The World Health Organization predicts that 20,000 people could be inflected with Ebola before the epidemic runs its course in West Africa, but how do you fight a deadly virus without basic medical equipment like gloves?
Dr. Timothy Flanigan, a Providence, R.I.-based infectious-disease expert, who is also a Catholic deacon, explained the struggle to contain the Ebola virus in West Africa with the Register and discussed his plans for bringing vital medical equipment to help St. Joseph Catholic Hospital in Monrovia, Liberia, renew its efforts to treat patients who have contracted the virus.
Deacon Flanigan is a professor of medicine at Alpert Medical School at Brown University. He has extensive experience providing care for patients with HIV and AIDS in different settings, including prisons. A husband and father of five, he was ordained as a deacon last year in the Diocese of Providence.
On Aug. 30, Deacon Flanigan will travel to Liberia, one of several West African countries battling Ebola, with medical and food supplies for St. Joseph Catholic Hospital in Monrovia, the capital.
On Aug. 27, he spoke with Register senior editor Joan Frawley Desmond about his upcoming medical mission.
According to the latest figures from the World Health Organization, 1,426 of the 2,615 people in West Africa who contracted Ebola have died thus far, and about half of the patients who died came from Liberia. Can you explain why Ebola is so infectious?
Ebola is like a number of viruses that occur in animals and can spill over into humans. Even common viruses, like influenza, can spill over into humans.
What makes Ebola so challenging and scary is that the rate of viral replication is highest when someone is ill. By contrast, some viruses, like influenza, are transmissible before the patient shows any symptoms.
Given that patients with Ebola are more infectious once they are symptomatic, it is vital to adopt good infection control to prevent transmission of the virus to health-care providers.
When you have Ebola, your bodily fluids are all infectious, and the hospital needs to have personal protective equipment that can limit the spread of Ebola: gloves, gowns, masks and goggles.
But many hospitals in Liberia and elsewhere do not have that protective gear. Is that why many health-care workers have died and why hospitals have closed in the midst of the epidemic?
The reason why the medical community’s response to Ebola fell apart in the West African countries of Guinea, Sierra Leone and Liberia, as well as a small part of Nigeria, is because they did not have the personal protective equipment, including gloves, in their health-care facilities. When such equipment is not available, hospitals don’t develop a culture of infection control.
Further, medical personnel in these West African countries have not seen Ebola before and were caught unawares.
Finally, the epidemic in the past has tended to break out in rural villages, and it is easier to move in and work with people who are in a village. This epidemic has spread in dense, urban areas that do not have clean water and where it is almost impossible to practice good hygiene.
That is the big picture.
How have public-health officials in Liberia and elsewhere tried to educate people about the proper way to care for the dead and prepare them for burial?
When someone is dying, we normally kiss him on the cheek and want to hold him. That is natural. But with Ebola, that is not possible. After someone dies, his body is still infectious.
You can be with someone you love, but you have to wear personal protective equipment, and that can be made available.
Why have hospitals closed?
So many of the health-care workers have died or become sick in major hospitals that they have had to close them.
To close a hospital is horrible. It means that if you have a car accident or a broken leg or difficulty during pregnancy, or appendicitis you have no place to go.
In the midst of the epidemic, the closure of hospitals has amplified the panic, fear and sense of abandonment. People lose confidence and trust and want to leave the country if they can.
How do you revive trust and hope?
You have to make it safe for health-care workers. In general, they are heroic and committed, but if they fear they have a high chance of infection and death, they won’t go to work.
That is what happened at the beginning of the epidemic. Many leading health-care providers got sick and died, including the best-loved providers.
On Aug. 30, you will be traveling with medical and emergency food supplies to Monrovia and will work with administrators at St. Joseph Catholic Hospital. Can you explain what you hope to accomplish?
I will play a modest role by bringing medical equipment and helping to re-establish health care at the Catholic hospital in Monrovia, which is run by the order of St. John of God, so doctors, nurses, laboratory personnel and cleaning personnel can safely do their jobs.
In the capital, St. Joseph Catholic Hospital is one of three health-care facilities, and it is supported by the Diocese of Monrovia. At different points in the epidemic, all three hospitals have had to close because of health-care workers being sick.
At present, the Catholic hospital is essentially closed. When key individuals, sisters, religious brothers and priests, who provide core leadership, die or become ill, it is almost impossible for such a hospital to function.
Once the appropriate equipment and training are in place, health-care workers will be able to provide Ebola-focused care and also re-establish general health care in a safe setting that will help limit transmission to the community. That will help address the distrust and fear that have developed in the wake of the epidemic.
Meanwhile, will U.S. health-care workers who are infected with Ebola continue to be treated in this country, at Emory University’s medical center and elsewhere?
In the United States, we have health-care facilities in place that maintain outstanding infection control, with some exceptions. We are well placed to deal with this type of infectious disease.
I also think that, from both a human and medical point of view, it was right to bring U.S. health-care workers back here for treatment. Emory’s care was superb, and it could be done safely.
But let me return to one point about the Catholic hospital in Monrovia. It never had adequate supplies to implement good infection control.
Today, when Americans get their blood drawn, the nurse uses latex gloves, a practice put in place in the 1980s to protect against the transmission of HIV/AIDS and Hepatitis B and C. Today, in this country, it is impossible to think that a patient would have his blood drawn without gloves used. And it is a poignant case of social injustice that you would have settings around the world where there are no gloves.
Do you, as a Catholic deacon, also hope to have time to offer spiritual support to staff and patients?
I do not know how things will unfold, but I hope to have an opportunity to serve in my role as a Catholic deacon and help at Mass.
People should know that many people on the front lines of this work in Liberia have a deep, compelling faith. Many are religious sisters who work quietly. Their dedication, commitment and sacrifices are unrecognized. I am told that, among the staff at St. Joseph's Hospital, one Immaculate Conception sister and two brothers and a priest from the St. John of God order died from the Ebola virus.
There are so many heroes and martyrs who provide care even when it puts them in harm’s way. They do it for love of the Lord.