Episode #62: Where Does Ebola Go From Here? (transcript)


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Quinn: Welcome to Important, Not Important. My name is Quinn Emmett.

Brian: And my name is Brian Colbert Kennedy.

Quinn: Hey, and this is a podcast where we dive into a specific topic or question affecting you and everybody else on the planet right now or in the next ten years or so. If it can kill us all, or turn us into a Cylon ...

Brian: What's a Cylon?

Quinn: The human-looking ... Have you seen Battlestar Galactica?

Brian: I don't know.

Quinn: Oh, man, we gotta go, folks.

Brian: Okay!

Quinn: Nope! What? You haven't seen the reboot? Started 2007?

Brian: No, I mean, I've heard of it, but ... So, Cylon's like some sort of space alien?

Quinn: Here's the deal. Save that for Fun Talk.

Brian: Okay.

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Quinn: Hey, Brian?

Brian: Yeah?

Quinn: This week's episode is Where Does Ebola Go From Here?

Brian: We have to switch this out so sometimes you say all the words.

Quinn: Our guest today is Karin Huster from MSF, or Doctors Without Borders, where she's currently bouncing between the Democratic Republic of Congo and Mozambique. She's trained as a nurse, having spent a decade in the trauma ICU before branching out, flinging herself, really, right into it, into the humanitarian emergencies across the world.

Brian: Yeah.

Quinn: She's been everywhere.

Brian: Of which there are plenty, and she is kind of the Forrest Gump of humanitarian field nurses. If it's a health-related outbreak, if it's a storm-related outbreak that turns into a health-related outbreak, she's there, and is inspiring as hell. And we learned a lot today about Ebola, and DRC, and previous outbreaks, current outbreaks, where it could go from here, if it's coming here, and how countries can protect against it, and what a difference that makes, and how invaluable people like Karin are. It's just ...

Quinn: Wild.

Brian: Preposterous, man. Alright, I think it speaks for itself. Let's go talk to Karin.

Quinn: Here we go!

Brian: Our guest today is Karin Huster, and together we're gonna ask, where does Ebola go from here? Karin, welcome.

Karin Huster: Thank you.

Brian: We're so happy to have you. Thank you for making the time for us today. Can you just start us off by letting us and everybody know who you are and what you do?

Karin Huster: Yes, I'm Karin Huster, and I work with MSF, Doctors Without Borders. And so, since we're talking about Ebola, I was in the Democratic Republic of the Congo, started in August of 2018, when we had the tenth Ebola outbreak for the country and what is now the second biggest outbreak. And I'm a field coordinator, again, for Doctors Without Borders [inaudible 00:03:40], so this was one of the missions that I did.

Quinn: Sure. And we don't usually get into, "Tell us your whole life story," because we like to look forward, but I know that you have kind of been everywhere on these emergency missions. Could you tell us a little bit just about, I guess, the past few years, and your experiences, and the places you've been? Nothing too extensive.

Karin Huster: So, pretty much, if it has to do with Ebola, I started in 2014 working on the West Africa outbreak. It was the biggest Ebola outbreak that we ever had. And then life took me on yellow fever in the Congo, on malnutrition in Nigeria, I went to [inaudible 00:04:31] for the war, and Haiti for hurricanes, Bangladesh for the refugees, and then succeeding missions in the DRC for the Ebola outbreak. And today I'm in Mozambique working on the cyclone aftermath.

Quinn: Sure, sure, just unreal devastation there.

Brian: Wow.

Quinn: I'm sure they're thankful to have you there. Can I ask, what prompted you to get into this line of work? I believe ... Are you trained as a nurse? I guess, what is your background, and what inspired you to live this life? Before we get into the rest of our conversation.

Karin Huster: Yeah. So, I actually ... So, I used to work for Microsoft. For twelve years I was a program manager working on Word, and designing features for the software. And then at some point in time, I decided that I wanted to do something a little bit more meaningful with my life. And so I went back to school, at the University of Washington in Seattle, and got a nursing degree. Worked for ten years as a nurse in the trauma intensive care unit, and that got old after ten years. So I went and got a Masters in public health, and my first sort of stint in this area was in Lebanon, working with the Syrian refugees. So that was back in 2012-13, when the Syrian refugee crisis was sort of just started, it had started in 2011, and really was kicking in with a lot of refugees coming into Lebanon.

Brian: Wow. Wow. [crosstalk 00:06:24] Did anything happen while you were at Microsoft that made you ... Was it one thing that made you think, "Well, I should go do something bigger and better and more impactful," or was it ...

Quinn: You just exhausted using Microsoft Word every day?

Brian: Yeah, I mean, not a good program.

Karin Huster: (laughs)

Brian: (laughs) Just kidding.

Karin Huster: No, no, no, no. I mean, you know, for ... Sometimes life puts you in unplanned directions, and actually, Microsoft was an unplanned direction, and it was fantastic for twelve years, but after a while you get back to what it is that you really care about. And I felt that, well, I was more drawn towards trying to make people's life a little bit better. And, you know, being a nurse working in the hospital was one person at a time, but it was in a very privileged country, in privileged settings, having access to the best of everything. And so, my heart was more drawn towards places where people didn't have that chance but still, I felt, deserved the same, so that's sort of how I started.

Brian: So wonderful.

Quinn: Well, that's exceptional.

Brian: I mean, thank goodness for people like you. Seriously. That's wild. Groovy. [crosstalk 00:07:43] Excellent, Karin. So we're gonna go over some quick context for our topic and our question today and then get to some action-oriented questions and steps that we can all take that get to the heart of why we should care about what you're doing and what we can all do about it to help. Does that sound good?

Karin Huster: That sounds perfect.

Quinn: So, Karin, we like to start with one important, seemingly-silly question, but we encourage you to be bold and honest. Something to set the tone here. So, instead of saying, "Tell us your entire life story," we like to ask, "Why are you vital to the survival of the species?"

