Who is Carlo Urbani? I’ll get to that.

We were sitting at an Internet café in Hoi An, Vietnam checking email and catching up on world events. The cloud cover and the dramatic dip in temperature were a welcome relief after several days of exploring the area in the heat of a midday sun. When I woke up the next I noticed that I had a tickle in the back of my nose. No big deal, I thought. But that night the tickle turned to a dry itch and by morning my eyes felt itchy and my nose began to run. No big deal, I thought, just a cold. I dug through our packs for some Echinacea we had acquired in South Africa and deliberately sought out a bowl of hot chicken soup.

Although I had developed all the symptoms of a cold: sneezing, drippy nose, watery itchy eyes and a few body aches we still ran around Hoi An, visiting shops getting measured for custom tailored clothing and getting lost around town. It was the seventh of March. The weather continued to be overcast to match my mood as I grew weaker and weaker. Although it had cooled down considerably Lisa noticed that I was sweating a lot. We unfolded our impressive backpackers medical kit and put our digital thermometer to use. It was official. I had a fever.

Convinced I was suffering from a cold, I remained in bed for the next two days and Lisa ferried food to me at regular intervals, even managing to forage for some hot Lasagna from our favorite Italian food place in town. Sometimes a cold is just a cold I told myself.

By March 10 my fever had been going up and down for three days. Somewhere in my mind was another thought, one so dark that I kept trying to push it to the corner of my fevered imagination. I might have malaria or some other god awful tropical disease. The thought was there but lurking at a distance like a wild animal circling a camp fire, wanting to attack but held back by the light. We had just spent four weeks in malarial areas of Northern Thailand, Laos, Cambodia and Southern Vietnam. I was also losing weight quicker than a Jenny Craig spokes-model, having lost 20 pounds since we had left Northern Thailand on Feb 12th, 26 days earlier. We talked about our options for almost ten seconds and decided to throw in the towel. We needed to get me to a hospital.

We cancelled our plan to visit Hue by train and to endure another 13-hour train ride to Hanoi several days later. On March 11 Lisa tried really hard to help me have a good birthday by buying me a one-way airplane ticket to Hanoi the next day. Lisa took good care of me and the words “…in sickness and in health…” still echo through my head as she cared for me and told me how much she loved me. I still felt like &*#%!

Through the night I continued to have hot flashes but surprisingly no chills. I had some bad dreams. I was exhausted but the sniffling, sneezing, stuffy head, itchy eye headaches had passed during the night which gave me a false sense of recovery. Unfortunately my chest was now bearing the burden. I had a dry hacking cough as I forced full lungs of air through my throat to clear some invisible collection of phlegm. I had developed the much-dreaded unproductive cough. My temperature continued to fluctuate between 99.0 and 100.4. One hundred and forty days on the road and memories of the comforts of home seemed like a distant dream of the land of milk and honey.

We packed up our massive collection of silk purses, dresses, shirts, silk lanterns and other souvenirs and had the guest house arrange a cab to the airport 30 km north in Danang. It was the fifth day I was sick and although I was convinced I had malaria I felt strangely energized with the relief that we were going to do something about it.

So who is Carlo Urbani?

I’m getting to that.

We arrived at the Hanoi airport and after the regular hassles of collecting bags, arranging transport to the city center and locating a hotel, we packed our vaccination cards and sterile hypodermic needles into Lisa’s purse and ordered another taxi.

Our guesthouse counter person advised us to go to the best hospital in Hanoi, which turned out to be the Vietnam-France Hospital. We agreed that the best in Hanoi would have to be good enough. “To the Vietnam-France Hospital”, we ordered our taxi driver and into the sunset we drove.

This is where things started getting really weird. We pulled up to the hospital gate and it was closed. The taxi driver spoke to the guard while we waited for the gates to swing open and the angels of mercy to extend their healing arms to us. We noticed a whole lot of people dressed in surgical gowns and wearing facemasks wandering around outside the hospital but inside the gate. It must be break time I thought.

Suddenly the guard was at our window and he asked us what we wanted. That’s a dumb question I thought. “I need to see a doctor” I exclaimed with as much authority as I could muster. The guard didn’t hesitate as he looked me in the eye and said, “The hospital is closed.” I was stunned. Surely this man had confused his native Vietnamese translation into English. We protested our right to access and the guard exerted his power to deny it to us. He produced a letter protected by a clear sheet of acetate and handed it to me. It certainly looked official. Sure enough, it said the hospital was closed.

My initial reaction when I saw the words was disbelief. Who closes a hospital? I mean, really, throw me a fricken bone here people! I could see what appeared to be doctors just mulling around, some lifting their masks to take a drag from their lit cigarettes. I scrutinized the letter and marveled at the official looking letterhead. I read on: “The hospital has been closed for one week for annual disinfecting.” I looked back up at the pale green-gowned staff caged like animals behind the wrought-iron fence. Something was not right. No one closes a modern hospital in a developing nation!! ……….unless………..Oh!!……...The thought struck Lisa and I simultaneously and we looked at each other with big eyes. Maybe there’s been an outbreak of something. Our boiling frustration instantly melted away to be replaced by confusion and relief.

