On the Front Lines Fighting Ebola

You may have seen Nahid Bhadelia, J99, F04, M05, looking poised and determined on the cover of Boston Magazine’s “Top Docs” issue back in December. The editors presented her as the local face of the Ebola crisis in West Africa, and this was a fair claim. Under the auspices of Partners in Health, Bhadelia is involved in her third grueling medical tour to Sierra Leone. “Once you’ve been there and seen how bad things are, I think anyone would be driven to go back,” she told the magazine.

The 37-year-old Bhadelia, a doctor specializing in infectious diseases and based at Boston Medical Center, came by her global perspective naturally. Her father was a world-traveling physician. “I was born in India, and I grew up in Saudi Arabia and Sweden,” she relates. “Then we came to the U.S. when I was 12 or 13 years old.” Moving from culture to culture taught Bhadelia how varied human societies can be, and how differently they approach their problems, while stamping her with something of a restless, unquenchable spirit.

She has had her eye on the big picture for a while now. Anthony Schlaff, a professor of public health at Tufts School of Medicine, remembers having Bhadelia in his class as a passionate medical student more than a decade ago. “She was strong-willed, very smart and enterprising,” he remembers, “and she had strong ideas about how she wanted to change the world.”

It was more than just talk. While in medical school, she served as an HIV/AIDS counselor and clinic coordinator for the Sharewood Project, a student-run clinic in Malden, Massachusetts, that cares for underserved populations. In 2001–02 she was an Albert Schweitzer Foundation Fellow, working to improve health care among Boston’s inner-city youth. She also founded and directed the Chinatown Community Health Program, which sponsored a cardiac screening program for Asian immigrants.

Her unifying fire has always been the link between social justice and medicine. Enrolling in the medical school’s combined-degree program with the Fletcher School, from which she earned a master of arts in law and diplomacy, constituted a logical—and perhaps inevitable—step.

Ian Johnstone, academic dean and professor of international law at Fletcher, says Bhadelia’s focus while a student was on human security. In contrast with national security, which involves military force, human security entails a consideration of factors such as a country’s endemic poverty, the quality of health among its people and environmental degradation. “Understanding these broad issues can make you more effective as a health worker,” Johnstone points out.

The well-schooled Bhadelia, who is director of infection control at the National Emerging Infectious Diseases Laboratory (NEIDL) at Boston University, is within a few courses of adding an M.P.H. degree from Columbia University to her résumé. “I’m having trouble getting down to New York City to get it done,” she offers with a smile. Tufts Now spoke with Bhadelia in early January, on the eve of her departure to Sierra Leone for a month’s stay, about her current work and some of its implications.

Tufts Now: What drives you to take on such hard and dangerous assignments?

Nahid Bhadelia: One of the reasons I did the M.D./M.A.L.D. degree is because I was very interested in how deeply seated emerging pathogens are in human movement, in culture, in economics, in politics. It was a new lens through which to examine how these diseases emerge and how they take advantage of vulnerabilities in health-care systems. It’s not so much the danger that attracts me. Instead, it’s always been that lens of how you tease out what’s causing diseases to emerge. You can stop at that level, of course. But more of my focus has been: How do you assess the vulnerabilities in health-care systems so that you can make them stronger?

These epidemics are disasters, but they don’t have to be disastrous. They’re only disasters because of the vulnerabilities in the health-care systems.

Most doctors are content to practice within relatively small geographic areas, but your approach is at the macro level, isn’t it?

My approach is really a mix of large and small. All diseases start at the individual level. What I’ve done here at NEIDL and Boston Medical Center over the past few years is very much the same philosophy as in Africa. At the hospital, I was a health-care epidemiologist; my focus was on how to limit the spread of infections within the hospital.

Let’s talk about Ebola. In what ways does this disease represent a diplomatic as well as a medical challenge?

Diplomacy is just one aspect of the Fletcher School. There are a huge number of people there who work on economic policy, humanitarian relief. A large component of the Fletcher student body focuses on disaster relief, and my connection is more to that part of the curriculum.

How do we, as medical professionals, determine the ethics of trying out experimental medicines in a crisis? How do we distribute new resources to desperate societies without inflicting more harm? How do we gather data in the middle of an outbreak? These are some of the questions I’ve been working on. How do you think about making sensible decisions for the patient, and sensible policies at the public health level, when you’re still learning about the pathogen?

How well coordinated was the American response to the Ebola outbreak? One expert quoted in the Boston Globe described the U.S. response as “a collection of random acts of preparedness.”

Two things—there’s been the actual preparedness, and then there’s been the narrative, which has been marred somewhat by the political environment. The big part of this country’s response had to do with our confidence. We are a resource-rich country, and we always had the resources to handle this. We needed to increase the confidence of our health-care workers so that they could deal with this threat, and the way to do that is through training.

With any newly emerging pathogen, we discover holes in our public health system. Ebola has played a role in teaching us how to do mass trainings on potentially new equipment. It’s also taught us the cost of overreacting—for example, by enacting travel bans from the affected countries [Liberia, Guinea, Sierra Leone] to our own.

History has proven that travel bans don’t work, and in fact can have very detrimental effects. When I was in Sierra Leone last summer, flights stopped. Commercial shippers stopped shipping things. We ran out of full-body protective suits in the field. People couldn’t travel, so we couldn’t get more hands to help. Those are dangerous situations made more dangerous.

Public interest in Ebola has waned as early predictions about the scale and rapid spread of the disease have not panned out. Does the lack of public awareness concern you?

It does. I think it’s important for us to realize that Ebola is still raging. There are hundreds of cases a week. I saw some heartbreaking things over the summer when I was there.

How would you describe our current understanding of Ebola?

The thing we know a lot more about now is how this disease is manifested in a large group of people and how it evolves during an epidemic. The previous mortality numbers for victims of the disease were quoted at 60 to 90 percent. The most recent numbers I saw had the mortality down to 20-something percent. That’s amazing! Maybe it was always an issue of how quickly care got to these patients.

It’s either that, or the virus has evolved into a different form. With most viruses, the way they work is that they become more pathogenic, which means they make you sicker and the viral load is higher, so more people catch it from you—or, over time, they become less dangerous in order to keep the host alive longer so that more people can get infected.

Do you fear a rise in epidemics brought on by global warming?

If you look back at the past 20-odd years, we’ve had 46 new human infectious diseases. Ebola was discovered in 1976. Almost every year now we have a new human pathogen. It is a combination of climate change and economic conditions that require people in lower socioeconomic communities to have to take advantage of natural resources around them. By doing that, we’re pushing farther and farther into habitats that we’ve not been exposed to before.

A huge number of viruses are still undiscovered, and the farther we push into these new environments, the more likely we are to encounter them.

Bruce Morgan can be reached at bruce.morgan@tufts.edu.