Q&A with Ebola physician William Fischer

UNC School of Medicine professor Dr. William Fischer II spent three weeks in Gueckedou, Guinea, fighting the Ebola breakout as a Doctors Without Borders volunteer this summer.

He sat down with staff writer Stephanie Lamm to discuss the region, the emotional toll and the possibility of containing the virus.

THE DAILY TAR HEEL: What is the process for treating Ebola patients?

DR. WILLIAM FISCHER II: There’s no antivirals or vaccines. In the past, the main treatment for Ebola outbreaks is to isolate people to stop the chain of transmission. They’ve never sent in critical care-trained physicians to run outbreak centers. We’ve seen in the past that aggressive supportive care can reduce mortality. Under ideal conditions, this model has reduced mortality to 40 percent.

We basically support the patient as much as possible until their immune system kicks in. Because they are losing so much fluid, their blood pressure is dangerously low. So as a part of the care, we gave everyone an IV, antibiotics and aggressive fluid recession.

I was a part of a team of specialists sent in to try to implement the aggressive critical care model in this treatment center. I was sent by myself to Gueckedou where there’s no running water or electricity, and I was able to reduce my mortality rate to 50 percent. I think with the proper resources, we could reduce it to 20 percent.

DTH: What was your daily schedule like in the clinic?

WF: My day starts with a bucket shower at 5 a.m. When you first arrive at the center, you check in to see who made it through the night and who died. In the morning, the humidity was so high that your goggles would fog up within 30 minutes.

Here at UNC, I’m spoiled by the incredible nursing staff. I hardly do anything compared to what they do. But there, we didn’t have the manpower. I was doctor, nurse, family member. If a patient had vomit on his shirt, I would bathe him, dress him and put him back in bed. In the clinic, we believed no one should die that way. It’s not fair to let them spend their last day like that.

DTH: What will it take to contain this virus?

WF: We need better resources, specifically monitoring technologies and improved health care infrastructure.

The other part of containing the virus is building trust between the people and the government. It’s not entirely unfounded. I have two boys, and if they were sick and someone told me that if I brought them to a facility there is a 90 percent chance they would die in there, I wouldn’t take them. So we need to invest a ton of resources into reducing the mortality of this virus, so that people are more trusting of the health care system.

However, it’s not all gloom and doom. There is incredible hope that we can contain this through aggressive critical care. We need to have a concerted international effort to provide resources to this region to raise the quality of basic health care available in these countries.

DTH: Can you tell me about the emotional toll of treating these patients?

WF: I can’t get the patients out of my head. The first cases that I saw were a brother and sister that had hidden in the bush until they were too weak to move. There was no hope. The day the boy died, he was sitting on the floor and he was just kind of flopping around. I picked him up, and I had blood and diarrhea all over me. It wasn’t fair for him to die like that. I washed him and put a shirt on him and, as soon as I laid him down in the bed, he stopped breathing. It’s miserable. His sister had this gaze that I saw a few more times while I was there. It’s this wide-eyed stare that looks through you. I’ve heard a few other people describe it, but it’s like nothing I’ve ever seen before. Within 48 hours of the onset of that gaze, she died.

There was a 9-year-old boy and his mother who were locked in his house by the community because they were ill. The mother died in transit right in front of the boy. He was alone in the isolation ward surrounded by people in spacesuits. He was so scared of us. I tried so hard to save him and earn his trust. We really thought we had a shot at getting him through. I coaxed a smile out of him by giving him cookies. I was so excited to see him the next day. I felt energized by this challenge. That night he died by himself in an isolation room.

Those are the bad moments, but there was hope. Our survival rate was improving and that motivated us to work harder each day. The alternative is to give up, and that’s not an option.

DTH: Did this experience give you any insights that you will pass on to your students?

WF: Inequality in health care is unacceptable. I don’t think anyone that goes into medicine can accept that people don’t have access to the care they need. A lack of health care infrastructure is unacceptable. I tell my students that a career in medicine is a life of service.

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