Ross Donaldson is one of just a few who have ventured into dark territory of a country ravaged by war to study one of the world’s most deadly diseases. As an untried medical student studying the intersection of global health and communicable disease, Donaldson soon found himself in dangerous Sierra Leone, on the border of war-struck Liberia, where he struggled to control the spread of Lassa Fever. The words, “you know Lassa can kill you, don’t you?” haunted him each day. With the country in complete upheaval and working conditions suffering, he is forced to make life-and-death decisions alone as a never-ending onslaught of contagious patients flood the hospital. Soon however, he is not only fighting for others but himself when he becomes afflicted with a life threatening disease. The Lassa Ward is more than just an adventure story about the making of a physician; it is a portrait of the Sierra Leone people and the human struggle of those risking their daily comforts and lives to aid them.
Dr. Ross I. Donaldson, M.D., M.P.H., is a UCLA medical professor and works in one of L.A.’s main trauma centers. He is author of several medical textbooks, has been a humanitarian in some of the world’s most dangerous places, and is host of Lifetime’s Street Doctors. He lives in Venice Beach, California.
"No matter how low a cotton tree falls, it is still taller than grass."
Those are the words that a humanitarian physician, Dr. Aniru Conteh, uses as he leaves a young medical student in charge of a ward filled with critically ill patients, in a hospital flooded with refugees from a runaway civil war. Ross Donaldson was that idealistic student who gave up his comfortable life in the States to venture into Sierra Leone, a country ravaged by fighting and plagued by conflict that was streaming across the border from neighboring Liberia.
In a hospital ward with meager supplies, Ross has to find some way to care for patients afflicted with Lassa fever, a highly contagious hemorrhagic illness similar to Ebola. Forced to confront his own fear of the disease, he stands alone to make life-and-death decisions in the face of a never-ending onslaught of the sick who are inundating the hospital. Ultimately, he finds himself fighting not only for the lives of others but also for his own life.
The Lassa Ward is the memoir of a young man studying to become a physician while trying to make his way through a land where a battle against one of the world's deadliest diseases matches a struggle for human rights and human decency. It is also the story of a young doctor-in-the-making who rises to the occasion and does his best to save the patients in his care, but not without finally having to confront his own human frailty.
"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 . . . 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 . . . 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."—Ross Donaldson, The Seattle Times
"Donaldson started out as an earnest, well-meaning American medical student, off on a great African adventure. He came of age in the middle of a raging epidemic, civil war, and hideous poverty, discovering a humanity few Americans ever experience. Donaldson has bared his soul, offering a lesson that should be required reading for every doctor-in-training."—Laurie Garrett, Pulitzer Prize winner and author of Betrayal of Trust: The Collapse of Global Public Health
"For living color, turn to The Lassa Ward, which effortlessly transmits both the facts and the fascination of a bad infectious outbreak. Dr. Ross Donaldson spent two months in Sierra Leone as a medical student in 2003. Malaria, tuberculosis, yellow fever and AIDS were rampant, but Dr. Donaldson, for reasons clear perhaps only to the invulnerable post-adolescent he was at the time, decided to spend his time with Lassa fever patients. This rat-borne illness is one of Africa’s dire viral hemorrhagic fevers; like Ebola, it can reduce a human body to a bruised, bloated corpse in days. It is terrifying—the secretions of infected patients easily spread the disease—but it is also treatable, and in the best cases patients get well and go home. Dr. Donaldson had trailed the elderly Lassa specialist Dr. Conteh for only a few weeks when, to his horror, he was left alone in charge of the Lassa isolation ward. 'No matter how low a cotton tree falls, it is still taller than grass,' the old doctor said as he left to teach in another town. In other words, the inexperienced Dr. Donaldson, with three years of medical school, had more formal education than anyone else around. With patients who were sicker than sick, and little in the way of tests or treatments, Dr. Donaldson clung to the usual life preservers: the advice of a couple of experienced nurses and his own common sense. At the end of two weeks, he writes, 'I hardly recognized the person I had become.' He was a Lassa expert, veteran of the old education-by-immersion process that terrifies medical students no matter where they are. His take on epidemic infection is dead-on, down to the bizarre stubbornness that often permeates stricken communities and prevents the very changes that might save lives. (For Lassa, a key preventive measure was to stop eating rats, but rat meat tasted far too good for that advice to be taken seriously.)"—Abigail Zuger, M.D., The New York Times
