Scenes from the Ebola front lines

'I will never forget the first time I walked into an Ebola isolation ward at Connaught Hospital in Freetown, Sierra Leone," Dan Kelly writes in Thursday's issue of the journal Nature.

"It was 20 August," continues Kelly, who grew up in Valley Forge, and graduated from Malvern Preparatory School and Princeton University before heading to medical school and founding a clinic in Sierra Leone eight years ago - long before Ebola spread fear and death through one of the poorest countries in the world. Now an infectious diseases doctor in San Francisco, he spent the last month in West Africa trying to slow the epidemic.

Inside the isolation ward that August day, people thought to have the disease were separated into three rooms. In the first, the people were healthy. "In the second room, patients barely had the strength to sit. Still, they were able to articulate how they felt.

"In the last room," he writes in the essay, "a young man was curled into the corner of his bed. He seemed healthy but was terrified."

Deathly ill on the night he was admitted - "there was no nursing staff to oversee patient care," Kelly says, and "the Sierra Leonean doctor who had supervised the ward had died" - this man had been trapped there for four days waiting for his blood to be tested, something that should have taken hours. While waiting, he had seen two others in his room suffer and die.

"I could only imagine how I would feel in that situation," Kelly writes, "watching others get sick and die, wondering if I would be next. Then I considered the deplorable conditions - no visitors were allowed, and a bucket served as a bathroom - and how I, wearing my protective 'spacesuit,' must have looked to the curled man."

It took four days for the collapsing health-care system to do a blood test and confirm that the man did not have Ebola. There are only two diagnostic centers in the country, Kelly said, a major factor fueling the epidemic. The closest was five hours away, swamped with samples from all over.

A month later, 1,214 cases of Ebola have been reported in Sierra Leone, and 474 confirmed deaths, at least half of them health care workers who were largely unprepared to protect themselves, Kelly said in an interview. The World Health Organization estimates that 20,000 to 100,000 people will be infected with Ebola in this small nation alone, he said.

Kelly, 33, has traveled to Sierra Leone many times - he used his time off to go there in March and June - since starting a village clinic in the Kono district, the diamond-mining region that had been decimated by war, while still a medical student in New York. But the outbreak of Ebola really began to spread in July in Sierra Leone, becoming an epidemic by August. The health care system broke down. Hospitals closed.

Modupeh Cole, a friend of Kelly's and fellow physician at his clinic, died Aug. 13. Kelly booked a flight that day.

"I felt like I was jumping off a cliff," he said Saturday from Sierra Leone. But he believed he had no choice.

"I felt there was some sort of moral responsibility to not sit in America and watch people die, but to stand up and do something," he said. "If I'm not going to go, and everybody knows I have close relationships with Sierra Leone, then who is going to go?"

He had no experience with Ebola. And he knew that if he became ill, neither the U.S. government nor anybody else would fly him out: "If I got sick, I was screwed."

The often-fatal virus is transmitted by bodily fluids - blood, spit, vomit, semen. To contract the disease, infected fluids must come into contact with the eyes, nose, or mouth, or penetrate the skin.

Kelly's focus was not direct patient care, but training health care workers in infection control: Show them how to protect themselves - what gear to wear, and how to safely put it on and take it off. He also explained how to slow the virus' spread, often using methods as simple as aggressive hand-washing and spraying of disinfectants.

In three weeks, he trained more than 1,000 health-care workers in Freetown, the capital, and at his own clinic, the Wellbody Alliance, in the village of Dorma to the east.

His goal was to give medical staff confidence that they could protect themselves, to try to calm the situation so the country's hospitals could reopen.

"One of the major issues is, there has been a lack of leadership from senior doctors," he said. "A bunch of their colleagues have died. They're afraid to work, forcing junior doctors to work in their place in isolation wards."

That has since changed some, he said. "Doctors are feeling more confident. . . . I feel like we're winning a lot of small battles in the big war."

International relief organizations have also taken a much more active role in recent weeks, he said. And the U.S. Agency for International Development will now fly American doctors and volunteers out of the country if needed.

Kelly returned Monday to San Francisco, where, as a fellow in infectious diseases at the University of California, he has a full patient load; he also is pursuing a master's degree in public health at Berkeley.

He felt guilty leaving Sierra Leone, but optimistic about what he could accomplish back home, rallying resources and support.

He does not believe he is at risk of contracting Ebola, but will be tested for symptoms - fever, severe headache, muscle pain, vomiting - twice a day for the next 21 days.

mvitez@phillynews.com

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@MichaelVitez