Lest We Forget: A Doctor’s Experience with Life and Death during the Ebola Outbreak

Two years ago I posted in my blog this question: Should you still care about Ebola now that the outbreak is over?

I received the author copy of my book debut, Lest We Forget: A Doctor’s Experience with Life and Death during the Ebola Outbreak is finally going to be in print and be widely available to the public on October 9, 2018. I’m glad that my story honoring the Ebola patients and the Ebola fighters who put their lives on the line caring for them is finally being told.

Ebola is still lurking. Since then there have been three more outbreaks all in the Democratic Republic of Congo (DRC), the third one in the North Kivu area, a conflict zone, is still on-going. To date, there have been 154 cases with 102 deaths. A recent infection was detected roughly 125 miles from the border of Uganda. It is not inconceivable that Ebola could spread to the neighboring countries of Uganda and Rwanda.

Here is a link to preview and pre-order the book: http://www.simonandschuster.com/books/Lest-We-Forget/Kwan-Kew-Lai/9781632280633

Reviews

“Picking up this book, I was quite unprepared for the gripping, page-turning quality, the deep personal insights, the lyricism, and the candid, heartfelt explorations of fear, courage, love and loss. This is an unforgettable book. A reminder of what contagion is like at its deadliest, and what medicine can be like at its very best." -- Abraham Verghese, author of Cutting For Stone

“A firsthand, eye-opening account of the devastating impact of a infectious disease outbreak, which has the potential to spread worldwide. If you are looking to be inspired by one person’s compassion and desire to help those inflicted with a deadly illness, this is a must read. This is a personal, heartfelt narrative of what it means to be a good global citizen by unselfishly serving those suffering from healthcare disparity and lack of education and proper training while understanding and respecting local culture. Thank you Dr. Kwan Kew Lai for being a voice for those who have suffered." -- Moeen Saleem, MD. Advocate Medical Group, Board of Directors, MedGlobal

Porter Square Books in Cambridge, Massachusetts is holding a book reading and signing event for my Ebola book on October 11 at 7 pm, I hope you and your friends could attend or tell your friends about the book.

https://www.portersquarebooks.com/event/kwan-kew-lai-lest-we-forget

If you can’t make it, there is another event in Belmont Books, Belmont, Massachusetts on November 20 at 7 pm.

Visit my author Facebook page for updates: https://www.facebook.com/kwankewlai.authorpage/

There are no walls or barriers to prevent Ebola or other deadly diseases to spread internationally. Lest we forget!

Should You Still Care about Ebola Now that the Outbreak is over?

I volunteered twice as a doctor during the Ebola outbreak of West Africa; once at the peak of the outbreak in Bong Ebola treatment Unit (ETU) in Liberia and the second time in Sierra Leone when the outbreak there continued, refusing to die down.  I was very moved by what I saw and the people whom I came to know, both the Ebola patients and the people who went there to help.  They inspired me to write a book on Ebola: Lest We Forget: A Doctor's Experience with Life and Death During the Ebola Crisis.

In today’s era of global travel, infectious disease epidemics pose a constant and ongoing threat well beyond their countries of origin. No recent outbreak has exemplified this more than the Ebola contagion of 2014–15. Devastating as it was to the three African nations it swept across—Liberia, Guinea, and Sierra Leone—its further spread was effectively cut off by an initially chaotic but ultimately successful international intervention by the World Health Organization, the US and other Western governments, many NGOs—and the selfless efforts of both African healthcare workers and hundreds of volunteers from around the world.

As an infectious disease specialist with experience gained from disaster relief efforts in more than a dozen countries, yet even I soon realized that my two six-week assignments to Ebola-stricken West Africa this was a different sort of volunteer mission. The Ebola contagion in West Africa, like the leprosy of an earlier era, subjected its victims to isolation and stigma. The patients who were in most need of close human contact had to deal with it virtually alone. Their sole relationship other than with fellow patients was with health personnel communicating through a barrier of protective coverings. Most terminal patients died a lonely and scary death, unattended, struggling with their last breath. Children separated from their parents almost certainly could not comprehend why they had been abandoned.

