The patient load assigned to Craig Spencer, M.D., M.P.H., while volunteering with Doctors Without Borders in the ebola-ravaged African country of Guinea would often reach 30 or more a day.
"No one would let me do that in the United States," he said, of his hospital assignment in New York.
In contrast, when the 33-year-old became an ebola patient fighting the deadly virus in New York City a month later, a team of health care professionals equal to his African patient load was assigned to take care of him.
Speaking to a capacity crowd of more than 250 in Scott Hall's Green Lecture Hall on Feb. 17, the 2008 Wayne State University School of Medicine graduate shared that disparity and many more of his concerns, lessons, observations and experiences as a provider-turned-patient at the center of the still-raging ebola epidemic in western Africa.
"What are the lessons learned? I have this fear that ebola will go away and we will have learned very little," he said.
For six weeks in September and October 2014, Dr. Spencer volunteered at an ebola treatment center in Gueckedou, Guinea, one of the three main countries at the center of the health crisis. He completed his work Oct. 12, and arrived in New York on Oct. 17. He followed the Doctors Without Borders guidelines for all returning health care workers, which include returning to normal life but self-monitoring for symptoms like fatigue and fever, remaining within four hours of appropriate medical facilities, and having a treatment room ready and "bat" phone to call the appropriate authorities if needed.
He did not return to the emergency room at New York Presbyterian Hospital, where he works as an attending emergency medicine doctor, because the organization discourages health care workers from doing that for 21 days -- not to quarantine them but to give volunteers time to recover from the grueling conditions in West Africa, he said.
"In the days that I was back to New York City, sure I was afraid. I was afraid if I had a fever and got ebola, that would be really horrible, which it was," he said.
He was rushed to Bellevue Hospital Center by ambulance Oct. 23, 2014, after he reported a fever, and tested positive for the virus. He was declared ebola-free Nov. 10 and released Nov. 11. He returned to work a few weeks later, and said Tuesday he feels completely healthy. He is using his new notoriety as one of only eight people in the United States to survive the virus to improve the understanding and treatment of epidemic diseases in developing nations. Tuesday's talk for WSU students, faculty and staff was one of only a few public appearances made by the physician since his recovery. He hopes to return to Guinea's ebola patients soon. There are still about 23,000 people infected in Africa, about 91 percent of all infections since the outbreak was discovered nearly a year ago, when Dr. Spencer first started thinking about going to help.
"Eventually I said, 'This is getting so bad… . If I'm not going, who is?' I just have a different set-point for what I think is acceptable and reprehensible," he said. "It's absolutely not for everybody. It is not only physically difficult but it is mentally exhausting and unbearable. (But) this is what my training and my service has taught me that I should be doing."
Most if not all of the 9,000 deaths to date in Sierra Leone, Liberia and Guinea are believed to be traceable to a single traditional healer who was not monitored, he told the crowd. He explained why the current outbreak differs from previous outbreaks, in a part of Africa where national borders aren't recognized, allowing infections to quickly spread to three dense capital cities. While he was in Guinea, a road was blocked for more than a day due to political unrest, trapping 14 people with ebola who were on their way to a hospital without food or water. Five died before the vehicle was allowed through. The anecdote is one example of how years of civil war have weakened the health care system.
He raised questions about who is responsible for care now, the unintended side effects of the U.S. government being overly cautious about quarantine and isolation requirements for returning aid workers, and discussed how some academic medical centers have made it nearly impossible for nurses, doctors, students and faculty to help in Africa.
"What is our moral obligation to respond as students, doctors, Detroiters, Americans, global citizens?" he asked. "Regardless of what you think about issues in Africa, regardless of whether you think African problems are our problems, what we hopefully have learned from this epidemic is that a weak health system anywhere makes us vulnerable everywhere," he said.
The circumstances leave a few dozen volunteer physicians and as few as 1,000 African physicians to care for thousands of patients with a highly contagious illness in a health care system already overwhelmed by high maternal and child mortality rates and deaths from preventable illnesses like measles, diarrhea and malnourishment.
"The virus is having a hard time going away," he said. "It is going to be incredibly difficult to stamp this out."
Some normality has returned and schools are reopening, including in Liberia this week. "But it's not a reason to be complacent… . If we are not interested, and if we think that the crisis is over, then the compassion, the money and the volunteers leave. And there's still a problem. Right now only 50 percent of cases that are found are from a known contact."
He also talked about the controversies surrounding the epidemic, stating that politics were used to both criticize and guide the domestic and international response to the ebola outbreak, which led to directing resources away from where they're most needed.
"What we need to do is treat it for what it really is, what the ebola epidemic really is. It is an infectious disease which requires addressing and resolving underlying problems like poverty, weak health systems, public health infrastructure and public misinformation. That's the way we need to approach this," he added.
Dr. Spencer is an associate professor of Clinical Medicine at Columbia University Medical Center. After graduating from the WSU School of Medicine, the Redford, Mich., native and Grosse Pointe North High School graduate completed his residency in emergency medicine at the New York Hospital of Queens in Flushing, N.Y. In addition to his work in Guinea, Dr. Spencer has provided medical care in the Caribbean, Central America and east African nations.
His interest in international emergency medicine and medical missions was sparked while at WSU, after traveling to the Dominican Republic with the School of Medicine's World Health Student Organization. He also is a field epidemiologist with a master's degree in public health, and has been involved in numerous projects measuring access to medical care and human rights in Africa and Southeast Asia.
Tuesday's visit was presented by Wayne State University's Center for Peace and Conflict Studies. The center's director, Frederic Pearson, presented Dr. Spencer with its Global Peacemaker Award during the program.
School of Medicine Vice Dean of Research Bonita Stanton, M.D., who introduced Dr. Spencer, was among the faculty who interacted with him when he was a student, supporting his decision to take a year-long leave between his third and fourth year of medical school to live in China. He met his fiancé while there, and the two plan to marry this year in Detroit.
"Thank you for all that you have done and are doing from humankind across the globe," Dr. Stanton said.