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Aug 8th 2018
Ebola Vaccinations Expected to Begin in Congo’s North Kivu
The World Health Organization says vaccinations are expected to begin this week, perhaps as early as Wednesday, to help stem the latest Ebola outbreak in the eastern Democratic Republic of Congo. WHO estimates put the number of confirmed and probable cases of Ebola at 43, including 34 deaths.
The WHO says the same expert team that led the the vaccination program during a recent Ebola outbreak in Congo's Equateur province will be deployed to the cities of Beni and Mangina in North Kivu province, where Ebola was detected last week.
It says vaccinations in North Kivu will follow the same ring vaccination method. That means people most at risk of infection, such as health workers and first responders, will be vaccinated first. They will be followed by family members, neighbors and other people identified as having come in contact with Ebola victims.
Tracing contacts could be dangerous in North Kivu's highly insecure environment. WHO spokesman Tarik Jasarevic says some of the people exposed to the deadly Ebola virus might be living in conflict zones and armed guards may have to be used to protect the health workers.
He tells VOA that WHO personnel will have to work with U.N. peacekeeping forces known as MONUSCO.
“For example MONUSCO is sending, already sent some security vehicles, in haste, to Beni on August 5th and we may have to use these sort of vehicles," Jasarevic said. "But again, at this stage, we are really trying to do what is needed to be done. So, the recommendation from the SAGE (Strategic Advisory Group of Experts) is to use ring vaccination.”
Jasarevic says the World Health Organization and partners are working non-stop to contain and stop this latest outbreak of Ebola as quickly as possible. He says 30 WHO staff members have been deployed to the area and more experts are on the way.
He says contact tracing has begun in affected zones. While more than 900 contacts have been registered in Mangina, he says this operation must be rapidly strengthened.
He notes the cost of responding to this disease is likely to be significant, especially in view of the security situation.
May 11th 2018
WHO expresses serious concern about Ebola outbreak
Officials at the WHO are seriously concerned about the new Ebola outbreak on
the western edge of the Democratic Republic of the Congo. There are only two
confirmed cases so far. But health officials say that there are at least
21 people known to have symptoms consistent with Ebola, 17 of whom have died.
And while the outbreak is in a remote area that's difficult to travel to by
road, a nearby town where there might also be cases is connected to the
Congo River, sparking concerns about infected individuals traveling by boat to
more densely populated areas. More here from
STAT's Helen Branswell
June 23rd 2017
When diagnosing a case of Ebola, time is of the essence. However, existing diagnostic tests take at least a day or two to yield results, preventing health care workers from quickly determining whether a patient needs immediate treatment and isolation.
A new test from MIT researchers could change that: The device, a simple paper strip similar to a pregnancy test, can diagnose Ebola, as well as other viral hemorrhagic fevers such as yellow fever and dengue fever in 10 minutes.
Jun 21st 2017
TORONTO, June 19:
Scientists have developed a new Ebola vaccine that has been found to be safe for use in humans in a clinical trial.
Researchers, including those from Canadian Immunisation Research Network (CIRN), found that antibodies are present in participants up to six months after immunisation with the experimental VSV-Ebola vaccine.
The trial involving about 40 healthy people aged between 18 and 65 years looked at the safety of the vaccine and the lowest dose required for an immune response after injection with one of three doses.
At a ratio of 3:1, thirty participants received the vaccine and 10 received placebo injections.
Researchers found that adverse events were mild to moderate, with only three severe reactions, including headache, diarrhoea and fatigue, which completely resolved.
“The results of this trial were positive and very promising – all three dose levels of the VSV (vesicular stomatitis virus) Ebola vaccine were well-tolerated by participants, and no safety concerns were identified,” said May ElSherif, from the Canadian Centre for Vaccinology.
The VSV-Ebola vaccine was developed at the Canadian National Microbiology Laboratory of the Public Health Agency of Canada. The study was published in the Canadian Medical Association Journal. (PTI)
June 9th 2017
DAKAR, June 8 (Thomson Reuters Foundation) - Scottish nurse Pauline Cafferkey, who survived Ebola after caring for patients in Sierra Leone, spoke on Thursday of the psychological toll on survivors and children orphaned by the virus following her first return to the West African nation.
