Ebola: “This is what it was like to respond to HIV,” doctor home from Guinea says

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At the end of last May, Dr. William Fischer was immersed in his work as a physician, researcher, and instructor at the University of North Carolina in Chapel Hill when he answered a call from the World Health Organization. He had been recognized the year before with the Infectious Diseases Society of America’s Young Investigator Award in Geriatrics, and WHO sought his input on critical care as it assessed the Ebola crisis in west Africa. This led to an invitation to work with a team from Médecins Sans Frontières in Gueckedou, the remote southeastern forest region of Guinea that was the epicenter of the outbreak. Fischer accepted the opportunity, but first, he had to tell his family.

“This is what it was like to respond to HIV,” was one of the arguments that he made for going, he said last week in an conversation with Science Speaks. The similarity, he said, extended to the fear and unknowns surrounding the epidemic, and also to the consequences of not responding effectively and immediately. Working in an isolation unit in Gueckedou, he wrote home June 2, nearly three months after the outbreak was recognized, and two months after MSF responders had warned that its impact without a swift response would be “unprecedented.”

“The despair,” he wrote during his first week there, “is suffocating.”

His emails to his friends and family, posted with his, and their permission on the University’s website, told starkly of overwhelming suffering —  people witnessing the agonizing deaths of family members and then becoming sick, helpless, deteriorating and succumbing themselves. He wrote of cleaning a patient covered in bloody vomit, only, as soon as he was done, to watch him die. He wrote of telling another man the last member of his immediate family had died. He wrote of the seemingly insurmountable obstacles to care with lack of protective gear, limited treatment resources, distrust between local people and treatment teams, and the “non-specific” nature of the viruses symptoms — fever, vomiting, diarrhea — allowing cases to go overlooked, untreated and uncontrolled.

In the midst of that, however, he cited hope, in an older patient (at least 85 he wrote then, admitting now that may have been an exaggeration) who was recovering and sought to cheer other patients with displays of calisthenics. He cited comfort — for himself, as well as patients —  in the care he was able to provide, and in knowledge that as care improved, the numbers of deaths would drop.

The older patient survived, he told Science Speaks. So did a woman living with HIV. Even care with meager resources made a difference, he said, cutting death rates from the virus nearly in half.

“Despite the despair, I actually do have hope,” he said.

That hope, though, is contingent on a response that greatly exceeds what has happened yet. It depends on the outbreak being addressed in western Africa as one would hope it would be in countries with more resources.  “We have to be looking for Ebola,” he said. “If they have symptoms, and contacts, either suspected or confirmed, they should be admitted and ruled out. If we wait for confirmation, we won’t get control.”

The speed of the response also will have to match the speed of the virus, he said: “The outbreak is doubling every three weeks.” If  2000 beds  are needed right now, and it takes three weeks to build them, he added, “that’s where you lose the game.” Fischer, who has since helped the U.S. Centers for Disease Control and Prevention develop the training it is now offering volunteer healthcare practitioners, is seeking now to balance his work obligations with a desire to return to West Africa.

“The place I find the most enjoyment,” he said “is being there, delivering care.”

Read his dispatches from Guinea here.

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  1. Pingback: Comprehensive health responses and lessons from HIV can guide efforts to confront sexual transmission of Ebola | Science Speaks: HIV & TB News

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