The Lassa Ward: One Man's Fight Against One of the World's Deadliest Diseases

The Lassa Ward\ One Man's Fight Against One of the World's Deadliest Diseases \ \ By Donaldson, Ross \ St. Martin's Press\ Copyright © 2009 Donaldson, Ross\ All right reserved.\ ISBN: 9780312377007 \ \ \ Chapter One \ Swept Away\ \ June 30, 2003\ Unrestrained cargo lurched precariously behind my head, but I did my best to ignore it. Instead, I clutched at the frayed seat belt in my lap and focused my eyes out the helicopter window, past streaks of frenzied raindrops, toward a growing brightness in the distance. There's no point in looking back, I told myself—the only option is forward.\ The cabin, filled with the whine of the antique turbines, shuddered violently when we flew over dry land. The lumbering transport bucked in stubborn protest as a lone light drew us down into flickering shadows. As the aircraft finally struck the ground with a jarring thud, we tilted dangerously to one side for a few nerve-racking seconds before settling.\ After quickly gathering my few belongings, I filed out the cramped doorway to sway briefly under the downdraft of the chopper and the weight of my backpack. For a moment I searched for a familiar face in the surrounding undergrowth, but I knew there was none to find.\ Out of the dim jungle a bear of a man steadily plodded toward me. "Merlin?" he yelled over the slowing chopper blades, naming the nongovernmental organization (NGO) that was providing my logistics.\ I nodded my head in whatI hoped was confident affirmation. "Ross," I shouted back as I shook his meaty hand.\ "Mikhail," the big man answered in a gruff Eastern European accent. He paused to fan his sweat-soaked T-shirt. "Hope you're ready for the heat," he added.\ The two of us abandoned the small refuge of light to step into darkness. Our driver, a man with midnight skin, materialized out of the shadows to assist me with my backpack. Then my two escorts ushered me down a dirt path to a beat-up Range Rover.\ Stickers of AK-47 machine guns, crossed out by big red Xs, covered the car. Bold letters underneath proclaimed no arms. I slid into the passenger seat, trying not to second-guess my own intelligence: why had I voluntarily entered a place where vehicles needed to declare their lack of an arsenal?\ Mikhail, clearly an assertive man, insisted on getting behind the wheel. Our chauffeur, rendered obsolete, climbed into the backseat and sulked there silently. "You don't mind, do you?" Mikhail asked me. "Just got here last week and I'm still getting my bearings," he explained. As we lurched forward, I shrugged to myself, content for the moment simply to be on the ground.\ A hot breeze engulfed us as we headed into the heart of the city. Freetown, the capital of Sierra Leone, was pitch-dark at night. My two guides and I drove without conversation, listening only to the steady hum of the engine as enigmatic buildings passed by the window. I tried to reassure myself that I could handle whatever my new home might contain, but didn't feel all that convinced. Nothing seemed even vaguely familiar to me. Nothing looked like home.\ Headlights suddenly materialized out of the darkness, followed by the frantic honking of an oncoming truck. For a few fearful seconds, I found myself pressing down hard at an imaginary brake pedal beneath my feet, my adrenaline surging as the oncoming vehicle swerved by, barely missing us. "Why did he do that?" Mikhail complained to our driver, after the road had again returned to the comfort of shadows. But while I tried to relax my legs, the backseat offered only indignant silence as an answer.\ As we entered the sleeping city center, our car passed a sole lit sign, a plaque identifying the adjacent building as the Sierra Leone Reconciliation Court. The country had been at war since 1992, with the government in Freetown fighting the Rebel United Front (RUF). These two main combatants had raped, maimed, and murdered wantonly before finally signing a United Nation-brokered peace accord. The mandate of the court was to prosecute the worst of the prolonged conflict's many war criminals.\ I watched the building pass, barely able to imagine the drama that had recently occurred within its walls. Just a week prior, judges there had issued an arrest warrant for Charles Taylor, the neighboring Liberian president. The magistrates accused the dictator of crimes against humanity, for creating the RUF and subsequently supporting the rebels by providing a conduit for the group's illegally mined diamonds to the international market. But no one knew what would come of the indictment. Charles Taylor was ensconced in nearby Liberia, safely out of the reach of international justice.