Casey Sautter, at left, and her sister, Robin, are medical students who have been in eastern Africa for several weeks. Casey is working on her fellowship in Uganda and Robin recently returned from Kenya with PAKEMA. COURTESY OF ROBIN SAUTTER
Casey Sautter, at left, and her sister, Robin, are medical students who have been in eastern Africa for several weeks. Casey is working on her fellowship in Uganda and Robin recently returned from Kenya with PAKEMA. COURTESY OF ROBIN SAUTTER

With much of the United States and the world up in arms about the ongoing Ebola crisis in western Africa, various opinions have been shared regarding the whole epidemic.

Many people in the United States have expressed concern for the virus coming to this country. Especially since the two Americans who contracted the disease have been brought back to the United States.

However, the difference between the reaction of a country so wholly unconnected with Africa, land-wise, and countries on the other side of Africa from the epicenter of the disease is rather interesting.

Graduates of Lanesboro High School, Robin and Casey Sautter are both medical students who have spent time in eastern Africa as the virus continues to blaze through Guinea, Libera, Sierra Leone and Nigeria in western Africa.

Robin recently returned from teaching in both primary and secondary schools with Pamoja Kenya Mentorship Alliance (PAKEMA) in Ndori, Kenya. She focused on leadership and mentorship in the high schools, hygiene and sanitation, nutrition and physical activity, disease prevention and women’s health.

"Each day was unique in that we would be visiting schools to teach lessons or recruit mentors (for PAKEMA)," Robin stated.

For the duration of time Robin worked in Kenya, she learned much of how daily living in Kenya contrasts with that of America. Rather than depending on reliable electricity, plumbing and cooking on stoves, each day she cooked on a small charcoal stove, fetched water from a spigot outside and had electricity only sometimes.

"I enjoyed the challenges that came with that way of living for it really made me understand more of my own culture and values while learning about a new culture too," she noted.

While Robin spent much of her summer in Kenya and returned to the country for school, her sister, Casey, remained in Uganda to complete her fellowship in international clinical research.

A graduate of Lanesboro, Casey earned a bachelor’s degree with majors in chemistry and biochemistry. She continued on to a master’s degree in infectious diseases, vaccinology and drug discovery, studying at universities in Europe and Southeast Asia. Eventually, she returned to America to become a physician.

"I have now completed three of four years of medical school and am taking a year off to complete a fellowship in international clinical research, a special interest of mine. I moved to Uganda about four weeks ago and will stay here until early May 2015," Casey said.

Casey moved to the capitol of Uganda, Kampala, researching pediatric infectious diseases in a government-run hospital there.

"I am working to help set up a clinical trial exploring malaria incidence and severity among children with sickle cell disease," she said.

Being involved in medicine, the sisters have had the opportunity to see the medical facilities available in eastern Africa. In Kenya, Robin noticed one dispensary, or clinic, and one pharmacy in Ndori offering family planning, immunizations, growth monitoring, out-patient services for stitches and minor wound treatment, counseling and HIV testing.

"The medical facilities are not nearly as advanced as in the States. The closest hospital is in the next town over which is about a 12-minute car ride away," Robin commented.

The biggest difference in medical facilities was the equipment available. Many of the tests regularly available and easy to perform in the States are not available. Any serious surgeries to be performed require a flight to Nairobi.

"If I had been in a major accident, the likelihood that I were to receive proper healthcare in time would be very unlikely. Additionally, if I were to have contracted a serious illness such as Ebola during my time in the village, I can say with certainty that the healthcare facilities are not adequately equipped to treat even one person suffering from the symptoms of the disease even after arriving in Nairobi," Robin stated.

In Uganda, Casey works at a hospital a little more like Nairobe.

"The hospital is the largest referral center in the country, where many complicated, severe or rare cases are sent from other clinics and hospitals all over the country," she noted.

As she spends most of her time in the pediatrics ward, she described patients crowded into large, open rooms and parents or guardians sleep on straw mats on the cement floor to assist the overwhelmed nurses due to budget and staffing cuts.

"There are private hospitals in Uganda that are supposedly better staffed and equipped to deal with injury and illness, but these are only available to the few who are able to afford such luxury," Casey informed.

In Uganda, many people live in small, one- or two-room mud, brick or cinder block homes with no running water or electricity. She does have the luxury of running water, electricity and a weekly jug of drinking water.

As both worked in eastern Africa, both Robin and Casey heard news of the Ebola virus in western Africa.

"Every night we would watch the news, and there were always reports about the Ebola scare in western Africa Honestly, though, that was all that we heard about it," Robin noted. “No one talked about how the virus could easily spread across the continent or even what to do if someone were to present symptoms of the disease."

