I Return to Heal Another
By Jenny Lewis
One of the first specialized healthcare workers sent to fight Ebola in Liberia, Christopher Perdue ’93 spent two months in-country treating the sick.
Christopher Perdue '93 spent two months fighting the Ebola epidemic at the Monrovia Medical Unit in Liberia.
By the time it was clear that something was very wrong with two-year-old Guinean Emile Ouamouno, it was already too late.
Just four days into an illness marked by an alarmingly high fever, diarrhea and vomiting, he was dead. In less than a month, so were his four-year-old sister and his mother. Then his grandmother. Then a midwife, who traveled to a nearby city for treatment.
Epidemiologists suspect Emile may have been the first case of Ebola. Patient Zero.
Emile got sick in December 2013. By the following March, the disease that killed him had spread to four West African cities, and had finally been identified as Ebola, the nightmare virus that sprang into global health consciousness in the 1970s with its 88 percent fatality rate. And before this new Ebola outbreak—by far the worst in history in terms of deaths, infections and economic impact—would begin to slow down over a year later, more than 10,000 people would die.
We don’t know exactly what woke the virus that winter, though we do know it started in steamy southern Guinea, near the border of Sierra Leone and Liberia, and that if Emile wasn’t Patient Zero, he was close to it.
FOR SIX WEEKS during the wet Liberian fall of 2014, Christopher Perdue ’93 slept during the day. The Lieutenant Commander started his rounds after sunset, reporting each evening to a low cluster of 12 tents cleaved to a flat among the palm trees.
At the Monrovia Medical Unit, Perdue and the other members of the night crew would be briefed by day shift clinicians and pharmacists and nurses, review patient notes and treatment plans and compare observations, and then, adjusting to the constant chlorine stink of the air, they would formulate a plan.
Every day required a detailed schedule: who would go into the hot zone, and when, and how, every move mapped in advance. Their patients were very sick; the Ebola virus, which they had come to treat, abhorred improvisation.
Perdue’s team, MMU Team 1, was the first clinical team from the U.S. Public Health Service Commissioned Corps to be deployed to West Africa during the 2014 Ebola epidemic. The 69 volunteers, all of them highly-trained health professionals, arrived to set up operations at the edge of Monrovia, Liberia, in November, not quite a year after Emile died. Their mission was to treat healthcare workers who had contracted Ebola while treating local Liberians. Perdue and his colleagues would have to be constantly vigilant to avoid becoming casualties themselves.
“The most difficult part of the deployment,” Perdue said later, “was the uncertainty of the risk associated with working in an Ebola treatment unit. That was nothing any of us had ever done before, and initially, seemed very complicated and frightening.”
EBOLA HAD BEGUN TO SPREAD in West Africa about a year before Team 1’s arrival, though it wasn’t immediately apparent that it was happening. Symptoms of Ebola are similar to those of a few other diseases more common in the area.
Scientists weren’t sure how it started. But they know Ebola can live in animals. That there was a tree in Emile’s village where the children liked to play; that inside the tree there were bats; that bats are a common bushmeat meal and that Ebola may be able to spread to humans from direct animal contact. Emile’s father said later he had loved to play with a ball.
There is no specific treatment for Ebola. The virus typically kills an infected patient within about two weeks, unless he recovers, which is possible with effective administration of intravenous fluids and electrolyte monitoring. But care is extremely risky to give without proper precautions, as Ebola is spread between people by contact with bodily fluids—a fleck of spit from a cough is enough. Even dead bodies remain infectious.
The virus spreads easily and rapidly; it moved in just a few months from Guinea to Sierra Leone and Liberia, the three countries hit the hardest by the outbreak.
By August 2014, more than 3,000 infections had been reported. The World Health Organization declared an international health emergency, later putting a point on it in a statement: “The Ebola epidemic ravaging parts of West Africa is the most severe acute public health emergency seen in modern times. Never before in recorded history has a biosafety level four pathogen infected so many people so quickly, over such a broad geographical area, for so long.”
The U.S. government soon joined international aid organizations around the world in stepping up its response to the unprecedented, increasingly out-of-control epidemic. President Obama pledged in September 2014 to deliver 3,000 medical workers and military engineers to West Africa; they would help teach healthcare workers how to treat Ebola patients safely and build new facilities to care for the ballooning population of the sick and the dying.
Keeping African healthcare workers healthy had to be a top priority, and treating the doctors, nurses and ambulance drivers who had acquired Ebola from caring for others would require a special contingent of highly-trained volunteers.
Some of these American healthcare workers came from the U.S. Public Health Service Commissioned Corps and ended up staffing the MMU; one of them came from Moses Lake, Washington, and majored in biology at Whitman College.
“I’m not a thrill seeker. I’m not drawn to dangerous situations.
It felt like a responsibility,” Perdue said of his decision to volunteer.
“It was a once-in-a-lifetime opportunity to do something with global implications.”
A SENSE OF DUTY and service has characterized Perdue’s career: he’s a physician and public health expert who served in the Army for 11 years—including a 15-month deployment to Tikrit, Iraq, at the height of the Iraq War—before transferring to the Commissioned Corps, one of the U.S’s seven uniformed, deployable services. He’s been a project manager for the Department of Defense’s work on global infectious disease, and has recently moved to the U.S. Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response, Office of Policy and Planning, the Division of International Health Security. His current role involves improving the U.S. government’s international-public-health-emergency strategies.
He’s also maintained strong ties with his alma mater. Associate Professor of Biochemistry, Biophysics and Molecular Biology James Russo, who taught Perdue at Whitman, has twice invited him to be a guest speaker in a class on infectious diseases. During his Liberian deployment, Perdue video-called Russo’s classroom from the MMU in Liberia to walk the students through the facility and discuss the challenges of caregiving in that environment. Russo is impressed with the trajectory of his former student.