\ As the sign for the Reconciliation Court faded away in my sideview mirror, I recalled the many crimes with which Taylor was charged. More than two hundred thousand people had been killed and one million forced from their homes in a lengthy war punctuated by some of the worst human rights abuses known to the modern world. The atrocities were so extreme that they seemed almost unbelievable: arbitrary killings of civilians, widespread torture, systematic rape, deliberate amputation of limbs, and the forced recruitment of countless child soldiers, among others.\ As I tried to come to terms with what it meant to have suddenly entered such a trauma-ridden land, Mikhail interrupted my uneasy thoughts. "Up for a drink before we hit the guesthouse?" he asked casually.\ I wanted nothing more than to find a safe room in which to huddle, but I didn't want to seem overwhelmed. "Sure," I cautiously agreed.\ We soon pulled off the road and parked next to a small porch, where an anemic light guarded a few empty tables. As we sat down, our driver greeted the waitress. "How dee body?" he said in a singsong timbre.\ "Dee body fine," the woman replied with a welcoming smile. I tried to follow the pair's conversation in Krio, Sierra Leone's official language, but could identify only a few words of the English-based dialect that freed slaves had brought back to Africa.\ Mikhail quickly ordered us a round of beers. When the waitress returned, she efficiently flipped off their caps, rubbed the open bottle tops with a used rag, and handed them to us. My large escort eyed his change in leones, unabashedly confirming the absence of fake bills before holding his beer up to the driver and me. "To peace and health," he said. The waitress encouraged us with a big pearl-white grin as we all three took a swig.\ The driver continued to chat up the waitress, leaving Mikhail and me to ourselves. The burly Macedonian turned to stare openly at me for a few moments. "So," he finally blurted out, "you're the Lassa guy?" I was clearly a lot younger than he had expected.\ I paused for a few seconds before answering. "Yeah," I finally grunted, doing my best to imitate my guide's gruff demeanor. Although it was hard to feign comfort with my brand-new title, I didn't want Mikhail to know how lacking I was in field experience. I had finished three years of medical school and a year of public heath, in addition to studying extensively before leaving. That would be enough, I silently hoped, to handle whatever challenges lay ahead.\ "A doctor died of that here last year," Mikhail continued with a knowing shake of his head, as if to say he was new to the country but was aware of that much already.\ I was also well acquainted with the story of the fated Freetown physician. He had died from Lassa fever, a viral hemorrhagic fever (VHF) limited to West Africa. His horrific demise was just one of the many details I had conveniently failed to mention to those close to me before I left for my trip. My dad and brother had told me I was crazy, while my mom had sighed deeply—her heart torn between needing to protect me and not wanting to stand between me and something I was passionate about. With worry already clearly evident in their voices, I had held my tongue. There was no need to burden my loved ones any more than I had already.\ From the moment I had first heard about the dreaded Lassa virus, during my second year of medical school in a sterile California classroom that now felt very far away, I had been drawn to the illness. The disease is one of four famed VHFs (including Ebola, Marburg, and Crimean-Congo hemorrhagic fever) that share a terrifying tendency to spread from person to person, as well as a gruesome clinical picture of massive bleeding frequently leading to death.\ Although there are countless TV shows and movies focused on the more riveting aspects of medicine, the extended study needed to enter the field is almost exactly the opposite of dramatic. Medical school is hour after hour of monotonous rote learning, memorizing a neverending series of facts that can seem completely disconnected from the act of caring for actual human beings.\ Years of exams merge together until you almost forget why you choose to go into medicine in the first place. Surrounded by highly competitive people, you can easily become distracted by which specialties are the most prestigious or the most lucrative. During that time, Lassa became a symbol to me of something different, of foreign adventure and unquestionable need.\ I knew that my trip was risky, some had told me even foolish, but the mix of danger and adventure surrounding the mysterious virus compelled me toward it. I had studied for years to swear an oath to care for the sick. In my eyes, confronting Lassa seemed to be the ultimate test of such moral fortitude. It meant that I had not yet lost a few threads of idealism, to which I so desperately clutched throughout my training.