On the train...

And so begins my blog about what it’s like to be a medical person helping out with the Ebola epidemic in West Africa.

I’m on a train in New York at 10:00 in the morning, Tuesday, January 26, hoping to get to Boston ahead of the blizzard. Once there, we are supposed to have three days of training, followed by departure for Sierra Leone on Saturday. We’ll see if the storm interferes with all that.

I should give everyone a little information about me. I am an anesthesiologist who finished his residency just last year at a very unusual age (53). Prior to that I was an actor for 10 years or so, and then a public health researcher and occasional program officer, focusing on international reproductive health.

You might be surprised to hear that an anesthesiologist is going over to help out with Ebola. I am mildly surprised myself (!). Because if one thing is clear, it is that I will NOT be doing standard anesthesia – keeping patients comfortable, safe, and healthy during surgery and other procedures and events – while I’m in Sierra Leone.

Many anesthesiologists ARE trained for extended periods in intensive care, which is pretty directly related to taking care of patients who may be gravely ill. I am not, however. What I am trained in – like all anesthesiologists – is maintaining the good functioning of patients’ body systems through hands on care over extended periods of time. In particular, we’re very accustomed to making sure patients have enough water in their bodies to successfully carry out bodily functions. Which is extremely important for a disease like Ebola. If you are vomiting and having constant diarrhea, you lose a LOT of water, and if you lose a lot of water, eventually your body just can’t function (this is what kills people who have cholera, or babies with intractable diarrhea). So my skills in this department – including but not limited to getting IVs and other “lines” into people when this may be difficult – probably will come in handy.

In any case, it wasn’t my decision. Partners in Health – the wonderful health-and-social-equity NGO which hired me – made the call. They sent out a mailing last fall asking for medically trained people; I responded; and they, knowing my background, took me on. I can only assume that the skills I have, coupled with the training they will give, will turn me into someone who can be of use.

And, interestingly enough, it is that question – “will I be of enough use?” – that causes me anxiety, much more than any question about personal safety. If you look at the numbers, the work simply isn’t that dangerous. Furthermore, it is important. If this outbreak were to morph into an uncontained, widespread, chronic condition of life here on earth, it would make all of our lives worse and more difficult for a long time to come (think AIDS circa 1985 crossed with the bubonic plague). If on the other hand it can be turned into a brutal, extended, but ultimately contained event (and things are looking up for that), then all of us will have dodged a bullet. It’s worth risking something for that chance.

Plus, as far as I know, all of the western medical people who have contracted Ebola have survived. It doesn’t sound fun to go through (although maybe not SO bad if you catch it early!), but the people have lived. This helps make the risk seem – just not that bad.

Note I am speaking here about WESTERN, “developed-country” medical people. Many, many local doctors, nurses, ambulance drivers, burial assistants, etc., etc., etc. have gotten sick and died. They are the ones really putting their lives on the line. It really makes me roll my eyes when I hear people talk about the western folks going over as “heroes.” Yes, I’m glad we’re doing it, yes, I think it helps, yes it’s probably important (among other things, to help strengthen health systems so the need for outside help next time will be lower). But up against the courage and commitment of people who put themselves out there 14 or 15 or 16 hours a day, 6 or 7 days a week, for months not weeks, with inconsistent, often shitty equipment, for little or sometimes no compensation, in settings where the resources available are rudimentary, and where, should you become ill, the treatments will be rudimentary, as well – well, I hope you can see that the “heroism” gap is pretty darn wide - ! Read the New Yorker story a couple of weeks ago about Liberia and Sierra Leone; look at the part about the two brothers who are (or, sadly, for one of them, were) ambulance drivers. That’s what I’m talking about.

So I’m not too afraid for myself (though I will of course be careful!). I’m more acutely aware that the people I will be taking care of need GOOD care; that I shouldn’t offer to care for them if I can’t give them good care; and that I’ve never done this before! I am concerned that I meet the obligation. That any learning curve I go through is a reasonable one. That I don’t screw up.

But I know that I’m not stupid or especially lazy; I know that every time I have tried to learn a medical skill, I have been able to; and I know that Partners in Health cares about their work and is not in the business of sending people to do it who won’t do it well. So I’m assuming I’ll figure it out. That’s what the next few days are about.