Chapel Hill News

August 15, 2014

Chapel Hill doctor on the front lines of the fight against Ebola

UNC’s Dr. Billy Fischer spent three weeks battling Ebola in Guinea, one of three countries hit in the worst outbreak ever of the virulent hemorrhagic fever, which is killing Africans by the hundreds – and some of the health care workers trying to save them.

Four vital days had already passed when the foreign doctors heard about the woman and her 9-year-old son, locked in their home by neighbors because she showed signs of Ebola, the deadly hemorrhagic fever that had been decimating their village in southern Guinea.

The virus is spread by bodily fluids of the infected, and it’s likely that she contracted it while helping ritually wash one of the dead, a custom in the area, then passed it to her son.

The weakening boy watched his mother die in the truck on the way to the Doctors Without Borders clinic.

“He barely had a pulse when he arrived, and we weren’t able to even detect his blood pressure, and his clothes were soiled with diarrhea and vomit,” said Dr. Billy Fischer, 38, of UNC’s School of Medicine, who was sent to the town of Gueckedou in Guinea in late May by the World Health Organization, the first time that group had ever dispatched critical care doctors to help fight an epidemic.

Fischer said that he’ll never forget the frightened boy’s eyes, looking up at the doctors and nurses, who in their protective suits and respirators might as well have come from space.

There are no drugs that target Ebola yet. But with simple, aggressive critical care techniques, Fischer and his colleagues were driving down the death rate, which historically had been nearly 80 percent for the strain involved.

And they used those techniques on the boy. Basic stuff, pumping him back full of fluids and electrolytes such as potassium to replace all he had lost. His pulse and blood pressure came back, and he even mustered a faint smile when they handed him a packet of cookies.

“That smile sucked you in,” Fischer said Friday in an interview. “You thought you had a shot, you thought you had a little bit of hope there. I will never forget that there was just this little glimmer of hope, this little bit of confidence we’d get him through this.”

At one hospital in Guinea, aggressive use of rehydration, electrolytes and frequent condition checks drove the mortality rate down to about 40 percent, and Fischer had great hopes for the boy.

Then the next day, the doctor came in for his morning shift, feeling pretty good and a little excited to see the boy. Then he noticed the boy’s name was missing from the board listing patients. Overnight, the boy had begun vomiting blood, and quickly he was gone.

An indelible horror. And just another day on the front lines of the biggest outbreak of Ebola in history.

More than 1,300 people in three West African countries have contracted the illness, and nearly 730 had died as of Friday.

More than 100 health care workers in the affected countries, which also include Sierra Leone, have contracted Ebola in the current epidemic, and about 70 of them have died.

It’s not unusual for health care workers treating Ebola patients to contract it, but usually that happens early in an outbreak, before it’s clear the culprit is Ebola and doctors and nurses begin taking proper steps, Fischer said.

‘A humbling experience’

Fischer worked in Guinea for about three weeks. At the facility where he worked, the main safety precaution was an outfit that was nearly debilitating in the heat and humidity of West Africa. It consisted of heavy rubber boots, goggles, an impermeable heavy paper suit like those worn by painters, a hood, two pairs of gloves and a respirator.

The workers themselves would lose large amounts of fluids while wearing the suits and overheat. They could tolerate them only for brief stints. In Fischer’s case, the longest he lasted was a little more than two hours, and the briefest was about 30 minutes.

“The first time I had it on, I really thought I wasn’t going to be able to do it,” he said. “It was a humbling, humbling experience.”

The second shift in the suit on his first day, he turned pale, developed a hammering headache and exhaustion. Others on his team had to keep pouring water on his head.

The suit remained brutal, but he “kind of acclimated” after a few days and managed to survive it.

Health care workers also face the threat of violence from local residents.

Guinea is one of the most impoverished places on the planet, and the literacy rate is low. The people have been subjected to one civil war after another spilling over from neighboring countries, and the only time they see well-resourced medical teams is when people start dying, Fischer said.

It’s perhaps inevitable that some begin saying that the outsiders actually cause the diseases they have come to treat, especially when their loved ones go into the medical facility with modest, nonspecific symptoms and then between 60 and 90 percent of the time come back out in a body bag.

On the weekend that Fischer left, two Guinean workers at the treatment center were attacked and wounded by machete-wielding residents.

A diverted plan

When he left the United States, Fischer wasn’t even supposed to be heading for Africa. He was initially supposed to go to Geneva to work on technical documents about two other emerging illnesses. But as the outbreak started to take off, the WHO started looking for doctors who spoke French, had training in critical care medicine and had lived in harsh environments before.

The new assignment required some serious phone calls between Fischer and his wife, Leah, who was home with their two young sons, and with his father. The WHO has kept tours short for doctors it sends to fight the outbreak because the work is so hard, physically and emotionally. It’s also hard to be home, Fischer said, little more than a spectator as the epidemic continues. He may eventually go back.

His own safety was important, Fischer said, but it pales given the stakes. “I thought, if I could improve the care of people there, if I could reduce mortality,” he said, his voice trailing off. “At the end of the day, every one of those patients has a mother, a father, a brother, a sister, a son, daughter, and they have the same dilemma I and my family had, but who’s looking out for them?”

In often wrenching emails home, Fischer wrote about his experiences, including the all-too-rare good moments. And there were some, like when patients who were declared cured were discharged, at once a victory over the virus and a public health victory, because of the example it set for skeptical locals.

In one dispatch, he all but crowed. “Yesterday, we had two and it was pretty emotional – the entire physician and nursing team were clapping and yelling as these two men walked out. Today we have another potential and I’m waiting for her test now.”

But then he wrote this: “A truck has just rolled up with a pretty sick woman and child, will write more later.”

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