Karin Huster: (laughs) Maybe the only thing that I can answer to this question is that maybe I try to instill some hope about us somewhere, you know? Trying to do something that feels meaningful, that is important, that maybe not many people care about, but trying to say, "Hey, we should be caring about this." So maybe in that sense, but otherwise (laughs) I don't think of myself that grandly, you know?

Quinn: Oh, well, we think of you that way.

Brian: Yeah.

Quinn: We'll say it for you. Awesome. Well, listen. Let me establish ... Just throw out a little context here. And please, correct me in all of many, many ways I'm sure I am incorrect here. Not going to try to go into too much detail, but we've talked about infectious disease before, again, with Dr. Nahid Bhadelia and a couple others. To focus on, sort of, Ebola today - and I do want to touch on the end about Mozambique as well, 'cause obviously we can't ignore that, and that is something that's probably gonna happen more often down the line.

Quinn: But, anyways, what is Ebola? I feel like at least Americans, which are probably the majority of our audience (though we've got listeners everywhere), you know, have heard about it, have thought it was coming at some point. It wasn't. They get scared about outbreaks. They get scared about it getting into the flight system, things like that. But let's talk about what it is and where it is and why it is.

Quinn: So, it is a viral, hemorrhaging fever in humans and other primates. And I believe there is six distinct but somewhat related Ebola viruses and I think they're named for the region in which they were found. Is that correct?

Karin Huster: Yep.

Quinn: And so, I believe we first found it, or encountered it, or had to deal with it, I believe in about 1976 and it sounds like it was simultaneously in the South Sudan and the Democratic Republic of Congo, which obviously can't seem to shake it. How does it work? Signs and symptoms typically start two days to three weeks after getting the virus. There's fever, sore throats, muscular pain, headaches, and then we've got vomiting, and diarrhea, and rash. Decreased function of the liver and the kidneys. Some people bleed both internally and externally. And it has a very high risk of death, I believe, between ... One of the statistics I found said between twenty-five and ninety percent of those infected, with an average of about fifty percent.

Brian: Jeez.

Quinn: It sounds like that comes most often from low blood pressure, from fluid loss, and is anywhere from six to sixteen days after symptoms appear. So it's not slow. From what I understand, it spreads through direct contact with body fluids such as blood from infected humans or other animals. It can also occur from contact with items recently contaminated with body fluids, of course. Fun story: fruit bats can carry it, Brian, but they are not affected by it, which must be nice.

Brian: That's wild

Quinn: I think as Karin alluded to, the largest outbreak was a few years ago in West Africa, and she was there, resulting in about twenty-eight thousand cases and eleven thousand deaths. That was mostly shut down finally in 2016 but now it's back in the Democratic Republic of Congo the past year and half, two years or so. And for a variety of reasons, we're having a hell of a job containing it, and the reasons are both fascinating and complicated, and that's kind of what I wanna get into today. So, Karin, anything I got wrong there, anything I should correct before we move forward?

Karin Huster: No, no, I think you're being very close to being an Ebola expert!

Quinn: Oh, oh god, no.

Brian: Well, hold on, no, no, no, that was all luck.

Quinn: Yeah, no, no, no. [crosstalk 00:12:24]

Karin Huster: No, no, I'm impressed!

Quinn: Oh, well, hold your breath. It only gets uglier from here. So, Karin, can you talk us through the current outbreak - I know you're in Mozambique, but - in the Democratic Republic of Congo? How it started and how things are going there. And then we'll get into the specifics of why this one is so complicated.

Karin Huster: So, this outbreak in Congo ... So, for your listeners, it's really important to know that this is not the first time that Congo is dealing with an outbreak. In fact, Congo was one of the first countries that identified Ebola. And Ebola Zaire is named after Congo, the old name of Congo which was Zaire. So it is actually their tenth outbreak of Ebola, and it is now sadly the second largest outbreak ever. It started in August, I think August 1, 2018, just a few weeks after Congo just finished an Ebola outbreak in Équateur, maybe even a week, and then this outbreak happened thousands of miles away, seemingly no relationship. And so it's happened in a place, in North Kivu which is really a tough place for an Ebola outbreak to happen because it is an area of conflict and it was an area that had never seen Ebola. Today it's nine months later, pretty much, and we're at 1180 patients and we are not at all close to seeing the end of this.

Karin Huster: What is really frustrating is that we know everything we need to know. We know how to take care of this illness. We know what to do. We now have tools that we didn't have for the 2014 epidemic, so for example we have vaccines now. We have treatments. And yet, this thing just is getting the better of us.

Karin Huster: Today was actually a record, it's kind of sad that you're calling me on this day, because it's the day where we've had eighteen new cases in one day. And out of those eighteen cases, eight cases were a community death. So it's not even cases that were confirmed Ebola cases. Out of those eighteen, eight were dead in the community. So that means that we never got to reach them. And that had been the crux of this epidemic which has been the lack of understanding of what the community is going through and the community understanding what this is all about. So we're sadly nowhere getting a handle on this, even though it's not a very intense epidemic because you're not seeing hundreds of cases every day like you saw in 2014, but you're seeing that we cannot get ahold of this epidemic, we cannot control, we cannot get it under control despite those lowish numbers, and that is just mind-boggling.

Brian: Yeah, I have to say ... You had said that this is the tenth time that the Congo has gone through this and I guess to the average listener, hearing something like that, would say, "Oh, okay, ten times, by now they must just keep making progress, and they must be shorter, and deaths must be less," yet it's the second largest one. Is it just that there's something different about the virus that hasn't been identified yet?

Karin Huster: No, I don't think so. I mean there is nothing that says that much. I think we ... You know, one of the things that I'm seeing is that there's a huge push on technology, there is a huge push on vaccines, there is a huge push on treatments, and we have those, we're getting there, they're not perfect, but I mean they certainly make a difference. But we haven't gone to do the work on the basics. And the basics is sort of this anthropological work that we need to do with it. It's me going in the community and understanding what the people in the communities are concerned about, what their understanding is of the disease, you know, what their behavior is towards the disease. And nobody spend the time. And, Doctors Without Borders included at the very beginning, none of us spent enough time with the community trying to get them to understand and us getting to their ... on the same page with them as to what this Ebola disease was.

