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Catching their breath

A respiratory therapist’s expertise and longstanding ties proved essential in helping Liberia confront COVID-19.

Michael D. Davis, PhD, was playing a round of disc golf early last June when he received an urgent phone call. It was the Minister of Health for the Republic of Liberia. COVID-19 was hitting the West African nation hard, she said. Liberia needed Davis’ help.

Davis, an assistant research professor of pediatrics at IU School of Medicine, felt a mixture of emotions, including a flash of doubt. “It was exciting, flattering—terrifying,” he said.

Davis wondered, briefly, whether he was qualified to help lead Liberia’s pandemic response. But within a few days, he was on a plane to Africa and taking a seat in a “war room” that included leaders of the Liberian government and public health officials from the World Health Organization and the Centers for Disease Control in West Africa.

The story of why Liberia called Davis began in January 2011, when he took his first trip to the country at the invitation of a colleague at the University of Virginia. Davis, a respiratory therapist, was set to begin working on his PhD in physiology and biophysics, focusing on pulmonary medicine, and global health wasn’t on his radar. But in a country devastated by decades of civil war, with an antiquated health care system and only one respiratory therapist in the country, his skills were precious.

“It just seemed like I was more useful than ever,” Davis said. “Respiratory disease is a leading cause of death there—and that’s what I do!

Davis put his PhD training on hold and his possessions into storage for a temporary move to Liberia by the fall.

Training Africa’s first respiratory therapists

In Liberia, Davis teamed up with Liberia’s lone respiratory therapist, Joseph Moore, who had trained in the United States after fleeing Liberia’s conflicts in the late 1980s. Moore eventually returned to Liberia, attempting to educate colleagues about the value of respiratory care. His vision was to start a school to train more respiratory therapists. But, as a busy clinician, he had no one to help structure the program and develop a curriculum.

Davis’ arrival seemed a godsend. He reached out for guidance from colleagues in the United States and within international professional organizations. The National Board of Respiratory Care shared much of its curriculum. Davis modeled Liberia’s board exam after the one American respiratory therapists take, adding questions relevant to sub-Saharan Africa. By 2012, the Liberia Respiratory Care Institute opened as Africa’s first respiratory therapy school.

The institute graduated its charter class of respiratory therapists in November 2015. To date, 28 new respiratory therapists have trained there. Noting the program’s success, neighboring Sierra Leone is looking to start its own program based on the Liberian model.

Drastically reducing COVID-19 deaths

When the pandemic first emerged in 2020, Liberia managed to largely dodge the initial wave, thanks to aggressive shutdowns of its airport and borders. The Delta variant, in 2021, struck much harder, prompting the Mayday call to Davis from Liberian Minister of Health Wilhemina Jallah, an OB-GYN who served as the respiratory institute’s medical director.

When Davis landed in Liberia, the national COVID treatment unit, set up months before, was overrun with patients. “It was the worst thing since Ebola,” said Davis, who also helped Liberia through that crisis in 2014-15. “If you were a patient who required treatment for COVID, the mortality rate was over 50 percent.”

Davis surveyed the operations and recommended ways to improve them, presenting to the Liberian government, the U.S. Embassy, the CDC, WHO, and the U.S. Agency for International Development. He also collaborated with the nonprofit Clinton Health Access Initiative, which redirected funds from another project to help train COVID unit workers in respiratory care. 

In Washington, Congress added $1 million for Liberia to legislation to provide pandemic funds to resource-poor areas in the world.

Davis and his partners trained COVID unit workers and got oxygen resources where they were needed—even to rural areas. And he is convinced that the newly trained respiratory therapists kept the COVID crisis from being much worse.

Within a few weeks, COVID mortalities dropped by half.

In a letter of appreciation, Jallah, the minister of health, called Davis a “true humanitarian” and thanked him for his willingness to drop everything and serve as her trusted consultant. “While we hope the worst of the pandemic is behind us,” Jallah wrote, “we are better prepared than ever if it returns.”

The director of the Clinton Access Initiative in Liberia, Moses Massaquoi, praised Davis for the collaboration it took to scale up access to oxygen and improve clinical skills. “Your efforts have helped to guarantee the successful training of over 60 clinicians thus far, with reach across 12 major health centers and hospitals in COVID hot zones,” Massaquoi wrote.

The International Council for Respiratory Care (ICRC) awarded Davis its highest honor—given annually for excellence in promoting the globalization of quality respiratory care.

Leading collaborative efforts in the lab

Since returning to IU, Davis has been working with longtime mentor and colleague Benjamin Gaston, MD, on a study to determine if an asthma drug they were developing could be used as a therapeutic for COVID-19.

Davis collaborated with researchers in the Department of Microbiology and Immunology and made the case to IU School of Medicine Dean Jay L. Hess, MD, PhD, MHSA, to commit funds to build a higher-capability laboratory for working with the SARS-COV-2 virus. IU researchers have since proved that the therapeutic drug could be used as a therapeutic and started a company aiming to bring this potential COVID-19 treatment to market.

The 15-year relationship between Davis and Gaston has come full circle. When they worked together in Gaston’s Virginia lab years ago, Gaston shared stories of his own early trips to Liberia—40 years earlier.

Now, Davis’ work is inspiring others. “Everything he does is cooperative—he doesn’t carry an ego around,” Gaston said. “To me, it’s often amazing how well he makes things work. He’s just extremely gracious in guiding people to the right decisions.”

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Laura Gates

Laura is a senior writer with the Office of Strategic Communications. A native Hoosier, she has 25 years of experience in communications, having worked with newspapers and other media organizations in Indiana and Florida, along with small businesses, community groups and non-profit organizations. Before joining IU School of Medicine in January 2020, she was editor-in-chief of a lifestyle magazine serving the community of Estero, Florida.

The views expressed in this content represent the perspective and opinions of the author and may or may not represent the position of Indiana University School of Medicine.