Ebola Epidemic: A Few Modern Heroes

From the NYTimes, Dr. Mosoka Fallah:

… Months into the Ebola outbreak, Liberia remains desperately short on everything needed to halt the rise in deaths and infections — burial teams for the dead, ambulances for the sick, treatment centers for patients, gloves for doctors and nurses. But it is perhaps shortest on something intangible: the trust needed to stop the disease from spreading.

Dr. Fallah, an epidemiologist and immunologist who grew up in Monrovia’s poorest neighborhoods before studying at Harvard, has been crisscrossing the capital in a race to repair that rift. Neighborhood by neighborhood, block by block, shack by shack, he is battling the disease across this crowded capital, seeking the cooperation of residents who are deeply distrustful of the government and its faltering response to the deadliest Ebola epidemic ever recorded.

“If people don’t trust you, they can hide a body, and you’ll never know,” Dr. Fallah said. “And Ebola will keep spreading. They’ve got to trust you, but we don’t have the luxury of time.”

With his experience straddling vastly different worlds, Dr. Fallah acts as a rare bridge: between community leaders and the Health Ministry, where he is an unpaid adviser; between the government and international organizations, which have the money to back his efforts…

When Dr. Fallah was 10 years old, his father lost his job as a driver for an American mining company, so the family moved to Monrovia. The family lived in West Point for two years and then moved to a squatter’s area called Chicken Soup Factory, where his parents eventually built a house. His mother still lives in it.

During Liberia’s civil war, he spent 11 years completing his college studies at the University of Liberia, and worked for Doctors Without Borders. A friend’s support led to graduate studies in the United States, where he earned a doctorate in microbiology and immunology at the University of Kentucky in 2011 and a master’s degree in public health at Harvard in 2012.

On an afternoon of heavy rain, Dr. Fallah drove out to two neighborhoods where local residents had begun organizing Ebola awareness campaigns on their own. In the face of the hysteria gripping the capital, they were joining forces and fighting back…

From the Washington Post, Joseph Fair:

Joseph Fair hunts viruses. That’s his thing. The 37-year-old American loves chasing dangerous pathogens, studying them in secure labs or searching for them in jungles where the microbes lurk.

And one virus has always loomed as the big one — Ebola. The scientists who first chased this dreaded microbe back in the ’80s and ’90s became legends, inspiring a generation of virologists like Fair. He read their books and papers. He studied how they contained the pathogen’s spread. And the scientists always won. The outbreaks ended, Ebola driven away.

So when the call came in March to travel to Sierra Leone, Fair was excited. He loved Mama Salone, as locals know the nation. He’d worked here for years. His new job: to advise Sierra Leone’s government on a tiny Ebola outbreak in neighboring Guinea, at the behest of the U.S. Defense Department. He set up an Ebola emergency operations center. He trained medical staff. He drew up just-in-case plans. By mid-May, the outbreak seemed on its way out. Fair packed his bags and left.

Then Ebola exploded…

“This is the big one no one expected,” Fair says.

It has been a humbling time. Fair has worked seven days a week, hunting for ways to curb the outbreak, at times begging international groups for staff and supplies. He is exhausted. He’s put on 15 pounds. He sent his girlfriend home to California months ago. Too dangerous here, he told her. He’s seen Sierra Leonean doctors and nurses — friends he’s known for years — get infected and die. He sweated out his own Ebola scare.

“As bad as it has been,” observes Connie Schmaljohn, senior research scientist at the Army’s Medical Research Institute of Infectious Diseases, “it could’ve been worse if people like Joseph hadn’t been there.”…

In the Telegraph, Thelma Kane, Dr. J. Soka Moses, and their colleagues:

… “We cannot cope, the demand is huge,” says Dr J Soka Moses, 34, the hospital’s clinical director, who opened the facility a month ago in what used to be a cholera treatment centre. He points through a gauze-covered window to the “high risk” area, where feverish, vomiting patients occupy both the beds and the floor in between. “This place was constructed for 35 beds, but I have 69 patients, so half of them are on the floor,” he says. “There isn’t even adequate space for us to walk between them. But if we turn them back into the community, they will infect other people.”

On busy days, that still happens — just as it does at the handful of other Ebola treatment clinics across Liberia, which has seen 40 per cent of the 2,200 Ebola deaths across West Africa. At the Médecins Sans Frontières clinic, on the other side of the capital, Monrovia, staff were last week turning away 20 to 30 people a day. Doing so seldom goes down well, as Dr Moses has witnessed. Last weekend, relatives of a man who died while waiting for treatment outside JFK hurled rocks at staff when they came out to spray disinfectant on his corpse…

The risk for medical workers, however, is not just from angry mobs. Last Wednesday, a French volunteer working at MSF’s clinic in Monrovia tested positive for Ebola, the first time any international staff member in the agency has caught the virus. It is proof that even stringent precautions cannot eliminate the risk. And it is that scenario that goes through the minds of Dr Moses and his team as they don multiple layers of boiler suits, aprons and overtrousers, with four separate pairs of gloves. Simply robing up takes 20 minutes.

“So far none our staff have been infected, although we have occasionally had patients develop neurological symptoms and become combative, requiring sedation,” says Dr Moses, whose fondness for medical terminology does not convey how frightening such incidents must be. “It is very dangerous, it is scary,” he concedes. “But if I don’t do it, who else will?”

While Dr Moses’s work has a personal cost — as a high risk worker, he is not allowed to cuddle his two children — he is proud of his ward’s record. Its 43 per cent mortality rate sounds grim by normal standards, but it is much better than the 70-90 per cent rates at the start of the outbreak. While treatment consists of keeping patients fed and hydrated in the hope that they fight the virus, survival rates have improved because more people are coming forward earlier.

By the time Dr Moses’s midmorning rounds are over, however, another five patients and their families are waiting in the rain outside the clinic’s gates. Among them is 15-year-old Faje Kan, who lies convulsing on the ground, mucus streaming down her face. Her elder brother, Kiwai, holds her head and shoulders upright, wearing two carrier bags as makeshift plastic gloves. “She was very sick overnight,” he says. “We got here two hours ago but we could not get in because the place was packed.” …