Avera doctor to help stop Ebola spread

A physician joining the Avera McKennan staff will delay his arrival in Sioux Falls to travel first to West Africa to try to help block the spread of the deadly Ebola virus.

Dr. David Porembka, 60, will see patients starting next week in Sierra Leone, one of four countries on Africa's Atlantic coast where the disease has killed about 1,000 people since April.

Porembka, whose home is in Maineville, Ohio, was to be on his way to Sioux Falls to work in an entirely different setting, Avera's e-services hub, but decided Africa should come first.

"I'm an intensive care physician. It's what I do. I work on the front line," he said.

Porembka has been working at MetroHealth Medical Center in the Detroit area and as a clinical professor of medicine at Michigan State University. He also worked seven years at Cleveland Clinic and 24 years at the University of Cincinnati. He will fly Sunday from Cincinnati to New York, Brussels and Freetown, the capital of Sierra Leone. He's expecting to be in Sierra Leone up to 10 weeks and then move to Sioux Falls by late fall.

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He estimates he is one of a few dozen U.S. doctors going to Africa to assist with the outbreak. He is going as an independent consultant, he said, although his connection is through the World Health Organization in Geneva, which provided him with a letter of introduction to officials in Sierra Leone.

Porembka spent the last few weeks receiving vaccinations against yellow fever and tetanus and taking pills for typhoid. He had his third round of rabies shots this week.

In Sierra Leone, one of the world's poorest countries, he will be attempting to help identify who has Ebola, a disease with a mortality rate exceeding 70 percent.

"My job is to aggressively support the care, to contain the infected area so it doesn't spread ... hoping it doesn't mutate in the meantime," he said. "I will be gowned up, head to toe, more than one layer."

Dr. Mark Huntington, residency program director at the Center for Family Medicine in Sioux Falls, said Ebola has no treatment other than supportive care. Someone seeing a patient with Ebola would want to rehydrate the patient, using an IV if available to restore the body as much as possible and give the natural immune system a chance to overcome the virus.

"The key is isolation, making sure others are protected," Huntington said.

Doctors going into such settings face a work environment that is very rustic, with limited labs, limited plumbing and electricity and often a host of cultural barriers.

"Just existing can be a challenge. It's largely an act of mercy," Huntington said.

Ebola, first discovered in 1976, spread initially by human contact with fruit bats and monkeys. It has spread since from person to person by contact with human blood and other bodily fluids.

Amara Konneh, finance minister of Liberia, wrote this week in the Wall Street Journal that "while the virus has killed almost a thousand people, most West Africans will never contract the disease or know anyone who does."

That presumes that emergency workers succeed in containing it. Many local traditions hinder the effort. One is diet. "Unfortunately, people over there eat fruit bats," Porembka said. Another is burial custom. The best means of disposal when a person dies of Ebola would be cremation, but the culture dictates a ritualistic hands-on washing of the dead, which would increase the possibility of its spread. There is also a mistrust of Western science and a traditional sense that a hospital is a place where people go, not to be healed, but to die, Porembka said.

In Sioux Falls, Porembka will work at Avera's electronic hub on the north side of town. The center provides e-services to hospitals and clinics in the Upper Midwest and Great Plains. Avera has a national model for using e-care to address a shortage of doctors in remote areas, he said, and he wanted to be part of that, right after Sierra Leone.

"This is a chance of a lifetime. I'm between jobs and going to South Dakota. It's like a door opened," he said.