American doctor's heartbreaking tale of encounter with Ebola in Liberia
As U.S. health officials face questions over the handling of the first case of Ebola diagnosed in the United States, an American emergency room doctor is recounting the heartbreaking story of Samuel Brisbane, the first Liberian doctor to die in the West African country's Ebola outbreak.
Brisbane, director of the emergency department at Monrovia's John F. Kennedy Memorial Medical Center, was "at once caring and profane, light-hearted one minute, intense the next," Dr. Josh Mugele, assistant professor of clinical emergency medicine at Indiana University's School of Medicine, writes in the New England Journal of Medicine. "A short, bald man with weathered skin and thick glasses, he spoke openly and easily; his laugh was best described as a giggle, and he swore frequently."
According to Mugele, who worked closely with Brisbane on the hospital's disaster-medicine program in 2013, the 74-year-old doctor worried about the hospital's ability to treat a viral hemorrhagic fever like Ebola:
When we conducted an initial vulnerability analysis for the hospital, we discussed our concerns about severe supply and personnel shortages, regular power outages, and occasional electrical fires. Dr. Brisbane replied that what scared him the most was the potential for an epidemic of some viral hemorrhagic fever. He was right to be scared. We encountered rationing of gloves, a limited supply of hand soap, and an institutional hesitance to practice universal precautions, probably because of the limited resources. The hospital was not prepared for the kind of epidemic it's now facing — nor was the city of about 1.5 million people.
Yet Brisbane, a father of eight biological and six adopted children and the owner of a successful coffee plantation, continued despite knowing the risks.
When Mugele returned to Monrovia in June, a few months into the current Ebola outbreak in West Africa, there "was no clear plan for what to do if a patient suspected of having Ebola showed up at the hospital. How would staff members protect themselves? How would they isolate the patient? How could they move the patient to one of the ministry's isolation centers?"
Brisbane, Mugele writes, "was a wreck. He chattered nervously, his smile disappeared when he thought we weren't watching, and he openly wondered how he could protect himself. He told us bluntly, 'Leave Monrovia.'"
He "checked his temperature religiously, fearing the telltale sudden fever," Mugele continues. "He wore a fedora in the hospital as a protective talisman. And yet he still joked with us, displaying a sort of gallows humor."
After Mugele returned to the United States, Brisbane treated a patient with "suspected Ebola," according to the hospital. Brisbane came down with Ebola symptoms a few days later and died on July 26.
"With apologies to his wife and family, who saw him die horribly and unjustly," Mugele writes, "we believe [Brisbane] died a good death — as did all the nurses and doctors who have sacrificed themselves caring for patients with this awful disease."
According to the World Health Organization, there have been more than 8,900 reported cases of Ebola since the outbreak began in March, and 4,447 deaths as a result of the virus — nearly all of them in West Africa. Liberia has been the hardest-hit, with more than 4,000 reported cases and at least 2,316 deaths from the disease.
The number of doctors, nurses and other health care workers who have become infected with Ebola has been "unprecedented," WHO said. Through Aug. 25, more than 240 health care workers had developed Ebola in West Africa, the organization said, and more than half of them died.
Dr. Bruce Aylward, WHO assistant director general, said Tuesday that if the global response to the Ebola crisis isn't stepped up within 60 days, "a lot more people will die." West Africa, Aylward said, could face up to 10,000 new Ebola cases a week.
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