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.http://chapelboro.com/news/international/epidemic-worsens-unc-doctor-details-battle-ebola/
UNC Hospitals may have to pay millions in Medicare penalties for a high number of patient infections and complications, according to a provision of the new health care law.
In an effort to lower health costs, the Affordable Care Act has authorized Medicare to make assessments of hospital-acquired conditions, and crack down on hospitals that aren’t meeting their standard.
Preliminary scores show 16 N.C. hospitals are currently at risk of penalties, including two of the largest in the Triangle: UNC Hospitals and WakeMed in Raleigh.
Medicare authorities score on a ten-point scale, with the worst of the infections and health complications of hospitals ranking higher. UNC Hospitals was scored at 7.375; WakeMed received a score of 8.025.
All scores above 7 fall below the 25th percentile.
“Medicare is comparing all hospitals across the country, but it isn’t making any adjustments or consideration for how sick the patients are to begin with. So if one hospital takes more sicker patients than another, it’s reasonable to think that there may be, in the aggregate, more infections. But that may not have anything to do with the quality of care that’s provided in the hospital.”
That’s Brian Goldstein, executive vice president and chief operating officer at UNC Hospitals on why its 801-bed facility ranks higher than most in hospital-acquired conditions.
Goldstein says the scores are self-reported and submitted to Medicare by UNC Hospitals, and rankings are calculated solely through assessments of Medicare billing, and monitoring hospitals for infections.
Hospitals were notified of their scores in April, allowing for administration to review their rankings before the final scores and penalties are released in the fall and administered in the 2015 fiscal year.
The scoring system has no minimum passing grade, leaving hospitals that do not receive a performance requirement score less than 7 with definite penalizations, and a 1 percent cut in Medicare reimbursements.
The program does not recognize any patient care documentation or factors outside of their final tally of infections, such as how sick the patients are upon admittance, or the socioeconomic backgrounds of hospital patients.
“Twenty-five percent of hospitals are going to get penalized through this program, no matter how much they improve,” Goldstein said. “The actual scoring is based on how the hospital compares to itself from a baseline period of 2006 or 2007. That’s how Medicare chose to score this so, let’s say, you’re a hospital that wasn’t doing so well in 2006 and 2007, but now you’re doing better. You’re going to get a better score. Now, let’s say you were already doing well (at that time) and you didn’t improve as much and your infection rates might even be lower than the other hospital but you’re still going to get a worse score in this program.”
Goldstein compares this system to a teacher “grading on a curve”, and announcing on the first day of school that 25 percent of students will automatically fail, no matter how well they do throughout the course – just because that is class policy.
The penalties provided by the Affordable Care Act have been a controversial hot topic in the hospital industry, as many of the largest and more research-based hospitals treat the sickest patients, putting them at a higher risk of infections and other common complications.
Goldstein told WCHL the Association of American Medical Colleges recently wrote to the Centers for Medicare and Medicaid Services to alter their scoring system for a more holistic reflection of the quality of a hospital’s care.
With final scores soon to be released, Goldstein says he believes it’s important for the Medicare system to be reformed, but also for hospitals across the nation to keep their focus on the health and safety of their patients.
“We could go a lot deeper and wider in discussing all of the efforts we make everyday to aggressively find and fix problems that could lead to safety issues and quality. That all needs to continue, but all we’re asking for is for these programs that tie back to dollars to be based on a fair assessment of the data that all hospitals provide.”http://chapelboro.com/news/health/unc-hospitals-face-medicare-penalties/
An early-morning fire beneath the walkway between the hospital and the Dogwood Parking Deck destroyed five golf carts, and temporarily shut down the bridge across Manning Drive.
Fortunately, the 2:30 a.m. blaze was extinguished by Chapel Hill firefighters in about 15 minutes, and no one was hurt, according to a press release from UNC Hospitals.
But as a result, the traffic light at the intersection of Manning and Hospital Drives was not working. Drivers were cautioned to proceed as if there were a stop sign there.
Pedestrians were advised to cross an alternate bridge or use the street.
Investigators have learned that the fire was caused by a battery malfunction in one of the golf carts.
The bridge and the valet parking lot will remain closed until a cleanup of the area is completed.
WRAL News reported that hospital visitors said they heard and felt an explosion.
***Update: The traffic light is once again operational; the pedestrian bridge has been checked for structural damage and is reported to be safe for pedestrians and golf carts.
