Thursday, December 25, 2014

IMA Advance Team Prepares to Deploy to Sierra Leone to Fight Ebola

International Mutual Aid's advance team has completed pre-deployment training, and visas and tickets have been arranged.  We will deploy December 30.

We be operating in Sierra Leone for several months.  Check back in here for upcoming pictures and stories from our response.

Friday, December 19, 2014

IMA is now a 501c3 organization

International Mutual Aid has received expedited approval by the IRS as a 501 (c) (3) organization!

Friday, December 12, 2014

Ebola Heroes: Dr Ameyo Adadevoh

The Doctor who stopped Ebola in Nigeria.

Nigeria is a country of 170 million, 3/4 of whom live on less than $2/day.  Nigeria's health care system was not prepared to handle Ebola, but fortunately the disease was stopped by the clever intervention of one doctor: Dr Ameyo Adadevoh.

In August 2014 an international traveler arrived in Lagos, at a time when all federal hospitals were on a labor strike. He collapsed at the airport, and due to the similarity between the general symptoms caused by Ebola and many other diseases, he was misdiagnosed with malaria by the first doctor he saw.  The following day Dr Adadevoh, who had never seen an Ebola case, suspected EVD and ordered a blood test.  She insisted on keeping the patient isolated, even while under pressure to release him so that he could attend an ECOWAS conference.  The patient's test came back positive for EVD.  There was no functional isolation ward in Nigeria, so Dr Adadevoh created one in her hospital.

Through this surprise exposure to an EVD patient, Dr Adadevoh and several of her coworkers became infected.  Dr Adedevoh succumbed to the disease on 19 August 2014. 

Due to her early action, Ebola in Nigeria was halted at 20 cases.

Photo from "Remembering my Aunt, Dr Ameyo Adadevoh, who stopped Ebola in Nigeria"

Thursday, December 11, 2014

Ebola Heroes: Foday Gallah

Monrovia Ambulance Driver, Foday Gallah, featured as one of Time's People of the Year: Ebola Fighters: 

"You don't want to know what Ebola feels like. If you're not psychologically strong and God is not on your side you will drop before you are taken for treatment because the pain is too great... I had known I would get it eventually. A lot of great doctors and nurses on the front line have died. They tried to be careful but Ebola still got them. I had carried so many patients in my ambulance and seen so many die in my arms... "

"I was {in the ETU] for two weeks. In the same tent as me in the treatment centre, a two-month-old baby died from the disease. And I lay listening to a lady who cried until she died..I don't know why I survived....I went back to my job, part-time, at the beginning of December...Now, ambulance crews are working 24 hours a day. When people are dying you need to be all over the city. It's hectic, our workload has tripled and we don't have enough ambulances in Monrovia to deal with the disease....Most of my friends now stay away from me because of my job."

Quoted from BBC News "My Fight Against an Invisible Enemy"

Wednesday, December 10, 2014

Ebola Heroes: The Teenagers of A-LIFE

Even as Ebola raged through the seaside Monrovia slum of West Point, many residents denied the existence of the disease.  In August, dubious crowds broke into a West Point Ebola holding center and "freed" the patients inside.  Many residents believed Ebola did not exist, at least not in West Point, and that perhaps the entire outbreak was a fabrication, made up by agents who wanted to steal funding, harvest organs, or conduct experiments on humans.

But on Sept 17, a group of 200 teenage girls, and some boys, marched through the tight streets of West Point, promoting Ebola education through song.  This was the official start of A-LIFE: Adolescents Leading an Intense Fight Against Ebola.  This drive for public education, the name, and the organizing of A-LIFE was all done by Liberian girls age 16-19.   The girls of Liberia, a country with extremely high rates of sexual violence, are no strangers to hardship.  Yet in West Point, they were leading public education efforts.

After learning of the girls' efforts, local UNICEF leaders provided them with safety education and basic PPE.  It is likely that ongoing public education efforts such as this are responsible for the dramatic decline of Ebola cases in Liberia.

Well done, A-LIFE members!

Photos from UNICEF,

Tuesday, December 9, 2014

Ebola Heroes: Gordon Kamara

During the peak of the Ebola epidemic in Liberia, when ETUs ran out of space and patients died outside, waiting for beds, Gordon Kamara continued his work as an Ambulance Nurse in Monrovia.  He worked on one of only 15 or so ambulances covering a city of ~1 million during a public health emergency.  At times he arrived at the ETU with a patient, only to be turned away because there were no beds available.

