Friday, October 3, 2014

Why I Hijacked My Sister's Blog (Guest Post)

On August 15, 2014, a friend (also my co-worker) emailed to see how my family in Nigeria was doing when she heard it had spread there. Below was my response (written on August 16th) and it answers why I partially hijacked my sister’s blog… I initially tried to use the Note function on Facebook but it didn’t seem to be working so I gave up and just wrote in dependable Microsoft Word – this reminds me to give a special shout out to the Bill & Melinda Gates Foundation for donating money ($50 million) and services to the Ebola epidemic.  –TAI

Thanks for always being so sweet... I have mixed emotions about it all: sad, hopeful, bitter, guilty, relieved, confused, and honestly... terrified...I think the scary answer is that only time will tell. What is known is that Guinea, Liberia, and Sierra Leone have been struggling with this crisis a long time and any numbers reported are underestimations. For Nigeria, it's so new and yet has the potential to be disastrous.

It's horrible this is happening, but not entirely unexpected (in some ways, it's a surprising relief it hadn't spread sooner). Any hope I have that Nigeria's cases will be limited is based on the fact that Nigeria is more developed than the other 3 countries. However, our healthcare system is still not something to write home about... in fact in a separate matter, there is currently a national physician's strike and in retaliation, the President fired the resident doctors (ALL of them)! Sigh... Back to Ebola, they reportedly have been keeping tabs on those who came into contact with the infected individual, so again only time will tell. I think the total days to hold one's breath is 60-120* days past the last case [my overestimation was based on a news clip I watched based on other past epidemics]. So far in Nigeria, reportedly only 11 people have been affected and 3 have died. I was extremely saddened to hear yesterday that an old schoolmate of mine passed away from the virus. She was a nurse who helped the affected man (Patrick Sawyer) from the plane. She wrote on her Facebook page that the hospital was taking appropriate precautions, but I doubt her hospital had [reliably] running water talk less of antiseptic wipes... Infection control does exist but it's certainly more vulnerable than anything we do over here. Double sigh... So everyone just has to be careful. The city affected (Lagos) is the most populated in Africa and people travel in and out of it all the time. I can only hope and pray, it stays limited. Another thing in our favor is that people in that city are largely educated and would at least in part understand the importance of this situation. In the other 3 countries, the education is a big problem as well as mistrust of the medical system (so some people run away from care and inadvertently spread it).

It's right out of a Hollywood movie (cf. Contagion or Outbreak), complete with a ground-breaking miracle drug - Zmapp! Triple Sigh... I've always felt strange with "compassionate use" scenarios. I'm happy that the favored individuals caught a break, but it's hard to know that there are those who didn't make the cut (this is something I struggle with even in our Oncology world). Now I've learned since that there are other companies working on other Ebola drugs too (all in the pre-clinical stages, though some are close to phase 1 trials). For some reason the Zmapp company offered their services and it was a risk, but it was also hope. A few days before my schoolmate died, one of our mutual friends posted on Facebook that everyone should sign a petition to get her Zmapp. What made her more worthy of it? Because her friends were educated enough to know such a drug exists? Because she (like the two Americans) were sacrificing themselves to help others? And so on... I can't judge or finger-point because I am clearly blessed living here in my First World existence. I can only pray for the best and try not be so stoic/ignorant of the craziness in the world (including in our hem/onc world).

Sorry for venting on you like this, I think I've been bottling it up inside, hehe. Thank you for caring! That's the most important and appreciated thing. :)

Thursday, October 2, 2014

The Problem with Ebola, Part 2

More thoughts from my sister about Ebola. --B :-)

The Problem with Ebola, Part 2                                                                         October 2, 2014

[May] the Lord turn his face toward you and give you peace. – Numbers 6:26

Ebola is especially terrifying to people, EVERYwhere around the world. As a doctor, I was reflecting, the ER was one of my most dreaded places because anything (i.e., any virus, bacteria) could show up and for at least a period of time, you were exposed to them. After you assess someone and then later fear they may have Tuberculosis (TB), you get a little/lot nervous (this is the year my TB skin test will turn positive, I would think) or learn that the person you are caring for with/without gloves has Hep C/B/HIV (let's not even get to the accidental finger sticks). I even remember taking care of a pregnant woman who was sick and turned out to be H1N1 flu positive (during the year it was viewed with most fear)... I washed my hands and face so many times, people would have thought I had OCD. But in our post-vaccination world, we are actually missing a lot of craziness that exists out there (i.e., other parts of the world). 

I did a month of clinical work outside of the US and saw Measles for the first time, but I didn't see the cute mnemonic I learned in med school (rash + the 3 C's - cough, coryza, conjunctivitis), I saw a child with disfiguring skin lesions, horrible stridor, and significant respiratory distress. Measles KILLS, a fact sadly, a few communities in the US have been learning recently with the "return" of it. In the US, I've seen Pertussis turn a thriving 1 month old (someone too young to get vaccinated) into a neurologically-devastated, machine-dependent infant. Her mom believed in vaccinating but some of her family members didn't get the vaccine and hence, the baby was unprotected. Again, in the US, I've seen RSV make babies look like snotty, yet happy, messes to the other end of the spectrum where it horrifically makes them "lose their breath" leading to brain and other vital organ damage. There was even a period of time that I had my fill of seeing teens and adults with STIs and refused to shake hands with anyone (for fear that they had the syphilis rash on their palms). I am a semi-recovering germaphobe... My condition worsened with med school after my Microbiology class (which I had wisely/unwisely skipped in college). Though much better now, I will probably always be more of a "2-second" rule girl and never a "5-second" rule person. 

