04 - Dr. Suzanne Donovan - Part 1: Outbreak
From Turku media imagine a hospital that fifty percent of the time does not have power. Many dead bodies were lined up against the wall. All the floors were covered with bodily fluids. There could be a child on next a dead body in in a room. There were many of the patients were naked. They didn't have close Renault suits. That was the voice of a true American hero. Infectious disease specialist Dr Suzanne Donovan Describing what she saw on her visit to in a bowl unit in Sierra Leone. I'm Bill Curtis and I'm joined by my Co Host Triple Board certified physician Dr Steven Tailback. How you doing Steve? Hey Bill it's good to be here. This was a a pretty remarkable discussion. We got to have isn't it. I'm still reeling. Actually from the impact that she's had on on us there's so many great physicians out there but then there's the physicians physician there's somebody who elevates themselves to a whole other level not just because of her expertise in her field but because of the type of human being that she is that she's willing to risk her own wellbeing to care for others and also to help prevent future illness throughout the planet. You know at a time like this. I think that our country has issues and we have some things to be embarrassed about but one of the things. That's a real sense of pride. Is that wind wind someplace in the world needs truly special medical attention they call someone here in the US and we have heroes that respond. I agree with you I mean. I'm very very patriotic person. So I see so much. What's good about this country? It's easy to overshadow or take for granted the amazing things that we do as a country as ah people as a community. Suzanne Donovan Really embodies those philosophies that actually make this country great. She is a truly gifted generous. Human being. She's in a class by herself. Okay so Steve. Should we dive absolutely. Let's go Dr Susan. Donovan joins me and Dr Steven Tailback back on medicine. We're still practicing. What was an interesting invitation? I got a phone call from whol. Oh and basically. They asked if I could help out with doctors and nurses were being infected in the hospitals in West Africa. We lost an entire generation of healthcare providers During that outbreak. I said yes immediately and the person on the other end of the phone call said No. I think you should think about it for twenty four hours. This is a big decision. We've had evacuate some of our personnel. So I gave it twenty four hours and I called back and said that I would go. That was after. I talked to both my the kids who are teenagers at the time so when I flew over there was actually kind of interesting because I was going over there wearing a hat of being the expert and how to prevent vent infections being transmitted in hospital. Actually how Isabel is spread. Ebola spread by Contact with infected fluids and that could be blood it could be stole. It could be vomit. The number one risk factor though free Bola in West Africa was a barrier practices. That were going on there. The burial real practice. Yeah so when someone dies in these countries the families gather they they bay the body They hug the body the body they take the water. That must have been very frustrating for you. Well it it. It certainly Underscored discord the importance in an outbreak of using an anthropologist to address some of the Cultural Practices Sierra Leone did on the. Who Did you some anthropologists thir politics. And we were using them to try to work with the communities so that They they could still so follow their burial practices but do it in a safe way but going back to your original question I arrived and when I arrived the first thing you do. Is You get training from the UN of how not to be kidnapped how not to be shot. They gave me a badge with my blood type in big letters and so I put underneath the blood type type. Do not transfer us because I would be butter for me to X.. Sangu nate than to get a transfusion during any bowl outbreak. So during that training I got pulled out because the hospital that I was going to be going to there was one doctor left a US doctor. And I was told that doctor just became came infected with you bola so I jumped in the jeep with my buddy who is a French physician physician fantastic and Dan. We traveled Eight to ten hours to the eastern borders Sierra Leone he was in the guest house my I e Bala patient was a US physician. And I knocked on the door. He answered the door and he clearly was sick and then what ensued as he did not want to be evacuated because it was night time he knew how difficult that was going to be the evacuation. He wanted meet up. Put them in the hospital. which shy said was not a good idea because number one we did not have consistent just in power in that hospital and it was a very high risk situation? I had not even been in the hospital and I knew it was a high situation when you went to visit him. Where you protected turn fine? No so so. I think it's really important when you talk about highly Fatal Diseases That are infectious is my approach roaches. I do a risk assessment although we talk about using the highest level of protection when you're actually taking care of a patient touching the patient politically in the advanced stages if someone is five feet away from me and I'm talking to them there's really not an