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All hands on deck: Doctor answers call to work on largest Ebola epidemic in history

DSCN0895 cropped and resizedIn the nearly 70-year history of the Centers for Disease Control and Prevention (CDC) only three disasters called for an "all hands on deck," Level 1 emergency response - Hurricane Katrina in 2005, the H1N1 pandemic of 2009 and the Ebola epidemic of 2014. This Ebola epidemic - the largest one in history - was the first assignment for Christopher Hsu, MD, PhD, from the Epidemic Intelligence Services (EIS) officer training program at the CDC.

As an EIS officer in the Division of High-Consequence Pathogens and Pathology at CDC, Hsu investigates and studies deadly and exotic pathogens like chikungunya, monkeypox, rabies and Ebola.

Given Hsu's work on disease at CDC, I was surprised to learn that the topic of his prestigious three-year fellowship at Stanford was cancer, not infectious disease. I asked Hsu about this and what it's like working on the largest Ebola epidemic in the world. He summed it up this way: "I get to work with very deadly and interesting diseases. I travel, see new cultures and am immersed in my work. I'm not just studying the disease; I'm in the jungle, studying the disease where it began with the people from that region. It's a great honor to be in that position."

Hsu's switch from studying cancer to investigating infectious disease sounds drastic, but it wasn't much of a stretch, he explained. Hsu earned a PhD in veterinary pathobiology studying interspecies disease transmission before he began studying cancer at Stanford. "I enjoyed the work, but I also recalled some savvy advice a mentor once said to me, 'you excel where your passion lies.' I realized I lacked the fire in the belly."

DSCN0828 cropped and resized-2When Hsu told his peers and mentors at Stanford he wanted to study infectious disease, Philip Pizzo, MD, former dean of the medical school and a specialist in oncology and infectious diseases, supported his decision. "I am very grateful to him," Hsu said. "He probably doesn't realize this, but he was a huge influence on where I am today after Stanford."

Two years later, Hsu and his cohort of EIS officers, affectionately nicknamed "the Ebola Class," learned the 2014 Ebola outbreak had just been classified as a Level 1 emergency. CDC Director Tom Frieden, MD, MPH, visited Hsu's class and personally asked them to take up the call to work on Ebola. Hsu's cohort was a mix of physicians, nurses, veterinarians, and scientists with specialties ranging from malaria to violence prevention, but after Frieden's visit, their professional interests no longer mattered. "We decided we were all working on Ebola in some capacity," Hsu said.

Many of the EIS officers in Hsu's Ebola class have completed one or two 30 to 90-day deployments to prevent and control Ebola in West African countries with widespread transmission (Guinea, Liberia and Sierra Leone), or in one of the other countries where Ebola occurred in the past. Hsu describes his disease fieldwork as part detective work and part disease control. "I investigated who was sick, what their symptoms were and who had contact with them," Hsu said.

In 2014, Hsu was invited to work in the Democratic Republic of the Congo (DRC) to help control the spread of Ebola. "Many people don't know that the CDC doesn't enter countries uninvited. It's not like the movies where the CDC moves in and takes over. We are guests and we collaborate with multiple international organizations. In order for this to be controlled it must be a multinational effort."

DSCN0859 cropped and resizedHsu's role in this effort extends beyond his work on disease; he also connects with the local people on a personal level. Hsu illustrated this point by telling me about an encounter he had while working in the DRC. "I'd just finished a day of meetings with international and local health ministries, and I was working in a chair outside. Suddenly a red ball rolled through the gate nearby and hit my chair." The ball belonged to a 9-year old boy who wanted to play.

He continued, "I kicked the ball back and forth with the boy in the middle of the Congo while Ebola and death were all around us. It reminded me that there's humanity in this. It was a simple act, but I'll never forget it."

Hsu credits his fellowship at Stanford with his ability to connect to patients and adapt to the unpredictability of work in the field. "Taking care of critically ill patients in oncology really served me well in the field. When you're in the jungle, you have to keep your cool and, because of my training, I didn't feel out of my element." Hsu paused and then continued, "I took a risk and it paid off tremendously for me. Don't feel limited to a career path. You can define your own path."

Previously: Physician at forefront of Ebola fight: "Ultimate award" is what you get back from survivorsBack home from Liberia, Stanford physician continues to help in fight against EbolaStanford physician shares his story of treating Ebola patients in Liberia and Stanford physician shares his story of treating Ebola patients in Liberia
Photos courtesy of David J. Sencer CDC Museum at the CDC. Upper right: A Medecins sans Frontieres (Doctors Without Borders) worker enters a home northeast of Lokolia in the Democratic Republic of Congo to spray it with bleach after a woman died of suspected Ebola. Center left: Hsu travels by foot after evening rains make the dirt road connecting the towns of Lokolia and Boende impassible by motorbike. Lower right: At day's end, Hsu journals at the Medcins sans Frontiere campsite in Lokolia.

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