Ebola survivor recounts days spent in Nebraska biocontainment unit

Rick Sacra recovers inside the Nebraska Biocontainment Unit. (Photo courtesy Debbie Sacra))
Sacra embraces his wife Debbie, ending his medical isolation. (Photo courtesy UNMC)
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April 19, 2017 - 6:45am

“I developed a fever one evening after a busy day at work. I was immediately concerned. I had a pretty strong suspicion even before my test turned positive it was Ebola.”—Rick Sacra on contracting the Ebola virus.


AFTER EBOLA is a special reporting project of NET News.

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Part 1: The Lessons Learned

Wednesday: The Ebola Survivor

Thursday: How Families React

Friday: Rural Hospitals Prepare

Dr. Rick Sacra watched the Ebola virus consume parts of West Africa. In August 2014 the virus found him. After his diagnosis he was airlifted from Liberia to Omaha, Nebraska for treatment at the Nebraska Biocontainment Unit, a cooperative venture with the University of Nebraska Medical Center, its partner hospital Nebraska Medicine, and the state Department of Health and Human Services.

Sacra had been splitting his time between practicing family medicine in Massachusetts and serving at the ELWA Hospital, a Christian mission facility, outside Monrovia. It was there, apparently while assisting a mother giving birth, Sacra came in contact with the Ebola virus.

He spoke about becoming ill and his recovery with Bill Kelly of NET News on a phone call from ELWA Hospital where he returns to serve as a physician a few months a year.


WHEN EBOLA HIT AFRICA

The first news of a new outbreak of Ebola came in March 2014. After a small spike in deaths the number of cases tapered off in May, leaving Sacra hopeful that “maybe it's blown over we're not going to get hit." When June brought fresh reports of the disease it became clear Liberia’s capital, Monrovia, would be at the center of the epidemic.

The biggest challenge during Ebola was that you didn't know. The initial symptoms of Ebola are just fever and body ache. Then three, or four, or five days in you start having vomiting and diarrhea but there are lots of illnesses that look like that.

The biggest challenge for me and for us as a hospital was trying to function and continue to care for pregnant women, and people in labor, and kids who were sick with diarrhea and dehydration, and people with typhoid fever and all those other things. Trying to sort out who had Ebola and who just had a bad case of malaria, or typhoid, or a bad dysentery.

The biggest headache of it was that almost all the other hospitals in Monrovia had closed because doctors or nurses had gotten sick with Ebola and they had to close for decontamination. There was just literally nowhere to go.

We were very short staffed. Some staff were not able to come to work. Some people's spouses told them, ‘If you go back to the hospital I'm divorcing you." It was a real challenging time.


THE DIAGNOSIS

In August 2014, still working with patients with more routine medical issues, Sacra developed a mild fever, one of the early symptoms of Ebola.

I was immediately concerned. Of course, I was hoping it would turn out to be malaria or something else. The fever of Ebola basically doesn't break. When you're observing it hour by hour and you see that it just never comes all the way down it gives you a hint that that might be what's going on, so I had a pretty strong suspicion.

Sacra at the ELWA Hospital in Liberia. (Photo courtesy SIM)

Debbie Sacra reads Bible verse to husband Rick in medical isolation (Photo courtesy UNMC)

(The phone call) came from my medical director, Dr. Jerry Brown who's a Liberian, wonderful colleague. I hadn't started having any symptoms except the fever so it was felt I was okay to stay at home. Once we got that result then they took me up to the Ebola treatment unit.

The (hospital staff) were very, very compassionate. The staff were amazing and coming around and taking care of you or bring food and medication. I (drank) a lot of this oral re-hydration fluid while I was in the hospital. We knew by then staying hydrated was one of the keys to surviving.

It's not a comfortable place. The staff would come in for an hour and make rounds and then leave, change (their protective gear), and cool off. A couple hours later they'd come in again.

You would have these periods of time for a couple hours where there was nobody available to call. I remember being cold one evening and just yelling, and hoping somebody would hear me and bring the blanket. It took a while and then finally the team came back in and somebody went and got me a blanket.

It's not like being in the hospital where you have a button to push and somebody answers you right away and that. It was a bit lonely and the bleach smell was really strong and unpleasant.


