Friday, December 26, 2014

IMA Advance Team Preparing to Deploy to Sierra Leone

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 for pictures and stories from our response.

Friday, December 19, 2014

IMA is now a 501 (c) (3) organization!

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

Sunday, December 14, 2014

Ebola: The Mutiplier Disease

In early November, as only a handful of international medical NGOs responded to the World Health Organization's predictions of exponential Ebola spread in West Africa, a small group of medical professionals in their 30's founded a new nonprofit group to fight the disease.  Follow IMA's story, from conception, through the incorporation/501c3/formation process, to advance team deployment to West Africa and work on Ebola, on my new blog:

Ebola: the Multiplier Disease: Taking out Healthcare Systems

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"

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"

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,

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"

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.

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.

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?

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.

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.