immediate need for what we call. PP's personal protective -tective equipment. So how did these doctors get infected. So you have two populations of doctors you have the nationals. Who have the risks in the hospital but they also have the risks in their community? So where did they get infected. And then you have the doctors who are coming from Europe and from the US to help. Ebola is a very unforgiving disease so the infectious dose of Ebola is like six to eight variants. It's tiny if if it landed on your skin you're not gonna get in fact if you have small abrasions. If you hear irritation if you touch him mucous membrane that would be enough for you to get infected so oh you transferred by sweat could someone. That's that's doctor that you went to visit if he had just opened his door. And you touch the DOORKNOB. Is it something that you know and and you can see. We don't we didn't have really any sustained transmission in the US with the cases that we had here when transmission occurs it occurs occurs at the very end of the illness when the the amount of virus or what we call the viral load is very very high and so the highest risk are going to be the healthcare co-workers which is why the healthcare workers are always the canary in the mind. Free Bowl and other hemorragic outbreaks and the second part is handling the body which is teeming gene with millions of copies virus which is why these burial practices were so high risk. You got there. You had one fairly disappointing disappointing conversation. So I'm very persuasive. It's very hard to say no to me that feeling already. Yes I convinced him. It was in his best interest to be evacuated by me. And my buddy. The journey back to Freetown was quite interesting because you can't go in the ambulance with him because it's a highly infected did environment so we followed him. And we had a police escort Because there's please stops all along the way and and our escorts kept on stopping and so this guy. Is this this physicians critically ill. And we're both wandering my buddy and me Frederick Bosh why do they keep on on stopping and so I finally us like. Have you been drinking. And they admitted that they had brought alcohol in the front of their police car because it was cold and it was about seventy five degrees and they needed to keep warm so they had to keep stopping so that they could go to use the bathroom. Oh Oh my God So we finally got to Freetown and We we got this very brave. US physician into the hospital. There there are where he was evacuated The next morning to the US he was in the ICU and emory for many months and survived. So so what is the win. He was given in order to survive. Well that's such an excellent question because we talk about the mortality rates for the mortality rate for healthcare workers workers in Africa who get a bowl of seventy percent. The current were meaning the death rate for those listeners so so seven out of ten individuals who get a bowl of that. Our healthcare co-workers are GONNA die if they're in Africa. You're you have no supportive services in Africa. You don't have oxygen. You don't have that own leaders very difficult to do. IV's so you don't have the support services the the more the death rate if you are evacuated to to Europe or to US or developed country is much less. I'm not minimizing it. Almost everyone who had a buffalo was in the intensive care unit. They were critically Lille. Many of them develop kidney failure and failure of their other organs but many of them survived. This type of support is not available. Would present thank you say actually survived. Once they've gone into multi system organ. Failure is a typical for the Russ. Is it commensurate with the rest of the data relative to multi system organ failure four standard septic shock that we see in the first world. I think it is and if you look at actually the death rate in the. US of of the Ebola infected acted healthcare workers. I don't know one health care worker. Who died the only individual who I believe died in the? US was African patient if they survive are the ramifications having had the disease absolutely absolutely were in much of this. We don't even recognize. We're recognizing now that there's reservoirs where this virus may persist. We know that there's long term impacts On your I evacuated or helped evacuate three of my colleague so it shows you the number that get infected. These were people I worked with are using reservoirs within the body then called ongoing inflammatory dams or reservoirs visa via typhoid Mary where you can be infectious and not be infected both sick from the vote the disease both once you've been infected and you have developed immunity to the virus and you have survived you no longer can be reinfected with that subtype so it's subtexts very similar to the kind of multiple so multiple so so to go back I think to your your your original question and you're not out of the woods if you walk out of the hospital we know that a month out you still can detect the virus and we're learning more every time in and it's probably different per the individual's right because there's probably a little bit of a different immunologic response. I think there's a lot more that we don't know about Ebola. We kind of look at Ebola that everyone one dies or they get very sick. I personally think that there's a lot of sub clinical infections That