Called to Serve

From the Winter 2015 edition of Vanderbilt Medicine Magazine

Boris Pavlin, M.D. Photo by Matej Kolakovic.
Boris Pavlin, M.D. Photo by Matej Kolakovic.

Within days of arriving in Liberia in September 2014, Boris Pavlin, M.D., ‘03, cared for three patients with Ebola—a mother, father and young son. It was his first face-to-face contact with the rare and deadly infectious disease that was raging through West Africa.

Pavlin, an epidemiologist with the World Health Organization, was stationed in Sinoe County in southeastern Liberia for six weeks as a field coordinator. The remote area is extremely poor, with little access to health care services.

He immersed himself in the county’s health team, first acting as a technical adviser in how to put on and take off personal protective equipment (PPE). “We just buckled down and did the work that had to be done,” he said.

Once the first patients presented, he designed and set up an isolation ward, and then supervised the health care staff taking care of the patients so that the patients were cared for safely and effectively.

The young boy with Ebola, who was malnourished prior to contracting the deadly virus, died several days later, and part of Pavlin’s work turned to instructing teams how to bury the boy safely, effectively disinfect the family’s home, and dispose of their contaminated belongings.

A few weeks later the parents, now recovered, returned to visit Pavlin and his team, which included colleagues from the Ministry of Health and the Centers for Disease Control and Prevention (CDC). “They came back to be our ‘ambassadors of hope’ to the rest of the community so that people could see that Ebola isn’t a death sentence,” Pavlin said.

“I got all choked up when I was able to shake their hands, the first time I had shaken hands with another person in two months. After all, they were the only two people in Sinoe that I knew didn’t have Ebola. I wanted people to see there was no reason to fear the survivors. They were just beaming. I’ll never forget that.”

Pavlin, based in the Pacific Island nation of Papua New Guinea, has a background in hemorrhagic fevers such as Ebola. He trained as an Epidemic Intelligence Service Officer in the CDC’s Special Pathogens Branch, and has always followed outbreaks closely. “After two invitations to be deployed that I had to turn down because of other work commitments, the outbreak was declared a ‘Grade 3’ corporate-level emergency response and it became clear that responding to the outbreak was the highest priority,” he said.

“I had been following this outbreak from the beginning, and like just about everyone else I never expected it to become as out of control as it has become. There have been many outbreaks in the past, and they all tended to either burn themselves out or they were able to be brought under control using conventional methods of meticulous case finding, contact tracing and safe burial of each case.”

Pavlin credits Medecins Sans Frontieres (Doctors Without Borders) for being the only voice of dissent early in the outbreak—they said this outbreak was different. “But unfortunately it seems no one listened,” Pavlin said.

 

Duty-bound

In addition to caring for patients in Liberia, Pavlin also participated in policy and planning during his 90-hour work weeks. Several times a week, he attended task force meetings at the county level, providing guidance to the various other sectors working on Ebola-related issues such as public works (roads) and education (reopening schools). He also attended town hall meetings in communities to educate them about Ebola and to answer questions.

He spent countless hours in a four-wheel drive trying to negotiate what he called the worst roads of the 65 countries he’s visited. “It really gave me a sense of the logistical challenges posed by the crisis.”

Pavlin said he was cautious when caring for Ebola patients, and not overly afraid. Standard PPE was a pair of rubber gumboots, an impermeable coverall suit, double gloves, mask and goggles. “There were a few specific times when things didn’t go as well as they should have,” he said. “Once when we disinfected and removed our PPE, I realized that the disinfection solution had been grossly underconcentrated. If you can’t smell the chlorine in it, it’s ineffective. Therefore, we were probably covered with live virus while disrobing.”

Pavlin said he was able to set aside his own fears because a population of patients needed help in a community unable to care for them. “I felt duty-bound to do it. I feel like I can protect myself adequately, and if I hadn’t been willing to go in and expose myself to care for the patients, I don’t think the local health care workers would have been willing to either. Or even worse, they would have felt obligated to provide care but would have done so without adequate training or supervision and then would have become victims themselves. I couldn’t live with myself if that happened.”

After leaving West Africa in mid-October, he remained in Switzerland, Australia and the Philippines for 21 days before returning to Papua New Guinea so he would have access to appropriate care in the event he got sick and to allay fears that he might bring Ebola into the country.

Initially drawn to public health because he was inspired at Vanderbilt University School of Medicine by William Schaffner, M.D., chair of the Department of Preventive Medicine, Pavlin said that Schaffner “opened my eyes to the world of public health and he has continued to be a mentor to me ever since.”

Hopefully events like the Ebola crisis will help public health take its proper place at the forefront of medical teaching, Pavlin said. “Our medical schools have placed way too much emphasis on curative services.”

Pavlin, who speaks five languages, returned to Sierra Leone in December and will be there until the end of February, and then on to wherever the next public health emergency takes him.

“My wife met me when I was at the CDC in Special Pathogens Branch so she kind of knew what she would be getting into. She was very supportive of my going (to West Africa). She knows it’s important to me, that I have a rare skill set that is very needed and that I do what I need to stay safe. Still, she’s always relieved when I come home in one piece.”