Infectious disease specialist Susan McLellan, clinical associate professor of tropical medicine, watched the Ebola outbreak unfolding and thought, “I can help with this.” She had been to Kenema in the past and knew the people and the area.
“I responded when WHO [the World Health Organization] called for volunteers. The description of what we were being asked to do was training, creating messages, organizing the system, and creating protocols. The real truth of it was that there was absolutely no one else to provide clinical care, so that’s what we ended up doing,” she says.
McLellan found herself working with only two other physicians in an Ebola compound with 90 patients divided among three wards which respectively housed suspect, confirmed, or recovering patients. She used a supply of personal protective equipment (PPE) that more than complied with the minimum WHO and Centers for Disease Control and Prevention (CDC) standards — a Tyvek suit, two pairs of gloves, a head covering, mask, and a head shield and was able to spend four to five hours providing care in that PPE, compared to the 45 minutes health workers are able to spend in Médecins Sans Frontières PPE.
“All other routine medical care had ground to a halt when I was there. There were no vaccinations and no reproductive care,” she says. Instead, work is focused on care for Ebola patients, which includes IV fluids, replacing electrolytes, oral rehydration, and treatment of secondary infections with antibiotics and antimalarials. Doctors also try to treat the abdominal pain and hiccups, common Ebola symptoms, and provide valium to relax patients. Patients who survive Ebola get a certificate, she notes.
Now home, McLellan reports that news representations of the situation are “correct in terms of the disastrous effects this outbreak is having on the economy, the routine medical care, which has gone down the tubes, and on the tension between absolute desperation to have outside help come in and very little trust,” she says.
Fear at home is a concern as well. McLellan also was on the team that made the policy for Tulane’s response to people coming to campus from West Africa, which adhered precisely to what was recommended by the CDC at that time. “If you’ve had no high risk contact, then you would just monitor yourself by taking your temperature and then the moment you think things are not normal, self-isolate and contact your doc and get a blood test,” she says, having practiced the same self-monitoring technique upon her return. Several states have since instituted policies that go beyond CDC guidelines, mandating 21-day quarantines. Deans and faculty of both the Tulane School of Public Health and Tropical Medicine and the School of Medicine have come out publicly against such advisories.