Indy man describes life on the front lines, fighting Ebola

Never before had Carl Rochelle been so glad to get a 3 a.m. email. Earlier in the day, word had spread that a Partners in Health clinician had contracted Ebola in Sierra Leone. Rochelle's colleague Justin Mast was in the same West Africa country treating Ebola patients with the same group.

Could it be the Indianapolis nurse who had fallen ill?

Then ping! Mast sent out a middle-of-the-night note assuring all he was fine.

The incident, which occurred toward the tail end of Mast's six-week stint in the country, helped underscore just how risky disaster medicine can be.

Even the decision to go proved a difficult one for Mast, a senior crisis and continuity adviser with the MESH Coalition, a public-private organization that advises health care providers on how to respond to emergency events.

The idea first occurred to Mast in August, soon after the first American to fall ill while tending to the ill in Liberia flew home for treatment. Mast had vast experience as an emergency response nurse, but he also had two young children at home.

One month passed. Then two. Then three. The Ebola outbreak waned somewhat in Liberia and then caught fire in Sierra Leone. Mast continued to hear the call.

Finally in November, he started looking for an organization with which he could volunteer.

"I decided this was something I wanted to do, needed to do," he said.

Two months later, the Indianapolis nurse arrived in Sierra Leone for six weeks of fighting Ebola. He joined a Partners in Health group of practitioners from around the country who received a week of training in Boston before leaving for West Africa.

While the outbreak's peak in December had passed, the country had not returned to normal. Since Ebola was first detected in Sierra Leone just under a year ago, there have been more than 12,370 cases of the disease and about 3,900 deaths.

When Mast and his colleagues first arrived, they spent a week in the capital, Freetown, undergoing additional training in the soccer stadium, left vacant by the outbreak. Ebola had also closed the local schools, although many restaurants, bars and some markets remained open.

Chlorine washbasins, considered one way to protect against Ebola's spread, greeted visitors to most public spaces. Common modes of greeting, such as handshakes, were off limits. Before entering some buildings, Mast and his colleagues would have to submit to a temperature check.

After a week in Freetown, Mast worked in an Ebola Treatment Unit set up by the Sierra Leone Ministry of Health in collaboration with Partners in Health. Formerly a technical school, the facility had about 100 beds on two sides, one for confirmed cases, the other for suspect ones, which could be malaria either instead of or along with Ebola.

When patients arrived, either by ambulance or under their own power, the first step was a blood draw on the latter side. Among the suspect cases, patients would then be divided into "wet" (those with active vomiting or diarrhea) and "dry." Each room contained about a dozen beds.

The work proved draining — both physically and emotionally.

By the end of Mast's time in Sierra Leone, the rainy season had ended and the dry season began to heat up. One day it hit 104 degrees. In the shade. Air conditioning did not exist there, though the hospital staff could slip on cooling vests under their personal protective equipment.

Limits were placed on how long one could spend garbed in the personal protective equipment. The recommended amount of time was about 90 minutes.

Because removing the outfit poses a risk for Ebola infection if it's not done correctly, Mast and his colleagues were careful not to exceed the limit by too much.

"You don't want to go until you're exhausted because you still have to get out," Mast said. "Every time you get in it, the more opportunity there is" for an Ebola exposure.

During an eight-hour shift, Mast typically donned the suit twice. While he did not have an exposure during his time in Sierra Leone, he saw it happen to others; someone might tear their suit on a door or catch it somewhere else. When that happened, protocol called for the person to stop what he or she was doing, immediately leave the patient area and take off the suit.

As an additional precaution, Mast and the others took their temperatures twice a day to ensure they were not in the process of developing Ebola.

Trained in emergency medicine, Mast had seen his share of nasty diseases and trauma. But Ebola was nastier than most of what he had seen, especially in terms of the sheer volume of vomiting and diarrhea that it could produce.

Two maxims, both aimed at ensuring the providers' safety as well as those of their patients, guided what clinicians, including the foreign volunteers such as Mast, could and could not do.

Number one: "The general rule is if it's not something you do at home, don't do it in the ETU." And the simpler number two, said Mast: "There are no heroes in the hot zone."

Young patients, never easy, posed an even greater challenge in this setting. Unlike in the United States, Mast knew he could not reach out with a hug or even a touch on the hand.

"There's a different place you put that in your mind and heart," he said. "I'm here to do a job and to do that job and do it safely, I have to stay focused on what I am here to do. You put up walls to make sure you can do it and not get emotional, but it was tough."

At no point, however, did Mast regret his decision to come. He saw how hard the doctors and nurses of Sierra Leone worked and how much they needed the outsiders' help.

Then, there were the patients. Some did die, but many survived the ordeal.

One in particular stood out in Mast's mind. Mast struggled to keep him hydrated, battling his fluid loss due to bouts of diarrhea and vomiting. He knew that keeping this man hydrated could mean the difference between life and death.

"He was in pretty dire straits," Mast said.

A few weeks later, though, his concern for the patient turned to "great joy" when he watched as he was discharged from the hospital and walked outside Ebola-free.

Call Star reporter Shari Rudavsky at (317) 444-6354. Follow her on Twitter: @srudavsky.