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Partners in Health to stay in W. Africa despite Ebola scare

Dr. Paul Farmer (center) and Ophelia Dahl, the Director of Partners.John Tlumacki/Globe Staff/Boston Globe

Partners in Health, the Boston charity that first made a mark in Haiti, remains committed to building a robust health system in West Africa even as one of its workers lies stricken with Ebola, according to one of the agency’s founders.

The international aid group plans to expand the foothold it established amid the Ebola outbreak in Sierra Leone and Liberia, strengthening the two nations’ ability to detect, treat, and prevent all types of illness, said Dr. Paul Farmer, who help-ed start the charity nearly three decades ago.

But now, Partners in Health is confronting Ebola within its ranks. A clinician working with the agency in Sierra Leone has been diagnosed with the illness, and 11 other US health workers exposed to the ill man are being closely monitored.


The Partners in Health clinician was working in an Ebola treatment unit and in a government hospital in Port Loko that tended to patients with malaria, tuberculosis, and other illnesses endemic in West Africa, Farmer said.

After testing positive for Ebola on March 10, the health worker was flown from Sierra Leone to the National Institutes of Health in Bethesda, Md., arriving Friday. The NIH changed his status from serious to critical Monday. The clinician has asked the agency to withhold his name and other information, including whether he is a doctor, nurse, or other health professional.

It is not known how the man became infected, but he could have contracted the illness from a patient whose Ebola infection had not been diagnosed, Farmer said. The clinician fell ill at the government hospital; other health workers were exposed to the deadly virus while caring for him there.

Ten were brought to the United States for observation over the weekend, and an 11th was scheduled to join them Monday. On Sunday, one of those health workers developed symptoms and was moved into isolation at Nebraska Medicine’s Biocontainment Unit, although this person has not tested positive for Ebola. In the first days of an Ebola infection, however, the test does not always detect the virus.


“Obviously, we hoped to never have this happen. Obviously, we didn’t try hard enough,” Farmer said.

While grateful for the care the clinician is receiving at the NIH, Farmer said his goal is to make such high level of treatment available in poor countries.

“Ebola is a disease of caregivers,” Farmer said. “Everyone I’ve met who survived, they’d all been taking care of either sick family members or sick people who they don’t know.  . . . I wish we could make sure that everybody who got sick, whether caregivers in the formal sense — health care professionals — or caregivers in the family sense, I wish we could give them all great care.”

The man diagnosed with Ebola, Farmer said, had just accepted “the job of his dreams” at an American hospital but postponed starting because he felt compelled to help in Africa. He had been in Sierra Leone for 16 days. Farmer said he had not met the clinician but has gotten to know his family since he became ill.

Although it plunged into an international health emergency in West Africa, Partners in Health is not an emergency response agency. Its specialty is training and empowering the local populace to improve care.


The agency helps governments recruit and retain staff, improve the pipeline of equipment and drugs, renovate buildings for better working conditions and infection control, and train cadres of community health workers, locals who can bring care and information to vulnerable and isolated people.

Founded in Haiti in 1987, Partners in Health expanded to sub-Saharan Africa in 2005 and works in Rwanda, Mali, and Lesotho. The agency first ventured into Liberia and Sierra Leone in November to help with history’s worst outbreak of Ebola, which has claimed more than 10,000 lives in those two nations and a third, Guinea.

But the agency never intended to “just do Ebola,” said Dr. Joia Mukherjee, chief medical officer. “Our commitment to these countries is open-ended.”

In Liberia, Partners in Health worked in rural areas that Ebola never reached, she said. Instead, the agency helped bolster community clinics. In one area, teams that originally deployed for Ebola ended up managing a whooping cough outbreak. In Sierra Leone, Partners helped run an Ebola treatment center that the government was building in a former school and coordinated care at another unit.

In both nations, Partners in Health trained people not only to identify Ebola but also treat illnesses with similar symptoms, such as malaria and tuberculosis. “As people were being ruled out for Ebola, we were capturing patients who have TB and HIV,” Mukherjee said.

The agency has 2,000 employees at work in West Africa, mostly local residents, including hundreds of Ebola survivors. Partners also has more than 150 American staff members in the two nations, many of them clinicians who work for five-week stints.


Partners in Health raised roughly $30 million for its Ebola effort, most of it coming from the US and United Kingdom governments, Mukherjee said. But that money is designated for Ebola. Now, the agency is looking to its donors — governments, foundations, and individuals — to pay for the ongoing efforts.

As an example of the organization’s hopes for West Africa, Farmer pointed to the construction of a 300-bed teaching hospital in Mirebalais, Haiti, which trains Haitian doctors and nurses while providing care to thousands of patients. The hospital, which opened in 2013, faced “mockery” when first proposed for Haiti, he said, because people did not believe high-quality care can be provided in impoverished countries. It took 30 years to bring it to fruition, he said.

The challenges may be even greater for West Africa if the world’s focus on the region dims as the Ebola crisis wanes. And yet the need for medical professionals is acute: Before the recent Ebola outbreak, Sierra Leone had just 136 doctors, Liberia barely 50.

The Ebola epidemic has started to abate in Guinea and Sierra Leone, despite worrisome flare-ups. And Liberia celebrated the discharge of its last-known Ebola patient. If no new cases in the current outbreak occur by April 4, Liberia will be declared Ebola-free.

But Farmer cautioned against the “Ebola triumphalist narrative” that implies the job is done. Ebola exploded in West Africa because the nations there lacked the health systems to contain it, he said. The disease is sure to return, he said, and meanwhile, people continue to need care for a host of other afflictions.


“We should use Ebola as the wedge to give them what they really need, which is their own institutions,” Farmer said. “You take care of Ebola patients as you build systems that solve other problems.”

Felice J. Freyer can be reached at felice.freyer@globe.com.