Ebola Causing 'Collapse Of The Health Care System' In West Africa, Boston Doctor Says

A group of Boston doctors just finished the first Ebola response training program run by the Centers for Disease Control. They're part of a larger contingent that Boston-based Partners In Health will be sending to parts of West Africa, where the virus is running rampant.

The chief medical officer at Partners In Health, Dr. Joia Mukherjee, was in Monrovia, Liberia, last week and at this week's CDC training.

WBUR's Sacha Pfeiffer spoke with Dr. Mukherjee and asked about reports of Ebola deaths happening in the streets of some west African communities.

Dr. Joia Mukherjee: You see that in isolated areas, maybe in one neighborhood of the city or maybe in one village. I mean, the city itself looks like a normal African city. It's bustling. People are going to work. They're in the market. So you don't see sickness everywhere you go, but there is a sense of foreboding. At every major public building and private building, such as a government hospital or a private hotel, there's a hand-washing station outside. No one is shaking hands; people will just bump elbows and stand at their requisite couple of meters away from one other. So you do see the presence of the fear and the infection control that people are trying to do, but you don't right now see this kind of rampant death.

WBUR's Sacha Pfeiffer: When you talked about infection control like hand-washing stations, is that accompanied by a lot of either billboards or public service announcements that get the word out that people need to try to follow certain protocols so it won't spread even more?

Yes, there's a lot of public education campaigns going on, a lot of posters. When you use your cell phone a message comes up about Ebola. Initially there was a lack of acceptance about Ebola even being real, so a lot of the education is about that, but I think it's less about that now than just trying to instruct people how to stay as safe as possible.

Despite those measures, the virus is still spreading. What do you think it will take to stop that spread?

I think part of the problem with public education campaigns in a very poor setting is less about people not understanding than about not having any alternative. So, for example, if you're a mother or a wife and your husband falls ill, you're going to take care of the person in your family. And if you were able to say, okay, there's a number I can call or a community member who can go alert an ambulance who will come and immediately take this person, you can limit infection. But right now that mechanism to remove people from their homes or their communities as soon as they're sick is just not sufficient.

We've heard many reports of people who go to hospitals for treatment and are turned away because they can't accommodate them. Is that happening in Liberia?

Absolutely, absolutely. Every day. What's happening is the general collapse of the health care system because physicians and nurses and other health workers are staying home. They feel unprotected and unprepared to deal with this — and they are. They're correct. So one of the efforts of Partners In Health is going to be to try to do general health system strengthening and try to help the district hospital level before even people walk in the health workers have the proper protection, they have triage at the gate, can move people with suspect Ebola out of the general hospital environs to an Ebola treatment unit, and take in the people who need treatment for malaria or need treatment for an obstetrical emergency because right now it is very difficult for health workers to do their jobs. They're very afraid and they're very, very unprotected for the threat

I understand that at the CDC-sponsored training you were doing this week there was a session designed to "orient participants to the unstructured situation and empower them to refuse to do things they are not equipped or prepared to do or to work in unsafe environment." Can you tell us more about what that means?

Yeah, I mean, I think many of us physicians, nurses, we take an oath, we're very serious about our commitment to patients and to really care for them. But if you're not properly protected and someone is very sick with Ebola, particularly if they're vomiting or they're in the later stages where we know the excretion and the shedding of virus is very high, it is an extremely dangerous situation for the health care worker. And so it's not advisable to provide care until you're in the proper protective gears.

So doctors need to be comfortable saying, "I cannot help you now because I don't have the proper equipment"?

That's right. So if I saw a child, for example, in my normal life who was throwing up blood and unstable, I would rush in and try to stabilize that child. And what we're learning is you can't really do that with Ebola without putting on the proper protective gear lest you become infected. It's that infectious.

Related: Boston-Based Partners In Health Leaps Into Ebola Crisis