Lessons from the Ebola Conference

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As many of you know, I recently went to the CDC’s Ebola Safety Training that was held at the Center for Domestic Preparedness in Aniston, AL. I was expecting a good experience, but it surpassed my expectations. The practice we received was excellent.

Part of our days were spent in lectures to fills us in on the most up-to-date information about Ebola in this outbreak. Some of this was humorous (we can’t have a whole conference and never laugh), some was sobering, and most was quite enlightening.

I wanted to share with you some of the better quotes from the conference.

“If you find a chimpanzee dead in the jungle, don’t eat it

I can’t say I’ve ever been tempted to eat a chimpanzee even if it were already dead. But, if I were staring in the jungle and food was lying right there, I would be tempted. Unfortunately, Ebola kills chimpanzees just as well as it kills humans. Some of the outbreaks in the past have been started with a dead chimpanzee found in the jungle.

In fact, don’t even touch it.

“Your hands can kill you”

We touch our faces a lot. Ebola and most infectious illnesses need to come into your body through your mouth, nose, or eyes. The dirtiest part of your body, your hands, need to keep away from your face when working with Ebola.

This require a surprising amount of discipline. As I am typing this, I rubbed my right eye without thinking. It is such a constant part of our lives to touch our faces. When working with Ebola, this needs to stop.

This is most important in the Ebola Treatment Unit. With every surface as a possible place for Ebola to hide, we are not to adjust our goggles or fix our respirator. If we must fix something, we need to doff out of the unit to do it safely.

“Ebola is the Anti-Compassion Disease”

Everything we do that shows compassion or care for someone is forbidden by Ebola. We can’t hug them, care for them, feed them without taking a serious risk. All human contact is cut off by this ruthless menace.

Imagine for a moment that everyone who cared for you was wearing a giant orange suit. The only skin you can see if their eyes in the goggles. When I was practicing in the ETU, I couldn’t recognize my classmates. Ebola even denies you the compassionate looks of those caring for you.

The worst case of all for this was the very real case of when a pregnant woman comes into an ETU with Ebola. The outcome for her and her baby is not good. She will almost certainly spontaneously abort the baby and then she will almost certainly die.

So the question arose, how should we handle such a case? Compassion drives us to hold her hand through labor and help deliver the baby. Caution warns us that there are a LOT of body fluids involved in delivery and we would be under a tremendous risk of being exposed to Ebola. There are no easy answers.

Ebola is the anti-compassion disease.

“Your first responsibility is to keep yourself safe.”

As health care workers, we generally think of the patient first in priority. Not so with Ebola. Our safety take preeminence. If I should get Ebola, the first casualty will be the reputation of the Ebola unit in the community. Credibility is a precious thing in these settings. Many will wonder at us if we can’t keep ourselves safe.

The second casualty will be the negative press worldwide which will discourage others from going into these places to help. Additionally, the huge resources that will be needed to send us to our home country will further burden stretched resources.

The third casualty could be me. While no American health care staff have died of Ebola, it is a dangerous illness. I could die. I could spread it to others.

So, the most important thing is that I keep myself safe. My second priority is to keep my team safe. My third priority is to care for the patients.

“Ebola can be beaten”

While Ebola is a challenging disease, it is not the scariest disease humanity has faced. With several vaccines in the works and a number of possibly effective drug, this may be the first and last great Ebola outbreak. Those drug and vaccines are months to years away, but once we have them in our arsenal, we should have the upper hand.

Even without them, we can take on Ebola now. If the success of the ETUs in Liberia has taught us anything, it is that with a concerted effort, Ebola can be pushed back. We need to keep up those efforts.

-Chip

 

Life in Fort McClellan

1280px-CDP_7-28-07_Smaller[1]Today is the first day of my training for Ebola care in a tropical setting. I arrived last night at the Center for Domestic Preparedness in Anniston, AL. I was surprised to learn that this is the site of the now close Fort McClellan. It closed in 1999 and changed into a training facility for various disasters. Among the cooler things that are kept here is active ricin and Anthrax. They actually work with the real stuff. Fortunately, the Ebola students don’t have to work with anything so deadly.