“Here’s this kid from Moses Lake,” he joked. “But, he was always someone who would take advantage of opportunities.”
Rachna Sinnott ’93 and Perdue have been close friends since they met in Jewett Hall their freshman year.
“He’s always been the kind of person who thrives on responsibility and leadership,” Sinnott said.
Sinnott is now director of grants and foundation relations at Whitman. In 2013, she invited Perdue to return to Whitman as an O’Donnell Visiting Educator in Global Health. Perdue accepted, teaching a short course and giving a public lecture on health security.
“He would have done something exciting [even] if he hadn’t ended up on the path he’s on,” she said.
“It was a little bit scary to think about him being [in Liberia]. It was right at the height of the epidemic. But he’s a very, very confident person, and he reassured us that he’d be taken care of, that he’d be fine.”
Any misgivings Perdue himself had gave way fairly early in his deployment. He said one of the more rewarding moments during his time at the MMU came just after his first round through the high-risk zone.
“It was my first ‘exposure’ to the Ebola virus; and after going through the doffing procedure [taking off the protective gear], I could clearly visualize how we were going to succeed and return home safely. Reaching that moment of clarity came with a huge sense of accomplishment and optimism.”
Getting to that point—completing a single round in the hot zone—is no easy task.
The MMU holds 25 beds and is divided into a high-risk area, where patients suspected of being infected with Ebola or confirmed to be sick are housed, and a totally unconnected low-risk area, where everything else happens: paperwork, pharmacy, supply collection, Christmas tree decoration.
THE VIRUS IS SO CONTAGIOUS providers must engage in a very strict series of safety protocols that include restricted movement around the MMU and “donning” and “doffing” Personal Protective Equipment—respirator, face shield, hood, disposable yellow plastic pajamas, inner gloves, outer gloves with a cuff, shoe covers, disposable apron—in the correct, many-stepped way.
Staying safe was a delicate dance, tightly choreographed: begin in scrubs and rubber boots; don, laboriously, the PPE; colleagues check each other for the tiniest gaps in costume; gather medicine, food for the patients and IV fluids.
Never go in alone. Never be out of sight of another well person. Sharpie your first name across the chest of your suit, a small thing to humanize you, a slow-moving mound of yellow plastic and goggles without a face.
Wash your gloved hands and booted feet in a bleach bath before entering or exiting a room. Sweat outrageously inside your layers upon layers of impermeable material. Move as quickly as you safely can to keep from passing out in the heat.
Treat the patients the best you can without touch, without being able to smile. Sounds and pressures muted by plastic, language thwarted by dialect.
Whatever you do, don’t fumble anything sharp. Wash your hands and feet in bleach. Repeat. Repeat again until rounds are done. Doff your suit one slow layer at a time, the safety crew spraying beneath every piece with bleach solution.
Once out, you can breathe. Chlorine cough. Do a pile of paperwork and prepare to start over. Two or three rounds a night; the day crew would arrive around 6:30 a.m.
“You could tell by looking at him it was an exhausting experience,” said Russo, whose classroom visit from Perdue came toward the end of the deployment.
“The mental strain of delivering care to patients [under these conditions]—you’re wanting to care for people but you’re so separated from them.”
THOSE WHO CAME to the MMU in hope received the highest level of care Perdue and the rest of the team could provide in the conditions they had to work with. On November 24, the MMU’s first patients were released: two Liberian healthcare workers—Stanley Sayonkon, a nurse, and Mark Tate, a clinical records specialist—had survived Ebola.
“The patients and their families were absolutely ecstatic. They hugged, sang and danced. It was a joyful and tearful moment for everyone, including me,” Perdue remembered.
In the spirit of a Doctors Without Borders tradition, Team 1 erected a survivor board in the MMU complex. In yellow paint on a dark blue background (USPHS colors), the top of the board bears the legend, “Today I Am Healed/Tomorrow I Return To Heal Another”; beneath the words, cured patients are invited to leave their handprints in paint. Sayonkon and Tate both left their yellow mark that day.
“Surviving the Ebola virus was a tragically infrequent event in West Africa, and the handprints and signatures on the survivor wall were intended to give hope to others,” Perdue said.
“Frankly, it was also a kind of gift to us…the patients were given the choice to place their handprints there, and I think they must have sensed how much it meant to us.”
More yellow handprints crowded the board over time. By Christmas, Perdue had returned home to Washington, D.C., and MMU Team 2 had replaced Team 1. The mission continued, one patient at a time, and eventually the efforts of the MMU and other treatment center staff around the country paid off: by March 2015, Liberia was nearly Ebola-free.
But the outbreak still raged. At the same time Liberia was down to a single case, Guinea still reported 100 new cases each week. The overall global response to this public health crisis had been harshly criticized for being sluggish and ineffectual, especially in the early stages, and though the epidemic had been geographically contained, it was far from being under control.
Questions remain: How long will this outbreak last? Could a crisis on this scale happen again? How could the world be better able to respond if it did?
Agencies and institutions around the globe may not have answers yet, but will learn from this Ebola outbreak. Perdue and others in the DIHS, for example, are working now to understand how global travel, health systems, public health practices and legal structures interact in order to better prepare for crises like this in the future. It’s a big job.
“I work with other U.S. agencies and foreign governments to strengthen the global capacity to prevent, detect early and respond efficiently to potential public health disasters,” he said.
“That sounds like a herculean task, but it is really just one small step at a time.”