And so it begins…

I’ve been here in Liberia for a few days now and would like to share some thoughts and observations. First off, despite countless previous deployments, trips, and missions I am shocked to realize just how much more I miss my family and friends. My heart just aches at times. Could be that it’s Christmas-time. Could be that I’m just getting older and it’s cumulative. Could be that my girls are growing up so fast. Could be the fact that Ebola is scary. Could be all four. I miss Jess and Haley and Piper and all of you dearly.

I was asked to be the Chief Medical Officer for a US State department funded assistance effort helping mitigate the Ebola crisis in West Africa. More specifically, I am working on a day-to-day basis recruiting, organizing, training, budgeting for and deploying hundreds of international and local health professionals to staff the Ebola Treatment Units (ETUs) we are in charge of.  Other daily duties include validating the clinical care protocols and perhaps my biggest job of all is keeping the peace (at least our part of it) with the various partners we have ranging from the US government and US military to the Liberian government, the multiple NGOs and private sector concerns and even the occasional church group here to save a few souls and hand out some medicines. I work on an hourly basis with Brian who is our Liberian contract manager and Erik my assistant medical director. Their talents and enthusiasm make up for my shortcomings. My clinical work and wearing of the bubble suit is limited. The larger effort is a bit colonial with the US taking the lead for Liberia, the UK for Sierra Leone and France for Guinea. I help run the Liberian part. My colleagues at Aspen in Australia are covering the Sierra Leone part under the auspices of the British government. I am lost as to what the French are doing in Guinea.

If you haven’t asked by now I’m sure you will. What is a plastic surgeon doing in this setting and what do I know about Ebola? The answer to the first question is fairly straightforward. I’ve spent my whole career developing a second skill set where I’ve gotten quite good at managing medical groups in austere and complex settings. Liberia certainly fits the bill. I’ve been a practicing surgeon for 27 years and needed a break quite frankly.  Also, the company I helped start, Aspen Healthcare Services, is the US affiliate of Aspen Medical Global and once we won this contract it became very apparent that it would require my full attention. In a very short time frame I needed to up and go from my day job at Kaiser and head to Liberia. Jess and the family were hugely supportive even given the uncertainties of time away and risk. I cannot thank them enough for their love and support.  The answer to the second question is easy. What do I know about Ebola? Nothing more than anyone else prior to this outbreak. It is not something you learn about in medical school. It wasn’t even discovered until the mid 1970s. Previous outbreaks were isolated and quick to burn out. This one was so tragically different as you all know. Still, the care is not that complex – even a surgeon can get it quickly. It’s all about proper diagnosis, isolation protocols, presumptive care (treat them like they all have malaria too which most do) and supportive care (fluids, nutrition and the like). For now there is no vaccine or direct treatment.

Our job is to provide the clinical staffing and support for several sites around Liberia. We do this in conjunction with our business partner PAE. PAE is a large very well established and preferred provider of services to government missions. In this case they are the prime contractor and provide all the logistical support. Together we are running four ETUs and perhaps a fifth. They range from 25-50 beds and are truly scattered around the country from the remote border regions of Sierra Leone, Guinea and Cote D’Ivoire to the inland jungles and coastlines. We rarely drive anywhere and if you do some of the places are a solid 24-hour drive away. Helicopters serve as the primary means of personnel transport. My clinical teams are comprised of US, Australian, New Zealand, European and African professionals. Just today I took another 20 Kenyans under my wing. My site management teams have the same mix. Some are brand new to this work. Others have the well earned t-shirt logo of been there done that. I learn from both groups.

I live in a base camp in Monrovia the capital of Liberia. I’ve been here before and we have had a primary care clinic here for several months, Aspen Medical Liberia, so I already had some friends and contacts here but it is still so far away. The base camp is comfortable enough with air conditioning and hot water most of the time. The food is OK. The coffee is bloody horrible. Still, I can’t complain. Many of my teammates, especially at some of our newer sites and extra remote sites are basically camping. I get to fly in and fly out a few days later usually. Most of them are on site for 6-8 weeks at a time. I expect to be here until March with a break and then perhaps another tour. When I’m finished with this effort I’ll return to Aspen full time. I may do some clinical work just to keep the hands warm. I do miss my patients and teammates in Honolulu.  A special shout out to Tracy and Brenda. I could use both of them here in a heartbeat.

We are on a crushing 16-hour a day schedule so that’s all for this first missive. I have two teams heading out Christmas day but I promise to get a short note out then and at least once a week after. Please take care of each other and thank you from the bottom of my heart for all the love and support you’ve shown my family in Hawaii, San Diego and Boston. And so it begins. Aloha.