situations, and we asked our colleagues to follow the national guidelines in place at the time. We know some colleagues would have preferred to use higher levels of PPE than the guidelines required, but the supplies of that type of PPE meant that we had reserve it for the very high-risk settings in which it was needed.
“During the pandemic, we have operated a set of management arrangements that should have allowed any issues about the availability of PPE to be raised and addressed and this did occur at times.
“We have reviewed the information provided and believe that the PPE provision for Josie and Oyenike was in line with national NHS guidelines.”
***
On 3 April, Josiane started feeling ill. She called the agency that arranged her hospital shifts, cancelled them and self-isolated in her bedroom. The children brought her food and made her tea – Josiane drank vast quantities of hot ginger and honey, usually in an enormous mug. She told them not to worry, that it was in God’s hands. By the third day, Josiane stopped eating. “She said the food didn’t taste right in her mouth,” Naomie remembers. She could not breathe properly. The children prepared bowls of peppermint-infused boiling water, so that Josiane could inhale the steam, which seemed to help. By 7 April, Josiane felt as if she was going to pass out. They called the ambulance.
“I was still believing, still holding on to that hope that she would be OK,” Naomie says. The paramedics had to carry Josiane down the stairs, because she was too weak to walk. As she was being loaded into the ambulance, Josiane spoke to her eldest son Jean-Claude on the phone. “She said: ‘I’m not well at all,’” Jean-Claude remembers. “‘Stick together with your brothers and sisters and fear God.’ Those were the last words she ever said to me.” The children hushed her. “Everyone was like: ‘Stop talking, you’re going to come back, relax,’” Naomie says. “It was like she was saying her goodbyes.”
Josiane was saying her goodbyes. Solange put on her healthcare assistant’s uniform and tried to sneak into Leeds General hospital to see her. She got as far as the door to Josiane’s room, but the staff would not let her any closer. So the sisters spoke on the phone, looking at each other through a glass panel in the window, for the final time. “She told me to be strong and to look after the children,” Solange remembers. Solange told her not to speak like that – everyone at her church was praying for her and they believed in miracles. “It felt like she knew she was going,” Solange says. “She was telling us so we could be prepared.”
On 9 April, Naomie woke up to a text message from her mum: “I’m going to ICU, but it’s fine.” On 11 April, doctors placed her on a ventilator, but her condition was deteriorating. On 13 April, the hospital called the children and said they did not think Josiane was going to make it. They arranged a video call.
“She looked very different,” says Jean-Claude. “I don’t understand – why didn’t they just close her eyes? Her eyes were open and you could just see the eyeballs. They were just white, all white. It wasn’t a nice moment. Her mouth was open and you could see the tube they put in her. It wasn’t a nice image. That’s not the last image you want to see of your loved one.”
The hospital ended the video call, but asked the children if they would like to speak to Josiane on the phone, until she passed away. The children talked about happy memories; they made jokes. Jean-Claude quipped that his mother would not be around to meet his new partner, whom he had recently started dating. “My mum, she was always not happy with the partners I brought home,” says Jean-Claude. “I said to her: ‘I can’t believe I’m finally bringing you someone I know for sure you’re going to be very happy with, and you’re not there!’” The children wanted their mother to hear them, to know they were there, even if they were not allowed to be physically present, to know that they loved her. They sang to her, they told funny stories about their dad. And then the line went dead.
Eventually, the hospital called back. The call had ended, they explained, because their mother was dead. The children were astonished that no one had told them before hanging up. “The way it all happened was just not the right way,” says Jean-Claude. “It was so disrespectful, to a human being and a mother who had so many children who loved her. Her dying all alone, feeling all alone – it wasn’t right.”
Two days after Josiane died, on 15 April, the government changed the rules, to allow relatives to be at the bedsides of family members as they died of Covid-19.
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According to Full Fact, an independent fact-checking charity, 181 NHS staff died of Covid-19 in England before 19 May; many more will have died since, but more up-to-date figures are not available. These people were cleaners, nurses, doctors, porters. Many of them, like Josiane, were black: according to the Office for National Statistics, black people are four times more likely to die from Covid-19 than white people. Sixty-one per cent of healthcare workers who have died from Covid-19 were from a black, Asian or minority ethnic background. How many of them would be alive if they had had the proper PPE? We simply cannot know.
“The government had a duty of care to all healthcare workers working in the NHS,” says Parmar. “And I think they’ve failed in their duty of care.” The Doctors’ Association is crowdfunding for a judicial review into the government’s provision of PPE during the pandemic, to determine whether its failure to provide adequate PPE may have contributed to the deaths of health and social care workers. “I’m angry,” says Kenan, about the circumstances that may have contributed to his mother’s death. “But, at the same time, I’ve also accepted it. Because she always wanted to help people around her. She knew she didn’t have the [right] PPE, but she kept going into work. She wanted to help people. That’s the kind of person she was.”
Parmar tells me that the Doctors’ Association received complaints from staff at Harrogate district hospital, about a lack of PPE, during the period Josiane was working there. Oyenike feels that they failed to keep Josiane safe. “She could have been alive, if she was given the best thing,” Oyenike says. “It is death by mistake. She shouldn’t have died.” Oyenike sobs as she remembers her friend. “I remember the night they told me she died,” she says. “I was crying and screaming. What a lovely girl. She was not supposed to die.”
Josiane’s children are doing what she told them to do. They are sticking together; fearing God. After her death, Jean-Claude rented a house for them in London and all the children moved in together. “We’re trying to get used to her not being around,” says Noamie. “It’s like there’s a void. Jean-Claude doesn’t like to talk about his mother in the past tense. ‘She is still with us,’ he says. ‘She just doesn’t respond in the normal way, when you talk to her. But she’s still there. She’s within us.’”
Her children were determined that their mother’s funeral should be as good as possible. They held it in Bedford rather than Leeds. In explanation, Naomie says: “We called up a lot of funeral directors until we found the perfect one.” The children also knew that whatever they put their fashion-loving mother in to rest had to be perfect, so they rooted through Josiane’s closet. With the help of Solange, Naomie settled on a colourful print dress in pink and yellow, with beading. Josiane used to love it when her children wore matching outfits. They hated it, but they figured: what better time to humour her than her funeral? So they cut up one of her old dresses and used the fabric to make customised matching T-shirts.
The day of the funeral, 6 May, was beautiful, sunny and warm. The family streamed the service on Facebook Live, for Josiane’s friends and family back home in the DRC – 5,600 people have watched it. “Rest in eternal peace, mama Josiane,” read a typical comment. There were dozens of people outside the Bedford funeral parlour, lamenting and ululating – a sign of respect and grief in Congolese culture. When Josiane’s body arrived in a horse-drawn carriage, bedecked with flowers, the mourners reached a crescendo. The noise was overwhelming.
The day after Josiane died, Solange’s 17-year-old daughter, Rosie, woke up in the night and smelled a strange perfume in her room. It lingered for a moment and then disappeared. A few weeks later, Solange helped the children to pack up Josiane’s things, before their move. She kept an old dress of her sister’s, by which to remember her. Rosie picked up the dress and smelled it. It was the same mysterious smell she had noticed in her bedroom. “She came to say goodbye,” Solange explains. She knew what she had to do.
“I said to Naomie: ‘We need to open the window in Josiane’s bedroom,’” Solange explains. “‘She needs to go and rest. She hasn’t disappeared, she’s in you, she’s your mum. But you have to let her soul go. That’s why she’s sticking around.’”
Solange opened the window and let her sister out.
• This article was amended on 19 August 2020 to clarify that the figure given for deaths of NHS staff in England was for the period up to 19 May.
