On the morning of Aug. 26, a crowd of physicians, nurses, and other medical staff gathered at a conference at the National Hospital in Abuja, Nigeria, to hear University of Maryland Professor of Neurology Walter Royal III, MD, present data from a preliminary study on HIV-related neurocognitive impairment that the university's Institute of Human Virology (IHV) had performed with its partners in Nigeria.
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Dr. Royal and colleagues are studying the frequency with which HIV-infected patients develop neurocognitive complications, their response to antiretroviral therapy, and correlations with strains of virus that are produced by blood monocytes. “The research provides an opportunity for better understanding of the efficacy and safety of various antiretroviral regimens, and how they work in suppressing these neurocognitive complications.”
Dr. Royal vividly recalled what happened next. “I was standing at the front of the room facing the windows, and everyone else was facing me. That's when I heard a very loud sound. It sounded like an explosion or a big thunderclap. We had been having some very heavy thunderstorms during that week, but there was no flash to suggest lightning, and I was very suspicious that it was an explosion.”
Neurologist Nura Alkali, MD, a local investigator on the study, tried to keep the group calm with the suggestion that since there was a large construction site close to the hospital, perhaps some rock blasting might be taking place. The group remained calm, and Dr. Royal was able to finish his talk.
But the calm didn't last long. “People's phones soon started vibrating as texts and phone calls were coming in,” said Ibrahim Mamadu, MD, a member of the IHV Nigeria team, who had traveled with Dr. Royal to visit one of the team's research sites in the territory of Gwagwalada, about 40 miles away. “There were sounds of sirens and helicopters flying overhead in no time. One of the high-ranking attendees was quietly called out and given some information.”
When he returned, Drs. Royal and Mamadu, and the rest of the gathered medical professionals learned what the world would soon find out: the United Nations (UN) headquarters in Abuja, less than a block away from the hospital, had been hit by a devastating car bomb. A suicide bomber barreled through two security barriers and crashed into the building's reception area before his vehicle exploded. Ultimately, 23 people — including 11 UN staff members — died and more than 100 were injured in the resulting explosion, which destroyed the lower floors of the building. The militant Islamist group Boko Haram later claimed responsibility.
“Several of the hospital staff immediately ran to the emergency room,” said Dr. Mamadu. “We, the IHV-Nigeria staff, also went to help.”
Instinctively, Dr. Royal was ready to get to work as well — but he quickly learned that would not be possible. “This isn't a story of any kind of heroism on my part. There was no running to the ER or pulling people out of the rubble. I am from the US and not Nigerian, and it was thought that my presence could put both me and my colleagues in danger. The neurologists and neuroradiologists who were hosting my talk strongly advised that I leave the scene.”
It was enormously frustrating for Dr. Royal. “I was escorted out of the hospital, and on the way out I could see ambulances arriving, one after the other, bringing people in from the building. They have a small ER and there were a number of people waiting outside to be seen and injured people lying in the hallways I was departing, heading towards my ride,” he said. “I could see people in the street who had been injured and some who had been killed. It was hard being forced to leave in that situation.”
Was he afraid? “I did think about the possibility of secondary explosions, but I don't think I really felt afraid. Looking around me at how others reacted to it, you tend to take on to a large extent that reaction of the group — one where you're thinking about the survival of those who are impacted and what it takes to be safe from that moment on.”
With Hurricane Irene gathering strength along the East Coast and rising concerns about the security situation in Nigeria for the next few days, a car and security team quickly took Dr. Royal back to the apartment where he was staying, and arrangements were made for him to return to the US that evening. “I made it back just before the hurricane hit Baltimore.”
Meanwhile, Dr. Mamadu, as a member of the IHV Nigeria staff and a general physician, took his place in the emergency room to help triage the less severely injured patients. “I assisted in general suturing and dressing of shrapnel wounds, setting up IV lines for fluid, and blood sampling patients for transfusion,” he said. “There were a lot of patients that just needed to have basic wound care and be stabilized.”
Amid the chaos and confusion, he said he witnessed something extraordinary. “In my experience, blood donation is a big deal for most regular citizens here,” he said. But as the word spread of the attack, a trickle, then a stream, then a flood of Nigerians appeared at the hospital, ready to donate blood.
“It was a great sight,” Dr. Mamadu said. “Some even got really agitated when we couldn't take their samples fast enough. In that sad event I saw a silver lining where regular folks showed the true spirit of charity and oneness; rushing to the scene of the blast to help out at risk to self and also coming out in massive numbers to volunteer whatever they could, including their blood, to save their fellow man regardless of ethnicity, religious divide or cultural divisions.”
It's that spirit that encourages Dr. Royal to return as soon as possible to Abuja and his research. “I'd like to see the security situation better under control, but I do look forward to returning,” he said. “I think one's commitment is heightened under a situation like this, and I hate that we were forced to leave. I think often about what it takes to work under those circumstances day in and day out — what it means for researchers to work in areas like this, the commitment it takes to do that.”
It's all about resilience, said Dr. Mamadu. “We in Nigeria joke that we are blessed with the ability to forget and move on. Days after these incidents, you find the citizens picking themselves up and returning to their regular schedules. This is not to say that the memories of everyone who is lost are forgotten, but we keep trying to honor them by continuing our lives.”
Security alerts have disrupted IHV-Nigeria's research efforts several times, hampering their travel to cities that house facilities like specialized labs. Recently, a quality assurance protocol that the team wanted to carry out on some reagents they received in Abuja couldn't be performed in a lab in one of the state capitals because a security alert kept them from traveling to that state for over a week.
“These are the kinds of challenges we contend with,” Dr. Mamadu said. “The IHV works with a wide spread of partner hospitals across the nation, so although these security hitches can be an impediment to our work, we try and manage to keep it running. Our morale is boosted by the good we see ourselves doing for our patients, the nation and the world.”