SURVIVING DESPAIR: UNC doctor tries to make difference in Ebola epidemic

Jun. 23, 2014 @ 06:32 PM

Billy Fischer thought he was just going to Geneva to work on technical documents.

But soon after he arrived in Switzerland last month, the Chapel Hill doctor found himself on a plane to the Republic of Guinea on Africa’s northwestern coast, site of an ongoing outbreak of lethal Ebola Zaire.
“That was a much more difficult conversation with my wife,” he said in an interview on Monday.
Officials with the World Health Organization wanted to draw on Fischer’s expertise in critical care and in working in resource-constrained regions. It would be the first time on such a mission for Fischer, an associate program director for research in the University of North Carolina's department of medicine division of pulmonary diseases and critical care medicine.
“Absolutely, I had second thoughts,” Fischer said. “There’s such fear around this virus and how it’s portrayed in popular media. I told them, ‘If you don’t get me on the plane soon, I’m going to think myself out of this.’”
So, on May 29, he found himself 4,662 miles from home in an isolation area in Gueckedou, Guinea’s capital, with Doctors without Borders.

Most of the time, he was out of touch with his wife, Leah, and their two young sons. Sometimes, though, he found a few minutes to email dispatches home.
The day before he caught the plane, he wrote:
“Two weeks ago, everyone thought the Ebola outbreak was over and there was a problem with contact tracing (involving who would pay the people for tracking down contacts). As a result, there are now multiple foci of Ebola outbreaks across the entire country and now into Sierra Leone.”
On June 1, he wrote home about the despair in and around Gueckedou. The epidemic showed no signs of slowing, despite efforts by Doctors without Borders and the WHO.
“The continuing epidemic is really a result of significant distrust between the local population and treatment/epidemiology teams, as well as the non-specific nature of the symptoms,” Fischer wrote.
Books and movies often portray the most extreme complications of the disease, such as vomiting blood. Those early descriptions came from end-stage cases.
Still, there’s no denying the lethality of Ebola Zaire, which left untreated has a 90 percent mortality rate.
In the treatment area, with temperatures around 86 degrees and 90 percent humidity, Fischer wore a makeshift hazardous materials outfit cobbled together from an impermeable Tyvek suit, scrubs, gloves, rubber boots, a full-length apron, a mask over the mouth, goggles over the eyes and a hood covering the head “so that there is not a single inch of skin exposed.”
“I had my doubts on the first day,” he wrote. “This experience does offer an important perspective on critical care in that one of the most important aspects of what I am able to do at UNC is reassess and adjust my therapy whereas here I have to assess, make a decision, run outside, yell for fluids to be prepared, which are thrown to me, then run inside and set up the IV. Then do it again for the 14 other patients currently in isolation.”
Although Fischer gradually acclimated to the weather, it wasn’t so easy to battle the grim ravages of the disease. Doctors without Borders reported on its website that more than 300 people had been affected by Ebola in West Africa during the latest outbreak.
“I had hoped that improving the care of patients might allow us to find some life amongst all of this death, but I’m not sure if it will work out that way,” he wrote.
On June 2, Fischer lost one of the first two patients he admitted on May 30.
“It’s pretty emotional to bathe a 27-year-old man who was incredibly strong and rendered completely helpless,” he wrote. “His sister is next door and will likely die in the next hour. This is all in front of the other patients in the room, many of whom are family members or neighbors. The despair is suffocating. My computer is running out of batteries. Sorry, more to come.”
A day later, Fischer wrote brightly of improvement in two patients.
“One is a young man who has started helping us encourage the other people in his room to drink more and to keep fighting. It is inspiring to say the least,” he wrote. “The other is an older man who claims to be 35, but is more likely 85, and every time I walk into his room he acts like he is doing calisthenics – it provides a moment of levity against all of the struggle that defines the isolation zone.”
But then he wrote of an 18-year-old pregnant woman afflicted with both Ebola and malaria.
“I thought being 18 was tough – I can only imagine what being pregnant, infected with a near uniformly fatal virus, having malaria and being in an isolation zone treated with people in space suits,” Fischer wrote.
She lost the baby and would follow not long after.
“Miserable,” he wrote.
On June 4, Fischer wrote of breaking that news to the woman’s husband.
The man said, “Ma vie est fini” – French for “My life is over.”
“Ebola has killed his mother, his mother-in-law, his wife and their unborn child,” Fischer wrote. “I worry that when the fight leaves a person, the body is quick to follow. Similarly, when a woman who died last week, her mother, who was also a patient and improving, soon followed. I’m not sure there is anything worse than dying with despair after watching your child die.”
He’s home now, back in Chapel Hill, clearly affected by the experience. But, despite his misgivings before that flight from Geneva, he wants to return.
“I came back with a lot of guilt that I’m not there and I didn’t stay longer,” he said Monday. “There’s no question I would like to go back. I think I can do better and I am totally committed to the idea we can reduce mortality. We don’t have to wait for a vaccine. We can make a difference right now.”

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