The accommodations here are very nice. Every meal is all you can eat and delicious. The old mess hall has been converted into a regular restaurant. As pleasant as the food is, the company is even better. I’ve spoken with the heads of disaster preparedness for hospitals, overseas doctors and nurses, and everyone in between.

We are staying in the equivalent of a private hotel room. I share a bathroom with the room next to mine, but otherwise you wouldn’t know it was different from a hotel, complete with an ice machine at the bottom of the stairs.

The only caveat to all this is that they do believe in a military schedule. Classes get going at 7:30 AM and the place really gets going at 5:30 AM. Classes run until 5:30 PM, so lots to learn in these next few days.

One of the funniest things for me has been watching the local news this morning. They are lamenting the ‘Cold Front’ and ‘Cold Conditions’ this morning. It was 39 degrees. I hesitate to mention that where I came from, 10 plus inches of snow are supposed to fall today.

Well, time to head off to my first classes. I expect to bake quite nicely in the full Ebola attire.

-Chip

Would an Ebola Quarantine Work?

quarantineThere has been a lot of buzz about the possibility of quarantines of health care staff. It is time that someone explained how a quarantine works and discussed whether it makes sense in this setting.

What is a Quarantine?

An important distinction needs to be made between quarantine and isolation. Isolation is to take people who are infectious and isolate them to prevent them from spreading the disease. Isolation can be mandatory or voluntary. Historically, Ebola has had mandatory isolation but for the most part, patients and families were willingly isolated to prevent the spread of the disease to others. Isolation is very good practice for a disease like Ebola.

A quarantine is more aggressive. Quarantines are where a population of healthy people are isolated because they might become infectious. They are usually involuntary because no one wants to be locked in with infectious people. It is usually accompanied by aggressive state actions to enfoce the quarantine.

When would a Quarantine make sense?

The justification for a quarantine requires two elements. First, the illness must be infectious. It would make no sense to quarantine cancer patients because they can’t transmit their disease. In the epidemiology community, the measure of infectivity is the Basic Reproduction Number or R-Naught (written as R0). It is the number of people you would expect, on average, to get an illness from an infectious person. Influenza has an R0 of 2-3, smallpox 5-7, measles is 12-18. The 2014 Ebola outbreak has an R0 of about 1.7 in West Africa. In the US, it is much lower with only two transmissions from the seven patients who have been treated.

The second factor is the severity of the illness.  Ebola, of course, is one of the deadlier illnesses out there, so its severity is certainly enough that isolation and quarantine are worth considering.

Both factors are important. Rabies and Mad Cow disease, which are nearly %100 fatal, do not require a quarantine because they are relatively difficult to transmit. Chicken Pox may be very infectious, but it is not so severe that we should consider isolation and quarantine. We would live in quite an oppressive society is the common cold was justification for isolation just because it was infectious despite the fact it is fairly benign as an illness.

What are the Advantages of a Quarantine?

At least in theory, quarantining an illness should isolate it to a small group of people where it can be safely treated or allowed to fizzle out on its own. To separate the potentially sick from the healthy does protect the healthy and may minimize the spread of the illness.

Another major advantage of quarantines is that they are a simple solution that makes the healthy feel safer. Quarantines are usually done by the healthy to the potentially sick. It allows the local leaders to say they did something which pacifies a frightened public.

One of the most justifiable and terrible quarantines in history is Typhoid Mary, who was an symptom free carrier of Typhoid. She was quarantined for 26 years of her life to protect the public from the outbreaks of typhoid that followed her. She was essentially imprisoned for life because of a disease she had.

What are the Disadvantages of a Quarantine?

Quarantines are not particularly effective. The only moderately effective quarantine I can find is management of Mad Cow Disease. It involved slaughtering 4.5 million head of cattle, which was the only effective solution because Mad Cow is universally fatal and untreatable.