WRAL News reported that fire began when a battery in a golf cart near the valet stand malfunctioned.http://chapelboro.com/news/fire/fire-unc-hospitals-parking-deck-shuts-walking-bridge/
For now, T’nesha Davis calls the Ronald McDonald House of Chapel Hill home. Her son, just a baby, was born 25 weeks early, weighing only 1 pound, 7 ounces.
While he receives critical medical care at UNC Hospitals, Davis said the Ronald McDonald House has proven to be a sanctuary for her family.
She watched on Tuesday as ground was broken on an expansion project that will enable the House to serve more families in need and provide them with support that goes beyond a place to call home.
“Knowing that this place is here is a blessing. It is a blessing,” Davis said.
She was pregnant with her second son and went in for a routine checkup when she found out some news that would change her family’s life.
The doctor told her that she had severe preeclampsia, a rapidly progressive life-threatening condition that affects both the mother and unborn child. By conservative estimates, these disorders are responsible for 76,000 maternal and 500,000 infant deaths each year.
Doctors told Davis that emergency surgery was necessary or both could lose their lives.
She traveled from Fayetteville, where she lives with her young son and husband who serves in the military, to Chapel Hill to seek medical care at UNC Hospitals.
After her successful operation, she later needed somewhere to stay while her infant son received the essential care he needed in Chapel Hill.
“It is not a place where it is a pity party. They are actually here to support you and to help you through this time. You can make a lot of new friends here. Don’t come in thinking that it is just a doomsday because your child is in the hospital. They are going to keep you going and uplift you,” Davis said.
Davis said in a matter of months, the House’s staff and fellow families became her support system.
“I wouldn’t have been able to be without my son and be far away from him. I’m a hands-on mom. I cry when I can’t be with him during the day because I have to be with my other son. But, having them [the Ronald McDonald House staff] and knowing that they can watch him—it’s a big extended family,” Davis said.
The House serves any family with a child who is receiving treatment at a local hospital and lives outside of a 35-miles radius of the medical facility, regardless of their ability to pay.
Though the House has helped more than 2,200 families of seriously ill or injured children, nearly 800 families are turned away each year due to lack of space. And this demand will only increase in the coming years as UNC Hospitals continues to expand.
In an effort to meet the growing need for its services, the House celebrated its groundbreaking ceremony on planned expansion that will double the facility’s current square-footage and increase the number of rooms from 29 to 53.
Shelley Day, Executive Director of the House, said it became apparent in 2009 that the expansion would be necessary.
“Frankly, we are all looking forward to late Spring 2015 when we will open and be able to say to every family who needs us, ‘Come on down, we have room,’” Day said.
Day was joined by other members of the community, including Woody and Jean Durham, to commemorate the beginning of a project that will impact so many lives. Durham was the longtime play-by-play radio announcer of the UNC basketball and football teams and the “Voice of the Tar Heels.”
The Durhams served as honorary co-chairs of the fundraising efforts for the expansion.
The House is also making history with a pediatrics palliative care pilot program called, “Loving Hands,” which provides care for children facing the end of their lives through a partnership with Hospice. It’s the first of its kind in North Carolina and in the global Ronald McDonald House network.
For more information on how you can donate to the Ronald McDonald House expansion project, visit the “MakeRoomForHope.com” website.http://chapelboro.com/news/non-profit-news/breaking-ground-ronald-mcdonald-ch-celebrates-future-expansion-serve-families/
Authorities say the man who was arrested for pulling a knife on a UNC student Sunday afternoon has been involuntarily committed to UNC hospitals.
According to the Daily Tar Heel, Chapel Hill resident and 31-year-old UNC graduate, Jesse Alan Kister was committed in UNC Department of Public Safety’s custody on Sunday. When he’s released, he will be charged with assault with a deadly weapon.
Chapel Hill Police and DPS coordinated the search for Kister. CHPD found him in The Chapel of the Cross on East Franklin Street. He was taken to the Chapel Hill Police Station and quickly turned over to DPS since the crime took place on campus.
Kister was found in possession of four knives valued at $100, according to the incident report.
Alert Carolina issued an emergency warning shortly after 4:00 p.m., when the incident first took place. Buildings on campus were locked down—including Carmichael Arena, where the UNC women’s basketball team was playing its first-round NCAA tournament game.
Alert Carolina issued the all-clear at 5:18 p.m. Sunday afternoon. There were no injuries.
The DTH interviewed one of Kister’s former professors who said he only knew Kister in the classroom and didn’t know him on a personal level.
