Africa, Hemorrhagic Fevers, Life and Death, and The Lassa Ward

Medical staff treating Ebola patient. Photo from lakareutangranser/Flickr.

An Ebola outbreak in Guinea has been in the news the last several weeks. Ebola is a virus that can cause hemorrhagic fever. It spreads through contact with bodily fluids of the infected host. There is no vaccine or cure for Ebola, so treatment strategies are usually limited to containing the spread of the virus. This latest outbreak has claimed 106 lives in Guinea, and prompted Senegal to close its border. Possible cases in places as far away as Canada tested negative for the disease, and health workers feel this current outbreak has peaked and is beginning to die down. Ebola is frightening for its horrifying symptoms and 90% fatality rate. The virus is associated with fruit bats, and spreads to humans from contact with infected animals.  Ebola is typically isolated to remote areas of central Africa, so the current outbreak in West Africa is unusual. I have paid more attention to this latest outbreak after reading a book called "The Lassa Ward," by Ross Donaldson.

In 2003, medical and public health student Ross Donaldson traveled to Sierra Leone to study a disease similar to Ebola, called Lassa (named after the Nigerian village where it was first identified).  While Ebola gets the most press, Lassa is no less lethal.  Donaldson chronicles his experiences in this well-written memoir. He went to Kenema, a small town in Sierra Leone near the Sierra Leone-Liberia border, to study Lassa. Many patients were refuges from the war in Liberia. The Lassa ward of the clinic/hospital complex in Kenema is run by Dr. Aniru Conteh. He has a small staff of assistants with limited nursing training. Donaldson struggles to adapt to the realities of medicine in this part of the world. Donated equipment languishes in a small supply room, waiting for someone to teach the staff how to use it. Medications like antibiotics can be purchased on the open market in town, but many families lack the few dollars necessary to acquire needed pills for their loved ones. It is a stark contrast to medical school and modern US hospital settings.

The book description reads:

In a hospital ward with meager supplies, Ross has to find some way to care for patients afflicted with Lassa fever... Forced to confront his own fear of the disease, he stands alone to make life and death decisions in the face of a never-ending onslaught of the sick who are inundating the hospital. Ultimately, he finds himself fighting not only for the lives of others but also for his own life.

Donaldson deftly weaves descriptions of the role of NGOs in the region, the benefits and limits of foreign aid, the devastating down sides of the diamond trade, and the political background of the area, into his narrative of his medical experiences in Kenema. His mentor, Dr. Conteh, leaves the young medical student in charge of the Lassa ward for a few weeks, and Ross is overwhelmed by the challenge. However, he soon learns to handle the crises, think on his feet, use his training, teach skills to the staff, and care for the patients. It is a steep learning curve, but in those few months in Sierra Leone, Ross transforms from a student to a physician.

The Lassa Ward in Kenema is the only Lassa isolation ward in the world.

I couldn't put this book down. I appreciated the way Donaldson writes about the people of Sierra Leone. He gradually comes to understand their perspectives, and through his writing, I found myself gaining similar understanding. In a country where infant mortality is high, and people who reach the age of 50 are elderly, it is no surprise that a different attitude exists about death and dying. "Dr. Ross" as the staff calls him, is watching and waiting by the bedside of a young patient. He describes the scene this way:

Dr. Conteh eventually returned from his meeting to find me still at Sia's bedside. I immediately felt relieved that the ward was back under his capable supervision and that I could return to my safe role as a medical student. But it still took my mentor's simple words to finally pull me away. "Not in our hands anymore," he said with the wisdom of many years. "Now God will have his way."

This acceptance of death, and of our limited capacity as humans to do anything about it, seems to give peace to the people Ross encounters in Sierra Leone. This attitude was one thing in particular that stood out to me as I read this wonderful book. The phrase "Now God will have his way" is a marvelous one.

Today, Ross Donaldson is a specialist in emergency medicine and global health. He is a doctor and medical professor at UCLA. Sadly, Dr. Conteh, who ran the Lassa ward for many years, contracted the disease from a needle stick, became ill, and died. Another physician has been found to run the Lassa ward, and Dr. Conteh's great work continues.

I highly recommend reading this book!

For more information check out  the Dr. Ross Donaldson website