The point I'm getting to is, I feel this Ebola crisis has made people more conscious of our invisible microbe frenemies. The general population is now experiencing the world more like how I feel in an ER (or in a grocery store). I previously posted (on Facebook) a NYT article on how Ebola has modified the social structure of Nigeria (and I've read similar articles from other countries faced with a worse outbreak). Now that it has "arrived" in North America (notice how I generalized that instead of focusing specifically on Dallas, Texas - yes, welcome to an "African's" world), I can feel the ripples from the waves of pandemonium. So why this fear with Ebola? I didn't see this much social outcry/fear with the SARS epidemic in 2003 (a virus that is airborne), but then again no American with SARS was ever privately flown to a hospital for fear of spreading the infection either. That means to the general public (and the world), no matter what the CDC or WHO says, Ebola MUST be different… Ebola MUST be feared...

I don’t think I can assuage everybody’s fears (and I feel some fear/respect is healthy), but I will share this: Currently, as a doctor who only sees patients with cancer and blood disorders, several of my patients have poor immune function so there is a germaphobe ideology we spread to their caregivers – but it’s pretty easy to follow –
1) good hand-washing which includes hand sanitizer (necessary for everyone); 
2) immunizations (necessary for everyone, especially if the child can’t get vaccinated due to their condition);
3) avoid sick people (not necessary if you have a normal immune system, if you do the above 2 things); and 
4) avoid large crowds (also not necessary if you have a normal immune system, if you do the above 2 things). 

Now back to Ebola - NO person or country or city asked for/deserves Ebola! I first became aware of the devastating epidemic when news broke out that national hero Dr. Sheik Umar Khan of Sierra Leone had contracted the virus and sadly passed away. Now, I am speaking as someone who is experiencing slight déjà vu – at the close of July 2014, I and other Nigerians gulped/gasped audibly when we heard we had the first case of non-endemic Ebola was diagnosed in “our” land); fear gripped us in different ways. We were sad (another devastating thing to add to our growing list), angry (why did that guy get on the plane and other questions abounded, along with several conspiracy theories), devastated (with each new case, with each reported death), the list goes on… I was one of many who had family in Nigeria (and some specifically in Lagos). I got a little nervous (only a little because I already knew the virus wasn’t airborne like the flu) when my dad (who lives in Ogbomoso) called me from Lagos saying he was at a meeting (although he reassured me that he was nowhere near the affected hospital or the airport). 

Then the world began to respond in varied, unpredictable ways; for instance, Korea stopped all flights to Kenya (which is in East Africa) as a preventive measure. Then, I became light-headed when I received an email from work stating anyone who traveled to the affected countries (including Nigeria) would not be able to come to work for 21 days! (This was even beyond the CDC recommendations, which the email said it was following.) My first thoughts were: when am I going to see my fiancé and parents again… what about our wedding (which is scheduled to occur in a few months)... I began to dedicate time to CDC and Nigerian news daily for any updates on the “case count.” During this time, a dear friend reminded me why Nigeria was blessed in comparison to Liberia, Guinea, and Sierra Leone. Yes, Nigeria is a third-world country like the other three, but we had the benefit of a warning (the others’ didn’t) and we had several brave (and generous) people (native and foreign) step up to the plate (the same spirit of the types who stepped up for the other countries). And praise God, Ebola CAN be controlled! 

I learned this last week, but I don’t know if I fully believed it until I saw several confirmatory articles, including the most recent that another dear friend sent me on October 1st (Nigerian’s Independence Day poignantly), which discussed the fall of Ebola in Nigeria due to the nation’s response. Underneath that headline was an article that described the first Ebola case in Texas. The déjà vu feeling came upon me because Dallas/Ft. Worth is a place I also consider home and I have loved ones there too. Yet, my fear is less… Here is why: the article my friend sent had this quote from the director of CDC: “For those who say it’s hopeless, this is an antidote – you can control Ebola.” He was talking about… Nigeria?! On the wake of its 54th Independence Day, Nigeria is giving other countries in our increasingly small world HOPE. My native country has given me hope in my adopted country, and I’ve never been more proud to call myself Naija. I hope those who are afraid, can also take heart in this message. And more importantly, do our part to provide hope to others.  –TAI

Below is a list of organizations that are currently serving countries affected by Ebola, you’ll notice Nigeria, Senegal, and United States are not at the top of any of their lists, because the pain/fear/loss we have experienced is a drop of water compared to the overwhelming ocean of suffering taking place in Guinea, Liberia, and Sierra Leone. For better or worse, you’ll also be reminded that Ebola is not the only horrible thing happening in today’s world. We can only pray for the Lord’s mercy and show gratitude for His grace.

Doctors without Borders
World Vision
Samaritan’s Purse
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