Ruminations of an Ebola Fighter: An Interview with Tim Jagatic, MD

JANUARY 03, 2016
Sanjey Gupta, MD
Editor's Note: MD Magazine contributor Sanjey Gupta, MD is an expert in wilderness medicine. While lecturing this summer in in Breckenridge, CO he interviewed Tim Jagatic, MD. Both were attending the Wilderness Medical Society Annual Assembly.  

Much went wrong in the global response to Ebola. But some things went well and lessons were learned. Despite the initial deluge of news regarding the progress of the Ebola virus disease (EVD) epidemic, there is little valuable reporting in the public sphere regarding the current status of the fight against this disease. 

As I sit with Tim Jagatic, MD, a Canadian physician who is a veteran of three volunteer missions with Médecins Sans Frontières (MSF) to West African EVD treatment centers during the uptick, height, and taper phase of the epidemic, I sense a sentiment of dissatisfaction with the global reaction to the epidemic.

In a word, he feels that the initial global response to the EVD epidemic was a “failure.”

According to statistics offered by the World Health Organization (WHO), as of the week ending December 30, 2015, the epidemic had claimed 28, 601 suspected or confirmed cases and resulted in 11,300 deaths worldwide. Jagatic first treated patients with EVD in April, 2014 in Guinea. 

He recounts that at that time that a treatment center was literally being built around him as he was first treating infected patients. Limited medical infrastructure for patient care had been created at that point of the epidemic. He reports that MSF (also known as Doctors without Borders) was well suited to help manage the outbreak as the organization had roughly 40 members with prior experience with treating EVD. However, according to Jagatic, the location of the outbreak posed the larger challenge. 

This was the first EVD outbreak in an urban setting with its accompanying high population density and poor physical and logistical infrastructure. The behavioral patterns and cultural norms of the local population regarding illness facilitated this EVD outbreak to progress to epidemic status. Further, Jagatic said that cooperation between many of the non-governmental organizations (NGOs) in West Africa at that time did a poor job of data sharing and collaboration, which contributed to the failure in recognizing the extent of the disease. That lapse also secondarily assisted in the propagation of the disease.

Jagatic does not mince words. He says that by June, 2014, that “Ebola was out of control.” He recalls that the number of ill seemed to be increasing exponentially and that the number of EVD treatment centers could not be increased without an increase in security. Relationships with the local population were souring as distrust of MSF and the other NGOs was increasing due to poor communication and due to the scope and description of the disease. 

The local population had never previously encountered Ebola, and often confused the disease with more benign illnesses like malaria or typhoid. The local population harbored much distrust of NGOs, seeing them as infiltrating their communities and wreaking havoc on their social norms in dealing with their sick or dying. He says that the participation of the rest of the world in the fight against EVD was poor and no one seemed to respond to the pleas for help. It occurred to Jagatic that MSF seemed to be the only organization providing meaningful medical response as it was the only group with experience treating EVD.

In July, 2014, Jagatic was stationed in Sierra Leone and reported treating up to 20 patients with EVD per day. During that time, MSF ramped up its operation in Brussels, providing a training facility for an increasing number volunteers for skills in PPE placement, in the approach to and handling of patients with EVD, with increasing emphasis on reducing personal exposure. Jagatic continued to feel that national governments were ignoring the outbreak. The turning point seemed to come when Kent Brantly, MD, working with the organization Samaritan’s Purse, contracted EVD and became the first American to return to the United States to be treated for the infection. 

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