CMDA-affiliated physician dies of Ebola

Editor's note: Dr. Martin Salia was a general surgeon and graduate of CMDA’s Pan-African Academy of Christian Surgeons residency in Cameroon.

Excerpted from "Ebola-infected physician dies in Nebraska," USA Today, November 17, 2014, - A surgeon infected with Ebola while treating patients in Sierra Leone has died in Omaha, Nebraska Medical Center announced Monday. Martin Salia, whose family lives in Maryland, arrived in Omaha on Saturday for treatment at the specialized biocontainment unit. He became ill Nov. 6 and tested positive for Ebola a week ago. Before his dad died, the son of Doctor Martin Salia said treating patients infected with Ebola was his "calling from God."

"It is with an extremely heavy heart that we share this news," Phil Smith, medical director of the Biocontainment Unit at the hospital, said in the statement. "Dr. Salia was extremely critical when he arrived here, and unfortunately, despite our best efforts, we weren't able to save him."

Smith said Salia was suffering from advanced symptoms of Ebola when he arrived, including kidney and respiratory failure. He was placed on dialysis, required a ventilator and received plasma, Smith said. Multiple medications included ZMapp therapy, a new drug that has shown promise in fighting the disease.

Salia is the second person to die of Ebola in the United States. A Liberian man living in Texas, Thomas Eric Duncan, contracted the disease in his native country but was not diagnosed until after his return to Dallas. He died Oct. 8.

Salia's wife, Isatu Salia, has said that her husband believed he had malaria or typhoid when he fell ill Nov. 6. Her husband had two negative tests for Ebola before the third came back positive Nov. 10, she said. Isatu Salia said her husband's voice sounded weak and shaky when they spoke early Friday. But she said he told her, "I love you."

Salia said her husband traveled frequently between the United States and his native Sierra Leone. He never stayed in the U.S. long because he believed people in Africa need him, she said. Ebola has killed more than 5,000 people in West Africa, mostly in Liberia, Sierra Leona and Guinea.

Commentary

Professor of Clinical Medicine at Georgetown University Medical Center and CMDA Campus Advisor Allen H. Roberts II, MD, MDiv: “With heavy hearts the news of Dr. Martin Salia’s death was shared, and with heavy hearts it is received. Most keenly is his death felt by his wife and sons, to whom our hearts and for whom our prayers go out, but it is felt deeply and dearly by his CMDA family as well. We pause in the midst of our daily rounds and of our own Ebola preparations to think about our brother in Christ, the life he lived and the death he died – both in the service of the Lord he loved.

“Martin’s predicament confirms what we are learning about Ebola. Patients who arrive at U.S. medical centers early in the course of the illness and are treated with aggressive fluid and electrolyte administration fare better. Many hospitals are developing protocols and ethics statements reflecting that with appropriate disease-containment interventions, the disease, when treated early, is survivable and containable.

“Dr. Salia’s death also came in the aftermath of an appeal that went out to CMDA members that we pray without ceasing for his recovery, and scores of members did just that. Yet, this dear brother died.

“Now is a good time to remember Jesus at the tomb of Lazarus (John 11:17-44). We may join Martha and Mary in their deep sorrow; we may join Jesus Himself in absolute indignation and anger over the death of a friend.

“And we are invited, then, to listen to Jesus utter these most astonishing words, “I am the resurrection and the life…” (John 11:25, NIV 2011). It was in the certain hope of the resurrection that Martin Salia responded to God’s call to minister to those with Ebola in Sierra Leone. He counted the cost, and he went.

“We know how the story ends for Lazarus and how it will end for Martin Salia and all who are in Christ. It may be in the months ahead that God in His mercy will lead us to an effective treatment for this dreaded disease. We don’t know. But it was on the cross that the fate of Ebola was sealed, along with that of all disease and all death in all history. Jesus’ tomb is empty, and so will be Martin’s.”

Action
Participate in CMDA's End Ebola Project

Resources
Ebola: ‘Beat the fire while it is far’ by Dr. David Stevens Ebola and Medical Missionaries

Public supports quarantine for Ebola health workers

Excerpted from “NBC/WSJ Poll: 71% Back Mandatory Quarantines for Ebola Health Workers,” NBC News. November 2, 2014 — More than seven in 10 Americans support mandatory quarantines for health professionals who have treated Ebola patients in West Africa, even if they have no symptoms, according to a new NBC News/Wall Street Journal poll. The survey shows that 71 percent of those surveyed say the health workers should be subject to a 21-day quarantine, while 24 percent disagree.

The question of mandatory quarantines exploded into the public debate after nurse Kaci Hickox battled with the governors of New Jersey and Maine over the mandated isolation, arguing that she has exhibited no symptoms and tested negative for the virus. Those who oppose the practice – including top health officials and White House administration officials – say that it is unnecessary and discourages health workers from fighting the Ebola outbreak at its source.

Support for the quarantines varies by political party, age and education level. Eighty-five percent of self-described Republicans say they think the quarantines should be enforced, versus 65 percent of Democrats and 60 percent of independents. Ninety-one percent of Tea Party backers also believe the quarantines are necessary.

Older Americans are also more likely to back mandatory isolation for the health workers. A third of those 18-34 years old oppose the requirements, compared with just one in 10 seniors. And those with lower levels of education are more likely to support quarantines (80 percent of those with a high school education or less are in favor) than those with college or post-graduate educations (63 percent are in favor.)

Commentary

CMDA Member and Chief of Infectious Diseases at Moffitt Cancer Center John N. Greene, MD: “The majority of people, including healthcare workers, favor the quarantine of those who care for patients infected with the Ebola virus, both at home and those returning from West Africa. This paradox exists despite the clear scientific evidence pointing to a lack of contagion of the asymptomatic but exposed person. The fear and hysteria created by the Ebola epidemic is unprecedented.