\ As I had researched the trip, I learned that the Freetown physician to whom Mikhail referred had contracted Lassa from a patient returning from southern Sierra Leone, where the disease is endemic. The doctor's and his patient's horrific deaths, their bodily fluids pouring like flowing tap water from every orifice of their swollen corpses, had caused panicked patients and staff to flee the Freetown hospital.\ Admittedly, Mikhail's comment disarmed me for a moment. I didn't want to be reminded about the past physician's death. To me, at that time, medicine was supposed to be about tales of human triumph. I thrived on stories of success, tumors removed and lives saved, not failure.\ I did my best to turn the topic to a more pleasant subject. "So, what do you do for Merlin?" I asked Mikhail.\ "Fix problems," the big man answered. "I'm in charge of logistics for Sierra Leone, moving stuff and people around the country."\ "You just got here?" I said.\ "Yeah, last week. The post has been open for several months, and they were pretty anxious to fill it, given the fighting in Liberia."\ "And before?"\ "I was back in Kosovo, where my wife and twin girls are. I worked for Merlin there, transporting medical supplies. But the pay is higher here as an expat."\ "It's a move up, then?"\ "Yep. And I'm already looking forward to buying my girls matching tricycles for their birthday," Mikhail answered, with a twinkle in his eyes.\ Then, just as quickly, that glimmer disappeared. With a sharp grunt, the Macedonian slammed down his empty beer bottle. "Time to go," he said, before herding the driver and me into the Range Rover. Assuming the wheel, my temporary guide proceeded to drive us a short distance down the dark Freetown streets to the Merlin guesthouse. As we approached, a growing glow from the building illuminated high walls—broken bottles, cemented on top, glinted beneath rolls of barbed wire.\ A group of more than fifteen armed security guards soon unlocked the gates to let us enter the compound. The African men wore winter hats and thick jackets, along with threadbare pants and sandals. "They think it's cold at night," Mikhail whispered to me, perspiration clearly beaded on his own forehead.\ As I greeted the near battalion of guards, the nearest man cheerfully grabbed my arm and proceeded to teach me the Sierra Leone handshake. We began with the normal Western grasp, then spun to clutch each other's thumb, and then back to the ordinary grip. I bit back a smile as each guard shook my hand the same way, the eldest with methodical dignity.\ Mikhail eventually led me through the small, dark house to my room for the night. "We should have a ride for you in a couple of days," he informed me. My final destination was Kenema, a southern town close to the border of warring Liberia. Merlin sponsored a ward there, the only one in the world solely dedicated to treating Lassa fever.\ I unpacked a few things and got into bed, but sleep eluded me. My comfortable mattress, where I had last laid my head in one of London's towering high-rises, seemed a distant memory. More than space and time separated me from that place—in between sped a river of differences. Concealed under the cover of night, I clung tightly to my makeshift pillow and silently hoped that the rising torrent wouldn't sweep me away.\ Excerpted from THE LASSA WARD by Ross I. Donaldson, M.D., M.P.H.\ Copyright © 2009 by Ross I. Donaldson\ Published in May 2009 by St. Martin's Press\ All rights reserved. This work is protected under copyright laws and reproduction is strictly prohibited. Permission to reproduce the material in any manner or medium must be secured from the Publisher.\ \ \ Continues...\ \ \ \ Excerpted from The Lassa Ward by Donaldson, Ross Copyright © 2009 by Donaldson, Ross. Excerpted by permission.\ All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.\ Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site. \ \

Journal Entry 1Prologue 3Part I Swept Away1 Swept Away 92 The Rains 163 Your Deed Is Your History 224 Just Say No 285 Little Buddhas 336 Risky Business 417 The Measure of Things 47Part II The Lassa Ward8 First Fee 559 Dr. Conteh 6110 The Lassa Ward 6911 Technical Difficulties 7612 God's Will 8113 Friday Rituals 8914 A Foreign Funeral 96Part III Alone15 An Unexpected Delivery 10516 Scarcely Taller 11217 Alone 11718 Twenty-four Hours 12519 Barely Medicine 13320 In Deep 14021 First, Do No Harm 14622 A Visitor 15423 Another Drop 161Part IV Finally a Doctor24 More Than Medicine 16925 Borrowed Chips 17726 Heal Thyself 18527 Dots of Hope 19028 A Tiny Miracle 19729 The Growing Darkness 20430 One Last Day 20831 Finally a Doctor 213Part V Last Rites32 Seeds of Suffering 22133 Soggy Footsteps 22934 Part of Africa 23635 Homecoming 24136 A Familiar Face 24637 Technologic Dreams 25438 Last Rites 257Epilogue 264A Note from the Author 267Acknowledgments 269

