This in not an official U.S. Department of State (DOS) blog and the views and information presented are my own and do not represent the Fulbright Program or the DOS.
As I write I am embarking on my journey to Uganda to complete my Fulbright Specialist Program (FSP) project with visit 3 of this grant. This is definitely NOT my last trip to Uganda, but the nature of the FSP is to conduct and complete a short-term project with the host institution, Makerere University School of Pharmacy in my case. So this is my last official trip for the development of the Pharmaceutical Care curriculum with support from the U.S. Government. My goals for the next month are to teach some more classes and observe the teaching of the course by Makerere faculty, to assess student learning, and assess the curriculum and process of teaching and make any necessary changes to ensure continuity in the future by the University faculty. Wow, as I wrote that I realized I definitely have a challenge ahead but working together with the Pharmacy School faculty will make this doable.
Over the past few weeks as I’ve had interactions with family, friends, co-workers, and fellow church members and explained that I’m headed back to Uganda again, there has been one common question: “But aren’t you scared of getting Ebola?” I have decided to dedicated this post to my recurring answer and maybe it can help to calm not only those who care about me but people all over the world as this tragic epidemic continues and threatens to break loose and wreak worldwide havoc.
As I wrote out my usual answer, I realized it was quite long so I’m going to get to the bottom line right away. For those that want a more detailed explanation, continue reading on past the bullet points below.
• Uganda is in East Africa, 6900 miles away from the epicenter in the West African countries of Guinea, Sierra Leone, and Liberia. This is 2.5 times further apart than New York City and Los Angeles, California are.
• Ebola is contagious only by direct contact with the virus loaded bodily secretions of someone infected: blood, vomit, diarrhea, etc. – As a pharmacist, I do not usually directly care for patients in terms of physical examination or caring for these types of symptoms.
• The fever comes first, then as the patient gets sicker the other symptoms occur leading to release of secretions. You can’t get it by touching a person with only a fever and no secretion production.
• Ebola is not transmitted by the airborne route. You can’t get it by breathing the air around the infected person. We should all be worried more about catching Influenza is much more contagious and you can get it if you are not vaccinated and are standing within 3 feet of a coughing person with the flu.
• Uganda has not had a single case of Ebola from this current epidemic, although the healthcare system is quite familiar with caring for patients and containing this disease from outbreaks in the past. Currently they do health screening at the airports and all borders as well as have a system in place to isolate any patients that could possibly have Ebola, until it is ruled out.
• Ebola is certainly a scary disease and we should have a very healthy respect for it and know how to protect ourselves. Mass hysteria and propagation of falsehoods regarding risks, though, is not helpful, nor is ceasing work in countries and areas not affected by Ebola where people and systems rely on the help of others like me.
• I read an article today from a newspaper in Council Bluffs, Iowa about a high school girl who is going to Uganda on a mission trip (or already went) who has agreed to voluntarily quarantine herself for 21 days after arriving back in the USA due to concerns of the townspeople and parents of the other kids at her school. Unless this girl has directly cared for patients with Ebola, she is not at risk for getting the disease. And she can’t transmit the disease to anyone else unless she actually comes down with Ebola and is emitting bodily secretions, which she can’t get if she didn’t actually take care of Ebola patients. And there are no Ebola patients in Uganda at this time. This is just an example of how very poor decisions are made when people don’t take the time to learn the true risks. The article also stated that Uganda was in Central Africa, which is not true. There is no reason for this young woman to be kept away from her school friends and classes for 21 days just to quell the unfounded fears of the townspeople. I certainly understand the fear of getting Ebola and if it were transmitted by respiratory route this whole thing would be a different story. Before things get out of hand, proper education should done.
Now for my longer answer and commentary for those who are interested:
To be at risk for contracting Ebola several things need to happen. First of all, you need close proximity. You have to be near someone who has the disease. I am going to Uganda, which is in SubSaharan East Africa while the Ebola outbreaks are in West Africa. To give you an idea of how far I am away from anyone who has Ebola, consider the distance from Monrovia, Liberia where Ebola maintains a stronghold to Kampala, Uganda where I will be spending the next month, is 6900 miles apart. That is 2.5 times greater than the distance between New York City and Los Angeles, California. Of course, air travel condenses this space but there are many less people flying between West and East Africa than between NYC and LA daily and my flight to Uganda come from Detroit to Amsterdam to Entebbe, Uganda.
