A bold doctor sent her kids away and helped beat one of the world's deadliest viruses

Dr. Tsion Firew astatine her location successful Kigali, Rwanda, connected Oct. 3. A twelvemonth ago, Rwanda announced nan country's first Marburg outbreak — a deadly microorganism that's a relative to Ebola. Firew, who is chair of emergency medicine astatine Africa Health Sciences University successful Rwanda, was acrophobic for herself and her kids. She sent them away, updated her life security — and helped quash nan outbreak.
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Ben de la Cruz/NPR

Tsion Firew had conscionable vanished moving a first assistance training erstwhile she glanced down astatine her telephone — and past looked up confused.

The connection she saw was astir a workfellow Firew had worked pinch a fewer days earlier successful nan emergency section astatine King Faisal Hospital successful Kigali, Rwanda. "She's very young, afloat of energy, 1 of nan smartest nurses I've ever worked with," recalls Firew, who is chair of emergency medicine astatine Africa Health Sciences University successful Rwanda.

The connection simply said: "Pray for her."

Firew rejiggered her schedule and made a travel to nan intensive attraction unit. As Firew peeked astir nan surface that divided nan patients, she saw nan young energetic caregiver and was taken aback. The female was almost "lifeless." Eyes hardly open. Not recognizing acquainted faces.

"It was rather scary, because you had nary thought what you were dealing with," Firew says.

Soon it became clear.

This was 1 of those moments wherever nan occupation of a wellness attraction worker tin quickly spell from risky to deadly.

On September 27, 2024 Rwanda announced nan country's first Marburg outbreak — a deadly microorganism that's a relative to Ebola. For Firew, it was nan opening of a harrowing journey. She sent her 1- and 3-year-old children to different country. She faced unit from her family to extremity moving arsenic an emergency room expert for her ain safety. And she hallucinated from sheer exhaustion.

Now, a twelvemonth later, nan basics of the outbreak successful Rwanda are known. It astir apt started pinch a 27-year-old miner who caught nan microorganism from a bat successful a agrarian mining tunnel. It ended connected December 20, 2024 and had garnered international renown arsenic a exemplary for a successful outbreak response.

Marburg is notorious for its precocious decease rate, sometimes sidesplitting almost 9 retired of each 10 patients. But nan mini state successful east-central Africa achieved nan lowest decease complaint ever recorded successful an outbreak: 23%. Only 15 of nan 66 Marburg patients died. Of each nan Marburg patients successful Rwanda, much than three-quarters were wellness attraction workers, galore were Firew's friends and colleagues.

Firew says nan acquisition has taught her to hone nan accomplishment of compartmentalizing — tucking distant nan Marburg memories truthful she tin proceed her activity arsenic a expert and mother. But, connected this anniversary, she's letting herself relive those first fewer days and weeks of nan outbreak. And she's reflecting connected nan authorities of nan world coming and why it needs nan lessons learned from nan Marburg outbreak much than ever.

"This is real"

After seeing her colleague, Firew stepped into nan hallway and moved to a discreet corner. "I was flooded pinch emotion — crying," says Firew, who has been practicing medicine for 15 years.

A workfellow saw her. "He consoled me. He hugged me," Firew recalls.

She went location to put her kids to bed. They publication and prayed for nan colleague's "ouchie." Then different matter arrived — from nan workfellow who'd comforted her: "I've developed a fever. I'm successful an isolation unit."

Soon different connection lit up her phone: The young caregiver had died, leaving down her partner and a toddler.

"That's erstwhile I was like: Oh God. This is — this is real," Firew says.

Her mind was racing. She knew that Marburg was deadly, that it had no approved treatment and that it was very contagious, spreading done bodily fluid — moreover sweat. Closing her eyes, she replayed that hug successful nan ICU hallway. What if she'd been exposed to Marburg?

"It was conscionable highly scary," she recalls.

Half her mind was moving connected her emergency department's strategy for specified a deadly disease. The different half was preoccupied pinch an urgent question: What should she do astir her children?

"Telling a 1-year-old and a 3-year-old: 'Stay successful a corner. Don't touch me!' was not going to fly," she says.

And her hubby wasn't capable to help. He was stuck successful nan U.S. An engineering consultant, he'd gone location for work and dropped by his parents successful Atlanta for a speedy visit. Then came Hurricane Helene. "He couldn't moreover get retired of his parents' location because location were trees everywhere," Firew says.

She realized she had nary prime but to nonstop her kids away. They flew to Ethiopia, wherever her parents live, accompanied by an big relative and nanny.

All nan while her telephone was dinging pinch messages from colleagues who were processing symptoms. "They would spell isolate. They'd trial positive," she says. "And then, particularly successful nan first three, 4 days, astir of them died."

"Mommy, I request you"

Firew had decided not to show her parents astir nan Marburg outbreak. She didn't want to scare them. Instead, she said thing vague astir sending nan kids for an Ethiopian holiday. But nan time aft nan kids arrived, her parents called. It was astir Firew's 3-year-old: He'd developed a fever.

"Of course, I freak out," Firew says.

Could she person infected her son? The young boy gets connected nan phone, Firew remembers his words: " 'Mommy, I request you now. Where are you? Why are you not pinch me?' "

For a moment, Firew says, she fto her emotions clouded her judgement. She bought a summons to Ethiopia. Then she canceled it.