Healthcare workers were also affected in ways that once seemed unthinkable. The epidemic devastated the fragile and inadequate healthcare infrastructures of the countries where it originated, literally killing off up to one half of all doctors and nurses and transforming hospitals from places of healing and refuge into incubators of the deadly pandemic.

This was one of the greatest and deadliest Ebola outbreaks since 1976 and it was the first ever in West Africa.  WHO designated it as a Public Health Emergency of International Concern (PHEIC) in August 2014 as it posed a public health risk and had the potential to spread widely to the rest of the world because of its high mortality, its intensive transmission pattern in the communities and healthcare facilities and the weak health systems of the countries affected. Thankfully it was stopped from becoming a pandemic by the coordinated international response although that took some time to happen.

It is true that Ebola has receded from the front pages to be replaced by the Zika virus which has become the latest global threat.  Zika is not a deadly virus like Ebola but has serious consequences on some fetuses causing microcephaly.  However scientists and public health personnel have warned about walking away from the Ebola outbreak once it is over and no longer grabs the attention of the public and politicians, that the healthcare infrastructure of the  three countries affected greatly by it ; Liberia, Sierra Leone and Guinea needs to be built up to ward off yet another outbreak of diseases.  Despite the warning the US government has moved funds spearheaded for Ebola till 2019 for surveillance and training purposes to Zika when requested funding for Zika is not forth-coming.  Our memory for the raging Ebola outbreak is short-lived and fades as soon as it stops to present a real threat to us.  Such a book on Ebola will be extremely helpful to continue to raise awareness for the general public and politicians.  But do they care and would they read it?

Last but not least, the Ebola outbreak is a tragic human story which has to be told and remembered even after it is over.  The memory of those who died and the frontline Ebola fighters who bravely confronted the deadly virus without regards to their own safety and life had to be honored.  Currently there are no books on the detailed narration of what the patients went through in the Ebola Treatment Unit.  The reporter from the New York Times embedded with us in the Bong Ebola Treatment Unit (ETU) pleaded with the medical director for admittance into the ward so she could have first-hand knowledge of the unit for her reporting but permission was not granted.  

There continues to be books written about the holocaust reminding us that we are not to repeat history.  Although Ebola cannot be compared to the holocaust, books on Ebola should be published and read so we learn from this devastating outbreak to prevent it from happening again.  No one lives in isolation in this highly mobile world.  There are no walls or barriers to prevent Ebola or other deadly diseases to spread internationally. Lest we forget!

Should you still care about Ebola now that the outbreak is over?

Altruism

I have been thinking about this word lately, especially during this largest and longest Ebola outbreak in history. The Merriam-Webster dictionary defines altruism as feelings and behavior that show a desire to help other people and a lack of selfishness.

The first time I heard the word mentioned was from the urologist who performed my kidney surgery to transplant my kidney to my sister who suffered from chronic renal failure as a result of her systemic lupus twenty years ago.  When I made the decision to do so, it did not occur to me that it was an act of altruism.  To me it was very simply out of my love for my sister.  I wanted her to be able to be free from peritoneal dialysis and hemodialysis, being tied to a procedure which did not allow her to do the things that she loved. 

It was also my way of paying back as many years ago when I was accepted to Wellesley College on a full scholarship, my sister and her husband bought a one-way ticket for me to fly from Malaysia to United States so I could attend college.  It was a great financial expense for them.  Hence I did not see my decision to donate one of my kidneys to her as an act of selflessness.  My three children were young then.  They were in the hospital when my sister and I had our surgeries, she in the next room being prepared to receive my kidney.  They had a real fear of the possibility of losing their mother. I did not think of it at the time but now thinking back my decision to do so must have made an impression on their young minds that when one of their siblings or friends is in need, no matter what it is, they should step up to the plate. 

So in donating my kidney, I might inadvertently be performing a selfish act.  When my sister and her husband helped me to fly to the States, there was no way that I could have repaid them in monetary terms for they did that out of love for me and out of the desire to help me to pursue my dreams.  My children benefited from this act by learning to treasure family tie and sibling relationship in ways that I could not have done otherwise. I delved in the pleasure of dreaming of she and her husband gallivanting about Europe once she was no longer tied to a machine.  All these rewards after an act of so-called altruism made it difficult for me to see that it was a true act of altruism and not an act of selfish pleasure.

