Publique un comentario 
Ebola epidemic in Africa: Cuban medical experience in this international health emergency (IV)
Epidemia de ébola en África: experiencia médica cubana en esta emergencia sanitaria internacional (IV)
Rafael Rufino Corona Pérez
Villa Clara University of Medical Sciences. Cuba. E-mail: rafaelcorona@infomed.sld.cu
ABSTRACT
The increase in Ebola cases in the Port Loko district, the main access route to Free Town, the densely populated capital city, raises the need to send an advanced exploration group with the mission of creating the conditions for the deployment of a hospital of collection and treatment of patients of that department in the border with Liberia, where the number of cases grew exponentially. The advance party was formed by three colleagues; one of them was Dr. Baez who had already started working as a clinician at the Kerry Town hospital where he probably got the disease. The article describes the main moments of his illness and his reincorporation to the brigade after his discharge from hospital.
MeSH: hemorrhagic fever, ebola, disaster sanitation, disaster emergencias, international assistance in disaster, education, medical.
RESUMEN
El incremento de casos de ébola en el distrito de Port Loko, principal vía de acceso a Free Town, la ciudad capital densamente poblada, planteó la necesidad de enviar un grupo de exploración de avanzada con la misión de crear las condiciones para el despliegue de un hospital de colección y tratamiento de los pacientes de ese departamento, en la frontera con Liberia, donde crecía exponencialmente la cantidad de casos. La avanzada la formaron tres compañeros, uno de los cuales fue el Dr. Félix Báez que ya había comenzado a trabajar como clínico del hospital de Kerry Town donde probablemente se contagió con el ébola. En el artículo se describen los principales momentos de su enfermedad y su reincorporación a la brigada recientemente dado de alta.
DeSC: enfermedad por el virus de ébola, saneamiento en desastres, emergencias en desastres, asistencia internacional en desastres, educación médica.
Editorial Note
The participation of Cuban health professionals in the global campaign against ebola was an unprecedented event in the history of humanity, in the history of Cuba, and in particular in the history of Cuban medicine that demands to be studied, researched and divulged. Their contributions and experiences should be introduced in undergraduate and postgraduate study programs not only because of the historical aspects, but also because of their impact in the medical sciences and because it is a serious health problem that is far from being solved, so outbreaks of the deadly disease are possible, since the conditions that originated it remain intact. From volumen 9, No. 2 on, EDUMECENTRO journal has published a group of articles under the title: Epidemic of Ebola in Africa: Cuban medical experience in this international health emergency, authored by Dr. Rafael Rufino Corona Perez, member of the "Henry Reeve" International Specialized Contingent in Disaster Situations and Severe Epidemics and professor of Villa Clara University of Medical Sciences, who writes his experiences as vivid testimony of what happened in those months, where the intellect, perseverance, courage and struggle for life prevailed facing the health disaster and were proclaimed victorious. In these research paper has been respected the writing in first person by the psychological implication of the facts that are narrated in the personality of the mentioned doctor.
Nota editorial
La participación de los profesionales cubanos de la salud en la campaña mundial contra el ébola representó un hecho sin precedentes en la historia de la humanidad, en la historia de Cuba y, en particular, en la historia de la medicina cubana que demanda ser investigada y divulgada. Sus aportes y experiencias deben ser introducidos en los programas de estudio de pregrado y posgrado no solo por los aspectos históricos, sino por su impacto en las ciencias médicas y por ser un grave problema de salud que dista mucho de estar resuelto. Las condiciones que originaron la enfermedad permanecen intactas. A partir del volumen 9, No. 2 de 2017, la revista EDUMECENTRO publica un grupo de artículos bajo el título: Epidemia de ébola en África: experiencia médica cubana en esta emergencia sanitaria internacional, cuyo autor principal es el Dr. Rafael Rufino Corona Pérez, integrante del Contingente Internacional Especializado en Situaciones de Desastres y Graves Epidemias "Henry Reeve" y profesor de la Universidad de Ciencias Médicas de Villa Clara, quien redacta sus experiencias como testimonios vívidos de lo acontecido en esos meses, donde el intelecto, la perseverancia, la valentía y la lucha por la vida se impusieron ante el desastre sanitario y se proclamaron victoriosos. En estas comunicaciones se ha respetado la redacción en primera persona por la implicación psicológica de los hechos que se narran en la personalidad del mencionado doctor.
Illness and recovery of Dr. Báez Sarría
In the middle of November it was decided to send an advance party to set the groundwork and create conditions for a brigade in Port Loko, due to the increase and high incidence of Ebola cases that endangered the population of the capital of the country. Port Loko is located about 100 km from Free Town where more than a million inhabitants live, and it is a necessary way to access the capital from the international airport of Lungi, in addition to having border with Liberia, country that showed a remarkable increase in cases.1
This advance party was integrated by Luis Escalona, vice head of the brigade; Felipe Delgado, epidemiologist; and Félix Báez Sarría, a clinician who served in the English hospital in Kerry Town. They began their work in early December. A few days later Comrade Escalona informed me that Felix Báez had a fever and that he would come in the morning of the other day, Sunday, December 16, to seek anti-malarial treatment, thinking that the disease was malaria, frequent among collaborators, and that he had an unconventional symptomatology.
In the report No. 55 of the Cuban medical brigade on Sunday, December 16, Dr. Felix Báez Sarría, 43, presented the following clinical picture:
"Yesterday night he felt chills and sweating. Today at 4 p.m began with a temperature of 38.5 0c, antipyretics were administered and the rapid malaria diagnostic test was performed, which was negative. No symptoms or signs of focalization. He started anti-malarial treatment with Lonard-DS. Eat food at mealtime and drink plenty of fluids. It is kept in close observation. At 11.30 p.m. it had 37.2 0c".