are going on in Africa and then we really. I wanted actually to check all the healthcare workers. Chris and I wanted to check the dogs. Because we're dogs going through all the Bali units. I wondered about other mammals besides bats which are a big reservoir free. Bola you know. Are they a also carrying this virus. So let's step back a little bit just from the very beginning the. Who came to you. And you said you didn't even think about it for twenty four hours. Have you always had this kind of courageous spirit that you're GONNA walk into the lion's den and without even much consideration. You're you say you're going to be either because in this permissive society where everybody gets in a An everybody is a hero because they they help an elderly person walk across the street. The fact act that somebody would actually put themselves in harm's way which to me is the definition of a hero for a greater cause it is truly heroic and yet it's something you did did with almost no thought whatsoever you knew right away over and over again Steve. She's been back to these kind of outbreaks many times indeed. Well well I thank you for those thoughts but this is what I would say. Is You know this is kind of what I do. I'm an infectious disease physician. I'm a specialist in infection in control. How diseases are transmitted so and also sorry I know lots of infectious disease doctors and I love them? They're great physicians. I rely on uh-huh every day but to have the courage truly the courage and the dedication to walk into such a dangerous environment is is truly amazing and inspiring. We have to take a short break but when we return Dr Donovan's going to describe what it's like to enter one of the most dangerous places on earth stay tuned Hi My name. Is Chris Porter from one. Last night left the show. You've been listening to is sponsored by proud water. Not only do. They distribute their water in these stylish and recyclable aluminum bottles. But the water itself sustainably sourced naturally actually filter proudcers water believes in the ripple effects that one person's actions can impact the world for the better. You do your part and I do mind maybe become better than we started. CROWDSOURCE WATER DOT COM to learn more about the company their vision and their walked. Leave the world better than you found. Drink proud source water. We're back with host Dr Steven Taback and our very special guest infectious disease specialist Dr Suzanne Donovan when you were. They're in the hospital. Tell us about what you saw. How many patients were there? How did you handle so many patients? So the first first day I walked in with with my body because you always enter an unit with another healthcare provider. You use the buddy much like when you go scuba diving on diverse so to me when I would train people I said Said you knew your approach to going into bowl. Unit is very similar to going scuba diving. You you have to be very compulsive you have to go through your checklist you do things the same way every time so when you don were you put on your. PPE's you put them on the same way the same sequence and when you D- off which is taking off of it you take them off in the same way very meticulously and you dive with a buddy so the the buddies checking you and you're checking the body in you. Try to stick together was a little tough in this unit because when when we walked in imagine hospital that fifty percent of the time does not have power. It's during the ratings season to get into the unit. You have to cross a little wooden bridge with running water. After you're gone up with a mask that has now fogging up. Because you're in the tropics. This is not like a spacesuit. Yeah that's Tivat suit. I'll send you a picture of sounds. Good we'll actually will anyone who who sends us an email. Send them a picture of of you in your get up. Opinion are in in our in our get up. We put our first name so that everyone knew I was Dr Suzanne so that the patients because it was very frightening in many of these patients were from remote villages. We look like we were from another planet and the unit was was filled with about one hundred twenty any patients which is really was the largest unit that I know of many dead bodies because once that physician was infected no one went back in that unit so bodies these were lined up against the wall. The floors were covered with bodily fluids. Oh my goodness The wards were co ED. So so there there there there could be a child Next to a dead body in a room there were many of the patients were naked. They didn't have close Renault sheets. And and so when we went in there no one had been there for for a couple of days we brought in what's called Aura for oral alligator rate a cheap gatorade Because one one of the reasons you're you die to answer your question. Is there such profuse diarrhea. That there's a lot of disturbances in Pettah potassium and magnesium. And I. I actually think a lot of these individuals digest from a rhythm. Yes and and emory published their data of how difficult was to keep up with potassium and magnesium which measures the potassium magnesium so. There was nothing guessing. We we have failure. You have have no idea. It's potassium we three laptops. We hadn't Bola test. We had a test for another hemorrhagic. Fever called Lhasa Fever and then we had the ability to due to a rapid malaria. Tuft does it