Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Tuesday, July 29, 2014

African Ebola Crisis

"The first week I worked in the Ebola treatment centre in Gueckedou, a forest region of Guinea at the border of Sierra Leone and Liberia, I learned how to put the (protective) gear on, how to remove the gear and deal with the patients on a day-to-day basis. No skin is exposed to the outside world. Under tropical conditions, it gets very hot, very quickly. It's like being in a sauna."
"I did training in tropical medicine in England, so I knew about Ebola. I had friends from MSF who did missions with previous Ebola outbreaks. But I had never seen a patient. The patients came (to the treatment centre) in waves. We had 16 admissions in one single day. We were overwhelmed, we were struggling to get things done."
Dr. Marc Forget, Montreal physician
Members of Doctors Without Borders (MSF) wearing protective gear walk outside the isolation ward of the Donka Hospital, on July 23, 2014 in Conakry.
Members of Medicins Sans Frontieres dressed in protective gear, in Guinea, AFP/Getty Images
Dr. Forget, whose training as a general practitioner took place at Laval University, mostly works in emergency medicine. He recently spent seven weeks in Guinea with Medicins Sans Frontieres/Doctors Without Borders. His mission was to travel to remote forest villages assessing people who presented with symptoms of Ebola, to try to convince them to seek treatment; mostly to persuade them to allow themselves to be taken to isolation in a hospital setting, to prevent communicating the disease more widely.

It is fairly easy to infect other people by contact; with the advent of international air travel. It takes weeks after coming in contact with someone suffering from Ebola before symptoms appear. Take the case of a man whose name was Patrick Sawyer, who boarded a flight in Liberia, stopped over in Ghana, changed planes in Togo, then arrived in Nigeria where he died in a period of days from Ebola, known to be one of the deadliest of diseases with a huge mortality rate, killing up to 90% of those infected.
A health agent checks a passenger leaving Guinea at Conakry's airport. Protection and healthcare material were set up at the airport to fight the spread of the Ebola virus.

A health agent checks a passenger leaving Guinea at Conakry's airport. Protection and healthcare material were set up at the airport to fight the spread of the Ebola virus.   Cellou Binani, AFP, Getty Images

Liberia has become the latest West African country now to seal its borders resulting from the latest outbreak of the Ebola virus, which has catastrophically taken 670 lives. International air travel has become a certain vector for the spread of disease worldwide. No one has any idea how many people Mr. Sawyer infected on his own unknown death journey. Health workers are attempting to trace anyone who may have been exposed to him as he flew across West Africa.

Ebola's initial symptoms appear innocuous enough, just like a flu; with fever, muscle and joint pain, leading to gastric upset, then vomiting and diarrhea, and things go quickly downhill from there. Most people die from the effects of dehydration and shock to their system, sometimes with neurological involvement. People's ability to communicate at that point is so compromised it is as though their minds are absent to response, and most die.

Dr. Forget, during his time in Guinea, assessed what appeared to him and his colleagues those whose presentations appeared suspicious. They decontaminated areas when it became clear patients were assessed as positive for Ebola. Once assessed as positive through a blood test, an outreach team comprising water and sanitation specialists along with hygienists, arrive at a home  to burn mattresses and spray chlorine everywhere to ensure the home can be occupied with safety.

"The co-operation was good in some places; in other places it was simply impossible. There was hostility to our presence. They associated MSF wit the disease. They said it was brought by 'foreigners'," he explained in an interview. In some villages rocks were thrown at their cars leading to 'red zones' where the MSF team knew they couldn't enter in safety. In those regions when someone becomes ill, the family attempts to care for the person with local treatments. Which will fail, and transmission from one person to the other occurs, resulting in increased numbers of victims.

The thought of being isolated would be enough to alert villagers with patients among them that they would be taken to a strange place, and there they would die. In a very real sense, this was true; the concept of isolation to halt transmission as a preventive, was unknown to them. What was known to them was that to be taken away was to be consigned to death. Added to that was the firm conviction that foreigners were taking internal organs to sell to the United States.

There were some patients who survived the disease, and that was what gave Dr. Forget and other volunteer medics who work under MSF, the impetus to continue their work. That, and the fact that their efforts, when they succeeded in influencing people to seek help, would have the greater effect of stemming the tide of greater infection rates. Two American doctors in Liberia have contracted the disease.

Yet the World Health Organization (WHO) is not yet recommending any travel restrictions in prevention of spreading the infection, so international flights continued to depart from Liberia and other affected countries, such as Guinea and Sierra Leone. Dr. Forget experienced one personal time when he felt that he too might have become infected when his stomach had begun acting up; a normal enough fear of physicians attending morbidly affected patients.

"I will join forces again", he said. "This is an unprecedented Ebola outbreak, in terms of the numbers of people affected and geographic distribution. It's the worst crisis we've ever had." Last week in Sierra Leone, that country's top doctor who had treated a hundred Ebola cases, contracted the dread disease himself, and succumbed to its awful effect.
Sheik Umar Khan, Sierra Leone's top Ebola doctor credited with treating more than 100 patients, has died after being infected with the virus
Sheik Umar Khan, Sierra Leone's top Ebola doctor credited with treating more than 100 patients, has died after being infected with the virus

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