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Dr. Rob Fowler, FRCPC: 2017 Recipient of the Royal College’s Teasdale-Corti Humanitarian Award

Rob Fowler

“He was instrumental in transforming the world’s clinical response to this crisis”

Dr. Rob Fowler

Internist and critical care physician

2017 recipient of the Royal College’s Teasdale-Corti Humanitarian Award

  • Professor, Department of Medicine, University of Toronto
  • Senior Scientist, Sunnybrook Research Institute
  • Program Director, Clinical Epidemiology & Health Care Research, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health

Prior to receiving our award, Dr. Fowler had already set examples for excellence in clinical care during the 2003 SARS outbreak and the 2009/2010 H1N1 pandemic.

Rob actually escorted me into the red zone the first time I went in, watched me don, watched me go in, kept an eye on me while I was there, and didn’t leave me until after I had fully doffed and left,” said Dr. Adrienne Chan, FRCPC, a specialist in infectious diseases who worked with Dr. Fowler in West Africa during the Ebola response. “As a colleague and as a person, it’s very meaningful to understand that somebody’s watching over you and that someone genuinely cares.

A Canadian Ebola Fighter

Dr. Rob Fowler is the 2017 recipient of the Royal College’s Teasdale-Corti Humanitarian Award. Rob took time off from his day job as a critical care physician to donate a year to the mission of the World Health Organization (WHO). Little did he know that he would be one of the first international physicians to arrive in West Africa in March 2014 on the threshold of the Ebola outbreak to help care for patients with Ebola Virus Disease.

Dr. Rob Fowler and Dr. Tom Fletcher

Dr. Rob Fowler and Dr. Tom Fletcher, providing clinical care to patients with Ebola Virus Disease in Guinea, March 2014

Advocacy for life-saving, supportive care

Working alongside national and Médecins Sans Frontières (MSF) health care workers at Donka Hospital in Conakry, Guinea, Rob and his colleagues pushed for new clinical protocols for the care of patients with Ebola Virus Disease, which was historically associated with a 70 to 90 per cent mortality rate. They focused on a much more aggressive, supportive method of care than had commonly been delivered to these patients. This is the kind of care that we take for granted in Canada — fluid resuscitation for severe dehydration, and support for electrolyte abnormalities and organ dysfunctions that accompany critical illness. Rob and his colleagues showed the world that these strategies would help patients survive Ebola Virus Disease long enough for their own body to clear the virus.

Ebola treatment facility

The makeshift Ebola treatment facility in Conakry, Guinea, where Dr. Rob Fowler and his colleagues treated patients with Ebola Virus Disease

“These Patients Don’t Need to Die”

While Rob’s role in West Africa was primarily to help care for patients, as a University of Toronto researcher, he also understood that clinical anecdote and opinion is easily ignored until it’s transformed into a hypothesis that is investigated, reviewed and put into print. In Africa, he pushed for ethics oversight of clinical data collection in the first treatment units, alongside clinical care. He and his West African colleagues published early descriptions of Ebola Virus Disease in many landmark publications, delivering the message that “these patients don’t need to die.” Their advocacy for aggressive supportive care was reflected in the peer-reviewed literature, such as The New England Journal of Medicine (PDF), but also extensively by the lay media. Rob was an advocate for continued improvement in clinical care in The New York Times and other media throughout 2014 and 2015.

A great team makes the greatest impact

The outbreak was expanding exponentially throughout the summer of 2014 with an alarming infection and death rate among national clinicians. Dr. Fowler recruited nearly 100 individual clinicians, including Canadian doctors and nurses, to the early Ebola response. Organizations such as Médecins Sans Frontières were providing terrific support across West Africa, but their human resources were maxed out. Against this backdrop, the World Health Organization put the call out to other international medical organizations to join the battle. In addition to Médecins Sans Frontières, the Public Health Agency of Canada, the Canadian Red Cross and the Canadian Armed Forces all responded, as did ongoing scores of individual Canadian clinicians. Rob, his colleagues and others helped to mentor hundreds of individual health workers on safe, front-line medical care. As the in-country clinical capability grew, they were also able to train thousands of local, pan-African and international health care workers throughout the fall and winter of 2014/2015.

“It’s terrific that every year the Royal College acknowledges the humanitarian work of physicians and surgeons,” said Dr. Rob Fowler, FRCPC. “While privileged to be a recipient, this isn’t an individual award, it’s an endorsement of the countless people and groups who do this sort of work every day.”

Mortality dropped from 80 to 20 per cent

The type of more aggressive clinical care championed by Rob and his colleagues challenged the historical status quo on Ebola management. At the onset of the outbreak, the mortality rate in West Africa was almost 80 per cent. With advocacy for more active clinical care from affected countries, new management guidelines, a growing African Ebola clinical team and response from the international community, access to care improved and the mortality rate dropped to under 40 per cent. Among the patients treated in European and American hospitals and critical care units with aggressive organ-supporting care, mortality dropped further — to less than 20 per cent, meaning that up to 80 per cent of people with Ebola Virus Disease now survived!

A role model for health care colleagues

Rob became a role model for frontline health care workers during the 2014 Ebola outbreak.

Dr Rob

He and his colleagues gave many of them confidence by stepping up, suiting up and showing everyone that a new standard of care delivery was possible in West Africa.

“There were genuine concerns for personal safety, and Rob has a wife and son,” said Dr. Jan Hajek, FRCPC, who witnessed Dr. Fowler’s work first-hand in Sierra Leone. “While many were paralyzed by fear of contagion and rendered powerless by confusion around personal protective gear, Rob would step up, suit up and provide direct patient care.”

“He became — with a gravitas and wisdom gained from repeated front-line work in risky epidemics — a role model for thousands of front-line health care workers in Guinea, Liberia and Sierra Leone,” said Dr. Sharmistha Mishra, FRCPC, an infectious disease specialist in Toronto. “The course of this epidemic changed because we now dare to do better for patients.”

The work of Canadian clinicians around the globe has always been an inspiration

Written by Dr. Rob Fowler

Rob and Group

Dr. Rob Fowler with members of the WHO Clinical Management Training and Mentorship Team in Freetown, Sierra Leone, December 2014

It is wonderful that the Royal College celebrates humanitarian work performed by physicians and surgeons at home and around the world.

As Drs. Lucille Teasdale-Corti and her husband Piero Corti championed in their own life’s work at Lacor Hospital in Uganda, it is a great team that makes the greatest impact.

I was fortunate to work alongside selfless Guinean, Sierra Leonean, Liberian and Pan-African clinicians. They risked their lives on a daily basis and some unfortunately died as a result.

The work that Canadians did with the Public Health Agency of Canada, Médecins Sans Frontières, the Red Cross, and the Canadian Armed Forces was an inspiration.

Individual Canadian colleagues deserve the thanks for all they have done and the examples they have set, including Drs. Neill Adhikari, Adrienne Chan, Paul Charlebois, Mike Christian, Paul Gully, Jan Hajek, Tim Jagatic, Lynn Johnston, Ray Kao, Gary Kobinger, François Lamontagne, Bruce Lampard, James Lee, Aleksandra Leligdowicz, Keren Mandelzweig, Denis Marion, Allison McGeer, Sharmistha Mishra, Srinivas Murthy, Andy Simor, Jim Strong, Ross Upshur, Abel Vanderschuren and so many others with whom I didn’t have the pleasure to meet directly.

Better Quallity

Dr. Rob Fowler with Guinean colleagues, Drs. Marie-Claire Lamah and Ibrahima Bah outside the Ebola treatment facility in Conakry, Guinea, April 2014

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