"Donaldson started out as an earnest, well-meaning American medical student, off on a great African adventure. He came of age in the middle of a raging epidemic, civil war, and hideous poverty, discovering a humanity few Americans ever experience. Donaldson has bared his soul, offering a lesson that should be required reading for every doctor-in-training."—Laurie Garrett, Pulitzer Prize winner and author of Betrayal of Trust: The Collapse of Global Public Health
"A touching and compelling account. The Lassa Ward brings to life the challenges and rewards that dedicated development workers face daily around the world."—Joseph E. Stiglitz, 2001 Nobel laureate in economics
"Intrepid medical-school student confronts a deadly virus decimating West Africa. During his second year of medical school, Donaldson became intrigued by the deadly Lassa fever, a rat-borne hemorrhagic virus closely related to the Ebola and Marburg varieties that, left untreated, virtually liquefies the body's internal organs. Convinced he could help ease the suffering, he spent the summer of 2003 in civil-war-torn Sierra Leone, where Lassa was reaching epidemic proportions. The trip, Donaldson admits, while initially an exhilarating 'mix of danger and adventure,' soon became an all-encompassing endeavor that he came close to regretting several times. After a tour of the poverty-stricken environs, the author apprenticed under renowned Lassa expert Dr. Conteh, who was in charge of the Lassa ward in the town of Kenema. A desperate fight to save a female villager from cerebral malaria would pal
Chapter One Swept Away June 30, 2003
Unrestrained cargo lurched precariously behind my head, but I did my best to ignore it. Instead, I clutched at the frayed seat belt in my lap and focused my eyes out the helicopter window, past streaks of frenzied raindrops, toward a growing brightness in the distance. There's no point in looking back, I told myself—the only option is forward.
The cabin, filled with the whine of the antique turbines, shuddered violently when we flew over dry land. The lumbering transport bucked in stubborn protest as a lone light drew us down into flickering shadows. As the aircraft finally struck the ground with a jarring thud, we tilted dangerously to one side for a few nerve-racking seconds before settling.
After quickly gathering my few belongings, I filed out the cramped doorway to sway briefly under the downdraft of the chopper and the weight of my backpack. For a moment I searched for a familiar face in the surrounding undergrowth, but I knew there was none to find.
Out of the dim jungle a bear of a man steadily plodded toward me. "Merlin?" he yelled over the slowing chopper blades, naming the nongovernmental organization (NGO) that was providing my logistics.
I nodded my head in what I hoped was confident affirmation. "Ross," I shouted back as I shook his meaty hand.
"Mikhail," the big man answered in a gruff Eastern European accent. He paused to fan his sweat-soaked T-shirt. "Hope you're ready for the heat," he added.
The two of us abandoned the small refuge of light to step into darkness. Our driver, a man with midnight skin, materialized out of the shadows to assist me with my backpack. Then my two escorts ushered me down a dirt path to a beat-up Range Rover.
Stickers of AK-47 machine guns, crossed out by big red Xs, covered the car. Bold letters underneath proclaimed no arms. I slid into the passenger seat, trying not to second-guess my own intelligence: why had I voluntarily entered a place where vehicles needed to declare their lack of an arsenal?
Mikhail, clearly an assertive man, insisted on getting behind the wheel. Our chauffeur, rendered obsolete, climbed into the backseat and sulked there silently. "You don't mind, do you?" Mikhail asked me. "Just got here last week and I'm still getting my bearings," he explained. As we lurched forward, I shrugged to myself, content for the moment simply to be on the ground.
A hot breeze engulfed us as we headed into the heart of the city. Freetown, the capital of Sierra Leone, was pitch-dark at night. My two guides and I drove without conversation, listening only to the steady hum of the engine as enigmatic buildings passed by the window. I tried to reassure myself that I could handle whatever my new home might contain, but didn't feel all that convinced. Nothing seemed even vaguely familiar to me. Nothing looked like home.
