Was Flying Hero Doctor With Ebola to the U.S. the Wrong Call?

Dr. Martin Salia contracted Ebola while working in Sierra Leone, and was flown to Nebraska for treatment where he died today.

Mike DuBose/United Methodist News Service

The loss of Dr. Martin Salia, a 44-year-old general surgeon who contracted Ebola in Sierra Leone and was flown to the U.S. for treatment, has incited anger among some of his comrades back home.

Diagnosed on November 10, Salia was five days into his battle with the disease and “critically ill” when the decision was made to fly him to Nebraska. In the minds of his fellow Sierra Leoneans, it was too late to make that call. “He should not have been flown out of the country,” says Arthur Pratt, a pastor and youth organizer living in Freetown, where Salia worked. “He would have more chances of survival here.”

Questions still remain as to who made the final decision to send the Phoenix Air medical evacuation jet (the flight company employed by the State Dept. to transfer Ebola patients) to pick up Salia. His church, the United Brethren of Christ, have denied having any input on the matter. The State Department reportedly said it helped facilitate the transfer.

Flying an Ebola patient halfway across the world is a difficult undertaking, to say the least. At a distance of more than 5,700 miles, the trip from Sierra Leone to Nebraska was likely a multi-day endeavor that included many hours at extremely high altitudes and at least one stop for fuel. In order to keep the crew in the Phoenix Gulstream III aircraft that Salia flew in safe, his disposable bed was placed in an oversized plastic tent separating him from the rest of those on board. While he was able to receive some medical treatment, it is unlikely that the crew was ready to handle the complete kidney failure he reportedly suffered en route.

Two widely publicized flights carrying America Ebola patients, Dr. Kent Brantly and Nurse Nancy Writebol, were successful, but decidedly different circumstances. Brantly, who was flown from Liberia to the U.S. in early August, was reportedly “extremely stable” throughout the flight and walked into the hospital in Atlanta for treatment. Writebol, flown three days later, was in more serious condition but had taken a turn for the better after her second blood transfusion. At the time of the flight she had “regained her appetite” and was able to walk with assistance as well.

According to Reuters, Salia's evacuation occurred "at the request of his wife," a statement which has yet to be confirmed. Whether or his wife made the decision, it is certain that she agreed with the decision to bring him here for treatment. "We're very grateful for the efforts of the team led by Dr. Smith,” Salia's wife said in a statement Monday. "We are so appreciative of the opportunity for my husband to be treated here and believe he was in the best place possible.”

Before takeoff, there were warning signs about the doctor's condition. According to NBC, a team of health care workers caring for Salia in Sierra Leone reportedly told Nebraska officials that he was "possibly sicker than the first patients successfully treated in the United States." By the time the plane landed, after more than 16 hours in flight, he had undergone kidney failure, was unresponsive, and struggling to breathe. Efforts to save him included an experimental treatment called ZMapp as well as a blood transfusion from an Ebola survivor—both of which have been successful in previous patients.

Walking around Freetown as he speaks to me on the phone, the typically upbeat Pratt sounds frustrated. Sierra Leoneans are sad about the loss—but angry, too. “People are not happy about it. Flying him out of Freetown, it wasn’t right,” he says. Pratt says the discontent centers on the portrayal of his country as completely incapable of caring for even a single Ebola patient—something he contests to be true.

Pratt points to the media as the cause of misinformation, specifically recalling a New York Times article from October 10 titled “Officials Admit a ‘Defeat’ by Ebola in Sierra Leone.” He says the article paints a picture of Sierra Leone’s medical situation as worse than reality. “Access to medical centers is different than that,” he says. “This story was taken out of context.”

Focused on the decision to provide at-home kits for family members left to treat their relatives with Ebola, Pratt says the article furthered fears that there were no places to go, damaging both the international view of Freetown and the local one as well. “It offended doctors and even some people in the government,” he says.

Looking at Salia’s situation through this lens, it’s not difficult to understand why he was flown back to America. But what if he was receiving adequate treatment? According to a contact close to Salia, he was receiving care at a treatment center in Freetown, the same intravenous fluid and electrolyte replacement therapies that he would have received here. He may not have had access to the experimental treatment ZMapp, but it's unclear whether or not the treatment actually works in the first place. By the time he arrived, it didn't matter.

Salia was the third patient to be treated in Nebraska, but the first to succumb to the disease. “It is with an extremely heavy heart that we share this news,” said Nebraska Medical Center’s medical director Phil Smith. “Dr. Salia was extremely critical when he arrived here, and unfortunately, despite our best efforts, we weren’t able to save him."

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Whether or not transporting Salia to the U.S. for treatment was the right move or not remains to be seen. But the courage with which he worked in his Ebola-stricken native land is inarguable.

While his family remained in Maryland, Salia fought bravely for the forgotten patients of Sierra Leone—those not suffering from Ebola. He did it all the while knowing that the chances he may encounter a patient that was an unknown carrier were high (the way many believe he contracted the disease).

When Ebola worsened in Freetown, Salia could have chosen to return to safety in Maryland. Instead, he took on the daunting position as chief medical officer of Kissy United Methodist Hospital, located in one of the area's most impoverished neighborhoods. In a video on the institutions website, Salia can be seen discussing his faith in his role as a surgeon—specifically in Sierra Leone. "I knew it wasn't going to be rosy," he says with a smile. "But why did I choose to do this job? I firmly believe that God wanted me to do it. And I knew deep within myself. There was just something inside of me that the people of this part of Freetown needed help."

It is this part of the late doctor's story that Sierra Leoneans will remember in the end, says Pratt. "People appreciate the work that he did. We are very thankful."