COVER STORY

The Ebola Web

Columbians race to stop an epidemic.

by Paul Hond Published Winter 2014-15
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Mukpo’s worst fears started to be realized in August, when he read about what happened in the Monrovia neighborhood of West Point. The balcony of Mukpo’s Monrovia apartment overlooked West Point, and Mukpo knew some of the seventy thousand people who lived in that maze of tin-roofed shanties. He knew their level of political mistrust. When some residents looted an Ebola treatment unit, resulting in the escape of seventeen patients and the theft of bloody bed sheets and medical equipment, the army placed the entire neighborhood under quarantine. Mukpo watched from afar as troops opened fire on Liberians “who didn’t understand why they’d even been quarantined in the first place,” he says. “They still felt that the threat wasn’t real.”

Mukpo had a media-studies background, and with a disaster unfolding in a country he loved, he considered returning to Liberia to report on it. “Professionally and personally, it was difficult for me not to want to go back when there was this massive crisis,” he says. “I just made that decision and said, ‘I’m going back.’”

His family tried to dissuade him, but Mukpo felt he had no choice. He landed in Monrovia in early September, to a situation that he was unprepared to see firsthand.

 

NEW YORK - “I want us to be on the ground tomorrow,” says Wafaa El-Sadr, seated in her office at the Mailman School of Public Health on West 168th Street. “I’m convinced we can actually make a difference. That makes it very hard to sit here.”

It is mid-November. El-Sadr and Strasser have been back from Sierra Leone for two weeks. Like anyone coming to the US from West Africa, they are required by the CDC to take their temperature twice daily and answer questions from the health department. Since neither of them worked inside an ETU, there is virtually no chance of their having caught the virus. In Sierra Leone, meanwhile, Ebola is spreading.

One big problem of the epidemic has been a lack of holding centers. In response, the British government, through the UK Department for International Development (DFID), is funding the building of “community care centers” — multi-bed units located near villages and staffed by laypersons rapidly trained by the British army. The idea is that patients will be more inclined to self-isolate if they know they’ll be closer to their families while awaiting their lab results. People who test positive for Ebola would be transferred to an ETU, like those run by Medecins Sans Frontieres (Doctors Without Borders). There is talk about ICAP evaluating these centers for safety and efficacy once they are functioning.

El-Sadr and Strasser, based on what they saw in Sierra Leone and on their experience fighting HIV/AIDS, have also drawn up a proposal to the CDC for a long-term strategy to improve the tracking of cases, expedite the turnaround of lab results, and — most ambitiously — find and train nurses. 

“The number of health-care workers who have died in this outbreak is substantial, and particularly nurses,” El-Sadr says. “Nurses are very precious — they provide the care.” Many on the frontlines have died, and those who haven’t died have watched their colleagues die. Even before Ebola, there were about two nurses for every ten thousand people in Sierra Leone.

Yet ICAP found that the prevailing assumption — that there were too few nurses to staff the new care centers — was incorrect. Organizations working in Sierra Leone could identify nurses who were ready and willing to respond, including unemployed and retired nurses.

“As we rush to find trained health workers, it is essential that we keep them safe,” Strasser says. “Buddy systems and on-site supervision are helping, but we need more. We’ve seen a situation spin out of control due to poor health systems. Nurses are at the forefront of these systems, and they’re the ones most at risk.”

 

On February 26, 1969, John Frame ’66PH, a doctor in the Division of Tropical Medicine at Columbia’s school of public health and the medical director of a network of Christian hospitals in East Africa, received a call from Nigeria. The caller was Jeanette Troup, a doctor at the missionary hospital in the town of Jos. Troup told Frame that a mysterious illness had broken out at the hospital. Two American nurses, Laura Wine and Charlotte Shaw, had developed fevers that progressed to nausea, hemorrhaging, organ failure, and death. Antibiotics were ineffective. Troup had performed an autopsy on Shaw, with help from the hospital’s head nurse, Penny Pinneo. The autopsy revealed multi-organ devastation.

Now, a week later, Troup said, Pinneo had a fever and mouth ulcers.

Frame ordered Pinneo flown to New York immediately. The fifty-two-year-old nurse was evacuated from Nigeria, along with blood specimens from her fallen colleagues. While Pinneo was being transported, Frame contacted virologist Jordi Casals at Yale, and told him to expect some blood samples.

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