The challenge of stopping Ebola when it keeps killing doctors

Sheik Umar Khan is being hailed as a national hero by Sierra Leone for his efforts to combat the worst outbreak of Ebola on record. Khan succumbed to the disease on Tuesday. (Reuters)

Daniel Bausch knows his way around an outbreak. The bald, grizzled doctor with Tulane University has traveled throughout Latin America, Asia and sub-Saharan Africa, battling terrifying viruses from SARS to Ebola. He advises bigwigs at the World Health Organization, United Nations and the National Institutes of Health. He pumps out research article after research article on Ebola.

Dr. Daniel Bausch and Dr. Sheik Humarr Khan. (Photo by Frederique Jacquerioz)
Dr. Daniel Bausch and Dr. Sheik Humarr Khan. (Photo by Frederique Jacquerioz)

But even Bausch, for all his experience and expertise, had never seen anything like this. On a recent July day at a Sierra Leone hospital in Kenema, he found himself amid 55 patients infected with Ebola. Bausch, except for one other doctor, was alone. The nurses, according to a Reuters report, had vanished. They wanted higher pay to take care of Ebola patients and, after several of them became sick themselves, had gone home.

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“This is for sure the worst situation I’ve ever seen,” he told Reuters. “…None of us expected to have as many healthcare workers get sick as we did.” Ten staff had gotten sick with Ebola during his three weeks at the ward. “There were times when nurses were getting sick and I thought, ‘We have to close this ward,’ but that’s just not an option.”

Since the worst Ebola outbreak in history first emerged in March in West Africa, 1,013 have died — including 81 health-care workers of 170 infected, according to statistics just released by the World Health Organization. The Liberian government announced on Monday the producer of the drug ZMapp, which treated two American healthcare workers, was shipping more of the drug to treat infected Liberian doctors.

But even with that announcement, the sheer number of deaths among healthcare workers and the subsequent fear have crippled some medical units fighting Ebola, which is currently killing around 60 percent of those infected. The recent strike of nurses in Sierra Leone “unfortunately does reflect those fears and it’s a normal fear for someone to have, of course,” Bausch told NPR. “Unfortunately, you get into a very negative cycle where you have a healthcare worker who gets sick. That causes more fear on the part of others, who then tend not to come to work and you get less and less healthcare workers in the wards, making a situation that becomes even less safe.”

On one such day at the Kenema unit, Bausch climbed into his biohazard gear — safety goggles, rubber boots, a mask, a plastic apron and full-body suit. He was likely already making tough decisions. “Even if you wanted to be a hero, you couldn’t take care of 55 people,” he said an interview with the New York Times. The goal, he said, wasn’t to treat the sickest — but the sickest who had the best chance of surviving. “If you’ve seen cases of Ebola before, you can see when someone is on their last gasp and trying to treat them won’t save them,” he said.

In this photo taken on Sunday, July 27, 2014, medical personnel work at the Doctors Without Borders facility in Kailahun, Sierra Leone where Dr. Sheik Humarr Khan died. A leading doctor who risked his own life to treat dozens of Ebola patients died Tuesday, July 29, 2014, from the disease, officials said, as a major regional airline announced it was suspending flights to the cities hardest hit by an outbreak that has killed more than 670 people. Dr. Sheik Humarr Khan, who was praised as a national hero for treating the disease in Sierra Leone, was confirmed dead by health ministry officials there. He had been hospitalized in quarantine. (AP Photo/ Youssouf Bah)
On July 27, 2014, medical personnel work at the Doctors Without Borders facility in Kailahun, Sierra Leone, where Sheik Humarr Khan died. (Youssouf Bah/AP)

Inside the ward, according to a New Yorker column, were many who appeared to be on that last gasp as he and the hospital’s director, fellow doctor Sheik Humarr Khan, got to work. “The floor was splashed with blood, vomitus, feces, and urine,” Bausch told the New Yorker, adding that floor was strewn with patients who had fallen out of bed. “You need a whole team to decontaminate the bed and lift the patient up off the floor and put him safely back in bed.”

Days later, Khan got sick. On July 29, after treating dozens of the infected, he died. Among his last words, the New Yorker reported, were to another hospital worker. “James, I am going,” he said. “You have to carry on.”

That has been difficult. “The ones who have passed are the only ones who would go into the Ebola ward,” a doctor named Joseph Fair told the magazine. “Now we have a huge void.”

Though the reasons are many, ignorance and impatience are two of the leading factors behind why many healthcare workers are dying, experts told Reuters. Protecting oneself against Ebola in hot conditions is a complicated and arduous business. Masks can fog. Just taking off protective gear can take 45 minutes, Reuters reported. Another person needs to help. After the healthcare worker disrobes, they’re doused with chlorinated water.

Though some workers worry, experts with the World Health Organization told Reuters the suits themselves are sound — but local doctors are misusing them. Indeed, Bausch said he saw some healthcare workers wearing only scrubs examining patients before the proper equipment arrived. And sometimes, even protective equipment doesn’t help.

“Even with the full protective clothing you put on,” Khan told NPR not long before he died, “you are at risk.” Workers might stick themselves with needles accidentally or take off protective suits incorrectly.

As the worst Ebola outbreak in history unfolds in West Africa, The Post's Joel Achenbach explains how the deadly virus wreaks havoc on the human body. (Davin Coburn/The Washington Post)

Hospitals treating Ebola patients can, in short, be a terrifying place to work. “Don’t touch the walls!” a Western worker at a Kenema facility told the New York Times this week. “Totally infected.”

“We’re very worried, now that our leader [Khan] has died from the same disease we’ve been fighting,” one worker told Reuters. “Two of my very close nursing friends have also been killed … I feel like quitting the profession this minute.”

Terrence McCoy writes on foreign affairs for The Washington Post's Morning Mix. Follow him on Twitter here.
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