Health & wellness

In Practice

Preparing for Ebola, remembering AIDS

Dan Page for the Boston Globe

One evening in February 1983, a medical resident named Hacib Aoun was working on a bone marrow transplant unit, taking care of a teenager with leukemia. The patient was hemorrhaging and required frequent transfusions and checks of his blood count. While performing one of these checks, Aoun cut his thumb on a glass capillary tube containing the patient’s blood.

Three weeks later, Aoun developed a rash, a sore throat, and a cough. He and his doctor chalked up the symptoms to “some virus.” Years afterward, Aoun wrote: “Little did we know how correct we were.”

Aoun recovered and went on to finish his residency and to marry. He and his wife had a daughter. But three years after that night in February, after Aoun lost weight and became fatigued, he tested positive for the recently-discovered human immunodeficiency virus. The teenager with leukemia had died, but a sample of his serum had been preserved and it also tested positive for HIV.

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I first met Aoun in July 1984. I was a medical student working on an oncology floor. He was a cardiology fellow known for his brilliance. He’d been called in to consult on a woman diagnosed with metastatic lung cancer during her pregnancy. The cancer had spread to her heart and, in the middle of the night, she’d become acutely short of breath. Aoun placed a tube in her pericardial sac to drain the fluid accumulating there and relieve her respiratory distress.

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Before going home, Aoun pulled me aside to compliment my work on the case. A consulting physician needn’t have bothered extending this kindness to a medical student, especially at 2 in the morning. Thirty years later, I still remember it gratefully.

I also remember the rumors that circulated around the hospital after Aoun was diagnosed with AIDS. A native of Venezuela, he must have visited prostitutes there. Or maybe he was using IV drugs, or was secretly gay. The subtext of these speculations is obvious now: This couldn’t happen to one of us.

As Ebola spreads beyond West Africa, I find myself thinking about the early days of the AIDS epidemic, and about Aoun. Because Ebola is only contagious via direct contact with infected body fluids, those at greatest risk are health care workers, family caregivers, and good Samaritans. Thomas Eric Duncan, the first patient diagnosed in the United States, may have been infected with Ebola when he helped transport a dying neighbor to a treatment center in Liberia.

Female nurses infected while caring for Duncan in Dallas have been unfairly accused of failing to adhere to an ill-conceived infection control protocol or use inadequate protective gear — while the first male doctors who contracted Ebola while caring for patients in Africa have been hailed as heroes. Still, health workers infected with Ebola have not been ostracized to the extent that Aoun was by his own medical community when he developed AIDS.

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One reason is that we know more about Ebola today than we did about HIV in the early 1980s. Ebola was first identified in 1976 and much is understood about the virus and its transmission.

In the early years of the AIDS epidemic, HIV had not yet been discovered. For lack of a microbiological villain, those known to be at risk — gay men, Haitians, intravenous drug users, and hemophiliacs or others who’d received multiple transfusions — became targets of discrimination. I recall the lame, nervous jokes (“You can drink from my cup, I’m not a gay Haitian hemophiliac”) in the hospital where I trained. Some surgeons, dentists, and obstetricians refused to treat patients with risk factors for AIDS.

We worked under the misconception that AIDS was something other people got, and from which health care workers were immune — as long as we were very careful. But we didn’t know then exactly what we needed to be careful about, so, to some extent, paranoia dictated hospital policy.

Before universal precautions regarding the handling of blood and other body fluids, people assumed to be at risk of AIDS had large warning placards fixed to their doors. That patients could be marked publicly as potential carriers of lethal infection based on their sexual orientation and other factors now seems medieval, like something from an account of the Black Death.

The world is smaller now than it was in the 1980s. Flow of information and ease of intercontinental travel make it harder to believe that a virus could only infect people we imagine to be unlike ourselves. It’s more difficult now to maintain the illusion — and it always was an illusion — that during epidemics medical professionals are invulnerable.

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Aoun himself was responsible, in part, for progress we’ve made in compassionate treatment of ill health care workers. After he developed AIDS, Aoun became an activist. He sued his employers for violating his privacy by publicizing his diagnosis against his wishes, and lobbied for improved health care benefits for medical trainees. A few months before his death from AIDS at age 36 in 1993, Aoun testified before Congress, arguing against mandatory HIV testing for nurses and doctors and in favor of their right to continue working if infected. He also fought bias within the medical community against anyone infected with HIV.

Despite progress we’ve made in managing epidemics, clinicians still need to be reminded to resist the self-protective reflex of demonizing the “other” when a new outbreak occurs. At a recent briefing for medical staff, Dr. Hilarie Cranmer, director of disaster response in the MGH Center for Global Health, noted that during an epidemic fear spreads faster than contagion — including among health care workers. Cranmer told doctors and nurses: “If we don’t get rid of the fear that we have, we’re not going to get rid of this disease.”

In 1989, Hacib Aoun wrote something remarkably similar: “It is up to us, members of the most humane profession, to fight against discrimination, to fight against our own natural fears, and to see to it that these patients are not abandoned.”

Dr. Suzanne Koven is a primary care internist at Massachusetts General Hospital. She can be reached at inpracticemd@gmail.com.