By the time Billy Fischer left the ebola treatment centre in Gueckedou, Guinea, early last month, he could complete the meticulous preparation routine in his sleep.
First, he donned the scrubs. Then, he pulled on a pair of thick rubber boots that came up to his knees. Then, he put on a body suit made of an impermeable material, two pairs of gloves, a face mask, an impermeable hood that covered his neck and - finally - goggles.
In the tropical Guinea heat and humidity, it was suffocating. But it also kept him alive.
"You lose about three to five litres of sweat, then you spend the next two hours hydrating before you go back in," Fischer, a doctor, said in an interview. "It limits the care you can provide, but it saves your life."
Guinea has suffered the most in the worst ebola outbreak in history. The disease has claimed at least 314 lives in that country alone and an additional 346 in neighbouring Liberia and Sierra Leone. Gueckedou was where some of the first ebola cases were identified.
Fischer, a critical care physician at the University of North Carolina-Chapel Hill, arrived in Gueckedou - a small rural town near the permeable border between the three countries - just as the ebola outbreak was getting worse, in late May.
Under the auspices of the World Health Organisation, he went to work at the Doctors Without Borders facility there.
His first two patients were a brother and sister. Both had developed ebola symptoms and promptly fled to the bush.
"They were found because they were too weak to run away," Fischer said. Even with treatment, they both died.
That was his introduction to the difficulty of stemming the outbreak, which involves both an aggressive effort to treat a deadly disease and overcoming the fear and distrust that helps it spread.
"Nine out of 10 their loved ones go into a treatment facility and they come out in a body bag," Fischer said. "The distrust is not entirely unfounded."
ebola brings with it only horrors and no cure.
It begins with fever and pain. With no treatment, nine out of 10 people who contract the virus do die, many from dehydration, hyperbulemia from excessive vomiting, and loss of nutrients due to diarrhoea and internal and external bleeding and sometimes kidney and liver failure, Fischer said.
But Fischer came to Guinea because there were some lives he could save - or at least that was the belief that sustained him. The outbreak has claimed nearly 700 lives and has infected some of the people who have been scrambling to stem its spread. A top Liberian doctor died over the weekend and two Americans have been infected.
In this case, "aggressive medical care" is really simple by modern medical standards, Fischer said. Saving lives might require as little as clean IV needles, fluids and basic lab tests, Fischer said — things that are readily available in resource-rich parts of the world.
"The travesty of this whole thing is that we have all these resources here, and it's not fancy," he said.
There's another travesty, and it is that there isn't much that can be said to alleviate the fear of death. With treatment, an infected person's chances of surviving are probably only as high as 40 per cent, Fischer said — better odds, but not that much better, than the survival rate with no treatment.
Doctors can't provide any guarantees. They often don't know who will die and who will survive, but they must treat them all.
According to Doctors Without Borders, which runs the Gueckedou facility where Fischer practiced, recovery rates have been lower there than in other Guinean communities because fear has prevented people from coming forward with symptoms.
And those who do come in for treatment but can't be saved are deprived of the respectful burial their families seek. Washing the body before burial only further risks the lives of their loved ones.
Fischer said he isn't surprised that the disease is believed to be spreading further.
In Nigeria, a man infected with ebola collapsed at a crowded airport in its most populous city, Lagos. He later died. And now authorities are closely monitoring up to 59 people he might have come in contact with, according to Reuters.
"I'm not surprised," Fischer said. "The majority of people think that ebola is a dramatic disease that kills people in no time. The reality is that the incubation period is 21 days. The potential for spread outside of Africa is there."
- The Washington Post