Heart to Heart of Lenexa heads to front lines in battle against Ebola

The way Jim Mitchum of Kansas City sees it, the choice was hard but morally obvious.

In West Africa, Ebola has infected more than 8,000 people, killing half. Every day, the deadly hemorrhagic virus attacks hundreds of others. With no cure or effective treatment, bodies are being buried or burned en masse.

“There is no evidence that the EVD (Ebola virus disease) epidemic in West Africa is being brought under control,” the World Health Organization reports.

To Mitchum — who in September had just begun his duties as chief executive officer of Heart to Heart International, a Lenexa-based humanitarian group that provides medical disaster relief — there seemed to be few options.

“We could not sit back and let those people die without some help,” said Mitchum, 62. “It’s what guides us. That’s why we exist. If we ducked it, if we said, ‘No, no, we’re not going to do this one,’ we would have to have a really good reason.”

The group never considered ducking.

But, at least at first, Heart to Heart also didn’t anticipate that it would be making an announcement, as it did last week, that the Kansas City group would become one of a handful of nonprofits to wade into the crisis in full force and full protective body suits.

Heart to Heart now has a 70-bed Ebola treatment unit under construction in Kakata, Liberia. That nation, along with Sierra Leone and Guinea, is one of the three African countries hardest hit by Ebola. Liberia, where half of nearly 4,000 infected people have died since the viral outbreak in March, is considered to be the epicenter.

When Heart to Heart’s unit is finished, perhaps as early as the end of October, teams of its medical volunteers will be among only a few prime caregivers running units that directly care for Ebola victims.

“International Medical Corps (based in Los Angeles) and MSF (France’s Médicines Sans Frontières, or Doctors Without Borders) are the only two I’m aware of right now in Liberia,” said Tyler Marshall, International Medical Corps spokesman. His group runs a 53-bed unit in Liberia’s Bong County that is being expanded to 70 beds.

Although as many as 27 treatment units are needed in Liberia, only six are operational. President Barack Obama in September promised to deploy troops to the region to construct as many as 17 units with 100 beds each, but those facilities have yet to be built.

Meanwhile, for every victim in a treatment unit or hospital, the U.S. Centers for Disease Control and Prevention estimates that four are receiving care in homes, all but ensuring the spread of disease to relatives.

Health officials in neighboring Sierra Leone on Friday acknowledged what one called “defeat” in attempting to treat that nation’s ill in the too-few treatment units that exist. Peter H. Kilmarx, who leads the CDC’s team in the country, said that the new national health policy would be to begin distributing rehydrating solutions, gloves and painkillers to hundreds of Ebola-afflicted households to allow those infected to be treated at home.

“It’s basically admitting defeat,” he told The New York Times, adding, “There are hundreds of people with Ebola that we are not able to bring to a facility.”

Marshall called the reality of victims being turned away at the doors of treatment centers in Liberia a “heart-wrenching tragedy.”

“The plan is to scale up,” he said. “Hopefully there will be more Heart to Hearts.”

Change of plans

Heart to Heart’s role became apparent in late September, Mitchum said, after an advance team from the nonprofit returned from a fact-finding trip to Liberia’s capital, Monrovia.

Originally, Heart to Heart thought that it might help provide basic medical care — treating broken bones and flu cases and helping with births — while others dealt with the Ebola crisis.

“That was our intent,” Mitchum said.

But the team quickly learned that Ebola has so infiltrated the country that for Heart to Heart to perform basic medical care would actually have put its medical volunteers at greater risk.

It would be better to knowingly and safely care for people with Ebola than to unwittingly come in contact with and be infected by those not yet diagnosed.

“We spent time in a medical center,” Mitchum said. “They were very clear with us: ‘You cannot do primary care. It is a death trap.’ To treat people who were simply ill or trying to give birth, we would not be able to do it safely. It would have been more dangerous. In fact, it was an unacceptable risk.”

Heart to Heart changed its plan. Instead of providing primary care at a cost of $1 million over 12 to 18 months, the group now aims to be on the Ebola front lines at a cost of about $1 million a month. The group is seeking funds from various private and public entities, including governmental sources.

Meanwhile, the Ebola treatment unit is going up. Volunteer medical personnel are signing on as well as being sought to deploy for six-week tours.

Counter to the common perception, Mitchum said, the volunteer medical teams will very rarely, ideally never, actually physically touch an individual infected with Ebola.

“The whole idea is isolation,” he said.

The Ebola treatment centers are much like M.A.S.H. units. The compounds are surrounded by fences. Each bed is isolated from the next. Liberians perform most of the actual patient care.

Marshall said that in the Ebola treatment unit run by the International Medical Corps, 161 members of the 178-person staff are Liberian nationals or expatriates. The medical volunteers organize and oversee that care.

“There are people in Liberia right now who are being trained,” Mitchum said.

The entire first week of the six-week stint focuses on safety protocol, such as putting on, removing and disposing of the personal protective gear. Almost all of it is incinerated after one use.

“Things like goggles and boots are cleaned with bleach,” Mitchum said. “All the other stuff is burned. It has to be. You can’t reuse it safely.”

With Liberia under the searing sun of equatorial Africa, the temperature inside the protective gear becomes so hot — upward of 115 degrees — that workers generally work one-hour shifts before being relieved.

“You are dehydrated,” Mitchum said. “Your boots are wet with sweat.”

As an administrator tasked with logistics, he said he would not be working inside the treatment unit.

“No one puts on the suits unless they have a purpose,” he said. “I don’t have a purpose to be in there.”

His role will include the necessarily mundane and the macabre, from bringing in supplies and working with government and health officials to understanding the logistics of burial crews. Although Mitchum won’t be inside the treatment unit, safety will still be paramount in public.

“First of all, you don’t touch people,” Mitchum said. “People over there have learned. Everyone is staying away from one another. You don’t walk up and hug people or shake hands anymore. We certainly are going to be out in the streets of Monrovia, but you’re not going to contract Ebola by driving around the streets of Monrovia.

“I’ll go to a bank. I’ll go to meet with a government minister. But I’m not going to be out in the market.”

Dispelling myths

Although the spread of Ebola through West Africa has created massive human tragedy, Mitchum thinks it’s important to dispel myths.

The disease is an epidemic in three African countries, he said, but it is not, as one might think from sensationalist coverage, a pandemic.

The virus that causes Ebola is not airborne. It’s mostly spread when a bodily fluid from an infected person enters the body of another, usually through a cut or by the eyes, nose or mouth.

As for its infectiousness:

“If you put it on a scale of zero to 10, from zero being hard to get to 10 being very infectious, Ebola is down to like a three or four,” said Lee Norman, the chief medical officer at the University of Kansas Hospital and a consultant in Kansas on biosecurity. “You have to get something on you, or in you. It’s not spread by coughing or sneezing.”

No medication that roundly prevents or cures the illness exists. Most people who survive it return to normal in relatively short course, Norman said.

Inside Heart to Heart’s Ebola treatment unit, Mitchum said, the goal will be as much to quarantine and isolate infected people, to prevent further spread of the virus, as it will be to treat them. Treatment, in some ways, may be a misnomer.

“What happens,” he said, “is that you try to make them as comfortable as possible. You rehydrate. You give fluids and feed them, provide pain medications. This is a really important thing to say: An ETU is really an Ebola care unit. There is no treatment …

“It is a battle between themselves, their immune system and the virus. They are going to either win it or lose it.”

This story was originally published October 11, 2014 at 10:17 PM with the headline "Heart to Heart of Lenexa heads to front lines in battle against Ebola."