A link to a boston globe "Perspectives" article titled "Unintended Consequences"

http://www.bostonglobe.com/magazine/2014/10/15/ebola-survivor-richard-sacra-what-must-next/Ht3relF2R19s7583e5xGtN/story.html

A Message from Rick

I asked Rick to write some comments that I might share at a press conference.  Here is his message:

I have truly been overwhelmed by words of kindness and support received over the last week since my diagnosis with Ebola virus disease. Some old friends from years past, some new friends whom I have not met, and others have joined a mighty chorus of prayer on my behalf. This is a very humbling and overwhelming experience.  Thank you all for your prayers. They have sustained me thus far as I make daily improvements in my condition. Thank you also for your contributions towards the work in Liberia. Without your generosity, the situation there would truly be hopeless. With your contributions toward supplies of personal protective gear and other medical supplies/medications, the door will remain open for SIM and ELWA Hospital to have the ministry God has called us to, providing medical care in Monrovia, a city whose entire health care system is in crisis.  Finally, thank you for your prayers and kind words of support and love toward my wife and children. We deeply appreciate every one and I feel like I am truly experiencing the body of Christ at work on a global scale! We love and appreciate you.

 

I have been told that the SIM Ebola project has received over $180,000 so far.  This morning, I received an email from Dr. John Fankhauser that some work to redesign the intake area of the hospital is nearly finished so that they can begin to care for patients in other areas besides obstetrics.  Please continue to pray for all the hospital workers to be protected from exposure to the virus. 

Update on Rick Sacra

Monday, September 8, 2014
Dear Praying Friends –
I can hardly believe that it was less than a week ago that I wrote you to ask you to pray for Rick because he had contracted Ebola virus disease.  You’ve all seen what has happened since then on the national news, so I am not going to fill you in on all of those details.  I’m not sure I can get the timeline right myself!  This has probably been the longest week of my life.

We have felt the power of all your prayers. I believe that the speed with which Rick was evacuated and his relative strength at the time of his evacuation is the result all that prayer.  The trip was tough on him, but each day since then has been a little bit better. I have appreciated all the messages of concern and encouragement and admiration that I have received from hundreds of people in the last week.  I hope that by posting on facebook and through this email, in addition to the information that we are releasing publicly, you feel that you know what is happening since I can’t get back to everyone personally.  

Max and I arrived in Omaha on Saturday and the Nebraska Medical Center has welcomed us kindly and generously.  Our country director from Liberia and his wife, Will and Jenny Elphick, have been with us over the weekend and Dave and Mary Decker will take their place when they leave today.  The last two days have been full of meetings with doctors, signing papers, planning a media strategy, a little shopping for things we forgot in our haste to travel, as well as trying to keep family up to date and stay in touch with Jared and Caleb. We are extremely grateful to be a part of SIM in this circumstance—their commitment to their members and to prayer have made us so proud and blessed to be members of this mission. 

 

Rick really did improve over the weekend, but the doctors are cautious because they don’t have a textbook on the clinical course of Ebola, and they are trying experimental treatments for the first time in a human patient with Ebola.  They are literally writing the book. We pray that the expansion of their knowledge will contribute to some medical solutions that are viable in Africa, and soon. 

I don’t want to make this long, but we do want to continue to use Rick’s story to remind the world of the tragedy that is going on in Liberia and West Africa.  Finally, it is getting the attention of the West and some resources are being allocated to support the medical efforts to save lives and stop the epidemic.  Pray that the money and supplies will be distributed quickly to the most effective partners in the battle.  If anyone asks you where they can make a contribution, direct them to the sim.org website, where clicking the banner will direct them to the contribution page. http://www.sim.org/ebola/

Thanks again for your love, concern, messages and your prayers.  God is with us.

Love, Debbie

Dear Praying Friends,

If you followed the news over the last month, you have heard that ELWA hospital has been at the center of the Ebola crisis in Liberia.  We are praising God for his mercy to our missionary colleagues, Dr. Kent Brantly and Nancy Writebol, who have been completely healed from the Ebola virus.  They have been reunited with their families and are taking some time to rest and recover their strength. 

