Guest: Dr. Mardia Stone
Guest Bio: Dr. Mardia Stone is an International Medical and Public Health Expert. Currently, she is Senior Advisor to the Chester M. Pierce, MD, Division of Global Psychiatry at Massachusetts General Hospital (MGH) /Harvard Medical School and Senior Advisor to the Liberia Center of Excellence in Mental Health and Psychiatry, working extensively on mental health issues, coordinating mental health research and training activities for MGH Psychiatry residents in Liberia.
Dr. Mardia Stone discusses her role in the placement of future Ebola Virus Treatment Centers in West Africa. She also talks about policies and politics as they relate to the outbreak.
Health Professional Radio
Neal: Hello, you’re listening to Health Professional Radio. I’m your host, Neal Howard. So glad that you could join us. Our guest in studio today is Dr. Mardia Stone – an international Medical and Public Health expert. Also, served as senior adviser to the Incident Manager, Incident Management system in Liberia – in Liberia’s response to the Ebola epidemic. Today, we’re going to talk a little bit about some of the treatments for Ebola and get a little bit into some of the experimental treatments that are being developed. And also, as Dr. Stone was an integral part in deciding were the future Ebola treatment centers would be built by some of the troops that are being deployed actually this week in Liberia, she’s going to talk a little bit about that too. How are you doing today Dr. Stone?
Dr Mardia Stone: I’m doing fine. How are you?
N: I’m doing well. Thank you so much for returning with us. As Senior Adviser to the Incident Manager in Liberia’s response to this Ebola Epidemic, you were integral in choosing where some of these treatment centers would be placed. We have American troops that are being deployed to West Africa and from what I understand to the media, their role would be to help construct secure modern treatment facilities specifically for this epidemic. What were some of the factors that went into deciding not only to build this treatment centers but in where to build them?
S: Well first of all, the critical reason for identifying location to build treatment centers is because the case rates were escalating and the one treatment center in Monrovia did not have the capacity to accommodate all these cases – all these people that were actually tested positive with the Ebola and have to be placed in the unit. There was a second site at the JFK Medical Center but that was being run by WHO but it only has the capacity for about forty to fifty beds. So in the whole of the Metropolitan Monrovia area where you have half of the population, you only had two treatment centers that would accommodate a maximum of three hundred to three hundred and fifty cases. So, it was imperative then to identify other places that were not in densely populated areas. So we looked at places that were in close enough to the communities and close enough to hospitals so that if someone came in and were triaged that has Ebola or symptoms of Ebola, they would be taken to one site and the others would be transfer to the hospital but the problem was that all the hospitals were closed. You know, the hospitals were not operating so you could not take people to the hospital for a stay. So when they were treated in the unit, there were two sides to it where people who came in with definite Ebola symptoms and tested positive were placed in a treatment unit and people who needed acute primary or secondary care were placed in another location because you have to separate the two groups of people.
S: And so the areas, we looked at schools in some communities that had the space because we were looking for places where we could put up at least a hundred beds. So we looked for schools that were large, that had large square footage and in areas were not so densely populated but were easy to get to – easy for the ambulance and the health professionals to get to – to take people out and take them to the centers. And the other thing is we looked for places where the roads were accessible because if it’s the rainy season in Monrovia, you know, one of the big problems there is having accessible roads. And some of the roads, even in the city, flood with heavy rains. So you needed to find places that you could access the facility easily and we looked at places that had large land maps. For example, one of the places we identified was the SKD stadium, it’s a football stadium. They had about fifteen or twenty acres of land that were unutilized. You know, they’re just land that surrounded the stadium and the reason for that is because they’re putting up tents. They’re creating field hospitals that are like tents. A lot of the treatment units are going to be in these kinds of tents – specialized tents – and one of the critical factors for the location we selected is how do you dispose of the waste because the waste of an Ebola patient has to be disposed specifically. You have to have these rubber holes because the waste has to be decontaminated and then it has to be buried into the ground.
N: Now doctor Stone, you were technical adviser and chief on staff to the Deputy Minister of Health, Chief Medical Officer of the Republic of Liberia, and you were instrumental in developing the First National Health Policy in Liberia. How much in the development of that policy was the Ebola virus addressed?
S: Well, we did not address the Ebola virus in that policy specifically because at that time they have not had a major epidemic of this sort in Liberia. What we addressed was, you know, public health systems. Having facilities that were accessible to the people, where people could get to easily and when we had infectious disease protocols put in place, that’s one of the things that we were concerned with because at that time that this policy were being developed, Liberia was just coming out of a fifteen-year war when most of the health facility was destroyed. So the focus was on rehabilitating health facilities that could be rehabilitated, constructing new facilities in areas where no health facilities existed so that people did not have to spend hours walking – three, four, five, six hours – to get to the nearest health facilities that were in proximity to their particular communities. So those were some of the focuses, providing the basic package, basic healthcare services, because since the system had literally collapsed even the basic primarily healthcare services were not being provided and so the strategic arm of the health policy was the basic package of health services that would be provided to all of the population. And then at some sort of the government decided that if you went to a public facility, all of your healthcare will be provided to you free of charge. And that was what we focused on.