We backed down on our demand and consulted our ragged guidebook hoping there was an alternative. SOS International, a private medical evacuation clinic, was near the city center. The clinic would be set up to get us to Singapore quickly for modern medical treatment facilities if it turned out I had come down with some dreaded tropical disease. We asked the taxi driver to take us there and he backed away from the gates and melted into the mass of traffic towards the city center. I did not feel feverish as we climbed the steps to the clinic. Once inside the air-conditioned clinic we were relieved to find a very clean and professional medical office. After the obligatory filling out of the papers I was sitting shirtless answering questions posed to me by an expert in tropical infectious diseases. The visit alone was a huge relief.

After taking my temperature and listening to my cough for an abnormally long amount of time, the doctor asked which countries we had been to. “How do I answer that one” I wondered. “Let’s see…Kenya, Tanzania, Zimbabwe, Botswana, Namibia, South Africa, Lesotho, Mauritius, Malaysia, Thailand, Burma, Laos, Cambodia and Vietnam”. Each had its own collection of nasty little bugs. I was impressed with myself and of our adventure thus far. Unimpressed, the doctor asked the pointed question, “Have you traveled to Hong Kong or China?”

“No, not yet” I replied. It seemed an odd question at the time. I would assume there would be more risk of catching some dreadful tropical disease in Cambodia or Laos or Botswana or Burma. A few more deep breathes with a cold stethoscope face pressed to my back. “So you haven’t been to Hong Kong or China?” I stuck to my guns with an emphatic “No”. I put on my shirt as the doctor sifted through the evidence in her head. She collected herself and sat motionless as she delivered her conclusion. My blood should be tested for dengue fever but my fever pattern didn’t match that of malaria. If the fever returned in the next day, she advised, come back in immediately and she would test my blood for the malaria parasite. Otherwise it looked as if I just had a case of the Asian flu. She didn’t bother to tell us why travel to Hong Kong or China was relevant and we didn’t bother to ask.

Ten minutes later I was lying on an examination bench in an immaculate clinic with a needle slowly piercing my skin in search of a vein. We had purchased a medical kit in London that included various sized hypodermic needles and syringes and for good measure we insisted on using our paraphernalia. It was all the same to the phlebotomist who took sadistic pleasure in pulling a length of surgical hose tight around my arm and searching for a bulging vein. I was surprised to learn that the test for dengue fever would only take ten minutes.

We were relieved to hear that dengue fever was not the culprit. I didn’t even know what dengue fever was when I was lying in a pool of my sweat back in Hoi An. A curious result of my blood test revealed blood platelet counts below normal levels. But rest and fluids would supposedly provide the remedy. We paid an outrageous sum of money for the clinic visit and retreated to our mini-hotel to suffer a night of midnight motorbike madness in the old quarter of Hanoi.

The next day while “taking it easy” in an Internet café we learned of the whole story of how the mystery virus SARS had brought the entire Vietnam-France Hospital in Hanoi to its knees.

So who is Carlo Urbani?

If SARS was an invisible infectious cloud blowing out of southern China, Urbani was the canary in its path.

Carlo Urbani was the director of infectious diseases for the Western Pacific Region of the World Health Organization(WHO). He was called to the bedside of Johnny Chen, an American businessman who came to the Vietnam-France hospital on February 26 with flulike symptoms that quickly deteriorated into pneumonia and fever, as well as dry cough. The hospital initially suspected that he had the Asian “bird flu” that killed a bunch of people in 1997. Rumors of a mystery pneumonia had been coming out of Southern China but the Chinese authorities had been tight lipped, even instructing local news reporters to ignore it. Before he died, Chen had infected 80 people, including more than half of the health workers who cared for him. His infections was traced back to the Metropole hotel in which he stayed on the same floor as a 64 year old doctor from Guangdong in southern China (where they think the virus originated).

Working in the French hospital in Hanoi, Carlo Urbani witnessed the SARS virus infect one nurse after another. He quickly realized the disease was highly contagious. He took unprecedented steps to warn the world of the danger, and then in a twist of prophetic irony, he died.

On March 9, Urbani and other WHO specialists pleaded with the Vietnam Health Minister to isolate patients, screen travelers, and to seriously consider closing the Vietnam-France Hospital in Hanoi. Because Urbani had a great deal of credibility with the Vietnamese government and with dozens of health care workers at the hospital sick, on March 11, my Birthday, the Vietnam Health Minister ordered the hospital closed. We arrived at the hospital gates less than 24 hours later. Urbani’s quick action was later credited with shutting down Vietnam’s first outbreak.

On March 11, Urbani traveled to Bangkok for a conference on de-worming school children. But he wasn’t feeling well. He was taken to a hospital where he began to feel better within several days but he had watched this play out before and he admitted to colleagues that he was scared. He ordered himself isolated and a special room was built for him. With personal connections to WHO specialists, several flew in to help him. Patches soon showed up on x-rays of his lungs and a few days later as his lungs began to weaken he was put on a respirator. As fluid filled his lungs he was put on a more powerful respirator and sedated with morphine. The end came at 11:45 on Saturday morning, March 29, 18 days after realizing he was coming down with the symptoms himself. Carlo Urbani was 46 years old.

With many of the hospital staff ill, our visit a day earlier would have certainly exposed both Lisa and I to massive doses of the virus. At the very least we would have been stuck in Vietnam under quarantine. It is very sad that to raise awareness as he did, he had to pay such a price. There is little doubt in my mind that Carlo Urbani’s quick action and resolve may have saved my life.

For that I thank you. God Bless you and your family, Dr. Urbani.

[Dr Urbani’s story from “Colleagues pay tribute to Carlo Urbani”, Bangkok Post, April 9, 2003]

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