The healthcare system in Liberia has had to go through a complete reboot after every single hospital in the city of Monrovia closed down to be decontaminated with bleach water as a result of Ebola cases landing in Emergency Rooms, outpatient clinics and medical wards. When I arrived on the 4^th of August, ELWA hospital was in the middle of this process.

On August 6^th, Dr. Brown, the medical director at ELWA hospital, opened the doors to Obstetrics patients. When the patients started arriving, they had often been to several other hospitals and traveled for hours seeking care. More than 35 cesarean sections were performed to save women and their babies in the first 20 days—sometimes two or three a day.  This past Sunday when I was on call, several women presented for care in various stages of labor and three wound up requiring C-sections.  One of them was a teenager with a full term pregnancy who had developed eclampsia, a combination of elevated blood pressure and seizures that would be detected in advance if she had been able to attend her regular pre-natal clinic.  She was brought by her family, sprawled across the back seat of a taxi, unresponsive and still seizing occasionally. We had to give her a general anesthetic and perform an emergency cesarean.  She is doing well now with her baby and will soon go home.

There are other medical emergencies that cannot be neglected much longer. Last week, I had a phone call from a friend to appeal for their neighbor, a 13-year-old girl who was very sick with severe abdominal pain. They had been to several hospitals but none was able to accept her.  The family was desperate.  Dr. Brown, who is a general surgeon, agreed to evaluate her even though the hospital was only open for obstetrics. Her exam indicated peritonitis, an infection in her abdomen, which would definitely require surgery.  We waited all day Sunday for Dr. Brown who was busy caring for critically ill Ebola patients in the treatment center. Finally he came to see Lisa at around 8:30 p.m. after what had already been an exhausting day. It was clear that her surgery could not be put off, so we started operating at about 10 p.m. and ended after midnight.  Dr. Brown found four separate holes in her intestine—perforations due to a typhoid fever infection.  Each hole had to be repaired and then her abdomen had to be washed out.  I spent the night on the pediatric ward monitoring her progress post-op, as she was quite ill with fever and difficulty breathing after the surgery.  Today I am happy to report that Lisa is improving and slowly recovering (she is pictured here.)   But she is just one of so many people in Liberia who are at risk because of the Ebola tsunami that swept through an already fragile healthcare system.  

We are getting news now that a couple other smaller facilities in Monrovia are opening, allowing ELWA Hospital to open soon for additional services without being overwhelmed with a huge flood of patients. On Thursday, the 28^th, we held a training session for all of our staff to review new triage procedures and infection control techniques to help protect us from unknowingly getting exposed to the Ebola virus.  We hope to gradually increase our services over the next couple of weeks to include children and adults, but we must first make some changes to our building to allow us to triage everyone before they enter the hospital grounds to check for any signs of Ebola Virus Disease (EVD).  A large shipment of personal protective gear arrived yesterday from our partner, Samaritan’s Purse. This has been one of the key issues in reopening—ensuring that we have adequate protective equipment.  So we are praising God for that!

Meanwhile, the number of people contracting Ebola continues to rise. WHO predicts the final numbers will be in the tens of thousands.  The isolation and treatment wards on our property are packed and patients continue to come. While I am not involved in the units, Dr. Brown is passionate about ensuring they provide the best possible care so he is dividing his time between facilities. Thankfully, many people are surviving if they come when they first show symptoms.  We rejoiced greatly that one of the ELWA nurses was released from the unit last week.

Please continue to pray!  Here are a few requests:

1.   That the international response to the Ebola epidemic will be vigorous!  Right now, the systems put in place like ambulance transport and even the burial teams to dispose of bodies are overwhelmed.

2.   Pray for ELWA’s ministry at this time, that we would be able to make a difference for Christ in the lives of those who are sick.

3.   Pray for the ELWA staff, for safety and protection from infection with Ebola. 

4.   Pray specifically for Dr. Brown and for Joe Wankollie, our SIM-ELWA Deputy Director who is running the whole show at this time. They are carrying a very heavy load.

In His Strength,  Rick

July 30, 2014

Dear Prayer Partners

As many of you are aware from the national news, the Ebola virus epidemic in Liberia and in the West African region has been getting worse and affecting more people.