The 41-year-old nurse contracted the disease in December 2014 at the height of an Ebola epidemic which swept through three countries in West Africa and killed more than 11,300 people.
Cafferkey, who now works as a nurse in Scotland, returned to Sierra Leone last month, for the first time since being infected, to meet Ebola survivors and orphans - some of whom she treated - and raise funds for the British charity Street Child.
"What was emotional was meeting Ebola survivors and orphans and seeing how they don't have the luxury of moving on," Cafferkey told the Thomson Reuters Foundation by email.
"The psychological impact is something no-one talks about but it is so clearly evident ... people are by no means over Ebola as it has clearly left an immense scar (on Sierra Leone)."
Cafferkey completed a 10 km (6.2 mile) run last month as part of an annual marathon in Sierra Leone organised by Street Child to raise money for children hit hardest by Ebola.
Some 12,000 children were orphaned in Sierra Leone by the virus, 1,400 of whom need urgent support, Street Child said.
"Thousands of Ebola orphans ... are desperately struggling," Tom Dannatt, head of Street Child, said in a statement. "They may have a roof over their heads but they are last in the line for food and school - especially if they are a girl," he added.
The world's worst Ebola outbreak, which was declared over last year, killed at least 11,300 people and infected 28,600 as it swept through Sierra Leone, Liberia and Guinea from 2013.
The first person to be diagnosed with Ebola in Britain, Cafferkey suffered life-threatening complications from the deadly disease persisting in her brain, and has been readmitted to hospital several times with illness linked to the infection.
She also faced disciplinary action over allegations she concealed her temperature on her return from Sierra Leone, but was cleared by a British nursing watchdog last September.
Yet Cafferkey said returning to the country after what she called a tough couple of years had helped her to move on.
"Before I went to Sierra Leone, I didn't know what to expect," she said. "I'm glad I came back, it has been emotional but it has helped to give me closure."
June 6th 2017
NEWARK, N.J. (AP) — New Jersey Gov. Chris Christie is nearing a settlement in a lawsuit filed by a nurse who was quarantined in 2014 after working in Sierra Leone during the deadly Ebola outbreak, according to court documents.
Attorneys representing Christie said in a letter last week to District Judge James Clark that the governor reached the agreement to settle “in principle” with Kaci Hickox.
The letter did not include details, and the American Civil Liberties Union, which represents Hickox, didn’t immediately respond to a request for comment Sunday.
Hickox was working with Doctors Without Borders in the west African nation during the Ebola outbreak. She was stopped when she arrived at Newark Liberty International Airport and was quarantined. She later tested negative for Ebola and was allowed to go to Maine, where she lived at the time. She now lives in Oregon.
A judge in September dismissed federal claims that Christie violated Hickox’s constitutional rights because of the quarantine, but U.S. District Judge Kevin McNulty ruled that she could proceed with parts of her lawsuit alleging false imprisonment and invasion of privacy.
Hickox said in a statement at the time that one thing is certain: “This decision vindicates my rights by giving me the opportunity to find out from Governor Christie directly whether the decision to detain me was motivated by science or by politics,” she said in a statement. “Christie was ultimately responsible for my detention, and he should have to answer for it and show it was made in good faith.”
The state argued that the primary objective of Christie, then-health commissioner Mary O’Dowd and other officials was the “safety and general welfare” of the public during the Ebola virus outbreak. State lawyers maintained that health workers acted with the public’s safety in mind when they had Hickox quarantined and that Christie and the other officials are immune from lawsuits over public health quarantines.
The outbreak of Ebola, which is spread through contact with an infected person’s bodily fluids, killed thousands of people in Africa. Only a few people were treated for Ebola in the United States.
Researchers from the University of Liverpool have conducted a study of Ebola survivors to determine if the virus has any specific effects on the back on the eye using an ultra widefield retinal camera.
