- Associated Press - Sunday, April 10, 2016

PIERRE, S.D. (AP) - A South Dakota man traveled to the nation of Guinea in west Africa to fight Ebola.

Lon Kightlinger, the state epidemiologist with the South Dakota Department of Health, went to Africa in November and December of 2015 - the tail end of the Ebola epidemic. He was chosen in part because he could speak French, the dominant language in the area, the Pierre Capital Journal (https://bit.ly/23epRUs ) reported.

Ebola has been known since the 1970s, when it emerged in the Congo. It was originally a bat virus but spread to humans.

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The disease is caused by a virus that gives its victims a “hemorrhagic fever” - a fever accompanied by severe diarrhea, internal bleeding and extreme pain that causes people to collapse. Patients with Ebola can bleed from their eyes, or seep blood. Then the organs fail. More than half the people who get it die.



Anyone who encounters an Ebola victim can also get the disease - but only by coming into contact with bodily fluids. It does not spread through the air, the way influenza does.

In the past, outbreaks were limited - the disease was so deadly that people died from it before they had a chance to travel and spread the disease. But in late 2013, a huge outbreak started in the coastal African countries of Guinea, Sierra Leone and Liberia, Kightlinger said.

Part of the problem was burial practices in the region. Without any funeral homes, families prepared the body for the funeral. The body was full of the virus, and the families would catch the disease.

“And also health care workers. Because people would come into the clinics and be very sick, and then the health care workers didn’t have proper protective equipment,” Kightlinger said. No gloves, no protective gowns, no facemasks or anything like that.”

A person could have the disease and not even know it. As many as 21 days could pass between the time of infection and the time the disease shows.

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When the epidemic started, doctors misdiagnosed it as typhoid or malaria, and it wasn’t until 2014 that health officials realized the depth of the outbreak.

At the height of the scare, in October 2014, a handful of people were diagnosed with Ebola in the United States - a Liberian man visiting family in Dallas, and a few health care workers who had come into contact with Ebola patients.

The U.S. Centers for Disease Control had sent many of its staff members to these West African nations to fight the epidemic. By late 2014, the federal agency had nearly run out of doctors and turned to the states for help.

“So, of course, I volunteered. I’d worked in Africa before; I’d worked in Madagascar for 20 years, which is a former French colony. So I had some background in French. So I put my name in the hat,” he said.

Kightlinger had to take a test to see if his French was up to speed. By the time he got to Africa, this was the “tail end.” That meant bringing the epidemic to an end, he said.

He spent six weeks in the area of Forécariah, Guinea, near the border with Sierra Leone.

“What we wanted is, everybody with a fever that would come into the clinic should be tested for malaria and for Ebola,” he said.

Another part of the job was going through the log books at the clinic, which were massive ledgers since nothing was on computers. Kightlinger’s team looked at how many people came in and what they were treated for.

Kightlinger traveled from town to town. He said a distance of 30 miles could take as much as two hours. The condition of the roads and bridges was very bad.

At the time, public health officials in Guinea were so concerned about making sure Ebola didn’t spread that people had to pass through checkpoints. Anyone heading to the next town would have a quick health checkup, he said.

“There’d be a roadblock, and then we’d get out, and we’d have to be fever checked. They’d check us for fever, and then we’d have to wash our hands in chlorine water,” Kightlinger said. “They had a little infra-red ray gun, a flash gun. And they’d hold it close, a few centimeters from your forehead, and zap it, and it would show your temperature.”

That’s what spread Ebola in the first place - people moving from one town to the next, he said.

Kightlinger said the people in Guinea were kind.

“They were very cooperative, very welcoming, very engaging. Good to work with. That was probably the best part of it was working with the folks over there, them putting up with me, somebody coming from the United States, from South Dakota, coming on to their turf,” he said.

It helped that a lot of scientists and doctors from other countries had already been through. In addition to other African countries, the volunteer effort brought people in from Canada, France, Italy, England and more.

The people of Guinea also knew what was at stake. They had 30,000 cases of Ebola and about 11,000 deaths, Kightlinger said

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During the time Kightlinger was in Guinea, he never came into contact with anyone with Ebola. However, when he returned to the United States, he was put on “fever watch” - meaning he had to report his temperature to authorities twice a day. This was a common practice, and in Sioux Falls, anyone traveling back from West Africa had to do the same.

Kightlinger warns that any time a new disease emerges, everyone is at risk. Nobody knows how the disease will react.

He cited several examples. Different forms of influenza can develop in isolated areas in a distant country, only to spread throughout the world, Kightlinger said.

The disease we now know as AIDS had its beginnings in Africa in the first decade of the 20th century, when people hunting monkeys cut up the animals, allowing a simian virus to spread to human beings. It would take another 50 years before people moving into the cities carried the disease with them - and then to the rest of the world.

Lassa fever is another one. The disease has spread from animals to humans in Nigeria, and occasionally, people bring the disease back to the United States.

South Dakota, meanwhile, has its own share of animal-to-human diseases. Hantavirus is spread through mice droppings. In the past “umpteen” years, Kightlinger said, there have been 15 cases, and about a third of the patients died from it.

“That’s something that we always warn people about. When you’re cleaning out your garage and you find mice droppings, don’t just vacuum it up, because that can ‘aerosolize’ it, and you can breathe it in,” he said.

Tularemia is another. It can spread from rabbits and voles to humans, either through tick bites or from coming into contact with contaminated water. There were 25 human cases in South Dakota last year, Kightlinger said.

There were 29 cases of animals with rabies in South Dakota last year. The last case of a human with rabies was 1970.

Yet another disease that has made its home in South Dakota is West Nile virus. That disease, as its name implies, had its origins in Africa, but since then has made a home here. One variety of mosquito in South Dakota, culex tarsalis, is such an effective carrier of West Nile that this area is now the worldwide capital of the disease, Kightlinger said.

There’s another mosquito-borne disease that has made a name for itself in the news, but this won’t arrive in South Dakota any time soon. Zika, by itself is a mild disease, but if a pregnant woman is bitten by a mosquito carrying Zika, the disease can cause severe birth defects to the child, Kightlinger said.

Mosquitoes in South Dakota are not good carrier for the virus, and therefore the disease is unlikely to be established here. However, the disease is very active in the Caribbean, Mexico, Central America and South America, so pregnant women are strongly advised to rethink the trip, he said.

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Information from: Pierre Capital Journal, https://www.capjournal.com

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