I have been wanting to send out an update for the last couple of days, but the situation keeps changing so fast that it has been hard to settle down and put something into a cohesive letter. For those of you who are on Facebook, Debbie or I have been posting some more frequent updates about the situation in Liberia there, so it would be good to follow along there if you are praying and want more details.

The key points to be aware of now are these:

The Ebola virus has increased in severity in Liberia. ELWA Hospital, in cooperation with Samaritan's Purse, has been running an isolation unit there caring for patients affected by Ebola. However, over the weekend two of our missionaries tested positive for the virus and now are undergoing treatment for the disease. Their names are Dr. Kent Brantly and Nancy Writebol.

Ebola is a virus which is spread only by people who are sick-those who are not ill cannot spread the disease. It is spread by direct contact with a sick individual or with bodily fluids. It carries a high mortality rate, often in the 50-90% range. There is no specific treatment-only IV fluids and other supportive measures while waiting for the person's immune system to respond.

I had been planning to make a trip later in August to ELWA to help there for a few weeks. I am praying now and consulting with our SIM leadership about the timing of my trip. Please pray for us as a family as we are asking the Lord to lead and guide.

Prayer items:

*Please pray for Kent and Nancy, for their recovery, and that the Lord would draw near to them.

*Please pray for the team in Liberia, both missionaries and Liberians  who are caring for many of the sick, as they are getting tired out and of course are experiencing fear themselves.

*Pray that good information about Ebola will be distributed and understood, so that precautions can be taken and so that the current epidemic can come to an end.

*Pray that Debbie and I would receive guidance from the Lord about my going to Liberia.

By prayer, Rick and Debbie Sacra

Reflection: Obstacles to stopping the Ebola epidemic

In the last four months or so, a major epidemic of the Ebola virus has spread through the three nations of Guinea, Sierra Leone and Liberia.  Over 600 have been infected and over 400 people have died.  The epidemic started out from an animal source—either bats or monkeys. It continues to spread when someone has close contact with a sick individual (touch or contact with infected bodily fluids—blood, vomit, diarrhea). It is felt that between 60 and 90% of confirmed cases will die. ELWA Hospital set up an isolation unit in April and had to start using it in June to treat patients infected with Ebola.  Here are some links with more information on the epidemic and the response from ELWA Hospital and Samaritan’s Purse.

http://simusa.org/content/latest-news/4312/elwa_ebola_update

http://www.samaritanspurse.org/article/ebola-virus-claims-more-lives-in-west-africa/

We in the medical field often feel that the solution to a health problem is getting the right diagnosis, or the right medication, or the right knowledge.  Once the right info is in the hands of the doctors and the patients, everything will be OK.

But the current Ebola epidemic in Liberia points out another major issue that we sometimes overlook:  Fear and lack of trust, and how it becomes an obstacle to tackling a major health issue.

The fear which the Ebola epidemic has created leads to conflict between those who desire to make a difference and those they are trying to reach.  This quote is from a CNN article posted online in the last 24 hours:  “There is also a real sense of mistrust toward health workers from communities. In Sierra Leone and Guinea, WHO has said that community members have thrown stones at health care workers trying to investigate the outbreak.”  In Liberia as well, there are teams investigating the epidemic or doing contact tracing (trying to keep track of and monitor those who have been in close contact with someone who came down with Ebola). These teams have run into resistance from communities, sometimes not even being allowed to talk with people who may have come in contact with the virus.  In several cases government officials have had to intervene.  And finally from a recent SIM update:  “Still unreported are the sick in hiding, too afraid to confirm their fears that they have contracted the virus. Just last week, three possible Ebola patients came to ELWA Hospital seeking medical help, only to leave before doctors could put on the protection suits required to treat them safely.”   I’ve talked with ELWA staff about this on the phone. Fear grips family members and they run.  When you put yourself in the shoes of a family member of someone who is sick, it is easy to understand the storm of emotions they are facing.