Karin Huster: And so we're back in 2014 where people are not understanding why we're telling them to put dead bodies in plastic bags and people are not understanding our behaviors, our scientific, white-people behaviors, because we haven't done the basic job of explaining to them why we're doing these things, and we're not making the effort of finding different ways to do the same thing but taking into account their culture and their way of doing things. And I think that's why we're not there today at all.

Quinn: That's really interesting. So, we kind of - not to minimize your work in any way - but it sounds like we blew in and did sort of some of the medical and technological things but didn't do the anthropology work to find out what that area, how that area moved and lived and understood and what their fears were. Is that right?

Karin Huster: One hundred percent. I mean that's exactly that. I mean, it does you no good to have treatments when people come too late to get those treatments, right? It's as if you were in Europe, or in the US, and somebody comes to you with stage IV breast cancer. And you go, "Well, Jesus, if you had come and done your mammogram and your yearly checks this would have never happened, we would have caught it at stage zero or I, and you never would have died, but now I'm sorry, I don't have anything to offer you." And it's exactly like that.

Karin Huster: And, by the way, in the US we still have that issue, right? There are some areas in the US where people do not have access or really have not understood how people really work. We haven't had access to those populations and we have those same issues. So rich people, you know people with the means, might have that information, but other peoples don't. And it's exactly the same in Africa, or in the DRC right now, where some people do have access to that information but most of the people that are affected by this illness, and these are people in pretty remote places. We haven't taken the time. We assume they understand. We assume they have the same level of understanding that we do. And we assume they would understand that a vaccine or a treatment is what is going to save them, but that's not what they understand.

Quinn: Sure. So, I just wanna back up real quick. So we mentioned that this, in this case, and it's in a few areas, at least one of them hadn't seen it before. But obviously these things don't just pop out of nowhere which I'm sure some folks assume can happen but that's not really the way a virus works. Where and how does it start in an area like that? And how important is it to find that source? Is it fruit bats? Or is it someone who has traveled into the area? Do we know for this situation? Et cetera, et cetera.

Karin Huster: No, actually, we don't know. So it is really important to try to get to the index case. So the index case is you try to go back and just like a policeman you try to go back to the source of the outbreak. Like, who is the first person you can identify? Who fell ill of this disease and what did this person do? Did they go in the bush? Did they eat a bat? What is it that they did? And to my knowledge, we still don't know. We know the Zaire strain, we know that. We seem to know that there is no link, no relationship between this outbreak, the tenth outbreak and the ninth outbreak which are thousands of miles apart, but people travel, so it could have been somebody. So we still don't understand what it is.

Karin Huster: There are so many bats in this area that it could very well come from a bat, you know, we just haven't put the puzzle together yet. But it always starts, or it often starts from bat populations because they are one of the carriers of the disease and so people can either, depending on them, they could be hunting for bats and eating them, touching them and then they touch themselves. There are so many different ways one can get it if you are in contact with an infected animal that it's not easy to ... I mean, it's difficult to make assumptions as to what happened exactly.

Quinn: Sure. Sure.

Brian: Of course.

Quinn: Wow.

Brian: Okay, so back to the people element. What are the anthropological things that we have learned? And what's different about the DRC versus West Africa?

Karin Huster: From a peoples perspective?

Quinn: Yeah, I guess. You mentioned, you know, how we didn't spend enough time early upfront really understanding the place and the culture and the anthropology of it. You know, I guess, were there assumptions that went in from previous outbreaks that didn't hold true, or other differences in how it operates and we need to operate there versus West Africa, for instance, where it was so big before, but we spent a significant amount of time and everything eventually succeeded?

Karin Huster: No, I think that's the same frustrating thing is that we keep on making the same mistakes. You know, we came out of 2014 and 2016, we came out with the realization that we need to understand people's understanding of disease. You know, people use traditional practitioners, traditional healers, people use different mechanisms to access, you know, for health-seeking behaviors. We need to understand that. It took some time for us in West Africa to understand these things so we educated people, we did a lot of community engagement work so that people finally trusted us. We had discussions about burning bodies versus burying bodies. Putting white plastic bags versus black plastic bags. We did all this work, you know, I think with the understanding that the community, the culture is important in Ebola. And so one would assume that we would do the same thing anywhere, right? So, in the US, in the DRC, it doesn't matter.

Karin Huster: But we came into this outbreak I think, again, with a sort of European, Western worldview of things, and we thought, "Okay, well, we have a vaccine, we have six new treatments, and this is going to solve our problem." And we, again, put as a second step, as a sort of afterthought, community engagement, whereas it should be completely the reverse. Community engagement should be the first thing you do when you have an Ebola outbreak. You need to invest time reaching out in the community. Doing this really basic work of gaining the trust of the population. I mean, it's basic but it's not basic. You know, it doesn't involve millions of dollars and years of research and pharmaceutical industries. It involves having a brain and sitting down and taking some time and not being arrogant about who we are. And we didn't do that. We do this after. And so we did exactly the same mistake.

Karin Huster: It became a big problem in the DRC and in [inaudible 00:25:37] so when I was there I did three missions there. So in August when it started, then I went back in November-December, and then I went back again this time, and the last time we were attacked. So people burned our Ebola treatment center, they attacked people, they were looking for doctor who they believed was killing people. And so [inaudible 00:26:03] these things, they were not ... you know, these things were actually a mix of mistrust of the population towards Ebola and people who were working in Ebola, but there was also a mix with political issues, right? Because in this part of the country, in North Kivu, there is a deep, deep distrust of government. And so there was also this underlying tone of the government putting Ebola there to cause more trouble. So it's a really multidimensional problem.

Karin Huster: But the fact of the matter was that people came, the white people, they come, Ebola is a business, and white people come and they take our organs. And then there were lots of rumors, lot of things going around that I think could have been for the most part prevented had we done community engagement first, and the fancy case management Ebola treatment centers, fancy treatment, fancy vaccination after. And I mean you don't need to do one and then two, but really community engagement needs to be the forefront of things.