Mr Kamara also worked as a combat medic during the long Liberian civil war.  "“It is nothing compared to this, The bullets you can get away from. Ebola is hidden within our own families.”

Mr Kamara has isolated himself from his family for their protection.  “It’s a very lonely virus... Not just for me, but for the entire country. We are all together, but all alone.”

Quotes and picture from NYTimes "Ambulance Work in Liberia is a Busy and Lonely Business"

Sunday, December 7, 2014

Ebola Heroes: Dr Martin Salia

Dr Martin Salia died on 17 November in isolation at the Nebraska Medical center.

Dr Salia was one of only 5 or 6 surgeons in the entire country of Sierra Leone. His wife and 2 children are US citizens, but instead of pursuing a lucrative private surgical career, Dr Salia returned to Sierra Leone to help his country. He worked long hours as surgeon and chief medical officer at Kissy Hospital in Freetown. He spent his free time putting in additional surgical time at the Connaught Hospital and Davidson Nicol Hospital in Freetown and lecturing at the University of Sierra Leone medical school. He only saw his family in Maryland a few times a year.

Had Dr Salia successfully pursued US citizenship instead of returning to his native country to assist people there, he would not have been exposed to Ebola.  Had he stopped treating patients, as many of his compatriots have, he might not have contracted Ebola.  Had Dr Salia been a US clinician volunteering with an international NGO, he might not have detected his own infection earlier, but he would have had a clearer medevac path, and his widow would not be left with a $200,000 medevac bill.

Here's to the surgeon who stayed, in the face of a disease that tears apart families and turns communities and nations against those who should be loved and remembered as heroes.

Saturday, December 6, 2014

Pre-Deployment Training at the CDC

Our first group of volunteer clinicians completes pre-deployment training for Clinicians Responding to West Africa, at the CDC.

Friday, December 5, 2014

Sending Clinicians to Treat Ebola Patients: Risks and Benefits

In an October 24th analysis, the New York Times reports that MSF has sent 700 doctors and aid workers from around the world to Ebola-stricken countries.  Of these 700, 3 have been infected with Ebola.  This means that each of those 700 volunteers had a chance of infection of 0.4%.  All three infected MSF expat clinicians recovered.  In fact, the death rate amongst EVD patients who have received Early, comprehensive supportive care in the developed world is near zero.  MSF has not been prompted by the risks involved to abandon their patients in West Africa, and we feel that this is the right decision.  Per the example of MSF, IMA will be seeking to better understand how transmission is occurring, and will be taking every possible measure to insure the safety of our clinic workers.

Allowing Ebola to become a permanent endemic disease in West Africa would create a much greater risk and expense than sending expat clinicians over to work in ETUs does.  If Ebola becomes endemic, hospitals in each affected country will have to consider every patient presenting with general illness will be a potential Ebola case- forever.  Initial triage/treatment of each of these cases would expose a number of unprotected clinicians to potential infection.  In West African settings, where many clinicians cannot even afford to use Basic Precautions PPE, this would make providing basic healthcare either horribly dangerous, or impossibly expensive.  In the US, any patient traveling from West Africa, with general illness symptoms, would have to be treated as an EVD patient until proven otherwise- forever.  To give some insight into the costs this would create: 1 MSF-style suit of PPE costs ~$80 and can only be used once.  This $80 does not include the PAPR recommended by the American Nurses Association.  Every ambulance, clinic, and hospital with potential for coming in contact with an EVD patient would have to keep unexpired stocks of this equipment on hand, and donning this PPE is only the first step in the isolation/treatment process. Imagine all the funding that would be pulled away from other medical programs, just by this PPE requirement.

If the current EVD wildfire in West Africa is not extinguished, but instead is only banked down to a slow endemic smolder, there will always be a threat of a spark traveling to a transit center in a large developing country.  Imagine Ebola in the slums of Rio, Mumbai, Lagos, or Jakarta.   Airport detection measures are notoriously unreliable, and there will not always be a clever Dr Adadevoh to provide an early, correct interpretation of the vague symptoms of Ebola.

