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The 2014 Ebola outbreak has been increasingly on everyone's mind, from the medical community and beyond. Ebola Virus Disease (EVD) continues to hit hard in West Africa, and now it's crossed borders to include cases in eight countries, including the United States. As of October 23rd, according to the WHO, there have been a total of 10,141 cases with 4,922 deaths since the outbreak began. Of those, 10,114 cases and 4,912 deaths have occurred in three countries: Liberia, Guinea, and Sierra Leone. Also since October 23rd, 450 Healthcare Workers (HCWs) have been infected, including three in the U.S. Now, at the Wilderness Medical Society, Ebola has hit home. Last week, Dr. Craig Spencer, a WMS member, colleague, and friend, became the third HCW in the U.S. to be infected by Ebola.

Craig in center with the 2010 Cornell Wilderness Medicine Course.

Doctor Spencer was working in Guinea with Médecins Sans Frontières (MSF) in the fight to contain the Ebola outbreak while treating patients in resource-poor West Africa. He was there for approximately one month, then returned home to New York City. Until last Thursday morning, Dr. Spencer had no symptoms of illness. But that morning, Dr. Spencer took his temperature on schedule, as advised in the MSF guidelines for returned HCWs, and found his temperature was 100.3 degrees Fahrenheit. That morning's 100.3 temp was Dr. Spencer's first indicator of disease. Doctor Spencer's very next move was to contact MSF, and in swift fashion, he went into isolation at Bellevue Hospital. Upon his return to NYC, Dr. Spencer followed MSF guidelines for the returned traveler to a T. This is a quote from MSF – Doctors Without Borders:

"Our colleague in New York followed the MSF protocols and guidelines since returning from West Africa. At the immediate detection of fever on the morning of October 23, 2014, he swiftly notified the MSF office in New York. He did not leave his apartment until paramedics transported him safely to Bellevue Hospital in Manhattan, and he posed no public health threat prior to developing symptoms."

The last time I heard from Craig was in July, just before our annual WMS meeting in Jackson, Wyo., this year, held in conjunction with the International Society for Travel Medicine. I'd gotten in touch with him to find out if I'd be seeing him in Jackson, but also to hit him up to teach for the annual WMS Student elective in Tennessee in February. Craig is a busy guy, but he'd shown up as volunteer faculty for prior Cornell Wilderness Medicine courses, as well as for the Mid-Atlantic Student Wilderness Medicine Conference (MASWM). Recruiting faculty to volunteer for the WMS Student elective, to be held just outside Great Smoky Mountain National Park next February, can be challenging. Here was Craig's response:

Craig responded by excusing himself for a slow response as he was in central Congo with solar powered Wi-Fi. He stated that he would be missing Jackson due to his commitment to his work in the Congo. He expressed the fact that he was very sad to miss the conference as it provided a combination of three of his loves: travel medicine, wilderness, and Jackson Hole all in one place.

Craig stated that he was honored and flattered to be invited to be a part of the 2015 elective, but he could not commit as he tentatively promised MSF that he would do epidemiology and clinical work for them during that timeframe. He did state that those plans may change, and if the plans changed, he would let me know a.s.a.p. in order to participate in the elective.

That's the kind of guy Craig is. Not only does he want to be everywhere helping everyone do everything, but you can tell even from reading that email reply that this is the guy you want to work with in resource-poor areas. This is the guy you want to teach with in 35-degree freezing rain in October in the Adirondacks. This is the guy you want to teach your medical students and residents – everything from the medicine to the bedside manner to the attitude. This is the guy you want caring for your family member. And this is the guy who has only one competing priority for his humanitarian work: his fiancée.

