divulgatum está dedicado a la difusión de conocimiento científico en español e inglés, mediante artículos que tratan en detalle toda clase de temas fascinantes pero poco conocidos.
divulgatum is devoted to the dissemination of scientific knowledge in Spanish and English, through articles that go into the details of all sorts of fascinating, if not
widely known, subjects.

Thursday, June 9, 2016

“Who would look after me?”

Relieving the impact of the recent Ebola outbreak on the affected regions’ health-care services will only be possible with years of effort.

Sheik Humarr Khan. (Credit: Pardis Sabeti.)

AS THE EBOLA epidemic in Western Africa wanes and vanishes from the media, it should be remembered that its effects have not vanished from the affected communities, nor will they for many years. In what has been the largest and longest outbreak on record of this viral haemorrhagic fever in humans, the Ebola virus sowed devastation throughout Guinea, Liberia and Sierra Leone during the course of the last two years, infecting over twenty-eight thousand people and claiming more than eleven thousand lives. The victims include numerous health-care professionals — doctors, nurses and others — who comprised the first line of response to the epidemic, risking their lives for their patients. Amongst these many health-care workers was Sheik Humarr Khan. His story is remarkable not for the way in which he died, but for the moral decisions that defined the trajectory of his life, and that would eventually lead to his death.

A native of Sierra Leone, Khan had dreamed of being a doctor since childhood. Part of his inspiration came from the story of a German doctor who had died of Lassa fever, another potentially lethal viral disease, after moving to Sierra Leone to help treat sufferers of the said malady. As with this doctor, Khan had a need to help the sick, being of the firm opinion that medicine should serve everyone, not only those able to afford it.

Following his vocation, and conquering the enormous difficulties imposed by his environment, Khan finally qualified in medicine and surgery from the College of Medicine and Allied Health Sciences of the University of Sierra Leone in 2002, and over the following twelve years he rose to prominence as one of Western Africa’s leading virologists. His commitment to the sick and his bravery became clear when, in 2005, he took the lead of the Kenema Government Hospital’s Lassa Fever Programme, after his predecessor’s death due to accidental infection with the Lassa virus. The Lassa Fever Programme currently has the only medical unit in the world that is exclusively dedicated to the treatment and research of a viral haemorrhagic fever, and becoming its head entailed Khan to move to the remote and neglected rural region of Kenema, turning down more lucrative job offers in the capital, Freetown. But if life had taught Khan something, it was that the needs of the patients and the community, and not money or prestige, were the only thing worthy of working for — something that not all doctors can say of themselves.

Khan’s research on Lassa fever was of great significance, despite his lack of resources — the norm for most scientists and health-care workers in this part of the world — and focused on questions relative to the evolution and adaption of the virus responsible for the disease. Khan was also deeply involved in the education of future medical professionals at the College of Medicine and Allied Health Sciences, where he studied, for he believed that the quality of this education was fundamental to improving the country’s health system. Those who knew him recall that where Khan really shone was in his personal treatment and his humanity, which made him one of the most outstanding and cherished personalities in the Kenema region.

Facilities of the Kenema Government Hospital’s Lassa Fever Programme, headed by Khan between 2005 and 2014. (Credit: Stephen Gire.)

When the Ebola outbreak reached Sierra Leone in 2014, the government asked Khan for help to direct the response to the epidemic. In spite of the clear hazard involved in such a commitment, the doctor accepted, leaving aside his engagements to teach abroad and devoting entirely to this task. Every day he tended to patients and helped to coordinate the efforts to control the disease, speaking with government officials and many others involved. He also shelved his Lassa research when the hospital became overflown with Ebola cases, starting to study instead the speed at which the Ebola virus mutates and evolves. Although he was very aware of the risks he ran whilst holding such a position, he never stopped working to ensure that his patients received the best possible attention. His response to his family’s concerns was simple: “If I refused to look after them, who would look after me?”

In July 2014, Khan began showing symptoms of Ebola infection. His illness and death that same month sparked great social unrest in the region, due to the fact that the medical workers from Médecins Sans Frontières (Doctors Without Borders) who tended him opted not to use an unproven experimental treatment on him, considering the risks to exceed any possible benefit. A few weeks later, the World Health Organization declared the application of experimental treatments to Ebola patients to be ethical.

After Khan died on 29 July, aged 39, Sierra Leone’s president, Ernest Bai Koroma, declared him a national hero, thanking him for having saved over a hundred lives. A new centre for the treatment of haemorrhagic fevers in Kenema will be christened in his honour, and his family has established a foundation in his name, with the aim of assisting those families that were profoundly hit by the outbreak, as well as helping to pay for the training of future doctors and researchers.

It would be false and unfair to say that Khan’s story is unique. Many other health-care professionals could be mentioned, each one of them with their own inspiring and grievous story. Ebola has claimed the lives of over five hundred medical workers in Western Africa, a sad price for the selfless will to help the sick. The many others who risked their lives and survived deserve no less respect and attention. Besides the ineffable emotional damage caused by the epidemic, the death of all these professionals constitutes a severe blow to the health-care and research systems of the affected regions. Recovery will only be possible through many years of work, accompanied by the implementation of extensive international aid programmes dedicated to the training of new medical workers — something which might never materialise. This is of urgent importance now that the Ebola virus has been found to persist in the central nervous system and the reproductive organs of some survivors many months after the disappearance of the disease’s symptoms, and to be transmitted from these carrier survivors to their uninfected sexual partners, thus posing an extremely serious risk of new infectious outbreaks. Moreover, it must be borne in mind that Ebola is but one of many diseases that these countries face, including malaria, HIV/AIDS and yellow fever, which also depend on specialised medical staff for their prevention, treatment and control.

As demonstrated all-too-often by the more unfortunate regions of the planet, devastating adversity can bring to the surface the breath-taking determination and self-sacrifice of those committed to putting an end to it. It has been thanks to the tremendous efforts, and sometimes to the lives, of dedicated professionals like Sheik Humarr Khan, that the epidemic could finally be controlled. Nonetheless, the death of so many indispensable members of these communities exacerbates the impact on countries in which the aftermath of Ebola will remain woefully present for a long time.

Special thanks are due to Isobelle Bolton for her invaluable help with translation.

Gibney, E. et al. Nature’s 10. Ten people who mattered this year. Nature (2014).
Green, A. Obituary: Sheik Humarr Khan. The Lancet (2014).
Bausch, D.G. et al. A tribute to Sheik Humarr Khan and all the healthcare workers in West Africa who have sacrificed in the fight against Ebola virus disease: Mae we hush. Antiviral Research (2014).
Heeney, J.L. Ebola: Hidden reservoirs. Nature (2015).