To find out more about the broad-ranging symptoms of Post Ebola Syndrome (PES), a clinical research team led by Dr Janet Scott and Dr Calum Semple, from the University's Institute of Translational Medicine, assessed survivors discharged from the Ebola Treatment Unit at the 34th Regiment Military Hospital in Freetown, Sierra Leone.
Two years on from the Ebola outbreak in West Africa, and many Ebola survivors are still presenting with symptoms of post-Ebola syndrome (PES), including joint and muscle pains and psychiatric and neurological problems.
Viruses, like Ebola, can stay hidden in our bodies by exploiting a vulnerability in our immune systems. This vulnerability is called "immune privilege," and comes from an old observation that foreign tissue transplanted into certain parts of the body don't elicit the usual immune response. This includes the brain, spinal cord, and eyes. Scientists believe this is because the brain, spinal cord, and eyes are simply too delicate and important to withstand the inflammation that's typical of an immune response.
An eye team led by Dr. Paul Steptoe, compared eye examinations of PES sufferers in Sierra Leone and the control population. A total of 82 Ebola survivors who had previously reported ocular symptoms and 105 unaffected controls from civilian and military personnel underwent ophthalmic examination, including widefield retinal imaging.
The results of the research, which has been published in the Emerging Infectious Diseasesjournal, shows that around 15% of Ebola survivors examined have a retinal scar that appears specific to the disease.
Dr. Steptoe, said: "The distribution of these retinal scars or lesions provides the first observational evidence that the virus enters the eye via the optic nerve to reach the retina in a similar way to West Nile Virus. Luckily, they appear to spare the central part of the eye so vision is preserved. Follow up studies are ongoing to assess for any potential recurrence of Ebola eye disease.
"Our study also provides preliminary evidence that in survivors with cataracts causing reduced vision but without evident active eye inflammation (uveitis), the aqueous fluid analysis does not contain Ebola virus therefore enabling access to cataract surgery for survivors."
The recent Ebola outbreak in DRC serves as a reminder for the need to have integrated development, so every nation can prevent, detect, and respond to the threat of infectious diseases.
On Friday, news broke that an Ebola outbreak was declared after three deaths and 6 additional suspected cases were detected in the Democratic Republic of Congo. Currently there is nothing to indicate that the outbreak will become an international pandemic, especially since DRC has experienced several Ebola outbreaks in recent decades and has a history on containing them. As suspected Ebola case numbers tick up it suggests the initial case wasn’t contained, highlighting the need for overall development and a world where every country is able to prevent, detect, and contain infectious diseases so global pandemics are less and less of a threat.
To achieve this dream though there is a lot of work to be done. Tons of other people have talked about the need to improve health systems (here, here, here, and here) which is obviously a critical piece of the puzzle, but I want to focus on other less talked about pieces. The non-health system development that is critical to ensuring the health system works, basic things many people take for granted like primary and secondary education systems, functioning roads that still exist when it rains, telecommunications, access to electricity, and trust in institutions.
When I worked in rural South Sudan doing disease eradication work, two of the largest challenges we faced were the lack of communication and ability to access remote communities. Typically, I would receive information on suspected cases from in these inaccessible areas from colleagues’ handwritten notes or by word of mouth from colleagues and community members. Getting to the area to investigate could then require hours to days of walking because it was impossible for vehicles to access the area, especially during rainy season. Conversely, if people were sick and wanted to go to a health facility they would often have to walk for days to get themselves there. For diseases like Ebola and measles that spread through human contact, this lack of access and rapid communication can mean an inability to contain the spread of the disease.
In Liberia, one of the countries that was devastated by the 2014 Ebola outbreak that terrified the world, there are only 1.4 doctors per 100,000 people (the US has 255.4 per 100,000 people), so even if there were functioning roads and communication systems there may not be enough health care workers to help, making it hard to contain a disease outbreak. This is where having a function education system is critical in addition to a functioning healthcare system. If more people have access to education in Liberia there would be a bigger pool to feed into beefing up the health workforce – not to mention other critical sectors – and with a literacy rate less than 50 percent there is a lot of room for improvement.
