UC San Francisco clinician Dr. Dan Kelly arrived in Sierra Leone on Sunday planning to teach infection-control practices to health care workers who would in turn train those combating the worst recorded outbreak of the Ebola virus in world history.
But when Kelly realized the health care system was crumbling from the disease -- there is just one surgical center still operating in the entire country, which is one of four West African nations reeling from the epidemic -- he began taking a different approach.
Kelly realized that there was a lack of structure among doctors and nurses caring for Ebola patients, so he developed a hospital-based infection-control management system -- which he thinks could have a widespread impact.
Speaking with The San Francisco Examiner on Wednesday from Freetown, the capital of Sierra Leone, Kelly said fear of becoming infected with Ebola has prompted doctors and nurses to flee as hospitals and health centers continue to shut down.
"There is this tremendous strain right now on the health care system," Kelly said. "Doctors are afraid to come to the hospital, to come to work, but patients are afraid to get care."
As of Thursday, the U.S. Centers for Disease Control and Prevention had reported 907 suspected and confirmed cases of Ebola and 374 deaths in Sierra Leone.
This week, a child believed to have contracted Ebola surfaced in the general pediatric ward of Ola During Children's Hospital in Freetown, prompting health officials to close the hospital, said Kelly.
"Everyone freaked out," he said. "They didn't feel protected."
Kelly visited an Ebola isolation ward as part of his assessment of the health system. He wore full protective gear -- an uncomfortable outfit that takes up to a half-hour to put on.
And although he has watched many people suffer from other diseases, he said it is never easy to take.
"Seeing these patients confused, restless, weak, incredibly sick -- it's something that I've seen before, but every time I see it, it's incredibly disheartening," he said. "Being around patients with Ebola, who are basically dying, is really sad."
Kelly is using Twitter to share his experiences in Sierra Leone, under the handle @DanKelly_MD. He discusses the situation with clinics and working with locals.
In Freetown, Kelly has trained about 15 people on how to implement quality control, supervision and coordination at hospitals.
That knowledge will then be shared with additional health care workers.
"The idea is to pilot this project at one hospital and do it right, then try to train a training team that can go around to other hospitals and build capacity," Kelly said.
The only hosptial in Sierra Leone with operating rooms still open is Emergency Surgical Center, which opened in 2001 in Goderich, a village near the outskirts of Freetown.
The hospital is part of the worldwide nonprofit organization Emergency USA that provides free health care in areas devastated by poverty, wars or other disasters. Its U.S. operation is based in San Francisco.
Patients seeking all forms of treatment at the Sierra Leone site -- from injuries sustained in roadside accidents to malaria to typhus -- have doubled since the Ebola outbreak worsened in May and other hospitals began closing due to a lack of staff and resources, said Eric Talbert, executive director of Emergency USA who was last in Sierra Leone in March 2013.
But the Emergency Surgical Center's more than 200 Sierra Leonean staff and about 20 international staff opted to stay after increased health protocols were implemented in May, according to Talbert. Emergency has two Ebola isolation tents where patients can be tested and wait to receive the results, instead of being sent to one of the two major Ebola centers in Sierra Leone, which is the approach at the other remaining facilities.
"There's a lot of fear going on that if people present symptoms that they will be automatically whisked away and never see their families again," Talbert said. "Our hospital is a place that people can go that's safe and where they will be treated."
Emergency has seen six suspected cases of Ebola, all of which turned out to be negative.
Meanwhile, Kelly planned to travel Thursday to the Kono District, where he co-founded the health care organization Wellbody Alliance in 2006. Kelly has worked in The City and Sierra Leone since then. He is scheduled to return to San Francisco on Sept. 5, a week later than he initially anticipated.
How you can help in the fight against Ebola
Crowdfunding: Every gift of $250 or more will be matched up to $50,000 by an anonymous donor. Donations are used for personal protective gear, infection supplies and other needs. Visit crowdfund.ucsf.edu.
Tilt: An anonymous UCSF donor will match $50,000 if Dr. Dan Kelly can raise an equal amount.
Donations: Visit tilt.com/campaigns/combat-ebola.
Emergency USA: Since 2001, the organization has treated more then 460,000 people in Sierra Leone. Donations support the Surgical and Pediatric Center in the village of Goderich to provide free medical care. Visit fundly.com/provide-life-saving-healthcare-in-sierra-leone.