“Just to point out one of many examples: A teacher returning from Kenya (a country with no cases of Ebola) was asked to remain at home for 21 days and bring in a note from a doctor at the end of her home-bound detention stating she is non-contagious before returning to teach children. All this due to parents and faculty being fearful of contagion despite the impossibility of transmitting an endemic virus the teacher was never in contact with.

“The real question is why would rational people, especially those of the Christian faith, believe the unbelievable? I think it is fear, which clouds one’s judgment, and a lack of trust in authorities and experts who have led us astray and do not hold our Christian values. If we believe the Bible commands us to be a beacon of light for unbelievers, then we need to allow perfect love to cast away fear.

“Jesus and the apostle Paul did not fear death but instead entered into dangerous situations that ultimately claimed their lives. Why? They entrusted their lives to Him who judges righteously and did not count their lives as dear to themselves. Why can’t we have the same attitude and encourage those who risk their lives to care for those stricken with Ebola virus disease? Let’s not punish them for their service by placing an unwarranted burden on them and forcing them into quarantine to be shunned and avoided. Rather, let’s tell them, ‘Well done,’ and embrace them with a warm hug for their Christ-like service of those who can’t help themselves. What a testimony for Christ the world would see if we could lead this charge and go against the tide of unreasonableness and a lack of love.”

Resources

Ebola: ‘Beat the fire while it is far’ by Dr. David Stevens
Ebola and Medical Missionaries

Action

Participate in CMDA's End Ebola Project

The ethics behind the Ebola treatment serum

Excerpted from "Ebola outbreak prompts ethical questions," BioEdge. August 9, 2014 — The worst-ever Ebola outbreak has prompted bioethical discussion on two fronts. The viral disease has killed about 1,000 people in West Africa, mostly in Guinea, Sierra Leone and Liberia. A few cases have been diagnosed in Nigeria. The chances of dying in this outbreak are about 50 percent. Newspapers in Western countries like the U.S., the UK and Australia are highlighting the possibility of their own epidemics.

The first issue, as bioethicist Arthur Caplan points out, is that developed countries only worry about exotic diseases like Ebola when it threatens them: “The harsh ethical truth is the Ebola epidemic happened because few people in the wealthy nations of the world cared enough to do anything about it. We do need headlines about Ebola ... A public health policy that ends at our borders is not fair, just or even smart.”

The second is equitable distribution of a vaccine. There is no approved vaccine at the moment. A small American company, Mapp Biopharmaceutical, has been testing a vaccine called ZMapp on animals. But no one knows whether it is safe or effective on humans. Only a handful of doses at the moment and scaling up production to thousands of doses would take months. However, two white American medical missionaries, Kent Brantly and Nancy Writebol, who contracted the disease in Africa have been given two precious doses of ZMapp and seem to be improving. Why were they chosen instead of Africans? Apparently it is regarded as good practice to treat "first responders" first because of a social responsibility to help those who help others.

The WHO has convoked a gathering to discuss the ethics of providing an untested vaccine. “We are in an unusual situation in this outbreak,” says Dr Marie-Paule Kieny, of the WHO. "We need to ask the medical ethicists to give us guidance on what the responsible thing to do is.”

Commentary

CMDA CEO David Stevens, MD, MA (Ethics): “I’ve debated Art Caplan on TV and radio on a wide range of bioethical issues. As I do with his comments in this article, we have agreed on some points and disagreed on others.

“He is absolutely correct when he says, ‘A public health policy that ends at our borders is not fair, just or smart.’ The danger in a country where people worship financial, physical and emotional security is that our claim of ‘compassion’ is merely a slushy sentimentality, a loose veneer barely covering our selfishness. At the first hint that a health crisis killing more than a thousand people could affect us, that thin veneer is quickly ripped to shreds. We’ve already seen that. Ann Coulter publically claimed Dr. Kent Brantley was “idiotic” for going to Liberia and that the U.S. should focus on its own problems. Others, including a few Christian leaders, decried bringing Dr. Kent Brantley and Nancy Writebol back to the U.S. for treatment.

“On the other hand, Dr. Caplan’s comment on providing untested treatment to Ebola sufferers puts us in an artificial binary trap of ‘treatment’ or ‘public health.’ It is obvious that the good public health practice is what is needed to contain and ultimately stop the epidemic. But that begs the question about whether an unproven experimental drug should be used to treat seriously ill Ebola victims. With Ebola’s mortality rate, no other alternatives and a deteriorating condition, I would have taken the drug just as Kent Brantley did. He showed marked improvement in hours. It is not good to take an untried drug, but it is the lesser of two evils when you are about to die and an unproven drug has showed promise in animal trials. What’s more, to prohibit its import to other countries if their medical experts desire to use it is paternalistic.

“Many called Kent and Nancy ‘heroes’ for their self-sacrifice for the good of others. “Greater love has no one than this: to lay down one’s life...”(John 15:13, NIV 2011). We should admire their faithfulness to deny themselves, take up their cross and follow Jesus by doing exactly what He would do, but I think Kent and Nancy would not want to be thought of as heroes. They consider what they did as ‘normal Christian behavior.’ So should we.

“For more than two milleniums, Christians have laid down their lives for others. If we seek security, we will never find it. If we give up our security to follow Christ, that is when we find real security in Him. Then true compassion wells up from our souls.”

Resources

CMDA News Release on Dr. Kent Brantly, with a live interview with Dr. David Stevens
USA Today interviews CMDA on Ebola
CMDA Resources on International Healthcare