Lack of trust in governments and institutions is another factor that can contribute to the spread of disease as it did in the West Africa outbreak. Since people saw governments and institutions as corrupt or untrustworthy there was a belief that Ebola wasn’t real, but instead a way for the government to make money from Western aid or for outsiders to harm people. To combat this distrust, institutions need to be strengthened so they are more effective, transparent and accountable to the people they represent and serve – not only in emergencies, but all the time.
Pandemics from emerging diseases like Ebola are a real threat to the US. Diseases don’t need visas to enter and can’t be prevented simply through stronger border security. Addressing this threat , and living up to our humanitarian values, will only happen through targeted investments in helping countries create the systems – health, education, governance, and more – that will allow them to prevent outbreaks and detect, contain and treat outbreaks when they occur. To work toward this goal, Congress must reject President Trump’s proposed budget and fully fund International Affairs programs; and the administration must ensure that US foreign assistance is focused on reducing poverty and creating strong institutions that can prevent and address challenges little by little rather than throwing billions of dollars at a crises. We cannot wash our hands of the problem and cross our fingers it doesn’t show up at our border again.
15th May 2017
KINSHASA, Congo (AP) — One person has been confirmed dead from Ebola in an outbreak in a remote corner of northern Congo as health authorities look into a total of nine suspected cases, including two other deaths, the country's health minister and the World Health Organization said Friday.
One case of the hemorrhagic fever was confirmed out of the five tested since the outbreak emerged April 22 in Bas-Uele province, Health Minister Oly Ilunga Kalenga said. He said the confirmed case was of the Zaire strain of the virus.
The outbreak could test a recently developed experimental Ebola vaccine that WHO says could be used in emergencies. The global vaccine alliance GAVI said 300,000 doses are available "if needed to stop this outbreak becoming a pandemic."
This vast, impoverished Central African nation has had seven known Ebola outbreaks in the past, including one in 2014 with several dozen cases. That outbreak was not connected to the massive epidemic in Guinea, Liberia and Sierra Leone that left thousands dead.
So far all the cases have been tied to a remote village, and it's a strain of Ebola that's been seen in the country before.
Dr. Allarangar Yokouide, the WHO representative in Congo, said the first teams of specialists should arrive in the affected area of Likati on Friday or Saturday. The zone is some 1,300 kilometers (800 miles) from the capital, Kinshasa.
"The area in Likati is difficult to access, but the work of tracing contacts is very crucial to stopping the epidemic in its tracks," he said. The community is near the border with Central African Republic.
Ebola occasionally jumps to humans from animals including bats and monkeys. Without preventive measures, the virus can spread quickly between people and is fatal in up to 90 percent of cases. There is no specific treatment for the disease.
Three people have died from an Ebola outbreak in a remote northern region of the Democratic Republic of Congo, as health officials travel to the central African country in response to a rising number of suspected cases, the World Health Organization says.
A 2nd case of Ebola has been confirmed in Liberia months after the
country had been declared free from transmissions, health officials said
[Sun 3 Apr 2016].
The 5-year-old son of the 30-year-old woman who died [Thu 31 Mar 2016] from Ebola has been taken to a treatment center in Monrovia, said Deputy Health Minister Tolbert Nyenswah. Authorities are now checking everyone the woman was in contact with and 10 health care workers from the hospital where the woman died are under observation.
There are strong indications the woman came from Guinea when the border was closed, Nyenswah said. The woman, who died on arrival at a hospital [Thu 31 Mar 2016], travelled with 3 of her children.
"We are investigating in both Guinea and Liberia how she entered," he said. "But knowing the porous border we are not surprised; she entered Liberia before getting sick or manifesting signs and symptoms."
The new cases are a setback for Liberia, which had been declared free from transmissions for a 3rd time on 14 Jan 2106. Liberia was first declared free of the disease in May , but new cases emerged twice, forcing officials to reset the clock in a nation where more than 4800 people have died from the deadly virus.
The World Health Organization has said Ebola is no longer an international health emergency, but flare-ups, at decreasing frequency, are expected.The
An Ebola story 3.4.16
Exactly one year after the physician and Ebola survivor Ian Crozier woke from his coma, I met him at an immunology conference in Raleigh, North Carolina, where he’d been invited to present a case study of himself.