Quinn: But it can't be left, like you said, it doesn't have to be one or two, but it doesn't have to be, it shouldn't be left as an afterthought, or else you just find yourself in that same situation again.

Brian: Right.

Karin Huster: Yep, yep, yep. Exactly.

Brian: Is that a problem that everybody at MSF recognizes and going forward now it is being changed? And you're going about it differently?

Karin Huster: Definitely, it was something [inaudible 00:27:52]. Usually at MSF we like to take an entire [inaudible 00:27:56]. When it comes to Ebola, it's really important to be present in all the [inaudible 00:28:00]. Typically, in a response you have pillars, you know? Like a case management pillar. So this is when you take care of the patient in [inaudible 00:28:06]. Health promotion pillar, a vaccination pillar.

Karin Huster: So there are basically different areas of a response. And typically we like to do all of those things because then we have control over, you know, what are the health promotion messages, what is the community engagement pitch that is happening? You're in vaccination. What are the messages that are being given? How does vaccination get presented to the population?

Karin Huster: And how, North Kivu, we did not do that because of the difficulties of the place. From a political perspective, from a violence perspective, we sort of were a little bit too cautious and we stuck to case management which is basically working in an Ebola treatment center. And we did not engage in community engagement, you know, health promotion activities, which we typically do, and I think this was a huge mistake, and I'm obsessed with it, mad with it, today. I mean it went so far as, you know, we don't believe that it's because we didn't do community engagement that our treatment centers got burned, but partially it is, you know? Because clearly people didn't understand what these places were about. Or did not want these places there because they had a different idea of what these places were doing.

Quinn: Sure.

Karin Huster: So clearly we view North Kivu not as successful for ... and, I mean, yes, we're able to have Ebola treatment centers which we get many people, we save many people, but we clearly could have done so much better in community engagement. I think it was a lesson learned for us.

Quinn: Sure. Wow. So there's a lot of obstacles to you doing your job in the most effective way possible, so, you mentioned that there's some serious conflict in the area, for example. Can you tell everyone a little bit about what that conflict actually is, and further how it's specifically affecting your ability to do your job?

Karin Huster: Yeah. So, I assess it's typically very ... in an organization that's very independent and neutral ... so these are some of the essential pillars for our work. So we go in a region and we treat everybody regardless of, you know, where they come from, who they believe in, their affiliation, et cetera, et cetera. But one of the things that is very paramount for us is that we do not view secularization of our patients and especially Ebola treatment centers, in this case, as the answer to the problem that exists in North Kivu.

Karin Huster: So in North Kivu, as I've said, this is a region of conflict for a long time, it has about sixty to a hundred different armed groups, the ADF being one of them, the Mai-Mai, there is just a collective of armed groups that is very complex to understand. Everybody has their own interests, but at the end of the day, the distrust of the government in place in Congo is pretty strong. So you're coming in a region where things are pretty volatile to start with, and so lot of people, a lot of actors, traditional actors, in aid, really having to step in because it is so volatile. You know, there are a lot of kidnappings, there is a lot of violence, and so it makes it a little bit more challenging to do your work.

Karin Huster: So for us that was one of the reason why we said, well, we'll stick to case management, to building Ebola treatment centers, and then the things that we do most of the time, for example surveillance, active case findings. So you're really in the community looking for people, explaining the disease, health promotion, all these activities that really involve the community. We're not gonna do them because of the security issues. And I think that came to bite us back, because we understood, at some point in time, that this was actually, you know ... We were overcautious, and we were too cautious in assuming that we just couldn't do community engagement of any kind. And so we corrected the course, over from August to now, we corrected the course, and we did become engaged, but it takes time to undo, you know ... Once you've, I mean, the months you've lost are lost. And the epidemic progress is ... And it's really hard to gain back that time. So I think this was difficult.

Karin Huster: So the population was imagining Ebola as being whatever it is that they thought it was, but some people thought that it was the government that put this disease there, or sometimes that it was a big business, and so their reaction to it was one of mistrust. And their response to mistrust was to, you know, not always to attack something, but to, you know ... They would show in many different ways that they were not trusting any of these things. And the problem was that the reaction of the government, or of the riposte, which was the official, you know, the Congolese Ministry of Health response mechanism to this Ebola outbreak was to increase secularization. So they would want to put, you know, when they would do safe and dignified burials they would put maybe the police sometimes because they felt that maybe the population would become angry and would attack the people who were trying to do the safe burial. And so it became this sort of catch-22 where you didn't know who was secularizing what and who was attacking whom.

Karin Huster: But at the end of the day it became an atmosphere of total mistrust on every side. They were trying to push to have security in front of Ebola treatment, and that is something we don't want to do, because if you have a sick person who doesn't trust in the government but they see that the military is in front of the Ebola treatment unit, the last thing they want to come to is this place, because they think this is run by the government, you know? And so you're stuck as an organization trying to, you know ... All I care about are my patients, and I care about their outcome, and I care about making them better, and bringing them back alive to their families, and I'm having all these obstacles, and it's just not helping. And so it was just a horrible catch-22 that didn't end very well for us because the treatment centers were burned and we ended up deciding that for the safety of our staff we could not stay in that region.

Quinn: Wow.

Brian: That's so wild.

Quinn: Wow. Gives you a new perspective to having a tough day at work. Jesus.

Brian: Yeah.

Karin Huster: It was a little wild, I agree with you.

Quinn: Yeah.

Brian: And, Karin, let's take a minute to talk about vaccines also, you know, vaccines are always in the news here, you know, with people not believing in them and somehow being sure that they cause autism and shit. You mention that they're a new innovation. How is it going over there with them, and how effective are they when you get to use them?

Karin Huster: Actually, vaccines have been pretty well accepted overall by the population. There are always some people who think that, again, this is, people ... for a while, before, you know, there were some elections pretty recently and Kabila who has been a person who was in power for many, many years and everybody believed that he would present himself again for the elections. And so what they believed was that this vaccine was a product that would make the people vote for him again, you know?

