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Ebola: A Global Issue

Ebola: A Global Issue
The Grady EMS Biosafety Transport Team in Atlanta, Georgia

In early August, an ambulance and motorcade approached the Emory University Hospital in Atlanta, Georgia, carrying Kent Brantly, M.D., a healthcare worker who had contracted Ebola. The first Ebola patient to be treated in the U.S., Dr. Brantly contracted the disease while serving as a missionary in Liberia. 

Training and Drills 

Photos from media outlets all over the country displayed images of that motorcade and the paramedics who emerged, clad in white personal protective equipment. The meticulous planning that went into the transport of Dr. Brantly from Dobbins Air Reserve Base to the hospital was thanks in part to Alex Isakov, M.D., MPH ’87, an emergency medicine physician and executive director of the Office of Critical Event Preparedness and Response (CEPAR) at Emory. Over the past 12 years, he and his EMS team developed policies, procedures and training for just this type of situation. 

“When we got the call, we pulled our team together and we said ‘so, this thing we’ve been preparing for 12 years; well, we’re actually going to do it tomorrow,’” recalled Dr. Isakov. 

While the public might have been eyeing that motorcade on the news with fear and skepticism (a Washington Post-ABC News poll conducted in October found that nearly two-thirds of Americans were concerned about a widespread epidemic in the U.S.), Dr. Isakov and Grady EMS were awaiting the patient, confident and well prepared. 

“All of that education and training, all the exercises and drills, give you confidence; you’ve thought this through,” he said. “The first time you do anything, you learn something new, so drills and exercises allow policies and procedures to be refined.” 

Initially, Emory University Hospital was one of just four facilities in the U.S. identified as having a specialized isolation unit for management of patients with a serious communicable disease. According to the Centers for Disease Control (CDC), nearly 50 U.S. hospitals have since been designated as Ebola treatment centers, including four in Pennsylvania. 

“Preparing to evaluate and manage a patient with Ebola has broadly contributed to improved hospital preparedness,” said Dr. Isakov. “Communicable diseases always pose risk, especially highly transmissible diseases such as novel influenza viruses and SARS. Healthcare will be better prepared because of meticulous attention to infection control practices.” 

Judith O’Donnell, M.D. ’85 is the hospital epidemiologist, director of infection prevention and control and chief of the Division of Infectious Diseases at Penn Presbyterian Medical Center, which is under the umbrella of the Hospital of the University of Pennsylvania, now an Ebola treatment center. 

“People are getting information about Ebola from all over the place. They’re not necessarily able to digest all of it or they’re only able to digest bits and pieces of it,” said Dr. O’Donnell. “It’s important to dispel the myths about the disease.” 

Around the time that the nurses in Texas contracted Ebola after caring for a Liberian patient, Dr. O’Donnell was leading simulation drills at Penn. (Even when this issue went to print, she said she was still “rigorously preparing even though the country moved on to other current news events.”) 

“Ebola preparedness is a team sport,” she said. “We need everyone involved: medical staff, nurses, respiratory therapy, cleaning personnel, security and human resources. Every department is involved.” 

Like Dr. Isakov, she believes having to prepare to manage ill persons with recent travel to Ebola-affected countries has benefited the U.S. healthcare system. 

“It’s been beneficial for hospitals all over the country,” she said. “While specifics to Ebola may not be something hospitals need to ultimately address, this is similar to any kind of disaster drill in preparation for, say, a bioterrorist attack. It’s essential to determine how you all coordinate and work together.” 

An Issue of Public Health 

James F. Cummings, M.D. ’88 is the director at the Department of Defense’s Global Emerging Infection Surveillance and Response Systems (DoD-GEIS). He is responsible for oversight, development, functionality and fiscal accountability of the DoD’s global surveillance program for emerging infectious disease, ensuring that “America is not caught off guard.” The program has more than 130 projects conducting activities in more than 71 countries worldwide. 

“There are nuggets of goodness in anything that occurs,” said Dr. Cummings. “The tragedy of the Ebola outbreak in West Africa has reminded us that we are truly a global society; what happens in places like Liberia and Sierra Leone can affect us all. It’s because of this that we’ve improved our public health awareness.” 

Dr. Cummings, who has spent many years working on a malaria vaccine (a disease that kills more people than Ebola annually), has helped to shepherd the resources and steer the research in response to the Ebola outbreak in order to create policy changes. One such project has been planning the construction of Ebola treatment units and diagnostic labs in Liberia. 

“Unless you have good diagnostics on the ground, you are in the dark,” he said. “This is especially hard to achieve in countries that lack infrastructure.” 

Overall, he said, it’s good public health measures that “really win the day.” 

“The battle’s not over yet. Although Ebola hasn’t been breaking news recently, the conditions are still difficult in Africa at large,” said Dr. Cummings. “We have to focus on garnering attention to the issue in order to resolve the current outbreak. My hope is that this is one piece of a more enduring response for better biosurveillance and public health overall.”

A Focus Abroad
Dr. Sara Gonzalez's experiences in Haiti encourage her to get involved with an organization that helps all Liberians access health care.

Sara Gonzalez, D.O. ’03 (left) and student Christopher Kustera, class of 2015, pictured in Haiti during the Medical Alumni Counsel trip in January 2015.

Sara Gonzalez, D.O. ’03 is a specialist in the Department of Medicine at Boston Children's Hospital. She completed a global pediatric fellowship with Partners in Health in Saint Marc, Haiti, in 2012 and 2013.

“Having worked in a situation where you find yourself without basic supplies, you can understand how this disease has taken control of places like Liberia,” she said.

Her stints in Haiti, where she often lacked basic supplies to care for patients, taught her about the incredible personal sacrifice it takes to serve as a medical professional in a developing country.  “When a baby is dying in front of you, it’s really hard to say to a parent, ‘I’m sorry, I don’t have the gloves to wear to save your baby’s life,” she said. “You have to take calculated risks.”

Dr. Gonzalez’s mother and fiancé, who knew she was strongly considering going to West Africa, asked that she stay home, at least this time.

“I think we each have our limits of what we’re able and willing to give,” she said. “People who are there, serving, are doing it with a lot more community support than we recognize both personally and professionally.”

She decided that if she could not go to Liberia, the second best thing she felt she could do was to invest her time in a longer-term approach so, in addition to helping prepare her home hospital, she began to work with a friend who founded Last Mile Health. The organization aims to “ensure we not only end the current epidemic, but build a health system where all Liberians can access health care - no matter where they live.”

 “We have to build supply networks,” said Dr. Gonzalez. “We have to give people the knowledge and skills they need to help, not just the patient in front of them but the medical staff who will be there for the next 10 years.”

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