Of course, this is not an option for humans. Quarantines have been rare in modern times. In 2007, a man named James Speaker was quarantined with extensively drug resistant tuberculosis. The last American quarantine before him was in 1963.

Quarantines can pacify a large segment of the population, but they often enrage the quarantined. During a smallpox outbreak in 1983, Local authorities attempted to quarantine the municipality of Muncie, Indiana. The population did not believe they had smallpox and several local officials were shot. Not only was the quarantine unenforceable, it created more problems than it solved.

Another difficulty of quarantines has been how often they are thinly veiled racial oppression. When a majority views a minority as dirty or disease ridden, it lowers the threshold necessary to quarantine them as a group. In 1900, California quarantined a section of San Francisco which was almost exclusively made of Chinese immigrants and their businesses. The effects were devastating to the local businesses and the quarantine was later thrown out by a federal court.

Does a Quarantine make sense for Ebola in America?

Ebola is certainly a dangerous illness with a 70% fatality rate in West Africa. A quarantine was tried in Liberia and Sierra Leone and both seem to have had no benefit and generally only aggravated an already tense public.

Ebola also is quite contagious to those performing funerals and direct caregivers of the sick. So the basic criteria for a quarantine are met in West Africa. Despite this, the quarantines that have been tried were failures. The energy and resources placed in the quarantine would have been much better spent on caring for the sick.

So would and Ebola quarantine in America make sense? The severity of Ebola in a modern health care setting has been much better than in Africa. There has been one death of Ebola in the US with this outbreak of the seven who have been treated. The death of Thomas Duncan was not surprising because even when he came for treatment in Dallas, he was sent home for several days. Despite this, Duncan only gave Ebola to the people you would expect him to transmit to, direct caregivers.

In fact, despite a botched handling of that outbreak, no one in the community developed Ebola. This is consistent with European treatment of Ebola patients where only direct caregivers of the sick have gotten Ebola.

So Ebola is not as severe nor as transmittable in a Western setting. This is not surprising as the toilet may be a greater safeguard than anything else. To take those infected body fluids away and have then adequately treated is probably more important than all of the personal protective equipment on the planet.

Taking all of this into consideration, I think a quarantine of health care workers or civilians who are not sick (which is to say, not contagious) would be neither effective nor beneficial. It is a political band-aid for a non-existent problem. In the history of this outbreak, no one has caught Ebola from a Western health care worker and no one has caught Ebola on a plane. There is simply no evidence to justify a quarantine.

But if even one person would get Ebola, wouldn’t a quarantine be justified?

This is an objection I have found is pretty common. As long as the life of a West African carries as much weight as an American, then this makes no sense. The small risk of an American getting Ebola much be weighted against the hundreds and thousands of lives that traveling health care staff going to West Africa can save. It only makes sense to say this if their lives don’t count. And their lives count!

Isn’t it selfish of those health care workers to risk the public by not quarantining themselves?

No more risk than when you get behind the wheel of your car. 34,000 Americans die in car accidents every year, so far one has died of Ebola ever. When you stop driving for public health reasons, get back to me.

As I have argued before, the burden on the health care workers who go overseas is heavy and to make it heavier only discourages us from going, which is a loss for everyone.

In conclusion

Let me end by asking that we, who want to go to West Africa, not be hindered. Care enough for the dying in West Africa to allow us to go and do what we are good at. It is no risk to you and a very great risk for them. Love them enough to overcome your fear.

And even if you are afraid, know that quarantines don’t really work that well. Find a better solution before you shackle us with a quarantine.

-Chip

Seven Difficulties Health Care Workers Face to Fight Ebola

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As a nurse, I am one of the many who wishes to run toward Ebola. Don’t credit us with too much courage. We of all people know how manageable Ebola is and how few health care workers get it when good precautions are used and how many fewer die when given good treatment. Ebola is not as dangerous as advertised.