THE FLIGHT TO NEBRASKA

In the ETU (Emergency Treatment Unit) I would be considered a VIP patient because I'm one of the doctors so everybody knows me. Having somebody like me with a critical illness here is a pretty heavy burden for the Liberians to deal with because they feel the pressure is on to save this person. I think they actually were happy to have me on my way. At that time, there weren't even enough beds for all the Ebola patients. People were literally waiting outside the gates to get in.

I had been diagnosed and in the unit for two days, and Wednesday was probably my worst day. Really weak. Not able to keep anything down. When I got that message that they were going to be able to send a plane for me it definitely lifted my spirits a little bit and gave me something to look forward to and a little bit more confidence.

When I got the message that I would be going to Nebraska initially I was like, "Nebraska?! Why Nebraska?" Initially I was a little puzzled.

Sacra and another doctor made the hour-long trip to the Monrovia airport in the back end of a Toyota Land Cruiser dressed in full-body protective gear. The patient was ushered onto an air ambulance provided by the U.S. Department of State.

I remember that pretty clearly. I was quite with it at that point and I did walk onto the plane. (I was told later) about halfway through the trip I got rather disoriented and confused and a bit delirious. I apparently at one point on the plane started to unzip my little plastic containment pod. Needless to say, at that point, the staff immediately sedated me with some pretty strong drugs so I don't remember the second half of the plane ride.


THE TREATMENT

I remember a couple of things pretty well from that first maybe 24 hours. I remember Dr. Dan Johnson starting (an I.V. line) in my neck, a central line and that was, of course, a little painful so that woke me up.

I think I was actually pretty reassured by it all. They were very calm, they were very professional, they were talking me through it. "Dr. Sacra now we're going to do this. Now, we're going to put the local anesthetic in." They really did a great job of doing everything in such a way that it was pretty reassuring.

Really the key to treating people with Ebola is keeping them alive long enough and keeping the Ebola damage at bay long enough so that the person's own immune system can kick in and beat the virus. It takes a good eight or 10 days to start making antibodies against an infection so as long as (they could) keep me alive and without major complications my own immune system is going to beat it.

I didn't have a lot of pain. Some people with Ebola have a lot of pain during it. I didn't have that. I never really felt like I was at the point of, "Oh my gosh, this is it. This is my last day on earth."


THE WAITING GAME

In the first week, I had somebody in there with me pretty much the whole time while my medical situation was still pretty tenuous. By the second week they were starting to leave me alone for a little time in between the different nurses coming in. Early on, once I started getting with it and when I was stable they would find different things to do.

They brought in a Nerf basketball hoop. I got to meet the spiritual care person and she brought me a Bible. Somebody brought in a chess board. These things were a bit like sacrifices because you knew they would never be used outside again (because they’d risk transmitting the virus).

While Sacra’s wife Debbie also traveled to Omaha, the risk was too great for a face to face visit. They used a computer webcam to talk daily.

We've done a lot of things long distance (while he was in Liberia and she was in Massachusetts) so I thought it was pretty good that I could see her and not only hear her. At the beginning, I was just glad to be able to see her face and hear her voice. That last week I was a little bit anxious and restless, and just wanting to hold hands, and take a walk, and be together, and not have to be apart.

Debbie read (Bible passages) to me several different times on our little Skype connection. (A verse she read aloud several times) was Psalm 20, "May the Lord answer you when you are in distress. May the name of the God of Jacob protect you. May He send you help from His sanctuary." That Psalm was very comforting and meaningful to me to hear that prayer from the love of my life who's stood by me through all of this.

After the Centers for Disease Control did two separate tests determining he no longer was at risk of transmitting the Ebola virus, Rick Sacra was released from the Nebraska Biocontainment Unit. Following physical therapy, some recurring vision problems and a brief scare that the disease had returned, Sacra returned to the ELWA hospital outside of Monrovia.

I feel very good. I am not having any complications, at this point, from my experience with Ebola and I'm very thankful and grateful for a full recovery. In fact, I've been doing a lot of distance bike riding. Did 160 miles over 3 days a few weeks ago to raise money for (the SIM ministry in Liberia) HIV/AIDS program. I'm in good shape.

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