For Crozier’s interview, I’d secured a key to the hotel’s only available meeting space, the elegant “Mahogany Boardroom,” with the promise of not touching a thing. Within seconds, Crozier was doodling on the dry-erase board walls, chattering about how much he “just loved these things” back in medical school. He spun in an armchair, his 6-foot-5 frame hunched, his tousled hair shifting on his forehead; his demeanor was oddly boyish for someone who had just grappled with death.
But Crozier’s post-Ebola symptoms lingered. He fiddled with the recline lever to ease his back pain; he’d pause mid-sentence, mutter ‘dammit,’ then squint his eyes, searching his slippery short-term memory for his of thought.
I started off with something benign: You’ve gotten a lot of press, I said. What question are you tired of answering?
He put down his Sprite can and crossed his arms. He was quiet for a moment. "I’m tired of people not logically linking my case to West African survivors,” he said. “People ought to be tired of hearing one man's story. I'm tired of telling it."
* * *
On March 29, the World Health Organization declared that Ebola was no longer a global health emergency—but many people in West Africa are still feeling its effects.
Fifteen-year-old Mohamed Kamara weaves through the crevices in his slum below the Hagan Street clock tower in central Freetown, Sierra Leone, leading me to the three-sided shack where he and his siblings live under the care of their mother’s friend, a woman named Salimatu; they call her “auntie.” If we’re planning to offer him another cold Fanta, he tells me in Krio, we should just give him the money for it, and preferably hand it over before we arrived.
We climb over two toddlers, a rusted cooking pot, and huddle of elderly women squatting on overturned buckets. We duck under a laundry line strung with lacy thongs and t-shirts. The image of Ernest Bai Koroma, the president of Sierra Leone, glares down at us from massive plastic portraits hanging on all four sides of the clock tower, as if his face were pressed up to the pane of an ant farm.
Mo, as I call him, looks about 9 years old. When we first met, I initially mistook him for his younger brother, Musa. A female classmate–three inches taller than Mo–squeezes the tip of his nose as she prances by, waggling it, teasing him. He cracks a shy smile, then wipes it off.
Mo scratches at his eyes, his burning photophobia triggered in the sunlight. My instinct is to bat his hand away, to warn him, “You’ll scratch your cornea!”, but I bite my tongue. A corneal abrasion would hardly exacerbate the fact that he is already going blind.
Mo is an Ebola survivor–one of the lucky ones who came out of the Ebola Treatment Unit (ETU) “without the zipper,” a local reference to all those carried out in body bags. But in the months following his discharge, Mo’s post-Ebola symptoms were rampant: joint pain, muscle aches, extreme fatigue, difficulty breathing. He had short-term memory loss and couldn’t hear well. Eventually, he noticed that he could no longer make out the words on the pages of his schoolbooks. Over the past year, he has lost all sight in his right eye, which strays off to the side. Now his left eye is going, too. The virus that ravaged Mo’s body, destroyed his family, crippled his country, is back for more.
In the aftermath of the epidemic, almost half of over 15,000 West African Ebola survivors have exhibited new ophthalmic symptoms that, left untreated, can lead to severe uveitis (inflammation of the eye), cataracts, and blindness. In Sierra Leone, where an already-weak health system has been leveled by the outbreak, ophthalmological capacity is dismal—the country of 6 million people has just three ophthalmologists. And the nightmare is magnified by a frightening curveball: the possibility that live Ebola virus could be replicating in the eyes of discharged Ebola survivors, pleading to be disrupted by instruments and released back into the population.
As long as that question goes unanswered, the eyes of Ebola survivors are considered inoperable. Patients who need surgery are told to go home, to wait, until researchers confirm whether their eyes are viral landmines. Meanwhile, they’re going blind.
* * *
Ian Crozier was treating Ebola patients in Kenema, Sierra Leone, when he contracted the virus in September 2014. Often considered the sickest person to ever survive Ebola, Crozier was evacuated to Emory University hospital, where he spent 40 days in an isolation unit, much of it in a coma. After he was released, the virus left him with severe joint and back pain, hearing and memory loss, and extreme fatigue.
