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September 29, 2009 at 5:02 PM

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Young doctor shares global health lessons from the front lines

Posted by Kristi Heim

Ross Donaldson went from a comfortable life as an American medical student into the front lines of the fight against Lassa fever, a neglected and deadly disease in central Africa. Now a doctor, he has written a book about his experiences called The Lassa Ward. Donaldson gave a talk at UW today and is appearing in Seattle Wednesday at the Greater Seattle Chamber of Commerce and also at Elliott Bay Books. I had a conversation with him about some of the lessons he learned and wants to share.

Q: What did the experience teach you about how make an impact in global health?

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A: When I got there I started doing hands-on medical care. One of conclusions I came to is how much bigger impact you can make through training local health care workers, so it's sustainable when you leave and multiplies your impact when you are there.

Q: What do you want people to know about Sierra Leone (where he traveled with the group Merlin to work in a remote hospital)?

A: The situation is quite stark. It's the last country in the world when it comes to health care outcomes. It's really a human rights issue. When I was there 1 out of 8 women were dying in childbirth. In the U.S. it's like 1 in 8,000. I spent a lot of my time going between the maternity ward and the Lassa ward.

Q: You didn't get Lassa fever yourself, did you?

A: No, thankfully I didn't. The day after I got back to L.A. I came down with a serious illness, myocarditis, an infection of the heart. About a third of people die from it, a third are permanently injured and a third recover fully.

My mentor Dr. Conteh I really think is the hero of the book. He's a physician who spent his whole life taking care of patients through wards and at the Lassa ward. Dr. Conteh had worked there close to a decade and had been OK. All it takes is one slip one day. Resources at the hospital are limited, so he was drawing blood from a pregnant woman. A glass vial broke and he cut himself and died from Lassa fever about 5 to 7 days later.

Lassa is one of four communicable hemorrhagic fevers, similar to Ebola or Marburg. Lassa comes from rats originally. In parts of the area people eat rats as a food source -- essentially there's no other protein in the diet. Every once in a while they will eat a rat with Lassa.

Q: Eating rats and dying from fever says a lot about the overall situation.

A: It really connects how important economic prosperity is with health and how the two are intertwined, and also with the political situation. They were fighting over diamonds essentially. I went out into the field -- Merlin had projects for public health outreach - to just tell people not to eat rats, we won't have the initial outbreak and peoples' lives will be saved. I somehow naively thought this would be an easy message to tell. The older men would look at me and say I've been eating rats for years and I'm fine and there's no way I'm going to stop. At first it seemed very foreign to me and then I realized it's similar to conversations I've had here around cigarette smoking. It's part of human nature not to want to change.

Being an advocate for health is a very important part of what I do and what I think physicians should do. Doctors get a lot of the credit but the truth is medicine is really a team effort. It's really the whole system that deserves the credit. When there's a breakdown, it's really the system that needs strengthening so you can bring up the level of care.

Q: Do you think health aid to Africa has been effective?

A: As long as I have been doing this work, there have been debates about the vertical, horizontal or diagonal approach to health programs. In some ways a continuing dialogue is very beneficial to the aid and insuring you're getting the most out of it. Overall I think the aid community is doing a lot of good but continually striving to make sure you're doing the most good is the ethical and moral thing to do.

Q: What would you advise young people who want to work in this field?

A: I have noticed over the last couple years there has been a huge upturn in people interested in global health, and I think that's fantastic. It really is going to take a lot of bright young minds to deal with these problems. The money might come or go, but if you have a good feeling about helping other people that's not something you're going to lose in a recession.

For students it's important to get some kind of skills they can help out with and also to get some experience in the field. Information and opportunities are available on ReliefWeb and Devex.

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