I am not in Liberia right now—I’m currently in Massachusetts.  But I’ll be returning to ELWA Hospital again at the end of August for three and a half weeks to help the team there. As I think about the situation my teammates are facing in Liberia, and the challenge confronting the entire healthcare community, I find myself wondering how the Ebola epidemic will be stopped.  An effective treatment would be nice, but that is years and millions of dollars away.  The above events move a different set of priorities to the top of my list. How do we respond to the kind of fear that grips communities in the shadow of this kind of threat?  How do we foster trust; how do we build the kind of relationships that will make the difference?   How do we give people the courage to face all the facts about this disease and take the steps to allow the health authorities to contain the epidemic? The best chance of survival right now lies in receiving supportive care like what is being offered at ELWA—how do we give people the confidence to come early on for testing and treatment?
I don’t have answers for this… but I know that when the answers come, they will be based on love, trust, courage, and faith.  Lord, please pour out your Spirit of wisdom and love on all of us who are involved in caring for those infected and those at risk. 

May trip update

Scriptsfrom the Sacras

“...And He sent forth His Word, and healed them”  -Psalm 107:20

I (Rick)  returned on May 20 ^th from a 3 week trip to Liberia. I was grateful for the opportunity to bring 6 pieces of luggage full of medications and lab supplies for the hospital, and to fill in for 2 of my colleagues who were attending a medical conference in Greece, especially with the possibility that there would be a serious need for medical care at the time. You may have heard about the outbreak of Ebola virus in West Africa in the last few months. While there are still a few Ebola cases in neighboring Guinea and Sierra Leone, Liberia has not had any cases for over a month.  ELWA Hospital prepared an isolation ward to be ready if needed, but we have not actually had any patients  admitted to it. We thank God that  the virus was contained so quickly.

Nonetheless, the hospital is very busy these days.  I do want to share a story about one patient that I took care of during my trip.  

Little Peter (not his real name) was sitting on a bench outside the lab.  He’s only 5. His cheek was swollen up, and he was drooling.  He had a terrible “bad breath” smell about him, and looked quite malnourished. Frieda Schmidt, the administrator of our dental clinic, was walking by and noticed this boy.  She asked the people nearby about him.  Peter was not even being seen at the hospital—he was just there with his mother who was also sick, and she had no money to pay for Peter to be seen and treated. 

Frieda brought Peter’s situation up with me and a couple of the other doctors.  As we talked it over, we knew that we couldn’t allow Peter to go home.  He wasn’t eating and would soon become critically ill.  SIM missionary Dr. John Fankhauser, our Deputy Medical Director, gave the official “OK” for us to tell his mother that we would admit him to the hospital and that the admission deposit would be waived. 

When we brought Peter into the emergency room and examined him, it turned out he had a very severe gum infection that had spread into the cheek, and that he wasn’t able to eat anything.  So we started him on antibiotics and saline rinses to help clear the infection.  We also did some labs, to see if we could find any underlying cause. That soon became apparent when Peter’s HIV test came back positive.  Little Peter had AIDS. 

ELWA Hospital has a Counseling Department focused on helping our 500 plus HIV positive clients live positively and remain healthy on antiretroviral treatment (ART).  This department was opened up in 2000 with the support of an SIM project.  Bee Mason, one of the counselors, met with Peter’s mom several times while he was in the hospital, to educate her about HIV, its cause, how it spreads, and how important it would be for Peter to take medication regularly, every single day for the rest of his life.  We also asked Peter’s mom to be tested and her test was positive as well.  The initial counseling process is quite intensive as we help people get past their denial and their despair to see that there is hope for those with HIV, both through good medical care, and through a relationship with God. 

Within a few days, little Peter’s mouth got better, and he was able to start eating.  But his mom required some help and education about what foods would help him regain strength, restore lost weight, and support his immune system.  It took over a week for his weight to start improving, but by the time he went home he was thriving and looking more active. 

Peter and his mom will be able to connect with others who have HIV through the ELWA Hospital support group—there’s even a special group just for kids, and this allows children who are a little older and who have had HIV for years to be an encouragement to those younger or newly diagnosed, to play together and to demonstrate the active healthy life which is possible for them.  It also gives our clients the opportunity to share the new life many of them have found in Jesus. 

Your prayers and support are deeply appreciated!  I will be making another trip, most likely in August.  We’ll keep you informed with another update in a month or so.