Next the disease in question needs to be contagious person to person. Ok, so Ebola is spread person to person. An example of a disease that is not contagious but is widespread in Africa is Malaria. A person who has Malaria can’t give it to someone else. [Bonus information: You can only get it from being bit by the female anopheles mosquito who harbors the parasite in her saliva. This is injected into the human when she takes a blood meal (bites you) for the sole purpose of feeding her embryos (baby mosquitoes in utero, in other words). Male anopheles don't bite humans- they don't need blood to survive. So the natural instinct of a mother to care for her unborn children is why humans get infected with Malaria. Interesting, huh?]
Then you need to consider how the disease is spread. We can all “thank our lucky stars”, as my mother used to say, that Ebola is not transmitted by the airborne route. You have to be in direct, unprotected contact with the bodily secretions (blood, vomit, diarrhea, urine, etc.) of a patient who has Ebola to get the disease and patients who are infected don’t start to develop these secretions and bleed until they have a fever. You can’t get Ebola from a patient who breathed on you or coughed in your presence. Influenza, on the other hand, is an example of a disease that is highly contagious by the airborne route. The possibility of contracting the flu should be of much greater concern to Americans and worldwide.. Although to most it means just a rough week at home in bed with a fever and feeling terrible, more than 58,000 people in the USA died in 2011 from influenza and pneumonia combined. (These are kept together because influenza often leads to pneumonia.) Maybe you are willing to risk getting the flu rather than getting the vaccine to prevent it, but you may not realize that before you even know you are really sick with the flu, you may already be spreading it by coughing and sneezing to anyone who comes within 3 feet of your airspace. And you never know when someone who gets it from you might have a severe illness and require hospitalization or even dies from influenza.
So let’s say a person does come into direct contact with the secretions of a patient who has Ebola, in order to get the disease you still have to get those secretions past the barrier of your skin. So if a healthcare worker, for example, is wearing protective gear but gets some on his skin while removing the gear AND the skin isn’t broken, like with a rash or cut, then it can be immediately washed off and the worker should be fine. The trouble comes when the worker unknowingly gets secretions on skin and it isn’t washed off or if the hand is contaminated and the person touches his mouth or eyes. Even then, contracting Ebola isn’t an automatic death sentence. In past outbreaks across the world, the fatality rate has sometimes been as high as 80-90% but fortunately the rate with this epidemic seems to be about 40-50%. The people who are most likely to survive Ebola are those with excellent supportive care given really early after diagnosis. Supportive care includes everything we do to help sick patients except for drugs or serums that are directly able to treat the virus. So this mostly includes stuff like hydration- giving plenty of fluids, possibly blood transfusions for patients who are bleeding, etc. Unfortunately, that seems not be be possible with many of the Africans who are infected. Since I’ve been doing work in Uganda since 2011 (this is my 6th visit there), I’ve realized that the Ugandans, and probably most Africans, are very self-reliant and do not seek medical care quickly when supportive care is most effective and helpful. They often try traditional medicines, herbs, and these actually do work sometimes for certain diseases- not Ebola-, or they just tough-out minor illnesses like colds and respiratory tract infections. They don’t even always seek care to suture wounds if not profusely bleeding and they think they can get it under control. This is one reason Tetanus is still a big problem and causes many deaths here. Even deep wounds can often heal on their own without stitches but the supportive care of a Tetanus Vaccine can truly be life saving and this isn’t obtained when a patient doesn’t seek healthcare. Ok, I digressed again. The bottom line is that I think that in the beginning of the outbreak, those affected probably didn’t realize the severity of their illness and seek care until it was too late. The longer the person suffers from the Ebola virus, the more virus particles grow in their blood and the more contagious they are to those who care for them. So not only is the prognosis much more grim, but more people become infected from the contagiousness of the body fluids. I would think currently the people in these countries are well aware of the symptoms and threat of Ebola and are trying to get to healthcare early, but their healthcare systems are breaking down due to the masses of those now infected and the numbers continue to grow. The countries where Ebola still has a strong grip, really need the help of the developed world. The USA should get involved, as we are doing, not only for the obvious humane reasons, but to also contain this disease before the numbers of those infected surpass the ability to get it under control. I just read an article in the NY Times today while on the flight that said an effective Ebola vaccine has been ready for human trials for 10 years but no drug company would sponsor it and provide the financing for this research because there wasn’t a market for it. From a business perspective, this makes sense, but this is a disease that should be in the interest of all the world to eradicate. It would be nice if drug companies could work together to solve this and share the cost burden or maybe World Leaders need to team up to figure this out. Unfortunately it has taken this growing Ebola epidemic to catch the world’s attention, but now there are plans for vaccine trials. I hope we can use this experience to look back for possible other untapped opportunities to arrest population-threatening diseases and think forward about how to get on top of this via research and infection control education before we are caught by surprise again.