In years past, volunteering in medical relief as a doctor in various parts of the world in natural disasters, conflict, and war, helping people to feel a little better, the refugees in the camps to regain some degree of human dignity and in the process saving some lives, actually give me a great deal of purpose in life and deep happiness.  Indeed losing oneself in the immersion of helping others is exhilarating, addicting, and intoxicating.   Studies have shown that those who help others have a healthier life and live longer.  So I may be the beneficiary of these benefits. When helping others or performing acts of altruism, the pleasure center in the brain lights up in the same area as when we are loved, when we flirt, have sex, or enjoy life’s simple pleasures.  If altruism gives us such pleasures, is it then an act that lacks selfishness? 

In my cumulative three months of volunteering as a doctor in the Ebola Treatment Units in Liberia and Sierra Leone in the Ebola outbreak in West Africa, I was emotionally overwhelmed by the intense pain and suffering of the people and felt powerless against the unrelenting waves of deaths caused by the virus.  Even in this situation of “altruism” as a volunteer in the Ebola outbreak, my rewards were immeasurable.  My volunteering gave me a strong sense of purpose in life, and a wholesome dose of incalculable fulfillment and untold satisfaction that in some subliminal infinitesimal way I played a part in something greater than myself.  I bore witness to the greater triumph of our noble, kind, compassionate, caring part of humanity which again showed its capacity to rise to the challenge of this deadly virus by the willingness of our fellow humans to even give their lives to save another.  As a participant in this outbreak I bore witness to the resilience and courage displayed by both the sufferers and the helpers, and the brave and selfless acts of numerous nationals and volunteers who displayed altruism in the true sense of the word:  “Greater love has no one than this: to lay down one's life for one's friends”. 

In less than two days I will be heading to Nepal to offer medical assistance to the quake victims. I am sure my reward will be far greater than what I could give. 
If there is internet, I will try to blog nepalkwankewlai@blogspot.com

End of Quarantine

My daughter called and said, ”Congratulations, you’re free from Ebola!”

April 15 was my last day of quarantine.  I had never once developed a fever or any symptoms except some short periods of fatigue right after a brisk run and once in a while troubled by my migraine, but no aches and pain to speak of. 

This time around after my volunteering, I was quite confident that I was not incubating Ebola. My experience in Sierra Leone was slower paced and less intense than my experience in Liberia.  I also felt safe in our infection control practices in the ETC.  Of course there were the subliminal positive thoughts of family and friends and the protective “pink bubble” into its cocoon some of my Wellesley friends have placed me for the duration of my time in West Africa.  With the end of my quarantine, I can now emerge into the world without fear of infecting a vulnerable person.

I was never cooped up in my house, having long walks into the ever changing Habitat of Belmont now that spring is coming, running almost most mornings and spotting snow drops and crocuses peeking through residual snow and dead autumn leaves.  Soon there will be the bright yellow forsythia, soft pink cherry blossoms and my backyard is already covered with carpets of deep blue Siberian squill Scilla, all signs of spring that bring a song to my heart.  There are also bright red Cardinals with their less opulently colored partners, fat red-breasted robins, Canadian geese, and ducks almost always traveling in couples.  Woodpeckers peck furiously on dead tree trunks at such a speed that one wonders why they do not suffer from concussion. Once a rafter of six turkeys flew into my neighbor’s backyard rousing the interest of Grisela who pretended she was really not interested in them and skirted around them and finally made a move for the kill.  They lived.  Another evening I saw what looked like an osprey flying in the sky with its big wing span.

Siberian squill Scilla

Grisela Stalking the Turkeys

In our neighborhood there is a lone wild tom turkey which must have lost his mate for at least a year but he roams around here, occasionally making a display of his tail and his gobbles could be heard in the evening.  He must be a very lonesome creature.  My neighbor has observed Gri stalking the tom some mornings when she is not stalking the numerous squirrels here.  In the evenings there are the Belmont bunnies coming out to feed in the gardens.