We see how many will die in West Africa if no one runs toward the explosion. In our protective gear, we are quite safe from contracting Ebola unlike the people of West Africa are in danger with about 70% of the infected dying. With the total cases now crossing 10,000 and a bleak future ahead if nothing changes, we feel the urgency to go.

With the new quarantines in New York, New Jersey, Illinois, and Florida, it is becoming increasingly difficult. There is a presumption on health care workers that our time and resources are acceptable sacrifices so that Americans can feel safe from their irrational fears. While West Africa is in serious danger, America is not. Even if 1000 sick patients got in a plane today and flew to every major American city, the outbreak would be under control within a few weeks.

The very first case of a nurse returning to the U. S. from an Ebola ward shows how needlessly aggressive the quarantining of health care workers can be. She was not treated as a kind person who took a risk for others and more like a  criminal waiting for the DA to charge her.

I don’t believe the public at large understands the sorts of barriers we face in getting to West Africa.

I hope to show you the difficulties I have faced in my own attempt to go to Liberia so that you can see that our help should not be presumed upon. We are not asking for your support as much as we ask that you not stand in our way.

1. The Fear for my Family

My greatest fear in all this is to come home and give Ebola to one of my kids. This is a remote possibility and a devastating one. It weighs so much on me that I plan on not returning home for the 21 days I could be infectious.

Lest I be accused of being hypocritical, I am not returning home because I can’t avoid close physical contact with my kids or my wife. It’s hard to avoid close contact with the lady sleeping in my bed or the kids climbing in my lap. I plan on returning to work (I have a phone job, so no close physical contact there either) and resuming my normal life. The public is at a minimal/non-existent risk and my life is not terribly inconvenienced.

Additionally, I will be checking my temperature multiple times a day and would promptly report a fever to the authorities. It is entirely possible I will be hospitalized with full protective gear for a minor stomach bug, but so be it.

2. The Fears of my Family

The next greatest weight we carry is the fear of those who love us. They mean well and wish for us to be safe. Of course, if I were sick with Ebola, my family would hope someone who had the resources and knowledge to help would come from far away to help me. I am hoping to be that person for someone else’s son or sister or mother or friend.

Their concern is not crazy. This is a dangerous disease. I don’t fear for myself because I am not in particular danger, but I understand their concern.

3. The Financial Pressure

When I go, I will be using my vacation time to do it. In fact, to even take three weeks of vacation time is difficult for my employer. I can’t support a house payment and our other expenses while taking significant time off. In addition, I am adding some expenses even though most NGOs pay for the travel and expenses there. Who will shovel my driveway when it snows? There are countless little things that need to be attended to while I am gone.

4. Work Pressures

My employer has been very understanding of my trip. Even so, many of my coworkers aren’t thrilled with the idea that someone who has been near Ebola will be working in the cube next to them. I suspect that I will given a wide berth when I arrive back.

Additionally, I feel that because people would be concerned that I should alert them that I have been to an Ebola hit country. I don’t want them to wonder if they should have shaken hands with me. They should be afforded the courtesy of making that decision for themselves even if I am comfortable with it.

 5. Public Pressures

Many health care workers have been afforded a return from West Africa like the Vietnam Veterans received. Many are thankful for their sacrifice and a vocal and frightened few are quite vicious to the nurse who was needlessly quarantined in New Jersey.  Here are several choice examples just posted in the comments from the link above:

Nurse Medusa with the outdated snake hair,showing her true liberal democrat selfish roots.

Then Jesus said, ‘How selfish of you to care for the afflicted at risk of your own life. And how dare you complain about unwarranted ill treatment on your return. You must be a liberal. I hate you’.

If she was a responsible health provider, who respects her profession and her fellow Americans, she would have quarantined herself for 1 month before stepping on a plane home. Isolation is a key factor when trying to contain an epidemic, one does not have to work in the health sciences field to figure that out. Selfish and ignorant!