\ From the Publisher"Effortlessly transmits both the facts and the fascination of a bad infectious outbreak...[a] portrait of contagion at the highest possible magnification."--The New York Times\ “A touching and compelling account. The Lassa Ward brings to life the challenges and rewards that dedicated development workers face daily around the world.”--Joseph E. Stiglitz, 2001 Nobel laureate in economics\ "Required reading for all medical students and anyone looking for a little armchair medical adventure."--Library Journal\ “Donaldson started out as an earnest, well-meaning American medical student, off on a great African adventure. He came of age in the middle of a raging epidemic, civil war, and hideous poverty, discovering a humanity few Americans ever experience. Donaldson has bared his soul, offering a lesson that should be required reading for every doctor-in-training.”--Laurie Garrett, Pulitzer Prize winner and author of Betrayal of Trust: The Collapse of Global Public Health\ "A potent mix of travel memoir, coming-of-age narrative and medical mystery. Donaldson's experiences treating a frighteningly infectious and often deadly hemorrhagic fever, the strength of his West African patients, and his own grave illness bring him to a contemplation of mortality, poverty, civil war, and medicine as it is practiced in the first and third worlds. " - Jo Perry, BookBrowse.com \ \ \ \ \ \ Publishers WeeklyDonaldson is a medical cowboy, chasing viruses in Africa, but also a UCLA medical prof and ER doc. This book is a wild and extraordinary memoir of his 2003 summer in Sierra Leone as a naïve medical student studying Lassa fever (a close cousin of the Ebola virus). Donaldson gives passionate and powerful reportage on a struggling clinic treating villagers and refugees from neighboring war-torn Liberia suffering from the devastating and often fatal illness. What inspired the adventure was the work of Dr. Aniru Conteh (who died in 2004), the hero at the heart of the story, whose Lassa ward served thousands. despite the lack of equipment, medicine and staff. For a week, Donaldson, untried and unsure, was left to treat the desperately ill patients alone-a test that turned a frightened student into a caring, if not altogether confident, young doctor. Despite a slow start, this astounding story of the seemingly insurmountable barriers to public health in a Third World country revs up into an irresistible tale of discovery, courage and kindness. (May)\ Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.\ \ \ Kirkus ReviewsIntrepid medical-school student confronts a deadly virus decimating West Africa. During his second year of medical school, Donaldson became intrigued by the deadly Lassa fever, a rat-borne hemorraghic virus closely related to the Ebola and Marburg varieties that, left untreated, virtually liquefies the body's internal organs. Convinced he could help ease the suffering, he spent the summer of 2003 in civil-war-torn Sierra Leone, where Lassa was reaching epidemic proportions. The trip, Donaldson admits, while initially an exhilarating "mix of danger and adventure," soon became an all-encompassing endeavor that he came close to regretting several times. After a tour of the poverty-stricken environs, the author apprenticed under renowned Lassa expert Dr. Conteh, who was in charge of the Lassa ward in the town of Kenema. A desperate fight to save a female villager from cerebral malaria would pale in comparison to Donaldson's months of frenzied work in the 20-bed facility, especially after Conteh departed for a week to oversee a program of health-care training, leaving the author in charge of the ward. Though overwhelmed and unprepared to make some of "the most critical decisions of [his] life," Donaldson and his bare-bones medical staff trudged on, diagnosing, curing and sometimes burying contagious villagers as lines continued to form outside his door. Near the end of his time in West Africa, Donaldson faced an extremely tough personal challenge as well-a diagnosis of myocarditis, a crippling, life-threatening autoimmune disease. Passionate humanitarianism permeates the author's memoir. In a heartfelt epilogue, he compassionately acknowledges that the work he performed in West Africa isintegral to the way he practices medicine today. A rewarding memoir. Agent: Gillian MacKenzie/Gillian MacKenzie Agency\ \