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Dr. Martin Salia’s death from Ebola Monday is a loss that Sierra Leone can ill afford. He’s the sixth doctor to die from the virus during this epidemic in Sierra Leone, a country that has few to start with.
Ebola is still spreading out of control in West Africa in part because there are too few health care workers to recognize and fight the virus in the first place. And the epidemic’s not just killing people directly. Its effects are filling up hospitals and clinics with Ebola patients, or forcing their shutdown, leaving people with other health emergencies from childbirth to malaria with nowhere to go.
Salia wasn’t even treating Ebola patients. He was a primary care doctor at a Methodist hospital, probably infected, experts believe, when he was treating a patient for other symptoms without suspecting he or she had the virus.
“Every one that is infected is a tragedy, both for the response and for their family,” said Dr. Emmanuel d’Harcourt, senior health director for the International Rescue Committee.
The World Health Organization says 570 health care workers have been infected during this epidemic, and 324 of them have died.
More than 100 have died in Sierra Leone. That’s a lot for a country that started out with just two physicians for every 100,000 people, and far fewer now by many counts. The United States has 245 doctors per 100,000 — more than 100 times as many. And it's not just Sierra Leone that comes up short.
"There is one doctor for every 100,000 people in Liberia," Rabih Torbay, who heads international operations at the International Medical Corps, told a House Foreign Affairs subcommittee hearing Tuesday. "That's before 324 died. So you can just imagine the gap now," he added.
Salia joins a long list of prominent doctors to fall victim to Ebola in Sierra Leone. Others include Dr. Godfrey George, medical superintendent of Kambia Government Hospital in northern Sierra Leone, who died earlier this month; Dr. Olive Buck, who was in charge of Lumley Government Hospital in the Sierra Leonean capital of Freetown and died in September; Dr. Modupeh Cole, who died last August at the Ebola treatment center operated by Doctors Without Borders (Medecins Sans Frontieres) in the northeastern town of Kailahun; and Dr. Sheik Umar Khan who died at Kenema in July.
“Every one that is infected is a tragedy, both for the response and for their family."
Sierra Leone’s government says it will pay $5,000 to the family of any health worker who dies because he or she treated an Ebola patient.
D’Harcourt says his organization is working to help train physicians, nurses and other health workers how to protect themselves — especially when treating patients who may not be suspected of having Ebola.
“You’d be surprised, but there actually is a lot that can be done that will reduce the danger,” d’Harcourt told NBC News. “It might not bring it to zero but it will greatly reduce it.”
For example, doctors or nurses shouldn’t touch the patient at first, instead using an infrared thermometer, pointed at a person’s forehead, to take his or her temperature. A series of questions should follow quickly to determine whether someone’s been in close contact with an Ebola patient.
Symptoms such as diarrhea and vomiting are important, also.
“If they have fever and two or more of the other symptoms, then they are considered very likely to have Ebola,” d’Harcourt said.
Such patients should be isolated and treated only by people using protective gear unless and until Ebola is ruled out by a blood test. In facilities where personal protective equipment (PPE) isn’t available, health workers should keep their distance. “You give them food and water and, in some cases, medicine, but not to handle them if (health care workers) don’t have equipment,” d’Harcourt said.
“We are working very diligently to make sure everyone does have equipment,” he added. But it’s not getting shipped where it needs to be quickly enough, he said.
“There continues to be a challenge in things reaching the ground,” d’Harcourt said.
The U.S. government is also working to address the shortage of health workers. The U.S. Africa Command will train as many as 500 new health care workers a week for six months and longer if needed. Four of the Americans treated for Ebola in the U.S. were doctors who served in West Africa: Dr. Rick Sacra, Dr. Kent Brantly, Dr. Craig Spencer and a fourth physician who hasn't been named. A fifth patient, Nancy Writebol, was working at a hospital helping medical workers.
“We are working very diligently to make sure everyone does have equipment."
Cuba sent a team of 100 nurses and 50 doctors. “Many countries have offered money, but no other country has offered such a large number of workers to go in and help do the most difficult jobs in this crisis,” said WHO assistant director Dr. Bruce Aylward.
And as doctors, nurses and other health workers die from Ebola, it can scare off others. Many feel the stigma may hurt their chances of resuming normal lives back home, or fear forced quarantines could cost them their jobs or at the very least keep them from the normal lives and families for an extra three weeks, on top of any time volunteered.
Brantly, who caught Ebola while treating patients in Liberia but has recovered, said such worries shouldn't keep skilled volunteers away. “If you are a medical professional considering traveling to West Africa, please don't let irrational fear stand in your way,” he said in an email distributed by the White House last week. “I am extremely confident that I did not contract Ebola in the isolation unit in Liberia — but rather in the emergency room of our hospital.”