In June, Sierra Leone's viral haemorrhagic fever specialist, Dr Skeh Umar Khan spoke to Politico. That was before he tested positive for Ebola and subsequently died. We first asked him how the fight against Ebola was going on.
Dr. Khan: We are moving on. As it is now, we have some cases currently being admitted. We have 41 being admitted at the moment, we’ve discharged so far 18 cases who have survived the disease.
Politico: You mean those who came in with it and then you’ve treated them and they no longer have Ebola?
Dr. Khan: Indeed yes, they no longer have Ebola and in fact as a matter of fact these are people I embrace myself on the day of discharge because don’t forget the stigma about Ebola with some people you have to give them certificates so that by the time they return to their villages people will understand that they are no more suffering from the disease and they are free to interact with the population. So right there at the gate that's where I leave them. I embrace them to, of course, tell the public that yes this is the situation...
Politico: Are you concerned that Ebola in Sierra Leone and even the Mano River Union of Sierra Leone, Liberia and Guinea is spiralling out of control as Medecines Sans Frontiers has said.
Dr. Khan: Well I wouldn’t say it is out of control. Rather because as I am seeing it, I can speak for Sierra Leone. Sierra Leone has a reference point here. We have the Viral Haemorrhagic Fever, in particular Lassa Fever, which we’ve been on for the past 10 years...
Politico: Well if you say it is not out of control, in under a month scores of people have been killed in Sierra Leone alone and most of them in the last two weeks. That gives one the impression that it is out of control.
Dr. Khan: In Sierra Leone,...usually when you have an initial outbreak you have cases coming in...the education we are giving our people will determine whether the situation is out of control. As it is now the Ministry of Health and Sanitation is responding and again with our partners there - the MSF, WHO, Tulane University who are partners as well as the Meta Biota - all are coming on board recruiting more people for us to respond. My problem about it being out of control perhaps is somewhere else and what it is. It is about the negative perception our people are taking. When we had the first case way back in Koindu, rather than coming out, the people rather thought this case had nothing to do with orthodox medicine....And then as a matter of fact the index case which was a probable case, not the confirmed case. What happened was that a herbalist somewhere around that area who had been treating people and then probably this was where we thought the infection already started. So she has been treating people perhaps way back from Guinea or somewhere else for diarrhoea and vomiting, claiming to be treating them. Eventually she died from the disease and then in their rituals and in their process of trying to bury that woman...only women went through that burial. That was why in fact the cases we had initially were women...
Politico: Well you say a lot of those who died are women but also many of them who have died so far are health workers. Are you concerned that nurses are succumbing to this Ebola outbreak. Just behind you there inside the Isolation Ward, I understand there are five of your nurses admitted there for Ebola. Does this concern you?
Dr. Khan: Yes, it is always of a concern. These are my colleagues and I am a health worker too. It is always a concern but the point here is what we have to understand clearly is the fact that the first port of call for somebody who is ill is the health worker. So who else? All the diseases, like we are sitting here, for the Eastern Province all of them will prefer to come to Kenema. So yes all what I am saying is there with our health workers somebody has to be vigilant, keep up your guard and make sure we all adhere to the universal precautions. Don’t forget the disease of itself is not airborne. That’s why I am proud. I am not afraid of working. It is all about contact, it is all about bodily fluids. If we continue the same universal precautions then we could be in the better position to save ourselves.
Politico: And the fact that your health workers are succumbing to it doesn’t that give one the impression that they lack adequate protective gear?
Dr. Khan: Well it may not be the case. Again because the one important thing is that Ebola of itself in our differential diagnosis is down the ladder…
Politico: Meaning?
Dr. Khan: Meaning if somebody is presented with diarrhoea and vomiting and the first thing you will think about is common diarrhoeal causes in our society which are Shingella, Lassa Meiosis, you think about cholera. And all these other diseases are the things we think about first. So in the process sometimes what people do the contact might be a bit slack with such situations.
Politico: Are you afraid for your own life yourself because you are the arrow head in this fight against Ebola talking about the risks associated with this fight...?
Dr. Khan: Yes of course, I am afraid for my life because I must say I cherish my life. And if you are afraid of it you will take the maximum precautions which I am doing. If you neglect you don’t take your life important then you will ignore most of these personal protective equipment and you wouldn’t do things correctly. So having that at the back of my mind I make sure whenever I am going into the isolation unit I make sure I am in full PPE...I make sure they are on, make sure my nurses are all in the same PPE. In fact if you go and watch at my dressing room you would see what we call the mirror. The mirror here is the policeman. Even if you’ve certified me that I am okay I will look at myself again objectively, without somebody looking at me and telling me I am fine So we have that at the back of our mind. We are mindful of those facts making sure all things are deposited. If you look right above maybe it's a bit not here, you will see the incinerator with smoke. So that tells you all those disposals are being taken care of.
Politico: Finally, are you enjoying this job?
Dr. Khan: I am enjoying it. In fact, as a matter of fact, when I finished my specialty I came back I was asked where I would like to work. "I’ll go back to Kenema" I said.
Politico: There was no Ebola then, now there is Ebola?
Dr. Khan: Yes, I know it is that risk that Ebola might come one day.
Politico: This Ebola how had you predicted it?
Dr. Khan: Well what happened was we were concerned that cases that were testing negative for Lassa Fever that are presenting as acute viral illnesses what else could it be?
(C) Politico 05/08/14