Karin Huster: So there are all sorts of things that happen surrounding the vaccines, but in general I think people accepted them pretty openly. There were, as well, there were some issues. There were not enough vaccines. So ideally you want the whole ... you know, if you know a vaccine works, and this one seems to work, we've known this since 2016 and 15, in the West Africa epidemic, we finally had those vaccines but we used them preemptively, you know, as a prevention measure. This is the first outbreak that we use it as a reactive measure. And the way that we do it is, so they say, "okay, here is a case, and now we're gonna vaccinate all the people who are around this case," so this is called ring vaccination, so you vaccinate the people who are directly contacts of that case, and then, this is where it's the most important, you vaccinate the contacts of the contacts.

Karin Huster: So if your father had Ebola, or got Ebola, and then you spent time with your father, you are a contact. But then all your friends who are contacts of you, so you would have to identify them, you know, "Yeah, I was with John, and Jim, and blah blah blah," all these people, these contacts of contacts, the outer ring, the bigger ring, this is the most important ring actually to nail down. Because if you get those people then you're pretty darn sure that around that case you've stopped that transmission because it takes about seven days for a vaccine to work. And so for you it might be too late, because your dad might already have given you Ebola, but for your friends it will take some time for this virus to integrate, and probably longer than that vaccine. So the vaccine will have kicked in by the time you might have had this Ebola from you, you know, your friends might have had this Ebola from you. So the contacts of contacts are the most important to vaccinate.

Karin Huster: So the problem is, that's the problem, is that we cannot vaccinate everybody yet. We cannot do a blanket geographical vaccination. We don't have enough of those vaccines that take a long time to produce. I believe, I'm going out on a little bit of a limb here, but the vaccine makers, right now they are giving those vaccines for free, and so it's not something that we can get just millions of dollars off just like ... So that's why they are still focusing on highly at-risk populations, healthcare workers being one of them for example, but they cannot just say, "Okay, everybody in Congo, you get vaccinated," and then they'll be done. If we did this probably it would be the best because you would have a better ... you know, people would be immunized, the problem is it's still an experimental vaccine. Even though we believe it works quite well, it's still an experimental vaccine, so you cannot give to everybody.

Quinn: Right, so this isn't, I mean, right, you certainly can't add it to American's or European's vaccination schedule if we can't even blanket the DRC with it. Like you said, it's being given away for free and as much as it's working it's still pretty environmental, because usually these things take quite a rollout and a testing to be phased in.

Karin Huster: Yeah. I mean, in the US, you would only give it to people, you know, if it were a risk in the US but since it's not a risk, I mean ... [crosstalk 00:41:26]

Quinn: Yeah, and that's what I wanna move to because I think during the West Africa one there was some worry about people and, you know, we ... I can't remember if we did shut down travel from those countries directly to the US or not but there was a lot of worry that it would come, and issues like that, so let's be clear here for everyone. There is no Ebola outbreak in the US, or in Europe. It's not coming here anytime soon. It's not on a flight today. But the current outbreak is in a bad way, and you all are throwing your very best at it, and it's complicated. How likely, considering how long it's gone on and what you learned from West Africa and things like that, that it travels to greater Africa, or let's start with out of the DRC, to greater Africa or beyond?

Karin Huster: Hmm. Well, I think this is what everybody has been dreading since August first when it broke, you know. Because where it is in North Kivu, it borders a bunch of countries. You know, it's not too far from Sudan, it's not too far from South Sudan, it's not too far from Rwanda. It's not too far from Burundi. I mean this thing can go very easily. People travel a lot. There are a lot of displaced people. So maybe with Ebola they are going to move back. Maybe they want to seek healthcare because they can't seem to find it in the DRC. It's pretty much a miracle, I will say, that, although there is nothing like a miracle, but it's really lucky ...

Quinn: Thank you for verifying that.

Karin Huster: Yes. Yes. It's really luck.

Brian: There's science, and that's it.

Karin Huster: That's right, it's science. It's really lucky it hasn't gone there yet. I mean it was caught once at the border, I believe, but it hasn't, that we know of, it hasn't yet ... And so that's why the WHO says, you know, "Yeah, it's contained." Okay, it's contained in a way, but it's not, I mean, it does not take very much for it to go, you know, especially when you think about the fact that most of the cases, or about fifty percent of the cases, there are, every day, there are coming up, are community deaths. So people dying in the community, that means that they have been sick for a while and they are hiding. They are not wanting to come forth to be treated.

Karin Huster: So it takes one person like this to go and, we don't know, worse, I did mention that, but most people who are diagnosed come from cases every day, are people that are not coming from a known chain of transmission. That means that we have no idea how they got this thing. So that means there are chains of transmission out in the bush and we don't know. And so they could be in South Sudan one day, they could be in Rwanda one day, what do we know? They can be in Goma, I mean, everybody dreading that it will go to big city, and we all know what it did in Liberia in Monrovia, this wasn't a pretty story. So I think there are a lot of worries with this thing and today was the worst day of the whole nine months of the epidemic with eighteen cases in one day, so it's pretty mind-boggling.

Quinn: I'm sure. So, if it did start to spread further into Africa, areas that, some are a little more stable or a little more developed, some less so. What factors would be similar to what we're facing here? Would we see other issues of armed conflict? Would we see other anthropological issues that are similar? How does that change?

Karin Huster: Yeah, I mean, it depends on the country. There are three or four bordering North Kivu, so depending ... Some countries, you know, Rwanda has a much better system in place. You know, South Sudan is getting ready. I know we have an MSF team in South Sudan. They've been, since August, thinking about, "Okay, what if Ebola comes? What if we have a case?" You know, getting prepared. So, I think, the countries, you know, they are beefing up their borders, and maybe putting a treatment center just in case there is a case with fever that comes through. So I think there are definitely some preparations on all those border countries, and then it all depends if they get them, and what the system that's in place for them. But it makes a huge difference to have something in place and to have people access health services and have a response that's [inaudible 00:46:42].

Quinn: Sure.

