Via WHO, an informative interview with Canadian critical-care physician Dr. Rob Fowler: Fighting Ebola from day one. Excerpt:
Q: How did you feel when you first entered the ward in Guinea?
Rob: My first entry into the ward was at Kipé Hospital in Conakry where there were a number of Ebola patients – most were health care workers. Other patients had already left the hospital in fear. There was only one nurse in the ward at a time and few doctors were left, uninfected. No one had the luxury of prior infection prevention and control training for Ebola and the result was devastating.
So my first reaction when entering the hospital was grave concern and no small amount of fear that anybody working in the ward was at risk.
In the early days of the outbreak there were about 4 Guinean doctors and nurses and 4 international physicians and nurses caring for patients in the capital. Over the following month, I think this team helped to set the tone for a style of clinical care – early aggressive rehydration, antibiotic and antimalarial treatments, and point-of-care laboratory directed treatment of metabolic and electrolyte abnormalities that has generally been adopted across West Africa. I give so much credit to MSF for their early response and ability to operationalize treatment units.
Q: What did it mean for you to be a part of this first team?
Rob: Ebola for me – and for other people – conjures up more concern and to be sure, some fear. So for me, that leads to apprehension and caution, but not excitement.
Having been in Toronto at the onset of SARS and admitting some of the first patients and taking care of colleagues…going through that experience, it was easier to mentally prepare for entering into an outbreak where the outcomes are uncertain and the mortalities are potentially high. New and emerging infections are anxiety-provoking; however, if you are a clinician and you find yourself in those situations, it is what you do.
Q: As a doctor, normally you develop a relationship with your patients, here that wasn’t really possible. Was it something that was missing?
Rob: Initially it was missing. I remember the first time going into the ward in full PPE and we were plain and faceless. The PPE that we had used was a much lighter version of what was starting to be used in West Africa, although with the same protection of your mucus membranes – eyes, nose and mouth, where Ebola typically gains entry.
So it did allow people to see more of our faces which I think allowed the patients to connect with us a little more quickly. We would write our names on our boots and aprons saying that we were OMS/WHO and say what our first name was: “Dr. Rob – OMS or Dr. Tom – WHO”.
In some places we could speak to patients across a barrier or a fence, without PPE, and that helped to create a bond that carried back into the treatment facility, where patients could not see us as well.
Q: You went first to Guinea, the next location was Sierra Leone
Rob: I went to Guinea in March-April, Sierra Leone in July-August, Liberia in September and Sierra Leone again in December.
Both in Guinea and in Sierra Leone we were in situations where there were too few clinicians to provide medical care to infected patients. MSF has been the predominantly humanitarian medical organization providing assistance to countries and care to patients with Ebola for the past decade but with this outbreak, despite terrific work, even MSF was overstretched.
It is not so common for WHO to send in clinicians – doctors and nurses - to assist Ministries of Health to provide direct clinical care; however, during this outbreak, especially in the first months the need was too great and assisting with the care of patients became one of our priorities – out of necessity.
Since August, the international foreign medical team community has really stepped up and there are now scores of organizations helping with Ebola care across West Africa for the first time. The WHO clinical team is now leading training for incoming teams and supporting existing teams in their Ebola treatment centres.