Iowa doctor returns from Ebola-impacted Sierra Leone

DES MOINES - The Ebola outbreak in West Africa is being fed by fear, mistrust, stigma and information deficiencies among people dealing with inadequate treatment centers and poor health care infrastructure, according to an Iowa epidemiologist who recently returned from Sierra Leone.

Dr. Samir Koirala, an epidemiologist working with the Iowa Department of Public Health who spent 25 days in west Africa, told reporters Wednesday he encountered a lack of trust between health care providers and their communities, reluctance among doctors and nurses to treat patients out of concern they could become infected and fear among people to go to hospitals to seek medical care for any illness that might lead to a positive test for the deadly Ebola virus.

'One of the many challenges in West Africa is a lack of patient tracing,” said Koirala, whose work centered on improving the medical data surveillance system in one of the three most-affected districts in Sierra Leona.

'Far too many times a patient is tested in one district, but transferred to another district for treatment if the test is positive,” he said. 'In the transfer process, some patients die; others die at the treatment center, and still others recover. Whatever the outcome, the patient's loved ones may not know what happened because the patient's paperwork does not follow them from one facility to the next.”

Oftentimes to prevent the spread of the disease infected patients who died from Ebola en route to a treatment center would be buried immediately with no information about their fate or whereabouts shared with their family members - a circumstance that further exacerbated the fear and mistrust, said Koirala, who assisted CDC Ebola outbreak efforts in West Africa.

Koirala said his team implemented a usable database and then trained people how to make data entries and manage the patient information to better trace contacts and compile meaningful reports. He also assisted in finding missing people and worked at the national level to develop a system to keep records of each and every person that was being transferred to the treatment centers from all over the country.

Koirala welcomed President Barack Obama's plan outlined Tuesday to ramp up the U.S. response to the epidemic in West Africa, saying more international doctors and sophisticated equipment is needed to address the Ebola crisis that has sickened nearly 5,000 people and killed at least 2,400 since it was first recognized in March. Liberia, Sierra Leone and Guinea have been the hardest-hit countries.

Health professionals face challenges now because typhoid and malaria usually hit African nations at this time of year with symptoms that are similar to the high fever, diarrhea and vomiting that accompany Ebola outbreaks - a situation which could get an ill person mistakenly exposed to Ebola in an isolation ward, he said.

Koirala also said there is a stigma that accompanies Ebola whereby infected people who are treated and cured still are shunned by their families or communities and forced to live on the street without food, where they become targets for robbery, rape or other bad outcomes.

The health agency epidemiologist said he took extra precautions to avoid contracting Ebola, a threat that was ever-present, and Wednesday marked the last day of a 21-day incubation period where his vital medical signs were monitoring daily after leaving the infected area to make certain he wasn't exposed.