Then, months after being declared Ebola-free, Crozier developed severe pain and inflammation in his left eye, a condition called uveitis. His doctors presumed that some common antigen had disturbed the eye due to Crozier’s weakened immune system. When they conducted an eye tap—extracting a few drops of fluid from the anterior (front) chamber of his eye with a needle—Crozier turned to his doctors and, half-joking, told them to remember the moment, “just in case we’re in the middle of a paradigm shift, and the virus is Ebola.”
It was. Doctors were stunned. Though undetectable in his blood, the virus had been squatting for months in the anterior chamber of the eye, perhaps even replicating, without spurring an immune response. In fact, by the time the eye tap took place, the level of virus in his anterior chamber was actually higher than the level in his blood during the peak of the acute infection.
The inner eye joined a growing list of immune-privileged pockets of the body, including the placenta, breast milk, the central nervous system, and the testes, where Ebola could hide. Research on where, how long, and at what concentration the virus can survive is ongoing. But if the virus finds a path out of these strongholds and into the outside world, the effects could be catastrophic.
Crozier says it was a strange first night, lying in bed with awareness that the virus was still hitching a ride in his body. Over the next three weeks, his left eye lost its intraocular pressure, transforming into the consistency Play-doh. Soon after, he lost his sight in the same eye. One morning, he walked up to a bathroom mirror to brush his teeth and was sickened to find that his formerly blue iris had turned green, “a bizarre Blade Runner moment.”
But between an experimental antiviral drug and a steroid treatment, Crozier’s sight began to slowly return. Though his vision is still far from perfect, the eye is now Ebola-free and blue again. Until recently, Crozier was the only Ebola survivor to have had an eye tap, so his physicians don’t know: Was Crozier’s left eye an outlier phenomenon, or are the eyes of the other 15,000 Ebola survivors teeming with the virus as well?
* * *
Even before the epidemic, Sierra Leone ranked fifth-lowest in the world in the number of doctors per 1,000 patients. Out of the 100 doctors in the country, only about half were practicing clinically, and almost none were specialized. Then the Ebola outbreak struck, redefining the notion of low capacity.
Last February, as the outbreak slowed and survival rates improved, eye complications emerged like a second epidemic. There were hundreds of uveitis cases like Crozier’s, but there were also plenty of people with “quiet” eyes (no longer showing inflammation), which had gone untreated and now had complications like cataracts and even retinal and nerve damage. Partners in Health, a global-health nonprofit, stepped in to help coordinate survivor eye care in the country. Groups like Médecins Sans Frontières (MSF), International Medical Corps, and a four-person team from Emory’s called Quiet Eye West Africa (QEWA) pitched in as well.
“There are real resource limitations in terms of people being reached and screened,” says Steven Yeh, the ophthalmologist who headed Crozier’s successful treatment at Emory and a member of QEWA team. “Sierra Leone’s few ophthalmologists on the ground are doing the lion’s share of the work caring for patients.”
During the influx in post-Ebola uveitis cases, the Sierra Leonean ophthalmologist John Mattia and two nurses at Freetown’s Lowell and Ruth Gess Kissy UMC Eye Hospital were performing cataract extractions on as many as 27 Ebola survivors per day. But when word of Crozier’s persistent virus in the United States reached the clinic, it nixed the possibility of continuing even routine eye surgery. A basic cataract surgery—an incision into the cornea to remove a lens and place a new one—would mean that the surgical instruments, and perhaps the health-care providers, would cone into contact with possibly infected fluid in the eye. The staff feared, quite reasonably, that penetrating even a seemingly quiet eye could expose them to a persistent virus or even introduce it back into the population.
“Everything has been based off of that one case,” says Paul Steptoe, an ophthalmic registrar from St. Paul's Eye Unit at the Royal Liverpool Hospital in the U.K. “It’s this idea that, yes, during any survivor’s active uveitis, [it’s possible that] there is live virus in the eye, and it is potentially as infective as anything else, as even the systemic infection. If you go in, you’re being exposed to live Ebola.”
