In the three and a half weeks Dr. William Fischer spent in Gueckedou, Guinea, he encountered between thirty and fifty patients suffering from Ebola. Only seven survived.
“It’s hard. It’s really hard work. It’s really intense work,” says Fischer. “But I’m totally sold on this idea that we can improve mortality with even just basic mechanisms right now.”
Fischer is a pulmonary and critical care physician at UNC Hospitals. He traveled to Guinea in May with the World Health Organization to help battle the latest outbreak of Ebola.
The current outbreak is the largest and deadliest on record. More than 1,200 have been infected and at least 670 have died in the past four months.
Unlike past outbreaks, which were located in remote regions in Central Africa, this began in West Africa, starting in Guinea before spreading to Liberia, Sierra Leone and Nigeria.
“It’s so easy for infection and infected patients to cross international borders, but it’s much more difficult for resources to follow that path,” says Fischer. “Increasingly we’re becoming a much more interconnected world. People are much more mobile. This is a very nice reminder of that interconnectedness, as this population is incredibly mobile and that mobility is sustaining this epidemic.”
The Ebola virus produces a hemorrhagic fever that is spread by contact with bodily fluids. The mortality rate among those infected can reach as high as 90 percent. There’s currently no cure, no vaccine, and no specific treatment, but Fischer says aggressive rehydration can help victims fight off the virus.
“I initially was skeptical about what care we could provide, but in fact, what I saw was that we can have a dramatic effect on reducing Ebola-related mortality with aggressive critical care.”
Yet Fischer said in his three weeks treating patients only a handful recovered, and when they did, the doctors were often happier than the survivors.
“One of the most difficult things about Ebola is that it doesn’t just kill people- it wipes out their families,” says Fischer. “This gentleman we were able to get through, but he lost his mother-in-law, his mother, and his wife and their unborn child. So you can imagine the despair that permeated every inch of that room when he heard that his wife had passed shortly after delivering their child.”
One of the biggest challenges facing doctors battling this current outbreak is convincing communities and individuals to seek medical treatment at the first sign of infection.
Western medical resources flood into the region only when an outbreak occurs, forming an association between doctors and death that’s hard for residents in the affected areas to ignore.
“They don’t understand that their best chance for survival is to come to a treatment facility early and that their best chance at preventing transmission to their loved ones is to go to the treatment facility,” says Fischer. “There’s an incredible amount of distrust between the people and the healthcare providers because they see their loved ones go to these facilities and then 90 percent of them return in a body bag. Facing those statistics, I’d be skeptical of those treatment facilities.”
Fischer says medical personnel need to reach out to community leaders to help stem the spread of the virus and build trust.
“This is a challenge. This is a major, major challenge. But it’s also an opportunity. If we can empower local community leaders to spread the word about the benefits of presenting early to a treatment facility- the benefits being it increases your chance of survival and decreases the chance of transmission- then we can have patients present earlier. If we can reduce that mortality we’re going to improve the trust between the community and the healthcare providers.”
This latest outbreak began in March and continues unabated. Fischer notes that with a twenty-one day incubation period and an increasingly mobile populace, this disease is poised to spread.
“I don’t see this ending any time soon, unfortunately. I do think that we are going to have to dedicate and we should dedicate a tremendous amount of resources, both from a material perspective as well as from a human infrastructure perspective in order to stop this outbreak before it gets even worse.”
Just last week a seemingly healthy man boarded an airplane in Liberia, only to arrive in Lagos, Nigeria with symptoms of Ebola. He later died. Officials are still trying to track other passengers on that plane.
The disease takes a toll on healthcare workers too, as they are often in contact with the bodily fluids that spread Ebola. Top doctors in Liberia and Sierra Leone have succumbed to the disease, and two Americans, a doctor and an aid worker, are currently in quarantine suffering symptoms. This has prompted two North Carolina-based charities to call for an evacuation of all non-essential staff from Liberia.
Nonetheless, Fischer says he is eager to return to the region.
“I’d like to go back. I think, for me, leaving was just as difficult as going. It was the thought that I was leaving in the midst of the epidemic as opposed to the end of the epidemic. I feel a strong draw to go back. My hope would be that I could, through aggressive critical support, reduce the mortality and then improve community trust.”
You can read Dr Fischer’s dispatches from Guinea here.