The State Health Department was quite concerned about my cat being exposed to me.  There is also a myriad of animals and living things in my yard that I made friend with…

Figuring that I was no longer a threat to anyone on my last day of quarantine, I went to Wellesley College to watch the carillonneurs play the Wellesley Carillon: 30 bronze bells from England in Galen Stone Tower.  In the evening, I attended a talk by Nicolas Kristof, the Pulitzer Price Award winner about his recently published book “ A Path Appears”

Galen Stone Tower of Wellesley College

I sneaked into the Museum of Fine Arts early one morning when I felt the crowd would be thin to see the exhibitions of the internationally known Japanese artist, Katsushika Hokusai who was most known for his woodcut print “Under the Wave Off Kanagawa (Great Wave)”.  I was actually swept away by the enormous crowd in the MFA!

Hokusai Great Wave

I was not the best behaved person during the quarantine but I mourn its passing because now I have no more excuses but to resume the responsibilities out in the “real world”. 

William Wordsworth describes my mood best in his poem: I Wandered Lonely as a Cloud

I wandered lonely as a cloud

That floats on high o'er vales and hills,

When all at once I saw a crowd,

A host, of golden daffodils;

Beside the lake, beneath the trees,

Fluttering and dancing in the breeze.

Continuous as the stars that shine

And twinkle on the milky way,

They stretched in never-ending line

Along the margin of a bay:

Ten thousand saw I at a glance,

Tossing their heads in sprightly dance.

The waves beside them danced; but they

Out-did the sparkling waves in glee:

A poet could not but be gay,

In such a jocund company:

I gazed—and gazed—but little thought

What wealth the show to me had brought:

For oft, when on my couch I lie

In vacant or in pensive mood,

They flash upon that inward eye

Which is the bliss of solitude;

And then my heart with pleasure fills,

And dances with the daffodils.

The Inconvenience of a Quarantine

Starting week two of my quarantine. 

The last time I had a fever was when I got sick with dengue almost two years ago and I have not had a fever since.  I am pretty confident that I will not come down with Ebola.  In Lunsar ETC, I don’t recall any breaches or exposure.  The time I spent in the ETC donning PPE was miniscule compared to when I was in Bong ETU, Liberia when the patient exposure was intense and the crammed quarters made maneuvering among infected patients quite treacherous.  

Asymptomatic individual does not incubate the Ebola infection and yet asymptomatic volunteers are restricted in appearing in crowds which goes against evidenced based reasoning.  Because of that, I will be missing my daughter’s first one-person Art Show in Burlington, Vermont, this evening and the Harvard Law Review Banquet at the Harvard Club next week.  I don’t care that much about the banquet but I am sure sorry to miss the opening of the Art Show.  This will be her first since graduating from Rhode Island School of Design years ago. If anyone is in the Burlington area, do drop by and view her paintings.  Break a leg, Cara or as Grisela would say,"Break four legs!"

My brother and I always dabble in painting in our spare moments; when I was twelve my colored pencil drawing was chosen and made its way in a traveling exhibition in Asia along with a whole bunch of works submitted by other children.  My brother also submitted his painting bringing awareness to world hunger.  Now and then my daughter and I have our works exhibited at the Belmont Gallery of Art.  Last but not least, Cara’s great grandmother was like my brother and me, a self-taught painter, and sold her paintings on the weekends in Greenwich Village in New York. There may be some genetic components to Cara’s art talent but her styles and ideas are uniquely her own (www.cara-doo.com). 

Great Grandmother Amolia Selling her Paintings in Greenwich Village 

I might have harbored the wish to be an artist when I was young but the reality of a starving artist was looming too large for me.  I needed to be financially independent and I definitely had no desire to depend on a spouse or others for my survival; like my poor mother who did not have a choice.  Looking back I still think being a doctor is still the best decision I made.  In my next life if there was one, I would, without a doubt, choose to be a doctor again. 

My Painting: A Swan in Trent, Italy

Homecoming

When I left for Sierra Leone in February, I did not tell my neighbors about it but did inform some friends.  The airing of the NPR interview might have reached some more of my friends.  I later learned that the news of an American being flown in for treatment for Ebola stirred up questions whether I was the one.  My family was able to quickly eliminate me by checking on my blog.  Similarly many of the American healthcare workers in Lunsar ETC had the same reactions from concerned family and friends.  Our presence in West Africa did cause continued anxiety which sometimes while we were there in the midst of the outbreak, we easily forgot.  

