Triage, Treatment & Tenderness
Instructor lends healing hand in Sierra Leone
Dr. Guy A. Giordano, left, says that Hassan, was the sickest patient at the Ebola Treatment Unit to survive. Giordano, a family physician in Williamsport and a part-time instructor in the college’s Physician Assistant Program, spent several weeks treating patients at the Sierra Leone facility.
by Tom Wilson, writer/editor-PCToday. Photos courtesy of Dr. Guy A. Giordano.
He could have yielded to contentment, guiltlessly reaping the fruits of a flourishing medical practice. His could have been an unconditional, don’t-look-back surrender to the comfort of a successful life, once he and his wife wrote out that final college tuition check for their youngest.
“I have never seen human suffering on that scale before.”
Looking back is exactly what Dr. Guy Giordano did, though – back to his service in Southeast Africa more than 30 years ago. A staff doctor with Susquehanna Health and a part-time instructor in Pennsylvania College of Technology’s physician assistant program, he was a clinical officer at the Likuni Mission Hospital in Malawi from 1984-86.
“I always wanted to try to go back to the developing world, at some point, in some way,” he said. “When the Ebola epidemic hit, it seemed like the best plan, to try to work with that effort somehow.” A National Public Radio report led him to US AID, which distributed his online application to a number of nongovernmental organizations. Partners in Health was the first to respond, and the original plan was for Giordano to go to Liberia in January.
“However, the Ebola situation in Sierra Leone went downhill fast,” he said, “so they asked me to go to there in December instead.” He said his wife, Dorothea (“D.G.”), was neither surprised nor afraid, but that she closely followed developments in that West African nation.
“She made sure that I packed every single item on my packing list,” the 1981 graduate of Thomas Jefferson University Medical School said. “I am not sure I would have packed mosquito netting, my own masks and boots, and a box of gloves, for instance – figuring that PIH would be supplying those things. But she made sure I packed them all.”
His three grown children had various responses, all of them more surprised than his wife. His oldest son, who since married in August, commented that “dying of Ebola was a really extreme way to get out of having to attend the wedding.”
When the Ebola Treatment Unit opened during the fall of 2014, Giordano said, it was primitive in the extreme. More equipment, supplies, medicines and personnel kept arriving, however, and by December, the staff had IV equipment and fluids, and some medicines. February brought plenty of antibiotics, more advanced IV fluid and administration sets, and the ability to run some chemistry tests.
“But we were always limited in our ability to monitor patients and were often struggling to assess just how sick each patient was and what they needed,” he explained. “We were constantly trying to get enough clothes, blankets, towels and cleaning supplies for the patients.”
Nothing could leave the unit once it went in, so there was no laundry. Regardless of whether the patient died or went home, everything was burned.
While the experience was anything but routine, the daily schedule was fairly predictable.
“We had a meeting every day at 8:30, in front of a large series of whiteboards, with all the patients’ names,” he said. “We reviewed how sick they were and what kind of care they needed, then we divided into small teams.”
Comprising each team were one or two Partners in Health doctors or nurses, one or two Cuban doctors or nurses, and one or two local nurses. The teams would don their full personal protection equipment – the head-to-toe Tyvek suits and head coverings familiar to anyone following news coverage of the epidemic. They would spend about two hours in the unit – providing nursing care, starting IVs and pushing fluids, administering some medicine, and trying mainly to get the patients comfortable.
“Ebola has about a 40-percent death rate, so these were incredibly ill patients – suffering terribly – and there was only so much we could do for them,” Giordano said. “After about two hours, you had to come out, because you could not stand the heat and the sweating any longer. Then you peel off the layers very carefully, getting sprayed with chlorine at each step, then sit, drink several quarts of water, rest and repeat the process in another two hours or so.”
New patients tended to arrive by ambulance in the afternoon or early evening, so late afternoon was especially busy as teams tried to assess and admit the newcomers.
“I never really worried about being close to danger,” he said. “I felt secure in the Tyvek suits. I just figured that I would not get Ebola. Actually working in the government hospital (the Port Loko facility, a few miles away, where he also worked in January and February) was more nerve-wracking than the Ebola Treatment Unit. We did not wear personal protection equipment in the hospital, and sometimes patients showed up there who were suspicious for Ebola and should have been in the Ebola Treatment Unit. In fact, one of the Partners in Health clinicians contracted Ebola about a week after I left, from working in the government hospital.”
That facility had closed in the midst of the epidemic in September 2014 and was trying to function again, an extreme challenge given limited supplies and medications.
“For instance, we could usually treat malaria OK but might have no medicine at all to treat heart failure or elevated blood pressure,” Giordano said. “The closest working X-ray machine was at another hospital, an hour away by car.”
Back at the Ebola unit, the apportionment of treatment by degrees of urgency proved to be emotionally difficult work.
“I have never seen human suffering on that scale before,” he said. “You could often pick out which patients simply were not going to make it, so we often concentrated very hard on the patients that were very sick … but that seemed to have a chance. It was a true triage situation: There were some patients that obviously were going to die no matter what, there were some patients that were not real ill and almost certainly would survive OK, and there was a third group that seemed more likely to survive with as much care as we could give them. I think we concentrated a lot on this group.”
What is the takeaway from being on the front lines of an international health crisis, where success is measured differently and conditions are anything but ideal?
“If there is a life lesson for me, it was in the dignity and stoicism of the patients with Ebola,” he said. “These were patients who were suffering terribly, and they bore their suffering with quiet patience. Also, it was great working with a group of clinicians who were trying as hard as they possibly could to do the best possible job, all day every day. No one held back.” ■
From Giordano’s return home in February through late summer, a handful of new cases continued to arrive every week. On Aug. 24, however, Sierra Leone’s last confirmed Ebola patient was discharged from its last remaining Ebola Treatment Unit. President Ernest Bai Koroma attended the celebration when the 35-year-old woman left – singing and dancing – during a red-carpet ceremony.