Karin Huster: It makes a big difference.

Quinn: Sure, sure, sure. So, I have to ask before we move on to our sort of action steps here, after those years at Microsoft and then dreaming of doing more and all the places you have been and all the people you've helped, do you feel like you're on the right path now, personally? Do you have any doubts? Do you have any major frustrations or things you would do differently going forward?

Karin Huster: Yeah, no. I mean, I think I have the best job in the world. But I mean lots of people can say that. But I truly do. I think I work for an organization that lets me do really incredible things. We get to be super responsive, very fast, you know, when there are any health issues or any natural disasters of any kind, so Mozambique being one of them, an epidemic, and outbreak. I get to work with incredible people trying to do something, trying to improve whatever it is that is not working. This is good for me. I'm in the field, so I really ... I'm not just sitting behind a desk pontificating or, you know, working far away from beneficiaries, I'm right there with them.

Karin Huster: So I really feel that I have a good understanding of what it is that they're struggling with, what it is that they need, and I think that I can really try to design the best package of activities to respond to what the issues may be. So, yeah, I feel sort of useful even though sometimes for example in this Ebola outbreak, it's been incredibly frustrating, so it is not always paradise but it's still meaningful, regardless. I'm still trying to do the right thing and I'm still ... Not just me, everybody, but still fighting for the right thing and I think that's what life is about. It's in DRC but it can be the same in advocating for people in Washington DC or in Detroit and from district [inaudible 00:49:06] is the same, it's just trying to give a voice and think about people who don't have the same privilege that we do, and try to improve their life.

Brian: Seems like common sense but it's not. And it's so rare that somebody, you know, that's such a rare thing, I mean, you just described all the shit that you go through, and then you said, "I have the best job in the world!" I mean, you are one of a kind.

Quinn: That is inspiring as hell.

Brian: Yes it is.

Karin Huster: You're nice but I'm lucky too, that what I've done before has put me in a position that I can do that. Not everybody gets the ... many people I'm sure would love to do these kinds of things but they have jobs and they just can't think beyond that job, right? I mean it's, "I work in a post office, I work this," and then to say, "Okay, I'm gonna go and do something in DRC," or, "I'm gonna go in the pits of Appalachia and work in dental clinics," I mean, not everybody has the means to do that, or the time. And for me, my years at Microsoft gave me some [inaudible 00:50:22] what it is that I wanted to do. I think that Americans are super generous. I found Americans actually being one of the ... I'm French, to start, so I'm not an American-born person, but I find Americans to be incredibly generous people, probably the most generous people that I've met. And so I respect everybody wherever they come from will contribute whichever way that they can, you know, and not everybody can do what I do but it doesn't mean that what I do is more important than what somebody else is doing, you know. At every level it's important.

Brian: That's just wonderful to hear. So, Karin, from a position of relative safety, our goal is to provide specific action steps that our listeners can take to support you with your mission, and we can use our voice, our vote, and our dollar. So let's get into that. What can our listeners, what can we all do, what questions can we ask, actionable questions can we ask our representatives to help support you and what you're doing all the way over here in America?

Karin Huster: Well I think, I mean, I think we need universal healthcare. You know what I mean? Forget about DRC for a moment, or forget about the rest of the world. Let's think about our country. We need universal healthcare, because what I'm seeing is the importance of health. If you're not healthy, you can't do anything, and if you don't have a health system in place where people of all means are taken care of and can have some guarantee that they can access basic medicine then this is not working. And our country, the United States, is not even close to being there, so I would ask our representatives to go and pass, you know, first of all get of Trump, and second of all, go and implement universal healthcare, go and look at Japan, look at France, look at Germany, do something.

Karin Huster: You know, we already have Medi ... which one? Medicare, Medicaid, I never know, I always get those two confused. But Medicare I think, for the old people ... this one, make it into universal healthcare. Give everybody that basic healthcare that they have the right to, and then, I think, I would be ... You know, this would be my, my most important ... There are people in the United States have done volunteer dental clinics in Appalachia and there are people at twenty-seven years old that were pulling all the teeth out because they had no access to dental care whatsoever and they don't have any money to go to that and that's not acceptable. We are the richest country in the world.

Quinn: I have a friend who did exactly that, ran a dental clinic like that, outside San Diego which is not Appalachia, and still saw people that, I mean, you would be, someone who's lucky enough to, and rich enough to have healthcare would be horrified at how long these people have gone without care of that nature. What about, specific to your mission, what about folks with their dollar, any specific places that can make the biggest difference right now and I guess in the long term as well?

Karin Huster: I mean, as far as where to put the dollars on what particular ... on the particular organization, you mean? Or [crosstalk 00:54:04] ...

Quinn: Yeah, yeah, literally we're gonna give 'em the website, you know. Is it Doctors Without Borders? Are there other folks that are also just as helpful?

Karin Huster: Yeah, I mean, of course, I mean, you know, I don't want to ... Yes, that, of course, go DoctorsWithoutBorders.org, MSF-USA, and you bet, give your dollars there because we don't take money from a government, so it means that the money comes from individuals. And individuals allow us to be the fastest responding NGO. We have incredible means thanks to individuals to respond to catastrophes. We were in Mozambique after the cyclone maybe two days after, and when the cholera outbreak broke here, we were able to respond super fast. And these kinds of things are only done when we ... if you don't have to write proposals to ask for funding and justify what it is that you want to do. Of course we all have to justify in some ways, but we have the means and we can directly respond, we can be very fast because we have those dollars in our bank account and we can just go, we don't have to wait for a response and then go, and it's often too late. So absolutely Doctors Without Borders is the place I would ask people to go and give their dollars to.

Quinn: Could you just take a quick minute and tell us a little bit more about the organization? How big is it? How big is the staff? Where else are you guys in the world? Nothing extensive, just so people understand what else you guys are up to and how it works.