Upon my return, I took a long walk in Belmont and my first encounter with a neighbor was “a keep-a-distance hello” but his dog came charging to greet me as most dogs do here. On my morning run several Belmontians were carrying placards campaigning for issues to be voted on in the local elections at the busy intersection in the center of town.  One of them who was all bundled up greeted me enthusiastically, “Welcome back!”  I did not recognize her at first but soon realized she lived right across the street from me. 

Many e-mail exchanges occurred between the people at the State Department of Public Health and the Beth Israel Employee Health as to how the responsibility of monitoring of my 21-day quarantine should be divided.  In the end the state will take the lead to be followed by the local Belmont Health Department; skyping daily for a face-to-face encounter and twice daily reporting of temperatures and symptoms. It only takes a few minutes but I still feel a little bit of an intrusion and harbor a feeling of defiance.

Grisela and Me

Grisela returned home from Burlington, Vermont, the day after my homecoming; my daughter cat-sat for us.  She is a year old now and no longer a kitten.

Gri, Me and Cara, my Cat-Sitter

The British military nurse recovers in London Royal Free Hospital having received an experimental drug MIL 77 and was discharged two days ago.  The American is still in NIH listed in serious condition. 

Last night I learned the greatest news yet; the infected national healthcare worker was discharged from Kerry Town Ebola Treatment Center for healthcare workers.  He is an Ebola survivor!  (thanda kuru) He never received any special experimental drug.  I rejoice in his recovery.  The center initially had no room for him despite him being confirmed with Ebola as a healthcare worker but had rooms for other American healthcare workers with potential Ebola exposure to the infected American but with no confirmed infection.  This happened in his own country!

Screening at the Airports

Locals at Lumley Beach

I traveled to Freetown planning to leave from there to Lungi Airport again taking the speed boat.  Lumley Beach is right across from the Family Kingdom Resort where I stayed, however as a beach right in the city it is not very clean and once I saw a rotting dog carcass.  Evening breezes were quite pleasant and despite the Ebola outbreak, the locals took their leisurely evening walks.  In the morning I ran along the beach for a way and a number of fishermen were busy pulling in their nets.  This weekend there will be in a lockdown and there will not be any activities in the whole of Sierra Leone.

The compound of the resort was filled with a number of cars from various NGOs, there seemed to be workshops run by Save the Children and WHO.  For our departure our temperature was taken at each of the stops, at the ticket office for the speed boat, at the gate to the airport and at the entrance into the airport.  There at the health stop we filled out questionnaires on where and what we had been doing in Sierra Leone and for any symptoms.  The gentleman ahead of me set up an alarm in the infra-red thermometer; his temperature was above 38 degrees Centigrade.  The tester used three different thermometers on himself and on him again.  He repeatedly set off the alarm.  He was then pulled aside and taken to some place.  That was a scary moment.  We arrived at the airport at least six hours early.  He did not appear in the waiting area until a couple of hours before departure.

On Leaving Sierra Leone

Our first stop was Brussels.  There we filled out a Public Health Locator Form in case if we got sick the airline could locate us and identified our seat assignment.  Again our temperature was taken.   

The screening at Washington Dulles Airport was much organized compared to last year.  This time I was put in a room again with stainless steel bench and table but no sink or toilet.  The officer kept the door open and told me I did not have to sit on the metal bench and politely offered me a proper chair.  The CDC officers had a lot more questions specifically on Port Loko District where the American healthcare worker got infected.  I did not make it clear to them that Lunsar is actually in the Port Loko District, only a half hour from Marforki ETC.  Since the three healthcare workers came down with Ebola we have not heard what happened to them, except the American's condition has been upgraded from critical to serious.  Several more people returning from West Africa had a shorter time at the office bypassing the CDC officers as they were there for reasons other than Ebola.

An hour later, I was able to get my bag through customs and onwards to my next leg of the journey back to good old Boston.