I now see the Kaci is going by private carrier to her home in Maine where she will “self quarantine”. A small part of me hopes she develops Ebola, and like the Dallas nurse recovers fully.

Additionally, we are treated like public property. There is no great discussion of the rights of these workers. As a libertarian myself, I have been stunned at the lack of discussion of the civil liberties of the health care community. We are not a resource or commodity, we are human beings.

6. The Difficulty of Even Getting To West Africa

It is not small feat to get the time to do the CDC training and get over to West Africa. While many of the NGOs pay for the travel, it is a lot of time and phone calls to even get to that point. We, like all of you, have busy lives with many responsibilities. Getting to West Africa is no small feat.

7. The Uncertainty of How the Government will Treat Us

When I take off in that plane to go to West Africa, at any moment the policy of Minnesota or the Federal Government could change requiring me to be quarantined for three additional weeks on my return. It would be a serious financial burden on my family if this happened.

A week ago, I might have agreed to go through JFK or Newark airport once I returned, now I will specifically request to avoid these airports to avoid the quarantines that have been placed there. There is even talk of health care community of flying into Toronto and driving home to avoid these onerous requirements.

Should I go?

As you can see, there are many barriers to going to serve these patients. I don’t want applause for this, I simply don’t want to be hindered. A few more roadblocks and, in the name of public safety, I will be prevented from going at all.

If we don’t go to help those in West Africa, this outbreak will spread and grow. Do you think that if Ebola exploded in Guatemala it would be contained well there. Wouldn’t it then march into Mexico and start walking across our own border there? The only way the U. S. will be safe from Ebola is if it is stopped where it is.

Without the aid of U. S. health care volunteers, it will never be stopped in West Africa. For their safety and for your safety, please let us go unhindered and return without barriers placed before us. If we don’t go, who will?

-Chip

Five Reasons We Are Afraid of Ebola

quarantineWhen Thomas Duncan, a Liberian man who lived in Texas, was diagnosed with the Ebola virus, the reaction in the community and the press was strong, surprisingly strong. I had anticipated fear when a case came to the US (something that was nearly inevitable), but not this level of fear.

Even as I write this, the headline story on the Drudgereport is Ebola is ‘disaster of our generation’ says aid agency. There are countless stories discussing every step Mr. Duncan took and the thousands of people he might have come in contact with. Unfortunately, Mr. Duncan died of Ebola. The news would have ended there except that two of his nurses have since contracted the virus. With fresh fervor, the hysteria reasserts itself.

This fear is out of proportion to the danger. It is no surprise that a patient gets Ebola and some of his caregivers get it. certainly there were serious failures of the health care system in this case, but if the total price we pay for those mistakes is only two infections, then we should feel fortunate. After puzzling over this for some time, I think there are a few explanations for this deep fear we feel as Ebola walked onto our shores.

1. We Overestimate Dramatic Deaths and Underestimate Boring Ones

Humans are terrible at estimating danger. We fear snakes when mosquitos kill a million people every year. We are afraid of bears when white-tail deer kill about 130 people a year. We fear flying when about 1.24 million people are killed in car accidents every year worldwide. We fear Ebola, which has killed about 5,000 people so far and yet ignore influenza which kills about 250,000 to 500,000 every year.

Ebola is definitely the diva of the deadly viruses. Symptoms such as vomiting blood, uncontrollable fever and shaking, terrible diarrhea, and bleeding from the eyes and ears make it a virus out of a zombie movie. If drama makes for great news coverage, then Ebola makes great coverage.

2. We Fear that Ebola will Spread in the US like it does in West Africa

One good watching of the movie Outbreak would make me fear Ebola too. While Ebola is not the virus in the movie, it is clearly based on Ebola. Dustin Hoffman is telling us to close the US border, right?

The fact is that Ebola is not as contagious as advertised. The lengths we are going through to establish Ebola as an airborne threat indicate how difficult it has been to show Ebola spreading through the air. But it does not spread like influenza or a cold virus.