The West African Ebola Epidemic is the first great epidemic of the Age of Globalization.  It is safe to assume it will not be the last, nor the most frightening.  It is safe to assume that not every epidemic will occur so far away from America.  The International Community's response to this public health emergency will set the precedent for future responses.  In the history book of the future, will our children read that we acted with courage and compassion, and sent in teams to treat patients?  Or will they read that we stood back, full of fear and indifference, and watched as a country collapsed and a new deadly disease became endemic?

Wednesday, December 3, 2014

Ebola: The Multiplier Disease: Taking out Healthcare Systems

Ebola is a disease of poverty, but it is different from other diseases of poverty such as cholera and lassa fever for one important reason: Ebola takes out healthcare systems.  Millions of deaths occur every year from various diseases of poverty, but these do not make the news the way EVD does.  This is because a single cholera patient does not have the potential to shut down an entire clinic.  5000 people die per year of Lassa fever in the same area that is now affected by Ebola.  However, those 5000 Lassa deaths do not shut down an entire nations' schools and hospitals; 5000 Ebola deaths did.  

Ebola deaths have a multiplier effect.  Every Ebola death indirectly leads to dozens of deaths from unrelated conditions that go untreated due to hospital closures.  As vaccination programs are suspended, each Ebola death leads to dozens of deaths from vaccine-preventable illnesses.  As markets, schools, and developmental programs are closed, each Ebola death leads to lost opportunities, general weakening of systems,an increase in the potential for political instability, and food shortages.

Tuesday, December 2, 2014

Why Should the United States Feel a Duty to Help West Africa Fight Ebola?

Most people think of America as the antithesis of a colonial power.  But in fact we did have a sort of colony in Africa.  During the mid-19th century, the American Colonization Society moved ~13,000 American settlers to a colony on the  Liberian coast.  This effort was publicly supported by American political giants such as Abraham Lincoln, James Monroe, and Henry Clay, and it received public federal funding.  The colony site was scouted out by a US Naval Vessel, the colony organized itself under US Laws, and it adopted a Constitution based on that of the US.  Today an estimated 5% of the Liberian population is descended from settlers that came from America.  This is why you hear place names in Liberia such as Monrovia (named after President Monroe), Maryland County, Buchanan, and the JFK Medical Center.  If any independent country in the world has strong enough ties with the US to hope for assistance during an emergency, that country is Liberia.

Ebola has historically occurred in very rare, self-limiting outbreaks, mostly in rural villages  in Central Africa.  A key difference in the currrent Ebola epidemic is that it is spreading in crowded, poor, urban areas.  The conditions that are present in Liberia are mirrored in many, many other poor urban areas in Africa, Asia, South and Central America.  At the current caseload of 18,000 - 40,000, Ebola has already spilled out of Guinea, to Sierra Leone and Liberia, and thence in limited quantities to Nigeria, Senegal, Spain, the US, and Mali.  During the early phase of the epidemic, unimpeded by effective international intervention, the disease spread exponentially.  In Sept WHO reported that since May 2014, the number of new cases of Ebola has been doubling every 20-30 days.  In September the CDC put out a worst-case scenario projection of 1.4 million cases by January. 

Monday, December 1, 2014

Why Should I Care about Ebola?

I live in Maine.  I live in a beautiful, peaceful, orderly place where people pride themselves on their willingness to help their neighbors.  When I'm not putting in a 100-hour work week, I'm off hunting, renovating my old colonial home, or restoring my 1965 Pearson Vanguard.  Why should I care about a disease in West Africa?

Believe me, I would like to be able to ignore the troubled places of the world and just enjoy my life and my family here in America.  After all, that is what my parents got to do.  Unfortunately the technological advances of this century are eroding that privilege.  Whether or not I want it or agree with it, Mainers and Americans are no longer isolated.   Much of the equipment I work with is made from materials produced overseas.  When our ambulance is called to our weekly drug overdose call, it is the result of what's wrong in Mexico and Central America as much as what's wrong in the US.  At the 9/11 ceremony every year I am reminded that when segments of other people's societies become psychologically sick, they are often willing and able to reach out and harm American civilians.  I turn on the news at the station and it's a barrage of images of suffering.  I try to ignore them but they stick in the back of my mind.  We go on a call and the patient is coughing; we have to go through Swine Flu protocol at the hospital, or we have to decon the entire back of the ambulance to prevent spreading Enterovirus.   Now, we are developing special protocols, stocking extra PPE, and asking all our febrile patients if they've traveled to West Africa.  We talk about Ebola, we joke about Ebola, we answer the public's questions.  In the past months Ebola has become our constant companion.

