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Pediatrician offers firsthand look at Liberia

July 31, 2014

Dr. Jackson Williams, a pediatric hospitalist at Baystate Children’s Hospital who has brought his medical expertise to Liberia many times, knows firsthand what the stress of a massive Ebola outbreak now hitting Liberia can place on an already stretched health care system.

A strained ratio

"The health care system in Liberia was left devastated after years of civil war. As a result, Liberia has struggled to rebuild their system as they have been left with very little infrastructure or trained caregivers to treat patients," Dr. Williams said.

He noted the ratio of doctors in the country is less than one doctor per 100,000 people. In Massachusetts, for example, we have over 450 doctors per 100,000 people.

"Now, adding to the situation, we are hearing from contacts in the region that some health care workers are not showing up for work for fear of becoming infected," he added.

A whirlwind campaign

Dr. Williams is now part of a fundraising effort being led by the Academic Consortium To Support Medical Education in Liberia (ACSMEL). It was formed by pediatric caregivers at Baystate Medical Center, Boston Children’s Hospital, and UMass Memorial Medical Center.

"We are heavily involved in training Liberian medical students and interns. In the last year we also helped launch the first pediatric residency program in the country," Dr. Williams said.

Since launching the fundraising effort to support clinicians in Liberia in their fight against Ebola, ACSMEL has raised more than $20,000.

"We raised half of those dollars in just 18 hours through fellow co-workers, former residents, and friends and family," said Dr. Williams, who noted about 25% of the funds raised to date have come from Baystate Medical Center employees alone. "Still more have come from our friends and family, as well as pediatric residents we once helped to train."

A devastating outbreak

Now, their work to help rebuild a troubled health care system and to advance pediatric care in Liberia is jeopardized due to the outbreak – now considered the worst-ever in the world.

Dr. Williams along with pediatric residents from Baystate Children’s Hospital were to travel to Liberia in April, but cancelled that visit due to the outbreak that started in late March, which has since killed more than 670 people in Guinea, Sierra Leone and Liberia.

"Since the outbreak, we have lost some of the country’s best doctors and nurses in Liberia. I personally knew and worked alongside Dr. Sam Muhumuza, who died several weeks after treating patients with Ebola and becoming infected with the deadly virus himself. He was an amazing physician, surgeon, and human being. He worked tirelessly in difficult conditions without complaint," Dr. Williams said.

Dr. Williams noted Dr. Muhumuza was the chief of surgery at Redemption Hospital, Liberia’s busiest public hospital.

According to the Baystate pediatric hospitalist, medical students and interns he helped train in Liberia have now begun to fall ill with the deadly virus. The Ebola virus was first detected in Sudan and Zaire in 1976. Since that time, the Centers for Disease Control and Prevention (CDC) cites 3,140 reported cases have been documented along with 2,000 deaths since its discovery. About a third of these cases and deaths have now been attributed to the current outbreak in West Africa.

Symptoms and spread

The often deadly virus can be transmitted to others through direct contact with the blood or secretions of an infected person, as well as through exposure to objects, such as needles, that have been contaminated with infected secretions.

According to the World Health Organization, there is no specific treatment or vaccine for the disease. The fatality rate can reach up to 90%. Patients are given supportive care, which includes providing fluids, electrolytes, and food.

Typical symptoms are fever, headache, joint and muscle aches, weakness, diarrhea, vomiting, stomach pain and a lack of appetite. They may appear anywhere from 2-21 days after exposure to the virus, but most commonly appear within 8-10 days.

Risk to healthcare workers

According to Dr. Williams, health care workers like Dr. Muhumuza are at great risk for contracting the disease while working in hospitals and clinics where protective equipment such as masks, gowns and gloves are in short supply.

"These supplies are needed to protect health care workers, who are at the forefront of caring for these infected patients, from becoming infected themselves and bringing the virus home to family members and others they may come in contact with," Dr. Williams said. "We hope these funds can be used to provide a more organized approach to treating the disease by creating special quarantined sites where patients can be treated, as opposed to in hospitals where they might infect others."

The CDC, which is carefully monitoring the African outbreak to help keep it contained, is asking health care workers throughout the United States to ask patients if they have recently traveled to West Africa. They are also asking healthcare workers to know and be alert for signs and symptoms of Ebola. These measures are precautionary; most doctors agree it is unlikely that a widespread outbreak would be seen in this country.

Dr. Daniel Skiest, chief, Infectious Disease Division, Baystate Medical Center, agrees. “While it is possible for Ebola to cross into the United States given the amount of worldwide travel today, with the medical resources available in this country and our ability to effectively quarantine patients, there is little worry about any widespread outbreak occurring in the United States,” he said.