matter though what they have. If you're if you're just treating symptoms anyway why bother having even any of those tests you have somebody who's bleeding having diarrhea having fever. Are you going to treat them differently. So that that that's a great question. The Ebola test was critically important for two reasons. Reasons Padilla logically me logically if we had a confirmed case every contact of that individual had to be followed up and that is is how you stop an outbreak. That's not what's going on right now on the com- call number two The PCR test which is a very sensitive way to detect the virus. One sat test became negative. You could leave and so these patients could be trapped there for a long time. So these tests were very important for morale and getting patients out of there And and hopefully back to their villages though many of them were shunned so The I think that was the moment when I realized I was in a situation in that I had not encountered before I've been in a lot of dangerous situations but when I was in that unit with patients surrounding me you know trying to ask for help with bodies lying on the floor you part of you could feel a little bit of you. You know this is not a good situation Suzanne. Also I'm a single mom and I thought to myself. How did I get myself in this situation? Well what what was your. What was your goal? Was your goal actually to to save the people in the hospital to save the town from future outbreaks to get them to stop burying their their their parents by by hugging them in washing them. Why we're in other words beginning? He's asking on behalf of your friends and family. What were you thinking? What is along with you? Well my my first goal. I'm passionate advocate for healthcare worker for safety when those healthcare workers when those nurses in Dallas became infected because they were not provided the appropriate protection action and education. I was incredibly angry about that because I think we failed them and I think we take healthcare. Workers for granted did Healthcare workers in the emergency room or an inpatient units can be beaten can be hit. They're are exposed to communicable diseases. They they sometimes put their life on the line and so when I initially went there my goal was whatever how healthcare workers were left. I wanted to protect them by the way. Not One health care worker. Why was there during that first My first deployment got got infected. Congratulations thank you misery first deployment. Yes I was there three times So that was my first goal to amazing. My second goal was to come up with some creative solutions and out of the box solutions because remember. I didn't work for the WHOL I worked for the CDC. So I didn't have to listen to anyone and so one of the things that I implemented was using survivors to care for the patients. There all right. So you're limited. You can't is a great idea. Thank you of their predominantly immune correct different Septimus than we paid them And then the last thing I did was closed down that hospital which I felt was way too dangerous in the way it was set up the hybrid model. But also the the setup when you're dealing with a highly infectious disease we have a certain approach kind of what I'm talking about scuba diving where you don't want want patients leaving. You don't want the mixing you don't want suspects with confirmed cases and we just had no control. We had no security. We didn't have really a very good engineering plan. And so when you supply with the WHO you give recommendations at the end. One of my recommendations was to to close down K. G. H. was called Journal Hospital and it's kind of like my life when people when I'd go back. Let's say you were K.. G. H. because it was known own as such a dangerous place and it closed in. I was told. Who will never invite you back you you. You're putting your basically basically closing down their model and I said well you know. What do I care I'd rather do what's safe for the healthcare workers there. Did you convinced vint the townspeople to stop burying their dead in that fashion so that was not my role at that time. We had many people and so that was as you know the CDC partnering with a lot of the epidemiologists and while we did hire an anthropologist and so part of what we would do is we would allow them to do a burial were. They could see the body because they didn't trust the body was actually in the coffin so they wanted to see the body was in there. We had kind of them at a distance so that they wouldn't hug the body or have intimate contact we'd allow them to put like a blanket linkin from their village or something personal and the coffin. We would bay the body with bleach. you know you bowl a very fragile virus. Bleach was kind of you know the the currency we used but I could've used other types of Disinfectants but bleaches cheap hand sanitizer effective or not quite as no hand sanitizer there so we use bleach and water but would it be effective. Alcohol would be effective. Yes so Dr Donovan. You've been around the world in some of the strangest places that I can't can't even spell. I wonder if you could tell me how you compare your experiences with governance and other countries some under developed some developing pink some even industrialized like Singapore the US Finland France Canada. Tell me what your observations are about how these governments