June 26, 2015
When Dr. William Fischer II, a global expert in infectious diseases, was asked by WHO, the World Health Organization, to provide his technical expertise on severe viral infections, he thought he would be spending two weeks in the comfort of a Geneva office. Instead, he found himself on a plane to Gueckedou in Guinea, the epicenter of the deadly Ebola outbreak.
The last keynote speaker of the 2015 session of IMD's Orchestrating Winning Performance (OWP) week used this experience to explain how the wisdom acquired in his field of expertise can also be useful in the world of business.
“We’re very different. To start with, I never wear a suit,” Fischer began. “But we share themes in common that are critically important.”
Dr. Fischer’s interest in emerging pathogens took him to Guinea and one of the most unstable situations in the world, a country that is surrounded by regions in conflict. “I deployed myself,” he said, although he admitted that the four days that preceded takeoff were unbearably long.
“How many of you would go and leave everything behind to face one of the most deadly viruses we have ever known?,” he asked, showing a photograph of his wife, Leah, holding their two toddlers. The faster he could get on the plane, the less difficult it would be, he told himself.
The paralysis of fear
When he arrived in Conakry, Fischer found the situation in disarray, with nothing happening and no decisions being taken. “Fear is paralyzing. But not deciding is worse than a bad decision. At least with a bad decision, there is a possibility to learn,” he stated, inferring that he was also drawing a parallel with business.
Fischer was sent to the outpost of Gueckedou, where Doctors without Borders had set up a rural operation. “One of the most remote places on the planet with no running water or electricity.” There he learned the second lesson that he shared with the OWP participants: In the face of uncertainty, routines are reassuring.
All the health workers were obliged to follow a strict step-by-step procedure before attending the patients. The layers and layers of protective clothing had to be put on in a predetermined order and the final result was vetted before the workers could proceed. The undressing took place in a reverse order, but with identical precautions.
“The structures of rules can help alleviate fear, especially when you are emotionally and physically exhausted. Routines reduce uncertainty in an uncertain environment.”
Learning in real time
The turning point for Billy Fischer was his encounter with Tomas, a 9 year-old who, together with his mother, had been isolated from the community for fear of the disease. The two were transported from their village, but the mother died on the way. Fischer gave her son aggressive care for over two hours, despite boiling in his own protective clothing. He retired after a long day with what he calls “a sliver of hope”.
Despite a mortality rate of over 70% from Ebola, he hoped that Tomas would make it. He didn’t, and Fischer was wracked with the feelings of sadness, fear and isolation that the child must have experienced before he died.
Fischer learned that Tomas had become infected through his mother who had participated in the funeral of a loved one, where traditionally there is a lot of touching of the deceased. Ebola has the odd characteristic of continuing to secrete body fluids even after death. “It penalizes families who are close and transforms tradition into transmission,” Fischer commented.
He asked himself: How can we improve care. Because the Ebola virus provokes massive losses of liquids through diarrhea, sometimes as much as 10 liters, he wanted to prioritize IV (intravenous) rehydration, but was told that any change to the protocols would have to come from Brussels.
By combining aggressive fluid substitution with antibiotics and antimalarial medication, the death rate was reduced from 74% to 50%. “This was a critical finding.”
The last lesson that Fischer shared was that better is not good enough: “We have not reached the ceiling of survival.” By bringing new people on the ground, including epidemiologists, he believes that the WHO is doing the right thing. “Advancement relies on a willingness to abandon standards.”
He referred to the Italian doctor, Gino Strada, who refused to provide inferior care and who introduced high-level equipment to deal with the epidemic. This led Fischer to talk about the concept of return of investment that should be revised: “We need to think not about what we are going to gain, but about what we are not going to lose.”
Billy Fischer repeated the importance of being proactive. He is currently embarking on a survivor study to attempt to understand how the virus survives and can be sexually transmitted.
His father IMD Professor of Innovation Management, Bill Fischer, was asked how he felt about his son’s dedication to a dangerous cause. Billy’s decision to go on the ground occurred during last year’s OWP, which was an additional difficulty, but their daily phone conversations were reassuring.
“That sliver of hope is what gets me up in the morning,” said his son. “Every person is a chance to do better.”