Steptoe, who this January spent three weeks in the ophthalmology department of Sierra Leone’s 34th Military Hospital (called MH34), last month took the first two anterior chamber samples from quiet eyes of Sierra Leonean survivors just month. Unlike Crozier’s active uveitis case, both quiet-eye samples came back negative for Ebola, meaning those two individuals may be cleared for cataract surgery.
Steptoe acknowledges the potential risk of Ebola virus in the vitreous jelly, farther back in the eye, which has never been tested in an Ebola survivor. (A cataract surgery should only disrupt the front of the eye, but in post-uveitis eyes, there’s an increased chance that fluids in the front and back of the eye have intermingled.) He has since returned to his post in Liverpool, so survivor sampling at MH34 is on hold until he returns next August. A much larger sample size would be needed to demonstrate that quiet-eyed survivors aren’t typically carrying the virus in the front of the eye, but Steptoe’s method was the fast-track way to get a couple of survivors with cataracts into surgery.
Over at the Kissy Eye Hospital, Mattia and his team are waiting on the results of the Emory team’s large-scale clinical trial, which, in typical systematic research fashion (the physicians still practice domestically and visit Sierra Leone a few times per year), seems to be crawling through the planning stages at a glacial pace.
“If they have cataracts, we just advise them to come back later,” says Mattia. “We don’t know when. But for now, we just can’t do that.”
* * *
When the virus first ransacked his family, 13-year-old Mo was the epitome of a middle child. His younger brother Musa had recently started showing him up on the soccer field, and his older sister Maruati refused to share anything. Mo was the closest with his mother. She fell ill four days after attending a burial ceremony for a relative; no one knew what was causing her condition–vomiting, diarrhea, hemorrhaging, and finally, an eerie delirium. When his siblings were sent out to buy rice, visit relatives, go to school, Mo stayed by his mother’s bedside, begging her to recover. She didn’t.
After her death, her blood tested positive for the Ebola virus. Strangers in space suits buried her, and Mo wasn’t allowed to say goodbye. By this time, the Hagan Street slum dwellers had heard of Ebola. Mo and his siblings were outcast from the community. Neighbors had heard the tales of horror and were terrified that the children were carrying the virus. The neighbors were merciless—but they were also right.
The three children had just been taken into Salimatu’s one-room shack when they began exhibiting symptoms. Mo was taken to MSF’s ETU at Prince of Wales secondary school in Freetown. (Mo later learned that both of his siblings had gone to other ETUs and survived. Salimatu never contracted the virus.) He has no recollection of his time there, aside from snapshots of his favorite nurses standing over him, urging him to eat. Those nurses say he was conscious for much of it; Mo’s amnesia was the first of many signs of post-traumatic stress.
Even when Mo’s eye issues escalated quickly–redness, itchiness, almost total loss of vision–he wasn’t sure where to seek treatment. He knew he couldn’t pay for it. After three months, he was connected to an MSF worker, who immediately traveled with him to Kissy Eye Clinic, where Mattia works. When he came home, he told his auntie what the doctor had said and he wept. So did she.
Mo had undergone the most basic types of vision exams: light projection into the eye, and recognition of hand motion when the hand is waving directly in front of the face. His left eye had a cataract, but he could still see light and motion. His right eye failed both tests.
“If you have some cataract, no matter how dense it is, you should still be able to see something moving in front of it. You should be able to perceive light,” says Steptoe. “If someone doesn’t perceive these things, that means it's not just the cataract. There's probably been severe damage to the optic nerve behind it. So even if we took that cataract out, the vision would not be improved.
The Kissy Eye Hospital staff suspect that aggressive pan-uveitis, like Crozier’s, had gone untreated as it festered deep in Mo’s right eye, ultimately destroying it. Mo returned to the clinic twice more over the course of the year, receiving steroid eye drops and then eventually oral steroids, with no improvement. the front of the eye, unable to reveal much of anything if a dense cataract like Mo’s covers the front.
