Public Health Lessons From a Clinician Turned Patient

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While treating patients with Ebola in Guinea, I kept a journal to record my perceived level of risk of being infected with the deadly virus. A friend who’d volunteered previously had told me that such a journal comforted him when he looked back and saw no serious breach of protocol or significant exposure. On a spreadsheet delineating three levels of risk — minimal, moderate, and high — I’d been able to check off minimal risk every day after caring for patients. Yet on October 23, 2014, I entered Bellevue Hospital as New York City’s first Ebola patient.

Though I didn’t know it then — I had no television and was too weak to read the news — during the first few days of my hospitalization, I was being vilified in the media even as my liver was failing and my fiancée was quarantined in our apartment. One day, I ate only a cup of fruit — and held it down for less than an hour. I lost 20 lb, was febrile for 2 weeks, and struggled to the bathroom up to a dozen times a day. But these details of my illness are not unique. For months, we’ve heard how infected West Africans, running high fevers and too weak to move, were dying at the doorsteps of treatment centers. We’ve seen pictures of dying children crippled by vomiting and diarrhea and unable to drink.

Yet for clinicians, striving and repeatedly failing to cure Ebola is brutal, too. The Ebola treatment center in Guéckédou, Guinea, was the most challenging place I’ve ever worked. Ebola is frightening not j…

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PMID: 31456182 [PubMed – in process]

Authors: Coughlin SS
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CONCLUSIONS: While many challenges to PrEP implementation exist, we focused on the three key steps of uptake, adherence and persistence as measurable processes that can lead to improved coverage and decreased HIV incidence.
PMID: 31456348 [PubMed – in process]

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