Craig attended Wayne State University School of Medicine followed by an Emergency Medicine Residency at New York Hospital Queens (Weill Cornell Medical College), where he served as Chief Resident his final year. Chosen from a very competitive field, Craig went on to join the elite International Emergency Medicine Fellowship at New York Presbyterian Hospital. During this fellowship, Craig earned an MPH from Columbia University's Mailman School of Public Health. During fellowship, Craig worked for months in Rwanda, the Democratic Republic of Congo (DRC), and Burundi. Since that time, he continues his work in Africa and Indonesia via grant funding, and his clinical work at NYP-Columbia as an attending emergency medicine physician. He has taught emergency medicine in India and Greece. In addition to English, Craig speaks fluently in Mandarin Chinese, Spanish, and French, and is conversant in Greek and Hindi. He spends some of his down time training for and completing marathons, Tough Mudders, and an ultra marathon, among other races.

Dedicated is an apt word to describe our esteemed WMS colleague. He is clearly dedicated to humanity via his international medical work. Craig is a dedicated, gifted, and creative teacher, and we've witnessed this in the field with Cornell Wilderness Medicine courses in the Adirondacks and Utah. Craig ensures his students understand the material at hand, and does not accept smiling and nodding for answers. Craig is dedicated to his colleagues in Wilderness Medicine and Emergency Medicine, assisting as volunteer faculty, and participating in research that led to presentations at national conferences. Lastly, he is dedicated to his friends, helping them succeed in their own goals and then some. To quote his friend and colleague Dr. Sanjey Gupta, also an emergency medicine physician and immediate past chair of the WMS Research Council:

"All I can say is that he is one of the most humble, selfless, and unassuming people that I have ever met. He has a zeal for life, travel, and to improve the lives of those who do not have the advantages that we have in the West. He is always excited for a new adventure or challenge, and just by his mere presence and beneficence, motivates those around him to achieve to the best of their own ability. I never would have done an ultra, started triathlons, or achieved in WM without his support and his persistently positive personality urging me on."

When I met Craig, teaching for the Cornell Wilderness Medicine Elective, we were backpacking in the Adirondacks. On day one of our hike in, late in the afternoon we finally reached our planned campsite: a lovely lean-to by the perfect water source. It was a campsite sent from the Adirondack Gods.

Our group turned out to exceed the regulated number of campers per campsite, and we had just crossed paths with a Park Ranger who was keeping a close eye on us; we had to split up. No one volunteered to go searching late in the afternoon for an additional campsite. No one except Craig. Once Craig did, because of that positive energy and reassuring smile, he had company.

Craig sitting for moulage rehearsal for a Bear Attack Scenario.

Multiple experts in Infectious Disease, Public Health, and Epidemiology conclude that there is no scientific basis for quarantine of asymptomatic returned HCWs from the most affected countries. The usually apolitical New England Journal of Medicine published an editorial this week calling the quarantines issued by some states "unfair and unwise." There is no public health risk when asymptomatic people move about in the community. Furthermore, experts agree the way to contain the Ebola epidemic worldwide is source control: send skilled HCWs to West Africa. Field experts agree that an imposed quarantine is unwarranted, and based on fear and panic rather than based on what we know about transmission of disease. Furthermore, it would deter heroes like Dr. Spencer from traveling to West Africa to fight on the frontlines.  We reported earlier this month in Breaking News, the basics of Ebola transmission. CDC guidelines for returned HCWs from West Africa, updated this week, are in line with MSF protocol.

Craig finds the perfect spot to shoot the group photo.

Quoting Dr. Jay Lemery, immediate Past President of the WMS, "Loads of our colleagues are interested in 'global health,' but very few have volunteered to attend to the dire need from the Ebola epidemic. In my mind, this is awe-inspiring."

Doctor Craig Spencer and his fiancée are front and center in the hearts and minds of the WMS community. We know Craig to be strong, positive, creative, and resourceful. These qualities have brought him the success we've witnessed in his life so far. His colleagues and friends at the Wilderness Medicine Society are rooting for Craig's swift and complete recovery. We look forward to seeing Craig next summer at the WMS annual meeting in Breckenridge, Colo., where the WMS Summer 2015 Pre-Conference will be on the apropos topic near and dear to Dr. Spencer's heart: Global Health.

Posted on November 1, 2014

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