Karin Huster: I think this organization is over fifty years old. They started in South Sudan way back when in the Biafra War where people were dying of starvation, and so there was a doctor called Bernard Kouchner who went there and started this organization and he basically had a bunch of volunteers and they tried to save all those people. Since then, it's become a huge organization that stands several operational centers in Paris, in Brussels, in Amsterdam. There in the US we have a big presence officially mostly of support for donors to contribute to. We work pretty much everywhere in the world where we're needed.

Karin Huster: We're impartial. We're independent. So we work a lot in conflicts. We are very respected. I think, we got - I don't think, I know - we had the Nobel Peace Prize in 1999 for the work that was done. We're in Afghanistan, we're in Pakistan. We're pretty much everywhere where there is a need. Most of the time it's a health need. I mean, Doctors Without Borders, it's mostly medical, but we have an immense logistics force that allows us to do also the work that we need to do so we're there for your natural disasters. Pretty much anything that's a catastrophe, we respond to. We stay there as long as we need. Even though we're emergency, there are projects that we have that are very longterm. For example in South Africa we're very, very invested into HIV, which is still a huge issue there with I think close to twenty-five percent of the population having HIV. And [crosstalk 00:58:05] population sixty percent. In Mozambique, actually, it's about thirty percent, so it's another area. So it's a mix of emergency and longterm investment in countries.

Karin Huster: In Congo we've been there for many, many years and we are really doing big projects that can ... it can be vaccination campaigns, it can be responses to epidemics, to outbreaks, it can be building a trauma hospital in a war zone. It's all these kinds of things. That's what we do.

Brian: It's incredible.

Quinn: Sounds like more or less the best place to send your cash.

Brian: Yeah. We have a feeling that you probably have some pretty important things to do so we won't keep you too much longer. Thank you so, so much for talking with us today, and making time for us in the middle of your wild schedule. We just have a few more questions if you have a second?

Quinn: Yeah.

Karin Huster: Go for it.

Quinn: Let's bring this home. A little more existential. Karin, when was the first time in your life when you realized you had the power of change or the power to do something meaningful?

Karin Huster: Wow, it's actually probably later in my life, and so I would say when I started working with Doctors Without Borders, when I had the experience of life that I had, that I was bringing to the table, but then I had, you know, I was working within a place where they would also give me the means to effect those changes, so probably then. So when I received my Masters in public health and started working on the Syrian refugee crisis, I could see that it might not be big, the change that I might effect, but, yeah, that might be the pick. Of course I could talk about my kids where I have total control of them, especially when they were very little, but that has nothing to do with what we're talking about, so.

Quinn: Sure, sure. Well, you must be inspiring as hell to them.

Karin Huster: Well, sometimes only. (laughs)

Quinn: Ah, well, I'm a dad, and Brian will be one day.

Brian: I will.

Quinn: And I can only hope to inspire one one-hundredth of what you've done. Karin, who is someone in your life specifically who's positively impacted your work in the past six months?

Karin Huster: In the past six months?

Quinn: Mm-hmm (affirmative).

Karin Huster: Somebody in my life who positively impacted me in the last six months?

Quinn: Mm-hmm (affirmative).

Karin Huster: Oi.

Quinn: You can say Brian, I mean, you know. [crosstalk 01:00:57]

Karin Huster: I can tell you something that in the past six months, I mean, my brain has been so focused on the stuff that I was doing that I don't even know ...

Quinn: It can be a patient, or someone you work alongside. Anyone.

Karin Huster: My husband just gives me so much freedom to go do what I want and what I feel inspired by, that he would definitely be an inspiration, but it's an indirect inspiration. No, I mean, it's not as romantic as that sadly for me. This is what I do because this is what I believe in. There isn't per se, you know, sometimes I see good things, you know, so yes there might be a patient that I go, "Oh yes," but there are so many other stories where I go, "Oh fuck this," you know, I'm out of there.

Karin Huster: So, no really, there are [inaudible 01:02:01] so many times that I go, "Get me out of there, why am I still here?" That it's hard to ... At the end of the day, I don't think in this way, I just ... This is my job. This is ... I know this is ... I do this because I believe in what I do, and I believe in the organization that I work for. I see the shit that happens every day in this world and ... but I don't ... I had any maybe but I don't ... I'm not, I don't have a good story only ... I have more sad stories than good stories sadly. (laughs)

Quinn: I feel like that comes with the job a little bit. But you seem to handle it.

Karin Huster: Maybe, yeah.

Quinn: You seem to handle it pretty well, which is a good segue to Brian's question.

Brian: Karin, when you feel overwhelmed what do you do specifically?

Quinn: As Brian says, what's your Karin Time?

Brian: What's your Karin Time?

Karin Huster: Haha. I like to have fun. You know? So, I write. I don't blog or anything but I've written some pieces, so for example, where was I? In West Africa, I think, I saw ... actually I came upon them in the morning at one Ebola treatment center and I just walked in and looked left and then I thought, "What the hell is this?" And it was the body, you know, she wasn't dead yet but she was almost dead, of a kid that ... At the end stages Ebola some people are affected in their brain and so they become sort of ... They meander places, they don't know where they go, who they are.

Karin Huster: And so she had walked naked in the middle of the night and was trying to leave and I found her under cardboard boxes that were completely soaked by the rain. This sounds sadly romantic, it's not at all, it's exactly how it was. And I was so angry because one, this kid I knew was going to day and she had come too late, but also we at the time were so way over our head with people dying left and right and I was having piles of bodies every day in front of me and here was another one and I couldn't do the most basic things, I couldn't do, I didn't have the tools. So I just went home or I went, not home, but someplace and I just started writing an article.

Karin Huster: And so these kinds of things do me good, and I've done this a few times since, and then so that's sort of a cathartic way for me to deal with things. Other than that, I don't deal with things very well to be very honest. I don't ... It's very, people ... I come home and it's a complete disconnect between what it is that I do and what people do over there. And [inaudible 01:05:08] my friends try to be interested. There is no way they can be. For me, I don't even, I'm not even interested in trying to explain to them. I don't even do this with my husband, by the way.