Headlights suddenly materialized out of the darkness, followed by the frantic honking of an oncoming truck. For a few fearful seconds, I found myself pressing down hard at an imaginary brake pedal beneath my feet, my adrenaline surging as the oncoming vehicle swerved by, barely missing us. "Why did he do that?" Mikhail complained to our driver, after the road had again returned to the comfort of shadows. But while I tried to relax my legs, the backseat offered only indignant silence as an answer.
As we entered the sleeping city center, our car passed a sole lit sign, a plaque identifying the adjacent building as the Sierra Leone Reconciliation Court. The country had been at war since 1992, with the government in Freetown fighting the Rebel United Front (RUF). These two main combatants had raped, maimed, and murdered wantonly before finally signing a United Nation-brokered peace accord. The mandate of the court was to prosecute the worst of the prolonged conflict's many war criminals.
I watched the building pass, barely able to imagine the drama that had recently occurred within its walls. Just a week prior, judges there had issued an arrest warrant for Charles Taylor, the neighboring Liberian president. The magistrates accused the dictator of crimes against humanity, for creating the RUF and subsequently supporting the rebels by providing a conduit for the group's illegally mined diamonds to the international market. But no one knew what would come of the indictment. Charles Taylor was ensconced in nearby Liberia, safely out of the reach of international justice.
As the sign for the Reconciliation Court faded away in my sideview mirror, I recalled the many crimes with which Taylor was charged. More than two hundred thousand people had been killed and one million forced from their homes in a lengthy war punctuated by some of the worst human rights abuses known to the modern world. The atrocities were so extreme that they seemed almost unbelievable: arbitrary killings of civilians, widespread torture, systematic rape, deliberate amputation of limbs, and the forced recruitment of countless child soldiers, among others.
As I tried to come to terms with what it meant to have suddenly entered such a trauma-ridden land, Mikhail interrupted my uneasy thoughts. "Up for a drink before we hit the guesthouse?" he asked casually.
I wanted nothing more than to find a safe room in which to huddle, but I didn't want to seem overwhelmed. "Sure," I cautiously agreed.
We soon pulled off the road and parked next to a small porch, where an anemic light guarded a few empty tables. As we sat down, our driver greeted the waitress. "How dee body?" he said in a singsong timbre.
"Dee body fine," the woman replied with a welcoming smile. I tried to follow the pair's conversation in Krio, Sierra Leone's official language, but could identify only a few words of the English-based dialect that freed slaves had brought back to Africa.
Mikhail quickly ordered us a round of beers. When the waitress returned, she efficiently flipped off their caps, rubbed the open bottle tops with a used rag, and handed them to us. My large escort eyed his change in leones, unabashedly confirming the absence of fake bills before holding his beer up to the driver and me. "To peace and health," he said. The waitress encouraged us with a big pearl-white grin as we all three took a swig.
The driver continued to chat up the waitress, leaving Mikhail and me to ourselves. The burly Macedonian turned to stare openly at me for a few moments. "So," he finally blurted out, "you're the Lassa guy?" I was clearly a lot younger than he had expected.
I paused for a few seconds before answering. "Yeah," I finally grunted, doing my best to imitate my guide's gruff demeanor. Although it was hard to feign comfort with my brand-new title, I didn't want Mikhail to know how lacking I was in field experience. I had finished three years of medical school and a year of public heath, in addition to studying extensively before leaving. That would be enough, I silently hoped, to handle whatever challenges lay ahead.
"A doctor died of that here last year," Mikhail continued with a knowing shake of his head, as if to say he was new to the country but was aware of that much already.
I was also well acquainted with the story of the fated Freetown physician. He had died from Lassa fever, a viral hemorrhagic fever (VHF) limited to West Africa. His horrific demise was just one of the many details I had conveniently failed to mention to those close to me before I left for my trip. My dad and brother had told me I was crazy, while my mom had sighed deeply—her heart torn between needing to protect me and not wanting to stand between me and something I was passionate about. With worry already clearly evident in their voices, I had held my tongue. There was no need to burden my loved ones any more than I had already.
From the moment I had first heard about the dreaded Lassa virus, during my second year of medical school in a sterile California classroom that now felt very far away, I had been drawn to the illness. The disease is one of four famed VHFs (including Ebola, Marburg, and Crimean-Congo hemorrhagic fever) that share a terrifying tendency to spread from person to person, as well as a gruesome clinical picture of massive bleeding frequently leading to death.
