Along with her colleagues at Sabeti Lab, computational biologist Pardis Sabeti studies genetics and infectious diseases, working to improve our knowledge and implementation of medical care worldwide. Pardis’ colleague Stephen Gire reports on his experiences in the field. This post continues Stephen’s story from A Brush with Ebola, in the aftermath of a lab accident that almost cost his life, and ultimately changed his life’s work.
It’s a five-hour drive from Freetown to the small town of Kenema, where our Sierra Leonean collaborators run a sophisticated isolation ward and laboratory for Lassa fever patients. Once we arrive in Kenema, we quickly reunite with old friends before gearing up to work in the high-containment field laboratory here at the Kenema Government Hospital.
Entering the lab requires a ten-minute ritual of donning a full-body protective suit, complete with built in booties and head cap. I put on two sets of gloves, making sure to tuck them into the sleeves of my suit so that no skin was showing. I bring up the hood cap and tuck my hair underneath, wiping the sweat that has already formed on my forehead. It’s at least 85°F where we dress to enter the lab. I will be in this suit for the next four hours as I process suspected Ebola cases with fellow lab members.
Today there are two samples to process from the north, somewhere near Makeni. When we get word of samples coming from the north, everyone holds their breath. “If Ebola were to enter Sierra Leone, it would be from the north,” says one of the local scientists in the lab. The two samples tested negative for Lassa fever, and people are now worried it may be Ebola.
We process the samples quickly and get to work on setting up the PCR (polymerase chain reaction) test, which amplifies and detects the presence of Ebola genomic material in a sample. The test takes about two hours. As we visualize the results on a gel, I sit for the four minutes it takes for the assay to develop, wondering how the sequence of events will unfold if the test is positive. I look down at the gel. Negative.
I am partly relieved and partly disappointed. The scientist in me eagerly awaits the first positive case. The scientific questions that could be answered with just one positive case are tremendous. We are virus hunters, after all—this is what gets us excited. But the implications for human life in Sierra Leone would be devastating.
As the day moves on, the heat finally takes its toll. I feel exhausted and my concentration wanes. I push the feeling aside, but I quickly start losing basic reasoning skills. I stare at my lab notebook, but I can’t make sense of what’s on the page. I have to get out: I am of no use to anyone in this condition. It’s ironic, almost; our protective equipment is supposed to keep us safe, but now it’s putting me at risk. I quickly decon out of the lab and remove my gear.
As I exit, one of the clinical nurses stands outside waiting for me with a man I have never met. He has a small medical “coolbox” hanging from his shoulder. These boxes are used to transport patient samples from villages. Even in my dehydrated state I recognize it. Sometimes people travel days to deliver just one sample.
The nurse quickly relays his story. He is from Makeni up north. The man followed a patient’s blood sample that came from the region—patient 032. At this point my eyes drift from the Makeni man to the coolbox, and back to the nurse. We had just received results from patient 032. The test was negative. My curiosity is now getting the better of me. The man tells me the box contains a skin sample from the same patient, and he wants me to test it for Ebola.
I look at the nurse, bewildered, and say, “Skin sample?” The nurse speaks with the man quickly in a local language I cannot understand and then exclaims that it is part of the patient’s finger. The man from Makeni gestures to show how much tissue was collected—a sizable section of the patient’s fingertip had been severed and was sitting in the coolbox.
You can imagine my consternation. Not only was patient 032 very ill, but s/he was now missing a piece of his/her finger. I relay to the man that there’s not much we can do with a finger. I thank him for his efforts, still slightly confused by the whole scene. Our outreach team is now tasked with yet another sensitization strategy: no more fingers.
This disturbing encounter underlines the fear that is brewing here over the outbreak. In Guinea, for example, there are reports of local villagers staging violent protests against MSF (Médecins Sans Frontières) volunteers. It’s hard not to shift blame to men in big white suits that just appear out of nowhere, and rumors spread more fear and misinformation. The fear often spreads faster than any virus could, revealing the delicate situation here in West Africa. It is important to keep this in mind as Sierra Leone implements its own response effort.
The days continue and each test comes back negative, bringing with it a glimmer of hope that Sierra Leone may emerge from this crisis unscathed. But I know things will never be the same. Ebola is now in West Africa. And with evidence that this strain co-evolved in the region, the virus is surely here to stay.
For West Africa—a region that already struggles with a heavy disease burden—Ebola severely complicates health policy and delivery. Now that future outbreaks of Ebola are possible and likely, it forces labs in the region to not only prepare for clinical management and containment of Lassa, but now for Ebola. This will be a massive undertaking, and it will require collaboration between international organizations, organizations that are, unfortunately, vying for control of biological data. Control of this data among Ebola researchers has become so poorly managed that it compromises research, and scientist are calling for the release of data in real-time to better aid public health and safety. The political situation in Sierra Leone is just as tenuous.
I take comfort, though, in the headway, however small, that our team makes together. Our long-standing collaboration with Kenema Government Hospital and many others helps to guarantee a successful trip. The support our team provides helps, in a small way, to prepare a country for the impending threat of Ebola.
As I pack up my things for my journey home, I can’t help but wonder what my life would look like if I hadn’t crossed paths with Ebola that day in Congo. It is rare that a scientist is given an opportunity to directly benefit human life. To know that Sierra Leone has the capacity to monitor the threat of Ebola and save lives is worth all the long hours spent in a hot laboratory sweating through my clothes. To know that a fellow scientist can work safely with a deadly disease is worth all the risk and inconvenience I’ve had along my journeys in Africa.