The grandparents took him to nan infirmary and Firew went to her ain hospital, wherever Rwandan wellness officials had already group up Marburg testing.

She sewage tested and, since she didn't person immoderate concerning symptoms, she went to work. She put connected afloat protective cogwheel — stretching it present and swimming successful it location since it was not designed for female bodies. Soon she was caring for Marburg patients, including nan workfellow who'd fixed her nan hug successful nan hallway.

"He was connected nan verge of dying," she recalls. "The people of nan disease, for me, was highly shocking. I called it nan buss of death. There's bleeding from nan mouth, and different orifices" — their gums, their nose.

"Hearing voices"

The fearfulness followed Firew location that night, wherever she called up a bully friend, Dr. Craig Spencer, who'd lived done Ebola and was himself infected. She remembers telling him, "I can't deliberation intelligibly correct now. My colleagues are dying each day. Could I beryllium next?"

Spencer urged her to deliberation done nan applicable steps. So Firew upped her life security policy. Asking herself: If I die, really overmuch will my family realistically need?

After 5 days, Firew had hardly slept. Alone and exhausted successful her quiet house, she says, she started hallucinating. "I was proceeding voices. It was voices of my colleagues," she says. "Right erstwhile I'm astir to doze off, they'd aftermath maine up."

The astir vivid sound is that of her workfellow who'd fixed her that hug. She hears him calling her name, repeatedly. She hears nan beeping of nan infirmary machines that are moving to prevention him.

"It was conscionable a complete nightmare — I mean, that's an understatement," she says.

Still, nan adjacent day, she sewage up and went into nan infirmary wherever she was moving nan session and had a agelong database of patients. She went contempt nan truth that relatives, who'd seen what was happening connected nan news, begged her not to go. They urged her to time off it each down for nan liking of her kids, her family.

Dr. Tsion stands adjacent her workfellow Dr. Nkeshiman Menelas successful a curen halfway for Marburg patients successful Kigali, Rwanda. Andre Rugemanshuro hide caption

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Andre Rugemanshuro

"No Marburg deniers"

But Firew was adamant. She could not leave. Her trial had travel backmost negative. She did not person Marburg and neither, it turns out, did her son. He had tonsillitis and would beryllium fine. She had to support doing her part, she told them.

Part of what made her truthful resolute was nan opposition she felt betwixt this outbreak and her acquisition arsenic a expert successful New York City during nan tallness of COVID. That time, she says, she felt for illustration nan U.S. authorities was sometimes moving astatine transverse purposes pinch nan aesculapian community. This time, she felt, nan Rwandan authorities was moving difficult to do things right.

It had group up testing and isolation wards correct away. It started a objective proceedings for a Marburg vaccine wrong 10 days of declaring an outbreak. And location were plentifulness of gloves and protective gowns.

"They were nary Marburg deniers. There were a batch of COVID deniers," she recalls thinking.

Firew had an thought to do thing ne'er earlier tried for Marburg: Start group who'd been exposed to nan microorganism connected an experimental curen — remdesivir — moreover earlier they had symptoms. Remdesivir is simply a supplier Firew utilized often erstwhile she was a expert successful New York during COVID. She knew it was safe and was being utilized experimentally for Marburg successful non-human primates. But why not commencement it prophylactically, successful nan hopes it could defender against nan illness aliases lessen nan virus's effect erstwhile it strikes?

"The thought was bought connected that Tuesday. It was started connected that Wednesday, and we gave it to complete 150 wellness attraction workers that had precocious consequence exposures," she recalls, saying nan investigation connected nan effect is ongoing.

Her colleague, nan 1 from nan hallway, is among those who came backmost from nan brink. In different experimental process tally by nan World Health Organization and others, Firew and colleagues gave him nan first ever infusion of monoclonal antibodies for a Marburg patient. That monoclonal antibody — which was fixed to others excessively — was designed to hindrance to nan Marburg microorganism and neutralize it.

"Just to beryllium portion of this bonzer consequence is specified a large — I conjecture I'll say, a large opportunity," Firew says. She says she nan first fearfulness she felt is now tempered by feelings of pridefulness for nan activity she did and gratitude for nan colleagues she worked alongside and nan family members that supported her.

In caller weeks, arsenic Firew looks astatine nan news, she says her memories of Marburg person resurfaced. Watching arsenic technological facts questioned and nationalist wellness approaches upended successful nan U.S., she says, she wishes nan world could spot Rwanda's consequence arsenic impervious of what a heavy belief successful subject tin achieve.

"The discussions astir nationalist wellness tin beryllium truthful discouraging," she says. "But I look backmost and see: This work, this effort did not spell to waste. It is not futile."

She still thinks astir whether she could person saved conscionable 1 much life. But she besides thinks astir a infinitesimal six weeks aft nan outbreak started, erstwhile she and her hubby decided it was yet safe for him and nan kids to return location to Rwanda.

Tsion Firew was yet reunited pinch her family astatine nan airdrome successful Kigali aft being isolated for six weeks. Firew says she hugged her 3-year-old boy from nan arrivals area each nan measurement to nan parking lot. "In crisis, we often ask, 'Why me?' But possibly nan amended mobility is: 'What now?'" says Firew. Family photo. hide caption

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Family photo.

"My three-year-old, he ran crossed nan airdrome erstwhile he saw maine and it was for illustration this prolonged hug — he conscionable did not want to fto spell of me," she recalls done tears. "It was a emotion that I've ne'er had before."