Ebola fighters charge ahead to deal with crisis

The goggles that physician Daniel Lucey wore to protect against the Ebola virus almost blinded him. The protective suit he donned in Sierra Leone is a one-man sauna, and the only available gloves are, he says politely, "sub-optimal." After one tore, he wore three per hand.

Lucey, an adjunct professor at Georgetown University Medical Center in Washington D.C., spent much of August on the front lines of the biggest Ebola outbreak in history, confronting the obstacles that face those trying to subdue this lethal virus. Those obstacles did not deter him: after less than a month at home, he leaves Sunday to treat Ebola patients in Liberia.

"It's dangerous. Ebola's about as bad as it gets," Lucey acknowledges, when asked why he's putting himself at risk. But "if I don't do it, who's going to do it, except the people who have no choice?"

Lucey is one of a select cadre of volunteers and professionals who have heeded the call to help in the Hot Zone – the cities and rural areas in Sierra Leone, Guinea and Liberia where the Ebola virus is on the rampage, killing more than 2,900 so far. Some 200 health-care workers had died of the virus, and two American doctors and an American helping in a hospital were infected but survived. That hasn't dissuaded a small but determined band of health-care workers from journeying to West Africa to train local medical staffers, run public-education campaigns and care for the sick.

"My wife says, 'Why don't you stay at home with your family?'" says retired pediatrician Alan Jamison of Morristown, Tenn., who spent much of July volunteering in Liberia for non-profit Medical Teams International. His family both supports him and worries about his safety, he says, "but I feel like I have another calling."

Those willing to venture into Ebola territory are few in number but tough in character, many having already seen duty in places like Haiti. Even for these veterans, the Ebola outbreak makes demands almost too heavy to bear.

There's the crushing workload imposed by the paucity of people willing to help. And there's the protective gear, which, in West Africa's sultry climate, can be tolerated for only a few hours. By one calculation, a person in the suit sweats away 2.5 pounds of water per hour. Wearers may notice their minds getting foggy, says Pranav Shetty, who's running an Ebola treatment unit in Liberia as a staffer for non-profit International Medical Corps.

But the suit confers a great benefit: if properly worn, it's a fortress against the deadly virus, which afflicts victims with high fever, uncontrollable diarrhea and acute weakness. That, counter-intuitively, means the Ebola-treatment units are some of the safest places in the Ebola zone, medical staffers say. The two U.S. doctors sickened by the virus are thought to have caught it outside the Ebola ward.

The ever-present fear of infection has forced health-care workers to shun hugs and backslaps. Instead they may greet friends with the "Ebola kiss," a close approach of the elbows. They cleanse their hands with chlorine every few minutes.

"We're not packing ourselves as tight when we sit in chapel together," says physician John Fankhauser, a staffer of the non-profit SIM who's working at a hospital in Liberia. "We don't shake hands. I'm mindful of everything I touch. … It's draining, I have to admit."

To physician Daniel Kelly, the greatest risk of his trip to Sierra Leone this summer came from "just walking around the hospitals and being in the community." Whenever Kelly, of the University of California, San Francisco, ran into a friend in the street, "I found myself asking, 'Hey, do you have a fever, by any chance? Are you feeling okay?' There's that extra layer of stress."

For all health-care workers, though, nothing is worse than the suffering caused by the virus, which also hobbles the efforts of those trying to alleviate that suffering. The protective gear and short staffing require compromises that can be difficult to accept.

"You can't provide the one-on-one patient care that you want to provide," Shetty says. "Patients are getting worse and will die, and there's nothing you can do about it. … That's not how we're trained or bred to think."

In a Liberian hospital this summer, physician Adam Levine saw a woman delirious and bleeding from Ebola infection begin having a seizure. Levine, a volunteer for non-profit International Medical Corps and an emergency-medicine specialist at Brown University, wasn't wearing protective gear. He could only stand by helplessly -- the first time in his career, he says, that he didn't rush to the side of a patient wracked by a seizure.

It's the children who died alone in the Ebola isolation ward this summer who haunt physician Lance Plyler, who returned to the United States from Liberia in August. The limitations imposed by the protective suits meant medical staffers couldn't be at the youngsters' bedsides every moment.

"We saw, time and time again, children perishing on their own," says Plyler, a staffer for Samaritan's Purse, a non-profit group. "We desperately wanted to be with them all the time, but it was physically impossible. It was gut-wrenching."

Grappling with a disease that has no cure, physicians find themselves performing tasks that in the United States would be left to more junior staff. Levine helps clean patients spattered with blood. Jamison emptied toilets, bathed patients and changed bed linens.

"I learned a long time ago that I'll not be able to cure every disease," he says. "But I can always care for these patients. … What I try to do is stay in the moment and keep trying to provide what I can."

The toll on those providing care has prompted some non-profit groups to step up their services to personnel serving in West Africa. International Medical Corps, for example, has added mental-health staff for volunteers to consult before, during and after their stints.

The Ebola effort "is an unusual response, and it requires unusual measures," says Margaret Aguirre of International Medical Corps. Medical Teams International, which sent Jamison to West Africa, provides medical-evacuation insurance and pays for a cell phone so volunteers can call home.

Amid the horror, medical personnel linger on the victories. Plyler remembers the man who attended an education session on infection control, took care of eight family members with Ebola – and didn't get sick, thanks to what he'd learned. Fankhauser recalls the "feeling of elation" he and his colleagues had after two boys, ages 11 and 14, finally shook off the virus after days near death.

Levine thinks of the nurse, critically ill when she entered the hospital, who is now on the mend. During his stint at one Liberian hospital, at least one patient a day would receive word that they were virus-free, prompting widespread celebration. "They often start doing a dance of joy," he says. "And sometimes the doctors and nurses in their PPE" – personal protective equipment – "start doing a little dance of joy with them. It's funny to watch people bopping around in their PPE."

But for every happy ending, there are too many tragedies. After two physician friends died of Ebola this summer, physician Kelly flew to Sierra Leone, where he helped found a medical clinic 8 years ago, to fight the virus in any way he could. The trip took a toll. He lost 10 pounds from stress and fear. His girlfriend, unable to tolerate his chaotic life, left him. But he'll return to Sierra Leone in October.

"The crisis is escalating," Kelly says. "There's a moral imperative to not just stand by and sideline yourself, but to respond to this incredible crisis."