Although there are countless TV shows and movies focused on the more riveting aspects of medicine, the extended study needed to enter the field is almost exactly the opposite of dramatic. Medical school is hour after hour of monotonous rote learning, memorizing a neverending series of facts that can seem completely disconnected from the act of caring for actual human beings.
Years of exams merge together until you almost forget why you choose to go into medicine in the first place. Surrounded by highly competitive people, you can easily become distracted by which specialties are the most prestigious or the most lucrative. During that time, Lassa became a symbol to me of something different, of foreign adventure and unquestionable need.
I knew that my trip was risky, some had told me even foolish, but the mix of danger and adventure surrounding the mysterious virus compelled me toward it. I had studied for years to swear an oath to care for the sick. In my eyes, confronting Lassa seemed to be the ultimate test of such moral fortitude. It meant that I had not yet lost a few threads of idealism, to which I so desperately clutched throughout my training.
As I had researched the trip, I learned that the Freetown physician to whom Mikhail referred had contracted Lassa from a patient returning from southern Sierra Leone, where the disease is endemic. The doctor's and his patient's horrific deaths, their bodily fluids pouring like flowing tap water from every orifice of their swollen corpses, had caused panicked patients and staff to flee the Freetown hospital.
Admittedly, Mikhail's comment disarmed me for a moment. I didn't want to be reminded about the past physician's death. To me, at that time, medicine was supposed to be about tales of human triumph. I thrived on stories of success, tumors removed and lives saved, not failure.
I did my best to turn the topic to a more pleasant subject. "So, what do you do for Merlin?" I asked Mikhail.
"Fix problems," the big man answered. "I'm in charge of logistics for Sierra Leone, moving stuff and people around the country."
"You just got here?" I said.
"Yeah, last week. The post has been open for several months, and they were pretty anxious to fill it, given the fighting in Liberia."
"And before?"
"I was back in Kosovo, where my wife and twin girls are. I worked for Merlin there, transporting medical supplies. But the pay is higher here as an expat."
"It's a move up, then?"
"Yep. And I'm already looking forward to buying my girls matching tricycles for their birthday," Mikhail answered, with a twinkle in his eyes.
Then, just as quickly, that glimmer disappeared. With a sharp grunt, the Macedonian slammed down his empty beer bottle. "Time to go," he said, before herding the driver and me into the Range Rover. Assuming the wheel, my temporary guide proceeded to drive us a short distance down the dark Freetown streets to the Merlin guesthouse. As we approached, a growing glow from the building illuminated high walls—broken bottles, cemented on top, glinted beneath rolls of barbed wire.
A group of more than fifteen armed security guards soon unlocked the gates to let us enter the compound. The African men wore winter hats and thick jackets, along with threadbare pants and sandals. "They think it's cold at night," Mikhail whispered to me, perspiration clearly beaded on his own forehead.
As I greeted the near battalion of guards, the nearest man cheerfully grabbed my arm and proceeded to teach me the Sierra Leone handshake. We began with the normal Western grasp, then spun to clutch each other's thumb, and then back to the ordinary grip. I bit back a smile as each guard shook my hand the same way, the eldest with methodical dignity.
Mikhail eventually led me through the small, dark house to my room for the night. "We should have a ride for you in a couple of days," he informed me. My final destination was Kenema, a southern town close to the border of warring Liberia. Merlin sponsored a ward there, the only one in the world solely dedicated to treating Lassa fever.
I unpacked a few things and got into bed, but sleep eluded me. My comfortable mattress, where I had last laid my head in one of London's towering high-rises, seemed a distant memory. More than space and time separated me from that place—in between sped a river of differences. Concealed under the cover of night, I clung tightly to my makeshift pillow and silently hoped that the rising torrent wouldn't sweep me away.
Excerpted from THE LASSA WARD by Ross I. Donaldson, M.D., M.P.H.
Copyright © 2009 by Ross I. Donaldson
Published in May 2009 by St. Martin's Press
All rights reserved. This work is protected under copyright laws and reproduction is strictly prohibited. Permission to reproduce the material in any manner or medium must be secured from the Publisher.