Without an anterior chamber tap, it was impossible to tell whether Mo had live virus in his eye, or even case symptoms identical to Crozier’s–such as an intraocular pressure change (measured by a more sophisticated instrument than the clinic had), or a color change (since his dark irises masked any pigment shift). They couldn’t be certain how, pathologically, the blindness had occurred. In some ways, it didn’t matter. The damage was done.
“I don't think Crozier was a unique circumstance. That was probably quite common. There are a lot of patients who have had the same uveitis as Ian Crozier, but they've just not received that level of treatment and examination,” says Steptoe. “Going in now, we’re seeing pan-uveitis cases that have burned out, and it's about what kind of damage has been done that remains.”
Mo’s auntie is a petty trader, swapping cassava and krain krain leaves in the market to earn a profit. She still owes 180,000 Leones (about 45 USD) for the children’s school fees. Mo’s failing vision has kept him back in the equivalent of sixth grade twice. Salimatu has been clear that if Mo doesn’t matriculate, or if his condition progresses to blindness, her foster care will end. Mo will be removed from school, separated from his siblings, and sent to work on his estranged grandfather’s farm in the rural provinces.
For Mo, the damage in the right eye was irreversible. Hope hinged on the quiet left eye–also opaque with a cataract, but still reactive to light and motion. It was possible that the uveitis in his left eye had left vital eye structures intact. Two nurses had been trained in cataract removal could have carried out the procedure in under 40 minutes, possibly restoring full vision to the eye. But Mo was an Ebola survivor, and the threat prevailed. After each of the three visits, Mo was told to go home and wait.
* * *
If an adult patient waits a year to remove a cataract, or even two years, a new lens might still restore vision to where it was before the cataract. This isn’t true for young children, since their rapidly developing brains begin to favor the strong eye, dissolving the connection with the weak one (called amblyopia). It also isn’t true for Mo’s right eye, where trauma farther back in the eye has destroyed the potential for his sight to be restored. But for cases like his left eye, theoretically, it’s possible.
But if Mo is expelled to the provinces later this year, he may never return to Freetown, let alone undergo a surgery that may or may not repair vision in one eye. For Mo, the chance will be over.
In the boardroom, I asked Ian Crozier about his two-week week flirtation with blindness in one eye. For Crozier, wearing a left eye patch meant swashbuckling with children in U.S. airports and dealing with anxiety over losing the left side of his world. It was a difficult time for him, he said, but not a life-threatening one. He had since returned to Sierra Leone with Emory’s QEWA team to develop treatment protocols and help care for survivors. He told me the story of a boy with circumstances much like Mo’s.
“The child is completely alone in the world. Now, I want you to imagine what happens if he goes blind,” Crozier said with an edge in his voice. The boardroom is silent, except a cart of pressed linens trundling down the hall. “Unimaginable. You couldn’t script anything worse.”
The Emory team’s study will take time. But it’s a race against the clock for cases like Mo. Can we remove cataracts in time to prevent their lives from collapsing?
“There is indeed a small window of opportunity in helping these people,” says Mattia. “Once this window is closed, the eye may not be salvaged anymore.”
* * *
Mo says he often thinks about taking his own life. We sit in a dusty, vacant classroom after school one day and talk about this.
Mo had wanted to become a lawyer—mostly because his auntie says he should, since he talks too much. But he had loved school. Each morning, he washes himself by the slum spigot and dresses in his uniform, which he keeps carefully on a hanger to avoid his least-favorite chore, ironing. If his auntie has some money, she gives it to him for rice at lunchtime. He looks forward to seeing Mr. Kamara, his math teacher, who teaches the class fun English phrases and tells goofy stories about birds landing on children’s heads before exams for good luck.
When his vision began to decay, school became torturous. Mo started bickering with peers who noticed him falling farther and farther behind. The brawls have escalated, letting up only when his auntie threatens to beat him. His classmates tell him the rumors their parents have heard: that all Ebola survivors go crazy in time. Mo worries that he can already feel the craze coming on. He can’t sleep. He can’t focus.
“There is a lot of suffering in the provinces,” he utters, suddenly in English, ensuring the translation is clear. “A lot of suffering.” Then he sits quietly, his head resting on a desk, waiting.