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A Florida doctor shares her experience working in Nigeria’s outbreak

By Kendra Smith

With experience managing healthcare at large-scale global events such as the Olympics and World Cup, Aileen Marty, M.D., a professor of infectious disease, was a natural choice to go to Sierra Leone to assist in the Ebola outbreak. In August 2014, she was set to leave Miami, where she teaches in the department of medicine of the Herbert Wertheim College of Medicine at Florida International University, when her orders were changed. Dr. Marty was redirected to Nigeria, Africa’s most populous country, where a new outbreak had begun that could have far-reaching effects. She spent 31 days there participating in a response that is now considered exemplary — just 8 deaths and 20 total cases before the World Health Organization (WHO) declared the country free of Ebola on October 20, 2014.

While in Nigeria, Dr. Marty worked with an international team to prevent cases from entering and leaving the country. She helped devise screening methods and train nurses, doctors, and volunteers to perform them, often in very remote locations — Nigeria has some 85 legal border crossings and more than 1,400 illegal crossing points in its 2,500 miles of land border, according to FIU. She also brought potential Ebola patients to places where they could get care, and helped with communication efforts to prevent the spread of the disease.

We spoke with her about her experience as a healthcare worker in the fight to stop the Ebola epidemic.

When did you know you would need to go to Africa? What happened that made you want to go be part of the effort? 

I’ve been interested in and involved with researching hemorrhagic fever viruses [like Ebola] for over two decades. When I first learned that there was an urban outbreak of Ebola, I was extremely alarmed because I knew even then that this would be an issue. I’ve been part of the virtual interdisciplinary advisory group for the WHO for quite a few years, so I contacted my department. Once they had the kind of funding that they needed — WHO has lost a lot money in recent years, almost 51% of their budget — I was one of the people they contacted: “You said you wanted to go, how soon can you get out there?”

What did your family and friends say about your decision to go?

I was in the Navy for a long time and they know that it’s sort of in my DNA, as it were, to try and keep harm away from my country, my community, and friends and family by being the person who takes on the responsibility and puts herself in harm’s way. Even though they quite clearly said they would rather I didn’t go, they knew I was going to go because this is something I’ve trained for and that I want to do.

Tell us about your work there.

I [was sent] to manage patients. However, a colleague of mine was already doing a fabulous job with the patients in the ward. So, my main role in terms of patients became that of identifying suspect cases and bringing them to the isolation ward and assessing whether they actually were Ebola patients. I traveled to a variety of different states so I stayed in a lot of different places. The work was every single day: Saturday, Sunday, no exception. Only towards the end did we finally get a bit of a break, in that we could wait until 10 o’clock to start Saturdays. Before that we were starting almost every single day by 7:30 in the morning and ending very late at night.

When you’re looking at a suspect case, if someone has similar symptoms to what we know are symptoms for Ebola, do you actually have to treat them as if they have Ebola? How do you work with that when you’re not sure and there’s so much stigma?

You explain to the person very clearly what symptoms they have that are suspicious and why you have to, maybe, put on appropriate PPE [personal protective equipment] and you handle them as a human being. You make sure that they understand what their risks are and why they will be much better off if they let you take care of them. And most people understood and responded. And then, yes, I would have to get into full PPE and take them to the isolation ward.

Aileen Marty, M.D. suiting up in PPE at the airport in Lagos.

Were you ever afraid for your health or the health of any of your colleagues?

Well, I’ve known this virus for a long time. I know it’s an extremely dangerous virus. More than 500 healthcare workers have been infected and about half of those have died, so there’s always a concern. In our situation, was we were particularly fortunate because we had a large cadre of very well trained MSF [Médecins Sans Frontières, also known as Doctors Without Borders] and WHO people who followed an incredibly rigorous protocol from the get-go. And because we knew how the index case had come in and where the risks were, we weren’t surprised in the way that some of the doctors and nurses had been surprised in some of the other countries involved. We always had a pretty good idea of when we had to put ourselves in protective posture, and that really helps. So, if you’re doing everything right, and you’re following these very strict protocols that we used in Africa, your risk is really greatly reduced.

What do you do to keep yourself, your fellow workers, and anyone else from getting Ebola, other than wearing protective gear?

You take universal precautions and you take them very strictly. This is a virus that you can’t mess around with. If we have enough indicators that a patient might possibly be infected with Ebola, we don’t touch them until we are appropriately dressed and attired. So, if we need to get an appropriate thermometer reading, not with a non-contact infrared thermometer, but with a thermometer that we would place under someone’s arm, we don’t do it ourselves. Instead, we take a fresh, unopened thermometer, place it on the table and say to the patient, “Please pick it up, open it, do this, do that, and then show us the reading.” You see? Little things like that add up to increased safety.

What is the attitude of the people living in the middle of these outbreaks? How do they seem to feel about what’s going on?

There was a lot of mistrust, at first. That is why we needed anthropologists and a lot of public relations-type people to try and build that trust. And more than anything else, within our doctor and nursing team, we would not handle people like they were something dangerous themselves. We would let them know that they are human beings and we care about them. And that helped build trust in the population. This is such a horrible [illness]… people feel really sick. Even the people who end up surviving, it is a very miserable disease to go through. They don’t feel good. They’ll be jumpy and irritable … all those things people are when they don’t feel good. So it’s our role as physicians to not take any of it personally and, instead, figure out how is it that we can encourage them to do the things they need to do to get better.

You mentioned you’re asking for more leave to go back. Why?

Because the problem is not over, and I have the skill set that is needed to help contain and eliminate this outbreak, to be helpful. People like me need to step up and do what we can. If there are things that I can do from here, and there have been quite a lot, then I should do those before I go back. In fact, I think just raising awareness and understanding of the situation is an important thing to be doing from here — helping staff prepare in case an Ebola patient presents at a community hospital, helping government officials pre-position resources here and [in West Africa] to solve the problem, and helping everyone understand that this [outbreak] is one of many consequences of our global economy, something we have to have a system to deal with — all these things are important things to do here in the US. But if I can have a greater impact by going back to Africa, then, I’d like to do that.

What can we do in the US to help support the healthcare workers in the effort to end this outbreak in West Africa?

First of all, having the right attitude is already helpful. People do need to get educated on what’s going on in the world that can affect them. We live in a global community; we do not live just in the United States. We are interconnected. How many people do you know who have visited some other country within the last year? Probably almost everybody you know, right? Think of all the commerce that goes on constantly. It used to be a rare thing for somebody to take a flight out of the country, but that’s not rare at all any more. Germs don’t know borders in any way, shape, or form and they don’t need visas. So, we have to figure out how we can help the health of those people that live in less affluent areas than ourselves, because their health problems affect us, our communities, our children. 

Published November 18, 2014

Kendra Smith is a health, wellness and lifestyle writer living in San Francisco.

See also:

• Ebola outbreak FAQ
• MedHelp Ebola community
• Video: Ebola prevention, transmission and more
• How major world events influence anxiety