Society of Critical Care Medicine (SCCM) member David Porembka, DO, FCCM, understood the risks.
“I told my kids before I left that there was a good chance I would not come back,” he said. “I knew how dangerous it would be medically.”
A veteran intensivist who will soon be joining Avera McKennan Hospital & University Health Center, Dr. Porembka spent three weeks in Sierra Leone during mid-August to early September treating Ebola patients and those who were suspected of having the deadly virus.
“I always wanted to do missionary-type work and help others in need,” he said.
Stationed at the Kenema Government Hospital, Dr. Porembka worked 16 hours a day, helping manage the overflow of patients.
Was he ever afraid?
“There was no fear because fear causes mistakes,” he said. “Once you were on the ground, you did what you were trained to do.”
Answering the Call
In June, Dr. Porembka received an email from SCCM encouraging critical care and infectious disease specialists to contact the World Health Organization and indicate their willingness to provide support in affected West African countries. Dr. Porembka fit the bill.
“Having clinicians like David volunteer, who understand the principles of intensive care, intravascular volume repletion and avoidance and treatment of shock, is crucially important in the ongoing fight against Ebola,” said Robert Fowler, MD, the intensivist and World Health Organization consultant who initiated and coordinated the appeal to SCCM’s membership.
Dr. Porembka was among the altruistic SCCM members who quickly heeded the call to action. He submitted his curriculum vitae and received a response forthwith. Several interviews and other pre-clearance processes followed. Soon, he was an official consultant for the World Health Organization.
In preparation for his departure, Dr. Porembka received a series of vaccinations and read widely about the Ebola virus disease. He also stocked up on needed supplies, including mosquito nets and head coverings, bug repellents, waterproof boots, ponchos, water filters, chlorine dioxide tablets, and clothes appropriate for a tropical climate.
In relatively short order, Dr. Porembka set off for Sierra Leone, flying into Freetown and then making the six-hour drive to the Kenema Government Hospital.
On the Front Lines
Almost immediately, Dr. Porembka realized he would be working with very limited resources.
There were no blood pressure monitors. There were no electrocardiography monitors. Providing oxygen therapy was not possible due to a lack of necessary supplies.
“You didn’t have the basics,” said Dr. Porembka, noting that the setup was reminiscent of something seen in the United States during the 1920s.
But this was the reality, and so Dr. Porembka set to work with the finite resources at his disposal.
Each day, he followed a methodological and meticulous preparation process before entering the Ebola-positive ward. Due to the intensely hot conditions, he would drink three liters of water before donning his Tyvek suit, his N95 mask, his face shield, and other necessary personal protective equipment.
“We had a buddy system,” he said. “We watched each other as we dressed. We double and triple gloved. We made sure nothing was exposed.”
Each glove, he noted, was a different color so that any tears could be easily detected.
The hospital staff would then provide a census report of sorts, detailing how many people had been brought in overnight, how many had died, and how many new patients either had Ebola or were suspected of having the virus.
Subsequent to this report, Dr. Porembka would enter the ward.
“You had to be extremely focused and totally vigilant,” he said.
Although he performed various duties -- which included the washing of patients -- he focused on “aggressive fluid resuscitation.”
Securing intravenous lines, however, proved difficult due to the stifling conditions. Heat, Dr. Porembka surmised, limited the adhesiveness of tape. It was to be a daily challenge.
The heat also caused his glasses to fog up without fail, necessitating breaks every two hours or so due to vision impairment.
Despite these challenges, Dr. Porembka worked valiantly every day to offer the best treatment possible to the patients he oversaw. Some days had their success stories -- patients treated and released. Some days were filled almost exclusively with sadness, deterioration and death. An average of six to eight patients succumbed to the virus every 24 hours and even some nurses fell victim.
To avoid a similar fate, Dr. Porembka followed all the necessary protocols and procedures to avoid any possible exposure to the virus. Whenever he left the ward, he would remove his personal protective equipment in a safe and appropriate manner and undergo a rigorous disinfection process.
“There is no cure,” he said. “There is no vaccine. That’s always in the back of your mind.”
After three grueling weeks, Dr. Porembka left Sierra Leone for the United States. Subsequently, he went into quarantine for 21 days. He found the isolation startling but understood its obvious efficacy. Thankfully, he ultimately showed no signs or symptoms of the Ebola virus.
As for the future, Dr. Porembka sees himself heading back to West Africa.
“I already volunteered again,” he said.
SCCM would like to thank all members who heeded the Society’s call to action.