Karin Huster: But it's because it's too disconnected, it's too science fiction-y, you know, in a way. Not everything, but often these ... especially these emergency missions and so I don't talk about it. And so that's not good, obviously because when you come back from Mosso and you have seen the things that we have seen, you clearly need to have some sort of a something happen to you to get this stuff out of your system and it's the same with Ebola and it's the same with everything. And [inaudible 01:06:04] writing helps a little bit but I'm too lazy to write too much, so.

Brian: You know, a little bit counts probably.

Quinn: Lazy is not the word I would probably use to describe you but I do appreciate you sharing that and being honest about how difficult it is and how hard it can be to deal with things. I think some folks probably assume that someone like yourself who goes and does this job so relentlessly and so proactively is probably pretty great at dealing with these things or that they've become numb to it in some way and I think that's probably a fallacy, at least in a lot of cases, so it's nice to hear that it's so hard. And the disconnect doesn't surprise me. We are very removed from it here thankfully, but hopefully conversations like these can make us feel a little more connected and understand what it takes and what it's like over there. It truly is a different world.

Karin Huster: Yeah, kind of, huh?

Quinn: Brian, why don't you bring it home?

Brian: Yeah, kind of. Karin, if you could Amazon Prime one book to Donald Trump, what book would that be?

Quinn: We've had every recommendation in the world. From The Little Prince to crossword puzzles to novels, you know, whatever you would like. Assume it would make an impact of some sort. I would love to hear what you think. We have a fun list that folks can go onto and they can order the books and send them to the White House. But I'm always curious.

Karin Huster: Oh, I wish you would have given me that question before so I was thinking about that.

Quinn: That's okay. You can also send it to us later.

Karin Huster: But, I mean, you know, yeah, I can do that. I mean one, I have so many books, but there are some French, like, things, there are some good stuff that would be really, but he wouldn't [crosstalk 01:08:12] ...

Quinn: Trump attempting to read French would be a fascinating experiment.

Karin Huster: No, no, you're right, you're right, you're right. I mean ...

Quinn: Or English.

Karin Huster: Yeah. Give me some time and I'm gonna think about it tonight.

Quinn: Yeah no problem, of course.

Karin Huster: Because I wanna pick the right one for him.

Quinn: That sounds perfect. That sounds perfect. I'm delighted that you care so much. So, we've asked so much of you, last thing, if you could take a minute and say anything else, use this as platform of some sort, just a minute, anything you'd like to say, speaking truth to power in some way.

Karin Huster: Yeah, no, I mean, thank you for having me first of all on your podcast. I hope that people have found it interesting. I think, go vote Trump out of this office. Get universal care on the table so that everybody has access to healthcare. That's what I see every day as the biggest need and what makes the biggest difference. And then, you know, care about things. And I think Americans already do, but really look at your neighbor, care about your neighbor, care about maybe your neighbors five streets down. We don't spend enough time taking the time to do these things. We're running around, you know, a rat race, [inaudible 01:09:42] like on the internet all the time. We're on our Facebooks and everything like this and we've forgotten to be human beings and taking the time for things. Just be with your friends, have a beer, have a glass of wine, whatever it is, read a book. To me, we need to get back to who we used to be, who were better human beings than this.

Quinn: Well, you've set some admirable goals. We will do our best to reach up for them certainly. We cannot thank you enough. This seems like a ridiculous question. Is there somewhere our listeners can follow you online, or your work, or anything like that?

Brian: Yeah. Keep up with you?

Karin Huster: Yeah, I don't blog. I don't like this. But if they want they can go and read ... sometimes I write articles, so I've written a few pieces. So I think some were on NPR, some were on the New York Times. So if they want they can go and read that. Otherwise, I don't know. I think they can follow MSF in general.

Quinn: Sure. Sure. Well, that works for us.

Brian: Excellent.

Quinn: That works for us.

Karin Huster: That's good enough, yeah?

Quinn: Yep. I would say that is good enough. Yes, Karin. Thank you so very much for taking the time today, I know it's very late at night there. I know you were attempting to take half a day off today and we demolished that.

Brian: Just ruined it.

Quinn: I apologize.

Karin Huster: No, no, you didn't even demolish that because it was ... I didn't even manage to get my afternoon off. So I'm gonna try tomorrow.

Quinn: Oh, god. Alright, well, let us know if you need us to write a note to somebody to get you out of school. Brian is very persuasive. We might even just send Brian.

Brian: I'm comin'. Get ready.

Karin Huster: Well, awesome. Brian, come to Mozambique. No, no, no, they tried to get me the day off, but you know how [inaudible 01:11:42]. You're here for a certain amount of time and you just don't stop. And so, that's it. [inaudible 01:11:49]

Quinn: Well, thank you for taking the time. I hope this has been cathartic or something for you. Thank you for all that you do and I do hope that we can check in again with you some time soon to continue to learn more about what's out there and what we can all do to help.

Karin Huster: Totally, this was a lot of fun. Thank you so much for you guys taking the time.

Quinn: Quite literally the very least we could do.

Brian: Yeah.

Quinn: Alright, Karin, get some sleep, and thank you so much, we really appreciate it.

Brian: Thank you.

Quinn: Thanks to our incredible guest today, and thanks to all of you for tuning in. We hope this episode has made your commute or awesome workout or dish washing or fucking dog walking late at night that much more pleasant. As a reminder, please subscribe to our free email newsletter at ImportantNotImportant.com. It is all the news most vital to our survival as a species.

Brian: And you can follow us all over the internet. You can find us on Twitter @importantnotimp. Just, so weird. Also on Facebook and Instagram at ImportantNotImportant. Pinterest and Tumblr, the same thing. So check us out, follow us, share us, like us, you know the deal. And please subscribe to our show wherever you listen to things like this. And if you're really fucking awesome, rate us on Apple Podcast. Keep the lights on. Thanks.

Quinn: Please.

Brian: And you can find the show notes from today right in your little podcast player and at our website, ImportantNotImportant.com.

Quinn: Thanks to the very awesome Tim Blane for our jammin' music, to all of you for listening, and finally, most importantly, to our moms for making us. Have a great day.

Brian: Thanks, guys.