LODI, California: Just hearing the word Ebola elicits fear. Since earlier this year when the epidemic in West Africa was first realized, millions of dollars have been spent preparing for a global pandemic. But for at least one physician, that is money not well spent.
That’s one of the messages Dr. James Appel shared on Monday at Lodi Memorial Hospital with area health professionals—many of them front-line workers in emergency and critical care medicine undergoing new training regimens to deal with the disease should a patient present in San Joaquin County.
Appel, 41, whose aunt and uncle are Stockton dentists Janice Scott and Michael Moreno, was invited to speak at the hospital by board member and Bear Creek Community Church pastor Bill Cummins. Appel recently returned to California from working at a hospital in Liberia, one of the three countries hardest hit by the Ebola epidemic.
He has spent most of his career since graduating from Loma Linda University School of Medicine in 2000 working in Chad, an African nation beset by hundreds of thousands of refugees fleeing neighboring countries.
In August, Appel was called by Adventist Health International to leave Chad and head to Monrovia, Liberia’s capital, to work as one of just three physicians in one of the few hospitals remaining open to serve more than 1 million people. He said the SDA Cooper Hospital where he worked was the only one in the city treating non-Ebola patients, and it was swamped.
He saw everything from complicated pregnancies and deliveries to stroke and gunshot victims.
“The other hospitals were closing down because of staffing shortages. Part of the job was to turn people away if we suspected Ebola. We sent them to an Ebola treatment unit,” Appel said, apologizing for sounding harsh while explaining that it was important for non-Ebola patients to have a hospital they could go to and not be exposed to the deadly virus.
“The problem we had was we had no way to test for Ebola,” Appel said. Its symptoms that appear from two to 21 days after exposure are those of other diseases: fever, severe headache, muscle pain, weakness, fatigue, diarrhea, vomiting, stomach pain, and unexplained bleeding or bruising.
Because most Liberians are familiar with the symptoms —Ebola to date has stricken more than 17,800 and killed more than 6,300 worldwide, almost half of them Liberians—“no one told me ‘yes’ to those symptoms” during the screening process, Appel said.
Because some of the symptoms are similar to those of malaria, a more prevalent disease endemic to West Africa, Appel said he learned to identify “the look” of someone with Ebola.
“There is this kind of look. It’s different than anything else I have ever seen. They look healthy but just on the verge of not looking healthy,” he said.
Ebola won’t spread
Appel, who has written a 147-page book called “Ebola-iculous: A Physician Encounters the Ebola Capital of the World,” available on Amazon.com, said he believes there are several clear-cut reasons why the epidemic will not spread beyond its current geographic borders of Liberia, Guinea and Sierra Leone. These are:
• Weak governments: In two of the three countries suffering the most, Liberia and Sierra Leone, there is a leadership void with “no one taking charge of the problem. It’s very chaotic and anarchic,” Appel said.
• Local culture: Tradition dictates that when someone is sick, everyone in the family, neighbors and even remote family come to take care of the patient. That exposes multiple people.
• Burial practices: In Islam, it’s customary to wash and bury the deceased within the first 24 hours. “That’s the highest period of risk, when the bodily fluids are oozing out,” Appel said, reminding his audience that blood and body fluids from an infected person are the primary means of Ebola transmission.
• Poor infrastructure: In Liberia, there are 50 doctors for 5 million people, “and that was before they fled or died,” Appel said, explaining that trained professionals who know how to deal with the disease are in extremely short supply.
• Lack of resources: “In some places there are no gloves, much less full space suits,” he cited as an example of the severe lack of basic protective equipment, medicine and supplies.
• No “real” public health programs: The focus has been on treating the sickest patients—not on prevention, not on tracking down contacts, not on going out into the community talking about exposure risks.
At the conclusion of his presentation, Becky Sanders, Lodi Memorial critical care director, said Appel “obviously knows what’s going on there.” She agreed with his conclusion that listening to the concerns of local people in their communities is key coming up with tangible solutions.
“Once again, he reinforced the chances of the United States having an Ebola epidemic here as extremely unlikely,” Sanders said.
Like other medical centers in the area and around the nation, Lodi Memorial is in the midst of the expensive process of training and conducting drills to prepare staff for the possibility that a patient with Ebola shows up at the hospital.