Isn't it all hype?  Won't the epidemic burn out like past Ebola outbreaks?

I certainly hope so.  Our organization does not expect that to happen in the short- and medium-term for the following reasons:  First, past instances of Ebola were outbreaks, not epidemics.  It is a difference of scale.  Before 2014, the largest-ever outbreak of Ebola infected a total of 425 people.  As of 12 Dec, this epidemic has infected over 18,000 people according to WHO's Reported Cases count.   WHO estimates large-scale under-reporting means the real number may actually be closer to 30,000-40,000 cases.  Either of these numbers represents the first great epidemic of an acute, deadly, infectious disease seen during the Age of Globalization.
Second, location.  Past outbreaks generally occurred in villages and rural settings.  This epidemic is raging through cities, through some of the most crowded and impoverished areas of the African continent.  Liberia and Sierra Leone are recovering from long civil wars.  Widespread lack of access to infrastructure, health care, and education, distrust of government, and cultural traditions are all contributing to the spread of the disease

That's sad.  My country has its own problems.  I don't know anyone from West Africa. Why should I care about West Africa?

I believe that you cannot force change on people.  Whether it is my cousin who is fighting an addiction, my neighbor who is fighting for her civil rights, or my fellow healthcare worker in Mexico who is fighting to keep a hospital funded... the primary motivation and workload needs to come from the affected party, not from an outsider.  I will give my cousin, my neighbor, or my professional ally all the help that I can, but only if they are doing all they can to help themselves.

I want to help West Africans because I admire them.  Over 600 health care workers have been infected in the epidemic, largely due to lack of safety equipment.  Yet nurses, doctors, ambulance workers, and body recovery teams continue to do their jobs.  Liberian nurses receive just $500/month in compensation.   Contact tracing and public information teams head into affected areas, often with little protection.  They risk becoming fatally infected and leaving their families with no means of support.  Many of them have not been paid in months.  They are often stigmatized by neighbors and family due to their work.  Yet they continue to make their vital contribution; often inspired to do so because they have lost someone they love to Ebola. 

The news is full of truly inspiring tales of heroism in West Africa.  Gordon Kamara, a Monrovia ambulance driver, has isolated himself from his wife and children to protect them and has seen them only a few times in the past 5 months.  He drives one of only 15 or so ambulances that cover a city of 1 million.
Foday Gallah, another Monrovia ambulance driver, went back to work soon after being infected with EVD, suffering horrible pain, and watching others die in fear and pain in the ETU. 
In August, a key study on changes in the genome of the 2014 Ebola strain was published in Science.  Unfortunately, 5 of the 50 co-authors of the study died of EVD before the study was published. 
Dr Martin Salia, one of only 5 or 6 surgeons in the entire nation of Sierra Leone, dedicated nearly all his waking hours to treating patients and teaching in Freetown.  Dr Salia was married to a US citizen, who lived with his children in Maryland.  He had every chance to pursue US citizenship and a lucrative career in America.  Instead Dr Salia dedicated himself to bettering his home country, continuing to perform general surgery in Sierra Leone in the midst of a public health emergency.  In Nov 2014 he contracted Ebola, was medevaced late in the course of his illness, and died in isolation in Nebraska.
Nigeria is a country of 170 million, 3/4 of whom live on less than $2/day.  Poverty, crowded, impoverished urban areas, and political instability make Nigeria extremely vulnerable to epidemic EVD.  In July an EVD patient flew to Nigeria and presented with nonspecific symptoms at a local hospital.  After evaluating the patient, Dr Stella Adadevoh ordered an EVD test, which was positive.  Dr Adadevoh and several of her staff contracted Ebola and succumbed to the disease, but Ebola in Nigeria was halted at 20 total cases, due to Adadevoh's crucial recognition of the disease.

Local healthcare systems received a terrible blow, starting early in the epidemic.  Several of the country's leading doctors and researchers fell victim to the disease they were trying to stop.  Yet West Africans haven't given up.  They are still taking heroic measures to try to help themselves.  No country can fight a disaster of this scale alone, and I think West Africans have earned our help.  IMA will be focusing on enhancing West Africans' demonstrated ability to help themselves by hiring and training talented locals to assist us as frontline healthcare worker staff.