For the Kenyans, people dying from drugged alcoholic drinks and murders posed much more of a concern than Ebola, though they are aware of the virus's existence.

The most attention Robin witnessed was during the flight back to London as the crew sprayed a kind of aerosol while walking down the aisles, though she is skeptical that it would do any good.

In Uganda, there have been outbreaks of the Ebola virus, most recently in 2012, according to Casey. The medical personnel there are aware of Ebola and of the current outbreak in the western nations. However, they are not as fearful about the disease as the United States.

"Ebola is a terrifying and often fatal disease. The risk of mortality, however, is much lower if cases are identified early and the patients receive intensive medical therapy. Unfortunately, many places in Africa simply don’t have the resources or the ability to provide these necessary treatments," Casey described.

According to her, the Ebola virus is the cause of Ebola hemorrhagic fever, a severe and often fatal illness. The mortality rate of the current outbreak is about 55 percent. Symptoms that are non-specific manifest two to 21 days after exposure to the virus, which can be difficult to diagnose.

As the virus progresses, it will include abdominal pain, decreased appetite, nausea, vomiting, diarrhea, rash and swollen glands. Internal and external bleeding follows in the severe cases and can lead to fatality.

Though the origins of the Ebola virus are unknown, it is thought to first infect animals and then transmit to humans.

"After Ebola has made this leap from animal to human, it is generally transmitted when a person comes into contact with the blood or secretions of the infected person," Casey described.

And in areas of cramped quarters, the virus can spread quickly to those not wearing protective gear like gloves or masks.

Since there is no vaccine approved for preventing Ebola virus infection at present, the best way to prevent the spread of the virus is to identify cases and contain it at its source using proper precautionary and isolation measures.

Mortality is decreased by early recognition of infection and administration of these supportive therapies.

"Those infected with the virus can be treated by intensive supportive therapies, such as fluids for hydration and electrolyte balance, respiratory support if needed and treatment of secondary infections," Casey noted.

Though the disease spread into Nigeria, Robin commented those she worked with in Kenya do not seem to be too concerned with the virus spreading to the rural areas of western Kenya.

However, she does think more education and awareness of the virus ought to be conveyed to the world.

"It scares me that many people do not know how the disease is transmitted, signs and symptoms, as well as what to do if someone gets sick," Robin commented.

In Uganda, measures are being taken for the prevention of the disease, to the extent the country’s medical workers are able to. Supplies are not as easily available for use there and their infrastructure is not adequate enough for effective treatment, Casey noted. However, they are on the lookout for possible cases.

"A day or two ago, however, a person traveling from Sudan, a country just north of Uganda, arrived at the largest international airport near Kampala with a fever and other symptoms. According to news sources, he/she was immediately detained, quarantined and is currently being tested for Ebola," she said.

"No recent cases have been reported from either Sudan or Uganda, so it is unlikely to be an actual case. However, it is heartening that precautions to prevent further spread of the virus are in place," she added.

Still, there is not yet an immediate need to stockpile medical supplies to counter the virus. Rather, the supplies they have are being dedicated to the illnesses they currently encounter.

Though they have not encountered anyone with the Ebola virus, the sisters are familiar with the conditions that face those in western Africa.

Both Robin and Casey sympathize with the decision to bring those Americans infected with the disease back to the States.

"Americans who have contracted the virus absolutely need to be brought back to the States or in a facility well equipped to handle this infectious disease to receive treatment," Robin declared.

Likewise, Casey firmly believes fellow American citizens must be brought back to our country for treatment, since it can be less costly. In her view, it makes sense contending the virus should be a priority for the United States.

"All able nations should contribute to efforts to contain an outbreak wherever it occurs, keeping the number of infected individuals, affected nations and costs to a minimum," she said.

Still, Casey added, bringing back Americans infected with the virus is the right thing to do for those who are helping others.

"For many reasons, humanitarian and political, bringing the Americans who have been infected by the Ebola virus back to the U.S. to receive medical care is invariably the right thing to do," she expressed. "These brave individuals risked their lives to not only help those dying from this virus, but also to prevent a lethal infection from spreading further and devastating more lives, both abroad and potentially on American soil."

"They deserve the best medical care possible and our gratitude. The countries where these Americans were working do not have the resources, medical personnel or expertise necessary to effectively control the infection or to provide essential medical care for those in need," continued Casey.

In addition, Robin related the Center for Disease Control has worked for years with infectious diseases and would endeavor to keep the public safe while providing the best treatment to the individuals.

"The United States has a responsibility to protect its citizens around the world, and to block their entry back into the States would simply be unethical," Robin concluded.