Close physical contact accounts for most if not all of Ebola spread. Think of who got Ebola from Thomas Duncan, it was two nurses who had, you guessed it, close contact with Mr. Duncan. To worry that it is spread by casual contact is to borrow trouble. Certainly it is possible, but it doesn’t seem to be happening. If you are a nurse caring for an Ebola patient, an abundance of caution is justified. If you are a member of the general public in the US, any fear you have of getting Ebola is unwarranted. You should be more concerned about white-tail deer.

3. We Fear the Unknown

Ebola is very other. It is foreign to us: far-away. Ebola epitomizes the dangerous jungle illness that has never been seen on our shores. This frightens us.

Now that Ebola is here, among us. We’re not sure what to do. There is this feeling that we shouldn’t have to face this. It ought to be someone else’s problem. The fear of this unknown drives us to feel silly things like that we should be immune or protected from it simply because we are here and it should stay over there.

While understandable, the only cure for fear of the unknown is to get to know it. Knowing Ebola doesn’t cause panic, but like anything dangerous, we learn to treat it with respect. Far from being unknowable, Ebola can be known. We just need to take the time to learn.

4. It is an Election Year

Ebola has a great marketing plan going. It chose to arrive in America in the months leading up to a Federal election. There are countless candidates looking for a stage to be heard from. There are very few stages more popular than one that pretends to protect the public from a dangerous disease.

Playing on our fears to get our attention, many have blamed the Obama administration not primarily because they care about public health, but because blaming the administration is what one does to the opposition party in October.

This is understandable, but very frustrating when it aggravates some of our most uninformed fears. What galls me the most is that it is working? Certainly the CDC and the hospitals involved should have done a better job, a much better job. But by reading the headlines you would have thought hundreds or thousands had Ebola in the US, not just three.

5. There is a Deep Distrust of the Health Care Establishment and Politicians

There is a deep and growing distrust of the health care establishment and of politicians. After years of wondering if cancer treatments really help, if vaccines are safe, should we really have antibiotics in our meat, and asking just when they figured out that this drug has a tragic side effect, the casual observer has a general distrust of the health care establishment.

It is worsened when Dr. Friedman, the head of the CDC, represents both politicians and medicine. It is further aggravated when he does the tried and true political process of providing the same talking points answers no matter what the question is. We feel manipulated because we are being manipulated.

But just because he is playing politics does not mean he is wrong. I wish he would give the straight answers to the questions. No, he should not be fired. Yes, the CDC was too slow. No, closing the US border to West Africans would not help. Yes, America is safe from a large outbreak of Ebola. Maybe the political environment makes such straight answers impossible, but I wish he would give them.

To Love People, We Need to Calm Down

Most of the fear we are experiencing over Ebola is not justified. We are reacting to our own anxieties and prejudices and not to the situation we are in. Ebola is not a serious threat to public health in the U.S. Heart disease is, but it lacks the drama that Ebola brings to the table.

The fear we experience is preventing us from considering carefully how we should proceed. There is a chorus of voices demanding that people from West Africa be prevented from entering the US. This might prevent some US cases of Ebola and it would certainly sentence tens of thousands to millions of West Africans to die. Ebola has been successfully contained throughout Africa for decades and even recently the outbreaks in Senegal and Nigeria have not had a new case in weeks.

The fear of Ebola is causing people to demand that health care workers who have cared for Ebola patients be quarantined for 21 days. This sounds like a grand plan unless you are the health care worker who has bills to pay and a life to live. By placing this artificial requirement, you make it very difficult for nurses to provide care for these patient. It does not protect the public and it is a bandaid political solution to a non-problem.

We need to accept that some people in the US will get Ebola. Some of them will even be cute ladies with dogs. Some might even be nice people we would like. Ebola will be spread to a few in America and it will stop there.

The same cannot be said for West Africa. If you are there you should be afraid. You should be cautious in public places. They face the prospect of living through Ebola and starving in the famine that is coming. They are dealing with homes where mom and dad have died and children are left to survive on their own. We should see through the blindness of our fear and have compassion on these people. They are in danger and we are not.