That same day Felix was transferred to Kerry Town where the test of Ebola was positive.
The terrible reality hit us all, especially those who worked in that hospital. His colleagues expressed their solidarity and willingness to take immediate care of him.
Comrades from other brigades began to call interested by Félix´s health status. We knew it would get worse and that the disease is deadly in most cases. There was not a single brigade member that faltered and the disposition for work was greater; we do not know why, but we all thought that Félix would recover as it really did.
I remember that a few hours before the fever occurred in Felix, the chief of the brigade and I were visiting them in Port Loko and I was sitting next to him, in close contact with his right arm, listening to Jorge Juan Delgado who was arguing with an Italian the request of personnel for one of its centers. Thus I verified once again that the transmission of Ebola occurs after the beginning of fever.
The story of careful attention at the University Hospital in Geneva and the happy result was quickly reported, but what may be unknown is that when the news was known, the Cubans sang the national anthem for the third time so strongly that the people of Sierra Leona and foreigners expressed their admiration for the patriotism with which the Cubans sang their national anthem. Thus we proclaim the decision to continue advancing with our mission of solidarity.
Félix Báez's illness forced Luis Escalona and Felipe Delgado to remain in the 21-day quarantine period at the Comfort Guest House hotel in Port Loko, which delayed the transfer of the brigade until the end of December. During this period, we were all very worried because they lived with Félix the night the fever appeared, we also had the uncertainty about other possible cases among the collaborators staying at the Compañero Hotel.
Our main concern has always been the care against Ebola infection. We were very aware of this reality, as shown by the fact that Felix Baez was the only one infected, probably during his work as a clinician in Kerry Town Hospital, as he was among the first to cross the Red Zone.
Upon his return from Cuba in January, when his health was well established, he was received by a part of the brigade's leadership team and by the charge d'affaires of Cuba, on a visit to the Mariam Hotel, as can be seen in the figures 1 and 2.
On his return and talking with us about his stay in Geneva he recalls: "... he had a very high and almost permanent fever with signs of encephalitis, generalized skin rash and conjunctivitis. Cough was really annoying. I was given two intravenous doses of ZMAP, they kept a permanent medical guard with three doctors and nine nurses taking turns, they did not leave me alone for an instant".
In a report written by Flor de Paz for Cubadebate, on December 14, 2014, Jorge Pérez Ávila, director of Pedro Kourí Institute of Tropical Medicine (IPK), who accompanied Féliz Báez in his cure, said:
"Now he is a living experience that those infected with Ebola can be saved, if treated properly. Félix is a person who has a lot of courage and a great commitment to his colleagues left in Sierra Leone and wants to return. He is even in better conditions than other members of the medical personnel who are at risk, but it has to be protected. On the other hand, he has become an interesting subject from the scientific point of view by becoming -potentially- a therapeutic source for other people".
"According to the Cuban expert, there are five types of different strains of Ebola. "Three affect humans and can cause mortality. Whoever survives the contagion is immunized against the one who infected him. Therefore, the person cured is not able to catch that variety of the virus".
"But it is still unknown whether immunity can be crossed, because there are very few survivors; it is unknown if the individual who survives is immune to other Ebola strains. It will be necessary to await the conclusion of ongoing investigations into whether immunity is total or partial. So far, it can be ensured that the patient develops specific antibodies against the strain that infected it and it is immune to this one".
It was then handled that immunity fell violently and that facilitated the opportunism of infectious germs, especially of malaria, so that broad-spectrum antibiotics and antimalarials were added to the treatment protocol.
Another aspect that created uncertainty was the possible transmission by the surviving patients: since it was known that the virus is kept in semen for more than 3 months. Fortunately, we knew that insects do not transmit the disease and that by air it had to be less than a meter from the patient. Decidedly, it is spread by contact from the beginning of the fever and its incubation period oscillates between 8 and 21 days. Today the disease emerges in cured patients, that is, somehow they maintain viral load; this determines a new direction in the investigations on the development of the disease from its beginnings.
The comprehensive care provided to Felix by representatives of the UN, WHO, Save the Children, Partners in Health and MINSA was truly impressive and allowed for its rapid healing and recovery; that's why we are very grateful. However, in the meetings held during the process of the disease and subsequently, the question always arose about the possibilities of attending to the national health professionals who also fought the disease with us and the conclusion was the same: "… it is not possible, because of the amount of resources that must be mobilized and the enormous expense that the treatment represents" It is a limited privilege even for First World workers, and as far as I know, the existing Zmap doses were depleted in the treatment applied to Félix.
What expectations are there for the African population? This situation ratifies that the fight against Ebola and the research in its natural outbreaks and its transmission, prevention, treatment and monitoring, far from concluding, must be increased in a common effort, since even if a vaccine can be applied against the disease, they will always influence the economic element and the selectivity for people at risk in these areas practically forgotten by the so-called First World; the constant presence of its deplorable situation is the cause of the emergence and development of this and other terrible emerging and reemerging infectious diseases.
Declaration of interests
The author declares that he has no conflict of interest.
BIBLIOGRAPHIC REFERENCE
1. Ubieta Gómez E. Zona Roja. La experiencia cubana del ébola. La Habana: Ediciones Abril; 2016.
Submitted: October 31 2017.
Accepted: November 20 2017.
Rafael Rufino Corona Pérez. Villa Clara University of Medical Sciences. Cuba. E-mail: rafaelcorona@infomed.sld.cu
Copyright (c) 2017 EDUMECENTRO
