From Liberia, a U.S. Catholic Doctor Pleads for More Help
Deacon Timothy Flanigan, an American infectious-disease specialist, is in Liberia to help Catholic hospitals address the Ebola crisis.
MONROVIA, Liberia — When Dr. Timothy Flanigan, a U.S. infectious-disease specialist and Catholic deacon, suits up to visit Ebola hemorrhagic fever patients in Liberia, he makes sure that every inch of his body is covered with protective gear — from goggles and gown to gloves and mask.
As confirmed by this week’s news of two health-care workers contracting Ebola from a Liberian patient admitted to a Dallas hospital, it is essential to carefully follow protocols when treating people infected with the deadly virus.
“The care of Ebola patients can be done safely, but it’s hard to do it safely,” Dr. Thomas Frieden, director of the federal Centers for Disease Control and Prevention (CDC), stated at an Oct. 12 press conference.
“Even a single, inadvertent, innocent slip can result in contamination.”
No one knows that better than Deacon Flanigan, a professor of medicine at Alpert Medical School at Brown University in Providence, R.I., who is in Liberia for a two-month medical mission focused on training health-care personnel in church-affiliated institutions to care for Ebola patients without contracting the virus.
During a telephone interview with the Register, Deacon Flanigan emphasized that qualified experts are desperately needed to oversee the adoption and promotion of guidelines designed to curb the pandemic in West-African countries like Liberia.
Deacon Flanigan spoke with the Register at the close of a typical day that featured the distribution of protective equipment and staff trainings at a health-care center. He also assessed a clinic’s triage system and reviewed the proposed design of an isolation unit for Ebola patients.
It is danger\ously late for Liberian medical institutions to be adopting such measures, but in the early phase of the outbreak, they lacked access to basic medical equipment and did not know how to fight a deadly virus that has since claimed an estimated 4,000 lives, mostly in West Africa.
Ill-Prepared to Meet the Crisis
When Ebola patients first began arriving at hospitals in Monrovia, Liberia’s capital, nurses and doctors did not even have latex gloves or masks to protect themselves. Hospital staff, including religious men and women at Catholic missionary hospitals, contracted Ebola and died. In Monrovia, all three of the city’s primary hospitals closed because of the crisis, deepening the fear and distrust of residents.
“When I left the U.S. for Liberia, I expected that fear of Ebola had already inflicted a deep wound in this country, in part, because it attacks families in the household and health-care workers,” said Flanigan, who noted that the virus is only spread after the patient shows symptoms, and thus relatives and medical personnel are most likely to become infected.
“Ebola can paralyze a health-care system, and I have seen that. But I am also in awe that many health-care workers still go to work,” he said.
Now, doctors and nurses use protective gear, and they are also learning how to care for patients without touching them.
Further, community leaders have begun to share public-health guidelines with local residents.
The first rule, said Flanigan, is that “only one person in a family can be exposed, and that person must be trained to prevent infection.”
Then, once the Ebola patient has been hospitalized, the family member who transported the sick person must be quarantined.
“After that, you wait 21 days to see if the infection will develop in the family member. That is how you break the chain of infection.”
When Flanigan left for Liberia with a large shipment of donated protective gear, he hoped he could play a modest role by helping local Catholic institutions to adopt new protocols and provide training throughout the city and outlying towns. Six weeks later, he is impressed that so many clinics have adopted updated guidelines for treating and caring for the sick.
“I recently visited St. Peter Claver Clinic, just outside the capital. After a co-worker died at the clinic, they took a month off to reassess their health precautions. Then they reopened,” noted Flanigan.
He is working closely with a number of Catholic missionary orders in Liberia, including the Franciscan Missionaries of Mary, the Consolata Missionary Sisters and the Hospitaller Order of St. John of God, and has been “moved” by their efforts to care for the sick under immensely challenging conditions.
“This is their vocation,” he observed, noting that volunteers and missionaries regularly gather to pray the Liturgy of the Hours.
Like other sectors of the country, Catholic religious orders that serve the sick have struggled to respond to myriad challenges posed by the Ebola outbreak.
St. Joseph’s Catholic Hospital, the largest Catholic medical institution in the capital, was closed after the deaths of nine health-care workers, including religious men and women. The hospital is run by the Order of St. John of God and supported by the Diocese of Monrovia, and Flanigan has helped to conduct trainings and develop effective triage-and-isolation units that must be in place before administrators can begin receiving patients again.
The Order of St. John has “suffered terribly” in the wake of the pandemic. And he noted that a Spanish-born member of the order, Brother Manuel García Viejo, 69 — a tropical-medicine specialist based in Sierra Leone, who served in the region for 30 years — had become infected and subsequently died, after he was flown to a hospital in Madrid, sparking headlines in Spain.
People “blamed the order for bringing Ebola to Europe,” said Deacon Flanigan, in a reference to public reactions to the news that a Spanish health-care worker, who cared for Brother Manuel, later tested positive for Ebola.
Failure to Respond
At the time of Brother Manuel’s death, the World Health Organization (WHO) estimated that 2,600 had died from Ebola, but just weeks later, the death toll has surged to 4,000. Meanwhile, WHO now predicts that there could be 10,000 new Ebola cases a week by December.
Experts say the rapid increase in Ebola cases reflects the failure of West-African governments and international public-health groups to respond quickly to the outbreak.
Liberia is one of three West-African countries brought to its knees by the Ebola pandemic, and public-health experts fear that it could destabilize the entire region, with political and economic consequences far beyond Africa.
The outbreak is “unquestionably the most severe, acute public-health emergency in modern times,” Dr. Margaret Chan, the director general of the World Health Organization, said in an Oct. 13 statement, reported The New York Times.
“I have never seen a health event threaten the very survival of societies and governments in already-very-poor countries,” said Chan.
The rapid spread of Ebola, she warned, threatens political stability, but it also exposes vast inequalities between health care in the developed and the developing world.
“The rich get the best care,” she said. “The poor are left to die.”
Indeed, while the CDC is evaluating problems in the Dallas hospital that resulted in the infection of two health-care workers, and helping U.S. hospitals prepare to safely treat Ebola patients, the government in Sierra Leone has directed its citizens to care for infected family members at home — a new policy that confirms an acute shortage of hospital beds in that country.
On the Front Lines
Right now, Catholic hospitals and clinics on the front lines of the pandemic also need more help, as they prepare for an expected increase in patients.
Flanigan will return to his work and family at the end of October, and he hopes to get other experts involved in the fight to combat Ebola in a desperately poor region.
“What is needed are individuals who have the courage to come over and help,” he said.
He emphasized that it is possible to “work here safely” and that experts are needed to direct an institutional response to the outbreak, rather than treat Ebola patients.
The shortage of experienced medical personnel in Liberia, he suggested, reflects the deep fears that Ebola stirs up in people, not only in Africa, but in the West, especially in the wake of new reports of infections in Texas and Spain.
“Many who could help are paralyzed, and that is sad. But if you came here, you would see that life does go on. You can accomplish a lot and help a lot,” he said.
The people in Liberia, he observed, are grateful not only for the assistance of medical experts, but the solidarity they express by coming to be with vulnerable people facing great peril.
“Anxiety is in the air. It is enormously helpful for the people and the Church in Liberia to see others come forward to be with them,” he concluded.
“Solidarity can seem like an abstract principle, but when you come here, that is truly solidarity in action, day to day.”
Joan Frawley Desmond is the Register’s senior editor.
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