On the Front Lines of the Ebola Outbreak

Colleen Kovach, M.D.

Colleen Kovach, M.D.

May 5, 2015

Giving up the urban lifestyle, where advanced technology and medical knowledge is literally at your fingertips, can be an abrupt and shocking change. Few are able to make the transition easily, and even fewer choose to stay. Regardless of the realities of humanitarian work abroad, as well as the risks involved, Colleen Kovach, M.D., clinical instructor and fellow in GW’s School of Medicine and Health Sciences (SMHS) Department of Emergency Medicine, didn’t think twice about going to where many call “ground zero”: Liberia in the midst of the Ebola epidemic.

Despite having worked with Syrian physicians in Turkey and Syria, who were fleeing a conflict that has left millions without food, water, or access to medical care, Kovach says her family and friends thought she was crazy, some of them calling her desire to go to Liberia “a death wish.” The stigma didn’t end there. On the many flight connections she had to take just to make it to Monrovia, Liberia’s capital city, strangers flinched and even shifted their bodies away from her when they heard her destination. The biggest support she received in making the journey, however, came from the emergency medicine department at GW.

The Office of International Medicine (IMP) learned of Kovach’s desire to travel to Liberia in October 2014 and worked diligently with departments across the university to help make the trip a reality. IMP created guidelines for traveling to Ebola virus-infected countries (EVC) and assisted Kovach in designing a communication plan and ensuring she had access to safety and security information. IMP researched the organization through which Kovach worked in Liberia, reaching out to them to make sure that she would receive proper orientation, training, and support.

Kovach’s arrival in Monrovia was surreal. Scores of United Nations trucks roamed the city, and restrictions and hygiene protocols – temperature checks, hand washing with bleach water, a no-touching policy, and a curfew – followed wherever she went. The restrictions were just a few of the many steps taken to bring transmission of the deadly disease to a halt. From the capital, Kovach journeyed for nearly four hours to Bong County, in north-central Liberia. There, she attended “cold training,” educational sessions on the basics of Ebola, organizational treatment protocols, and the general structure and flow of the treatment units. “Hot training” followed, and Kovach treated patients and learned how to properly put on and take off personal protective equipment (PPE).

The Ebola treatment areas consisted of USAID tarps with wood frames, and orange plastic separated low risk zones from high-risk zones. Low-risk zones — where day-to-day activities took place — housed offices, staff break rooms, the laundry, and the pharmacy. In high-risk zones, also known as the “hot zone,” patients with suspected and confirmed cases of Ebola were kept in semi-quarantine. The pattern in which providers saw patients was dictated by process and protocol. When recalling the difficulty of treating patients, Kovach said, “It was unbearably hot and uncomfortable with 80 percent humidity, and you’re completely dressed in the PPE suit; you can’t sit and it’s hard to move. There were no lights, it was stuffy, and there were people everywhere.” Kovach described what she called “the Ebola look”: a lifeless stare and slow shuffling of feet.

Communication barriers made treatment more difficult, with both linguistic differences and the physical barrier caused by the protective suit. In order for the patients to hear her, Kovach had to nearly scream at the patients. Kovach learned local terminology to ease communication. “Hot body,” for example, meant fever. “Runny stomach” meant diarrhea. Protocols reiterated themselves in the pattern of questions the patient was asked and in the order in which tasks were completed, from asking about symptoms to testing, treating, and administering medication.

Although major issues were manifold, knowing how much medical treatment to give and how far providers could go without risking themselves were the two recurrent problems. For example, organizational protocols, which varied widely throughout Liberia, limited the IV fluids patients could receive because of the nearly 100 percent risk of contracting Ebola from a needle-stick injury; many patients, as a result, received only oral fluids. Additionally, only basic treatment was available as there was not consistent contact between patients and physicians, and the patients did not have continuous nursing. Physicians would go in to do their rounds, and the nurses would follow.

For Kovach, rationalizing Ebola was more difficult than other disasters she has encountered, such as the conflict in Syria. “The stark difference between Liberia and developed countries, such as the United States, in terms of available resources for medical care are startling,” she said.

Kovach later returned to Monrovia, planing to work in a new Ebola Treatment Unit (ETU). A decline in patients, construction delays, and funding, however, meant the ETU never opened. Kovach opted to leave Liberia two weeks early. Without a focus and a solid line of work, she couldn’t justify staying and earning a salary that was enough to provide for three-to-four local staff for a month. Kovach also had the misfortune of being a mugging victim; she was physically attacked and robbed of her camera, credit cards, and passport, a not uncommon risk of traveling and working in unsafe conditions. Her negative experiences continued once she had returned to the United States. While she endured one week of isolation and two weeks of monitoring, her friends and family, fearful of jeopardizing their own health, were reluctant to see her. Friends with whom she had worked in Liberia faced similar stigmatization. “[The mugging] was a terrible experience,” Kovach said, laughing, “but would I do it again? Absolutely. I learned a lot about humanitarian aid and delivery.”

The current focus in Liberia is on helping to rebuild the health care system and create an infectious control policy. “I would love to go back one day to help with emergency medicine,” Kovach said.