are handling you are field. That's an outstanding question. And you know I think that really depends On the country that we're looking at in general unroll. I spend most of my time. In under resource countries and those countries do just do not have the ability to have an effective public health response without external aid or ineffective clinical response so I just returned from Nepal where there are two outbreaks going on the main outbreak as a dengue outbreak and You know there's a very very large clinics that were calling fever clinics where there's thousands of patients being seen Very little clinical support for it. If you don't have resources patient you you. You don't get treatment at most of the institutions. It's always difficult for me to see people die. Die From vaccine preventable diseases in these under resource countries win they would really benefit from being immunized and many of these vaccines are being declined by by our communities here in the United States Suzanne tells about something. Good that's happening in this world when it comes to Communicable Diseases Infectious Diseases Clearly you've taken your last thirty years and dedicated to diseases like AIDS. So I you know. I saw my first AIDS patients in nineteen eighty-five and Tanzania dar-es-salaam. And you know it was wards and in whom billy which was the hospital. They are filled with people dying with HIV most of them also with tuberculosis. which is Probably the most common infection internationally that complicates HIV and I'm old enough that I was there when. Azt was introduced and then we had to drugs than than we introduced a ninety six ninety seven the cocktail which totally changed change the face of HIV all of a sudden we had a disease that progressed in one direction which is really into the hospital and then people would die where people are getting their lives back. There were going back to work having children Really have normal lifespans and it's incredibly gratifying to see the advances of of what really our country has done with a lot of the expedited medication-approval through the FDA to get these new drugs out there and to people with or without insurance because remember HIV has been carved out by the federal government. And so if you don't have insurance you will in most states have access to care for HIV treatment. Definitely in California if you have no insurance documented undocumented you will get treatment for your HIV and that is a very important thing to do irrespective irrespective of the insurance coverage because treating someone with HIV means. It's not going to spread to their partner. So it's a public health intervention. It's not only going to keep them healthy. It's going to break the chain of transmission because this epidemic is driven by untreated individuals else treated individuals. If they're taking their medication do not transmit this disease for the most part. I've been taking care of women. who are pregnant for the last twenty years hundreds of women. I've had no infected babies zero and I- institution and all those individuals I treat during the pregnancy We treat the babies after they deliver. I've not had one infected baby. This is huge from an infectious disease standpoint and this is something that can occur in Resource Limited countries the gates foundation and other foundations. I've been incredibly supportive. In addition to the US and providing access to care in countries like Africa that has have a very high rate infected women. An infected pregnant women are providing therapy to prevent transmission. Well doctors whose Donovan I have to say that the way you have dedicated your life to making our planet a better place and helping the rest of us and being so selfless and diving into some of the most dangerous areas in the world. Liz A special place in heaven waiting for you and we WanNa thank you very much. You are a hero. Tell me if someone wants to follow you and learn more about you. Wish they go. No one is no. This website is not savvy person about it uh-huh okay And I think that speaks volumes as to the type of human being that you are and not edit that out at all. I think that's an important important statement right there which says at all absolutely you are a person for the people and You're not about marketing in any way I I want to echo what bill says I'm just Actually aw and and honored to have this time to spend with you and it's been real pleasure meeting you and talking to you as well. I mean and really a wealth of information both. Thank you Dr Steven Tailback in Dr Suzanne. Donovan thank you for making this such a special episode of medicine. We're still practicing next time in part two of our conversation with Dr Donovan. We'll talk about the importance of immunization. And how the Anti Vaccine Campaign may be putting us all at risk. You don't WanNa miss it. If you like what you hear please tell your friends and let us know how we're doing by leaving a comment. It really helps if you give us a five star rating and we really appreciated. You can also subscribe to the show on Apple podcasts. Stitcher or wherever are you. Listen to your favorite podcast. This episode was produced edited by Mike. Thomas Audio Engineering. By Michael Kennedy and the theme music was composed performed performed by Celeste and Eric. Thanks for listening room. Kirk Oh media media for your mind.