Ebola: “You can’t say we didn’t know,” says a doctor returned from West Africa

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“I don’t want to say ‘what has been allowed to occur, so I’ll backtrack, and say, ‘what has occurred’ . . .”

DanLuceyDr. Dan Lucey is an infectious disease physician who teaches about epidemics at Georgetown University, but when he spoke there last week about his experiences treating Ebola patients in Sierra Leone and Liberia last summer and fall, he began by summing up the challenge of discussing what he saw there.

“It’s still very difficult to talk about,” he said. “Easy to remember, impossible to forget.”

Some of it he starts, and leaves listeners to think about the rest.

He couldn’t finish the sentence he started about seeing very old people turned away from a hospital, to die.

Other memories, he summed up briskly, but repeatedly: “The day we had 17 patients and 13 beds.”

He  could describe the conditions that health workers, 500 of whom have died since the West African Ebola crisis began, face willingly, in addition to the threats to their own survival: the hellish heat inside the tents that costs patients in sweat the fluids they haven’t lost through diarrhea and vomiting, the frustration of trying to provide treatment in 45-minute stretches from the confines and even greater heat of protective suits. He described the futility that limited resources led to: patients who arrived dead at the end of a 10-hour transport to the nearest health center, patients exposed to each others’ illnesses as they waited —  not hours, but days — for test results, together, in a sweltering ward, buckets for urine, vomit, feces at the foot of each bed.

But the day of 17 patients, 13 beds, sums up something bigger for Lucey, that he finds difficult to talk about, impossible to forget.

You could be forgiven for thinking he didn’t know what he was getting into when he says with the enthusiasm of someone half his age, “I’ve always wanted to go to an Ebola outbreak,” and considered himself “fortunate” at the end of July to get a call from a colleague telling him of an opportunity to volunteer at an Ebola testing and transit unit in Sierra Leone last July. But he has enjoyed a 30-year career full of, as an article in the magazine of the Dartmouth School of Medicine, of which he is an alumnus, put it, “chasing things you wouldn’t want to catch,” including SARS in China and Toronto, H5N1 bird flu in Viet Nam, Thailand, Indonesia and Egypt, MERS, and Anthrax.

And the issue behind the the day of 17 patients 13 beds, is more confounding to him than how to treat an infectious outbreak.

“You can’t say we didn’t know,” he said, to sum up all the things that were missing and needed.

An audience member pointed to the often cited fear re-ignited by the West Africa crisis, that “it could happen here.”

That was when he started, but couldn’t finish the sentence about old people, turned away from the hospital to die. He paused, to collect himself.

“Would this have happened if it was France? If it was the Netherlands, or Belgium? It’s a rhetorical question,” he said.

What sets patients in West Africa apart from patients in those places, in the United States? He can answer that on one level, but not another. All of the healthcare workers treated for Ebola in the United States were monitored for levels of potassium, electrolytes, red blood cells  — none of those ever measured in healthworkers, let alone other patients treated in Africa. In America, they received intravenous rehydration — still a matter for debate in Africa. All of the healthworkers treated in the U.S. have survived, even one who was on life support, Lucey notes, while by that day, 500 healthworkers in Africa had died. And while treatment units for Ebola patients here are air-conditioned, even new ones built in the belated donor awakening to the crisis in Africa, are not.

“Why not?” Lucey asked. “Why not? Why not?”

These were the questions that confounded him, and presented him with a conundrum: He didn’t want to stay, couldn’t leave.

He stayed, six weeks in Freetown, Sierra Leone, and then returned to Africa to serve with Médecins Sans Frontières, in Monrovia, Liberia, because, he said, “Every single day you could do something good.”

In Sierra Leone he composed a list of 18 problems, 18 solutions, that he titled “Essential Improvements ASAP in Freetown’s Largest Ebola TESTING and Isolation Centre.” He capitalized testing to emphasize that some of the people isolated there weren’t sick — yet. The list included delays in drawing blood for Ebola tests, samples not transported to the lab, delays in results, delays in moving patients, no safe way to transport infants. Some were addressed, while he was there. Some he found answers to — going to the market and buying “baby Moses baskets” to transport infants. He copied the list and gave it to everyone he met in a position to do anything about it. It’s one of the reasons he says now, “You can’t say we didn’t know, these things are known.”

The resources considered essential to Ebola patients in America, he said, tell a story. “We all knew about that before Ebola. We knew about it during Ebola. We know it now.”

At the end of November, he returned to Georgetown and produced another list, of things he wants to see there, he called “A Way Forward.”

It includes an exhibition on global virus outbreaks at the Smithsonian National Museum of Natural History in 2016. It includes a working group made up of non-World Health Organization staff to meet monthly and advise when a global event has reached the point that it should be considered a “Public Health Event of International Concern” (WHO did not make that call on the current crisis for another four months after Ebola cases were identified in Guinea’s capital, the first time ever that Ebola had been identified in a capital city, Lucey pointed out). And it includes a memorial to the more than 800 health workers who became sick during the current outbreak, and the more than 500 healthcare workers who died.

Dr. Dan Lucey received a grant from the Infectious Diseases Society of America Education and Research Foundation to defray costs associated with his second trip to West Africa.

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