N: You know, we’re hearing of Canadian companies involved in the development of experimental treatments for Ebola. We’re also hearing of some other places, in Kentucky, for example, ZMapp is being developed. It’s a tobacco leaf derivative is what I understand. What is your knowledge and your experience with this experimental drug and do you think that enough of it can be produced going through the approval process in order to get it to folks in a timely manner once our troops are being deployed and build these facilities?
S: Well the process of developing ZMapp is kind of complicated. It’s not something that you put some chemicals together and “Boom!” you’re going to get a drug because the antigen has to be injected into the tobacco plant. And then the cultivation of that whole process takes about three months before you get the end product. So it takes about three months to develop the batch of ZMapp and that is the reason why it is in short supply. They weren’t developing it in mass because until you had Americans that contracted Ebola in Liberia, they were not taking ZMapp to Liberia, it’s still an experimental drug. It is only after Kent Brantly and this other woman contracted Ebola in Liberia that they flew in this serum to do an experiment and see if they would be responsive – if it would work and if it would somehow reverse the illness. But it’s complicated to create ZMapp because if you have to wait three months to get a batch, you know, people sort of hold on to what they have and it’s not widely disseminated.
N: Uh huh.
S: For example, they only provided three doses to Liberia and there were only three Liberians who got ZMapp after Kent Brantly got that – two doctors and a physician’s assistant. One of the doctor’s died and the other two people survived. Now, why did one die and why did the other two survived? Is it because of ZMapp, we don’t know because all three had ZMapp. Again, your immune constitution – how strong your own immune systems is – is equally important in the process of your recovery.
N: So, the very young, and the very old, or the very sick already are prime candidates to actually die from contracting Ebola as opposed to someone who’s healthy and strong and young?
S: Well I would say so. However, we’ve seen people, you know, that are in their 50s who have survived Ebola so it depends again on your own immune constitution and how exactly you get to a treatment center. Because, you know, if you’re kept there when the viral load is not so high, your chances of survival are great. For example, you’ve heard of Thomas Duncan in Dallas, Texas?
S: Okay. Now, Thomas Duncan had Ebola and he had Ebola in the very advanced stage. They did not have ZMapp available, I understand, and so they did not give him a trial of ZMapp and so they gave him antiviral drugs. Now, the difference between ZMapp and the antiviral drug is that ZMapp will attack the virus on contact. You know, almost immediately you would begin to see people show signs of improvements because whatever the viral load is in your system, whatever virus that’s running around in your system, all of them would be attacked by the ZMapp drug. Not so would with the anti-viral. The anti-viral will attack the virus from replicating – from making new viruses – but whatever is floating around in your system will still be floating around in your system. You will only be protected from replicating and creating and producing new viruses. So the question is, if Thomas Duncan had been given ZMapp, would he have survived? We don’t know that. How effective is this anti-viral? They had not used this before for Ebola patients for it was experimental again. Now people ask the question, why didn’t he get a blood transfusion from Kent Brantly? And I understand that the blood typing was different. That they did not match. You know, before we can transfuse the blood of an individual into another person, they have to have a compatibility of their blood type…
S: and apparently Duncan, his blood was not compatible with Kent Brantly’s blood. But I want to say one thing though Neal …
S: This idea of transfusing the blood of someone who has recovered from Ebola into someone who is ill with Ebola – actively ill – is not new. It was done in Zaire way back in the 1970’s. The African doctors took that chance because all these people were dying and they were dying quickly. The few that survived – what they decided to do – well you know, because of the antibody response, they decided to transfuse the blood of some of the people who have recovered into those people who were ill and dying. And they had a miraculous recovery. So this idea of the transfusion of blood from some of the people who have recovered, I just want to give credit to those people who had that idea because even then they were being advised not to do it by so-called experts in the field but they decided they’re gonna do it anyway because they had nothing to lose.
N: Nothing to lose. Great. Now, as we wrap up this segment, what are your thoughts on the recently implemented screening procedures that are taking place at some of the airports?
S: You know, the airport screening, because it’s critical for you to understand. What happened in Boston yesterday, for example, an Emirates flight that was coming from the Middle East. They had to remove five people from the plane who had flu-like symptoms. It turned out nobody was had Ebola but this kind of fear, you know, and the readiness of your health system to response, this has to be disseminated because people are fear mongering. You have a lot of negative information being disseminated that people are just panicking and I think that is something you need to address on yourself.
N: So it seems that there is so much more behind the headlines. When we’re talking about Ebola, there are so many things that are behind the headline and the politics as those politics apply to the treatment of Ebola patients and also to the development and distribution of any experimental drug that may or may not work. It’s been great having you here with us today Dr. Stone.
S: It’s been an absolute pleasure to share my experience and I hope you we could do this again in the future.
N: Absolutely. Transcripts of this program are available at HPR.FM and also at healthprofessionalradio.com.au and don’t forget to subscribe to our podcast at iTunes.