Kister received his bachelor’s degree in information science from UNC in 2005. He also earned a master’s in health care administration in 2008 and information science in 2011.
After Blake passed away, Laux decided to follow-through on a special project the two had planned to work on together as a way to honor her friend and all children fighting cancer.
The finished product was the video, “The Wavin’ Flag Lip-Dub,” featuring the song, “Wavin’ Flag,” by musician K’naan.
The video documents a 2013 family retreat for patients coping with cancer, blood disorders, and bone marrow transplants.
It shows patients, their families and volunteers having fun during all kinds of activities and singing and dancing along to the song, which is about being courageous.
Laux one of those volunteers who went on that retreat. She works with the program, CPALS (Carolina Pediatric Attention, Love, and Support), a student organization that pairs about 91 Carolina students with children at UNC Hospitals who are undergoing treatment for cancer or serious blood disorders.
Through CPALS, Laux was matched with Blake in January of 2013. He was undergoing treatment for a rare form of cancer.
“He was in the hospital sometimes for 20 to 40 days at a time. I was trying to think of fun things he could do, and he loved music! I thought that together, maybe we could work on a project. I was thinking about these [lip dub] videos, and I thought this could be something we could do together,” Laux said.
A few years ago, Laux saw a video that Seattle Children’s Hospital had produced. She said it sparked the idea to create a similar video, but with a stamp of Tar Heel style.
Because Blake loved to sing, especially in duets with Laux, she said she knew it would be something he would enjoy.
“I told him that this is something that we could do together and it would be so fun. Unfortunately, he passed away in September. Shortly after his passing, I knew I wanted to stay involved in CPALS, and I was trying to think of something I could do that would make a difference. I went back to [the idea of] this video and knew that was something I wanted to do,” she said.
Pooling together the resources of Laux’s fellow CPAL peers, the group planned to document the family retreat. She said it was not just about taking part in a fun project. The greater message of the video was to capture the strength of the children and their families.
Laux said it was also a chance to remember Blake.
“The video is a way to honor him and his love of music and then to honor all of these children and their families. The big theme of this video is: ‘Together, we are brave.’ That is really the mantra at UNC Hospitals. When one person in a family is fighting cancer, really everybody is fighting cancer.”
Laux said she still keeps in touch with Blake’s family.
“I sent the video over to his mom, and I wanted her to be able to see it and kind of show her what I had done for him. She really enjoyed it, which I really loved,” Laux said.
Jessica Irven is the Pediatric Psychosocial Support Coordinator for the N.C. Children’s Hospital and also the Coordinator for CPALS.
Irven, who still gets chill bumps while watching the video, said it was a “show piece” for the family retreat and the larger support program offered to pediatric cancer patients and their families.
“It was a really great chance to go back and forth between getting our support needs out and having chat times and just letting loose,” Irven said. “We were just dancing and celebrating to the words of that fantastic song about being brave.”
**Listen to the Radio Version of this Story**http://chapelboro.com/news/unc/unc-students-special-video-celebrates-kids-families-coping-cancer/
CHAPEL HILL - The transplant wing at UNC Hospitals is $30,000 closer to being named after the man who formerly cheered on North Carolina as Rameses.
“That’s just more than we had; that’s the way to look at it,” says Charlotte Ray, the mother of Jason. “Each step that we take—no matter what it is, what anybody does for us—that’s just getting us closer and closer to it.”
Jason died in 2007 after being hit by a car. He was in New Jersey with the UNC men’s basketball team for the NCAA Sweet Sixteen.
His organs help save four lives and positively affected so many more. Because of his meaningful story, UNC Hospitals contacted the Jason Ray Foundation with the idea of naming the transplant center after him.
Sunday was the Second Annual Jason Ray Brunch and Silent Auction in which that idea took a few steps closer to reality.
“There was right close to—with the cheerleaders and everybody—I would say approximately 170 people that attended,” Charlotte says. “It was wonderful. We made a little over $30,000.”
Jason’s parents were left with the terrible burden of having their son taken from them without warning, but Charlotte says moments like Sunday when people come together to pay tribute makes it a little bit easier.
“Everybody’s been just so generous and supportive that it’s just therapy to think what a legacy this is for him,” Charlotte says.
Donations can always be made to the Jason Ray Foundation by clicking here. There’s one more event this year at which people can contribute: the Fifth Annual Jason Ray Golf and Silent Auction August 25 and 26 in Davidson, North Carolina.http://chapelboro.com/news/non-profit-news/unc-transplant-wing-30000-closer-to-new-name/