-Chip

The Image Above is courtesy of Jason Scragz and used with permission.

The Miracle Drug for Ebola

1280px-Ebola_virus_virionWe Americans love our medications. It seems every other Ebola news article spends a few paragraphs talking about ZMapp or a possible vaccine or even a homeopathic cure for Ebola. We crave the silver bullet that will take Ebola down and (more importantly to us) make us feel safe from it.

Wouldn’t it be comforting if we were infected with Ebola and an unconcerned doctor gave us some pills and said we would be virus free in a few days. Such a plan is safe, sterile, and reduces the uncertainty of our lives.

Life doesn’t have those certainties. Ebola has no existing silver bullet and even if it did, there is another virus on the horizon that also will resist a simple cure. We have been battling with HIV for decades and only recently have started winning.

The truly effective treatments for Ebola are not so spectacular or mysterious. The best treatment is prevention, which is why Ebola isolation wards are the first and best line of defense. But what of those people who do get Ebola anyway. What is the best treatment for them?

IV fluids.

Yes, I know it is disappointing. Salty water is not a sexy cure for anything. But what those patients need the most is a steady drip of sterile saline flowing slowly into their veins. Ebola kills by depleting fluid volume and IVs are the cure for that, replenishing the fluid volume.

Now this miracle cure won’t save everyone. Ebola is a vicious little bug and will kill some anyway, but the most powerful and effective weapons in the fight against it don’t look powerful. They are gloves, gowns, masks, and goggles. While we spend 42 million dollars on ZMapp, what remains the most effective treatment is the most boring ones.

We as a people and a medical community need to let go of the super hero model of health care where powders and pills have mysterious powers that will save us from our enemies. Sure there are miracle cures that come from time to time, but most of them are built on the backs of basic, boring health care and prevention.

We should pray (another boring yet effective treatment) and fight for a cure for Ebola and all other disease, but let’s also recognize the limitations of these cures and move forward with tried and tested solutions to disease.

And by that, I mean boring solutions.

-Chip

 

Ebola and the Death of Shakie Kamara

Ebola CrowdThe following is based on real events.

Shakie Kamara had a hard life. He had suffered through much more than a 15-year-old would normally be expected to. When he was young, his mother and father had died, leaving him the care of an aunt, Eva Nah. Eva was not in a good financial position to care for Shakie, but she took on the responsibility with a firm sense of duty.

She had been a good caregiver within her means, which were not great. The only housing she could arrange was in one of the poorest slums in Monrovia, West Point. Their small home was cramped, but relatively happy despite the circumstances.

When Shakie had first heard the word Ebola, it was in a radio broadcast talking about a strange sickness in Lofa County. He had not thought much of it then, there were many bad sicknesses in the world and Lofa was far north.

Within weeks, Shakie was hearing from friends that Ebola had come to Monrovia. The discussions in the shacks on rainy days were conflicted. Some were very afraid of this new illness that cause you to bleed from your eyes and eats. Some said that this was a plot by Ma to get more money from America. Some said this was a plague made by white men to eliminate Africans.

Shakie didn’t concern himself with such grand things. Day to day food was a much more pressing issue for him. Eva worked where she could and Shakie also did whatever work he could for their small home.

When the first West Point residents were taken to the hospitals with Ebola, the community became tense. Several people Shakie knew had gone to those hospitals and very few of them ever returned. Not only were they fighting the ever-present plague of hunger, now a fearsome disease was stalking among them.

When the West Point Clinic was opened, Shakie was somewhat relieved. There was not a place for the sick to go. Maybe he wouldn’t get sick now. Plus, with the schools closed and the clinic in the schoolhouse, maybe Eva will get off his back about learning to read better.

The next day, Shakie saw a crowd trotting toward the new clinic. He followed at a distance (they didn’t look friendly). They arrived at the clinic. Men in the front yelled and ripped the gate off its hinges. A mass of humanity rushed into the clinic and many of the sick people were brought out.

Shakie did believe in Ebola so he avoided all the people leaving the clinic. When he saw people leaving the clinic with mattresses, sheets, and food, he rushed into the clinic himself to see what he could grab for his home.

The crowd had been swift and thorough. There wasn’t a stitch of fabric or a crumb of food left in the entire clinic. Shakie searched but all he found were a few nurses and about ten sick people who refused to leave the clinic. On seeing them, Shakie made a quick exit.

There was a strange calm in West Point over the next day. It felt like being heard for the first time in a long time. The slum had been ignored by the government for so long and they had shown them that they mattered. While Shakie didn’t like what was done, it did feel good to be heard.

The following morning, Shakie woke to a commotion outside. There, at the entrance to West Point, was a mound of debris blocking the streets. Soldiers stood behind the piles with guns in hand. A man who had an air of authority to him walked up with a megaphone.

“West Point, Ma has placed you under quarantine. You cannot come or go. If you have any sick people, please bring them to be taken to the hospitals.”

He repeated this several times. Few in the crowd knew what a quarantine was and it took a lengthy explanation from the  soldiers to get the message through.

They were trapped in West Point.

Well, to be clear, people without money were trapped. The bribes to leave came quickly. People quickly learned that if they looked poorer, they could get out with a smaller bribe. Most of the residents didn’t even have the meager amount necessary to bribe the soldiers.

Shakie was on the poor side even for West Point so he and Eva were going nowhere.

The calm after the clinic had been ransacked was gone. Now West Point seethed. Through the night the people of West Point became more and more agitated. They quickly realized they would run out of food. Prices for rice and fruit had doubled immediately once the quarantine had been placed. The soldiers had not mentioned anything about food coming. No one could go out and get food to bring it back.

They would starve.

The air that night was pungent not simply with the usual smell of humanity, but with the sense that something was going to happen soon. As men sat around small fires discussing, all of them were planning how they could escape from West Point.

Shakie was not involved in such discussion. Eva made sure that he was in before dark. During these troubled times, she had kept him on a shorter leash.

As dawn broke, Eva asked Shakie to go to a small shop near the entrance to West Point to get some tea and bread for them for breakfast. After grabbing what he hoped would be the necessary funds, he left. As he approached, a large mass of humanity moved quickly to his left. In an instant, Shakie realized he had walked into a riot. A soldier with a bullhorn was yelling some final warning, but the crowd rushing the barricade was no to be stopped.

Gunfire…

As suddenly as the crowd had lurched forward, it exploded in every direction away from the barricade. Some were bleeding, but in good enough condition to run away. No one noticed a small, 15-year-old boy with his legs mangled beneath him.

“No ma, No pa,” he screamed into the sudden stillness around him. Some trails of blood led back into sundry places in West Point, his blood left no trail, but a pool.

The soldiers didn’t know what to do and stood, paralyzed for a moment. The man with the bullhorn quickly ordered them to call for an ambulance and to tend the boy as best they could.

Despite the close proximity to several hospitals, ambulances in Monrovia take some time to arrive. Shakie was already unconscious with an inconsolable Eva nearby by the time the ambulance pulled up. Shakie was rushed to Redemption Hospital where he died quickly of blood loss.

The Defense Ministry claimed the Shakie had been killed by barbed wire, but the staff at Redemption were not persuaded. Shakie had obviously died from gunfire. The war had taught many of them what a bullet hole looked like in a person’s body.

Shakie Kamara never caught Ebola. The infection was spreading through Liberia and was slowly working out a much deadlier and more dangerous disease: panic. Though Shakie did not die of Ebola, it most certainly killed him.

-Chip

The story above is based on real events. I have taken some artistic liberty, but the events are real. I do not personally know anyone involved, but I felt that the story, as much as it is known, should be told.

The image above is from Abrissa Someri and is used with permission.