ANOI, Vietnam, May 5
Doctors and nurses clustered around the bed of Nguyen Thi Men when
she emerged in mid-March from a nine-day coma, urging her to stay
alive.
"Breathe, breathe," they said. "Keep trying. Your husband and
your children are waiting for you."
She heard them and she tried, although she felt as if she were
drowning, she said in an interview this weekend at her home.
"I saw a lot of doctors looking at me and it really raised my
spirits," she said. "So many people looking after me. I was very
touched."
What she did not yet know was that they had gathered to view a
miracle. She was the only survivor from among the six most
critically ill patients infected when SARS broke out in the Hanoi
French Hospital more than two months ago.
Her survival became a hopeful symbol for Vietnam, which on April
28 was declared by the World Health Organization to be the first
nation to contain and eliminate the disease. Vietnam earned that
distinction by going 20 straight days without a new case after
recording 63 infections, including the six critical cases. Five
people had died.
"Vietnam has been able to show the world that there is hope that
SARS can be contained," said Pascale Brudon, the World Health
Organization representative for Vietnam.
The country's success was not a miracle, said Aileen Plant, who
led the fight against SARS in Vietnam for the World Health
Organization. "This was real, old-fashioned infectious disease
containment," she said. "It all comes back to the same thing, which
is stopping infected people from infecting other people."
After a crucial meeting on March 9 with members of the World
Health Organization, the government decided to fight the outbreak
openly and aggressively, Ms. Plant said. A task force was formed,
information gathering was centralized and virtually the whole
government was mobilized to deal with the infection and its
consequences.
"It was the speed, the leadership, the transparency, the
flexibility, the intensity with which they educated people what to
do," she said. "It all sounds a lot easier than it is."
Vietnam's luck was that the disease had entered the country
through just one infected person, an American who brought it from
abroad. The Vietnamese capitalized on this luck by moving fast to
confine the outbreak to the hospital.
That patient, Johnny Chen, a 50-year-old businessman, came to
Hanoi in late February after a stay at the Metropole Hotel in Hong
Kong, where many of the early cases were contracted.
He fell ill and was taken to the privately run Hanoi French
Hospital. He was later evacuated to Hong Kong, where he died. His
illness was first identified as a new and unknown disease by a World
Health Organization doctor, Carlo Urbani, 46, who later died of SARS
himself.
At the urging of Dr. Urbani and his colleagues, Vietnam closed
the hospital to new patients and visitors on March 11. Most of the
hospital's staff remained inside, some falling ill, others watching
their colleagues sicken and die.
"The net effect probably was that they gave SARS to each other
and not to the outside world," Ms. Plant said.
Ms. Men, 46, is a pediatric nurse at the hospital, but she often
helped out in other wards. It is impossible to know exactly how she
was infected, but on the evening of March 1, she said, she spent
some time in the room of Mr. Chen, who was critically ill.
In the following days she began to suffer headaches, fever,
diarrhea and exhaustion. "It was strange," she said. "A strange,
overpowering tiredness."
When she checked herself into the hospital, two other nurses had
already fallen ill, but, she said, "it never entered our heads that
we could die."
They were friends in nearby beds and they joked, they gossiped,
they sang and they left their rooms to wash their hair. But they
grew sicker. One nurse, Nguyen Thi Luong, who would be the first to
die, was put on a respirator in the next room. Ms. Men could hear
it, "Beep-beep, beep-beep."
As the hospital's doctors and nurses were falling ill, the
government was coming to grips with the crisis.
It formed a steering committee, led by the health minister, that
reported directly to Prime Minister Phan Van Khai and involved the
departments of transportation, customs, finance, education and the
interior as well as medical experts.
Provincial officials were ordered to file daily 4 p.m. updates.
They were told to isolate patients and send them to two designated
hospitals in Hanoi. Two suburban hospitals were prepared as
isolation centers in case they were needed.
Health workers traced and monitored hundreds of people who had
interacted with workers or patients at the hospital, including one
"very friendly" man, the father of a patient, who had more than 120
close business and social contacts.
Each of these people was visited every day, said Huang Thuy Long,
a steering committee member who heads the National Institute for
Hygienics and Epidemiology.
An immigration screening system was set up, soon to be bolstered
by seven $50,000 infrared machines at airports and border crossings
to detect people with high temperatures, Mr. Huang said. Hundreds of
electronic thermometers are being bought for use by immigration
agents.
He said 2,000 Vietnamese students studying in China would be
isolated for 10 days whenever they returned.
Health experts say there are sure to be more cases of SARS as
travelers pass in and out of Vietnam.
The challenge for the government will be to identify and isolate
them quickly, as it has now learned to do, before another epidemic
is touched off.
The Hanoi French Hospital, in which the outbreak was contained,
has transferred the last of its patients to another hospital and is
being thoroughly disinfected.
The walls are being repainted, the carpets are being changed and
medical equipment is being steam cleaned.
Ms. Men desperately wants to go back to work when the hospital
reopens, but it is not certain that she can.
She is still weak and short of breath, and her right leg,
immobile during her coma, is painful and has lost some of its
function.
When she emerged from the coma six weeks ago, she said: "I
couldn't even recognize my own body. It wouldn't do anything I
wanted it to. It seemed to belong to someone else."
There was pain everywhere, as if she were being tortured.
"The doctor told me, `Now everything depends on you,' " she said.
" `You have to try hard to breathe.' "
Before he removed the tube that had been forcing oxygen into her
lungs through an incision in her throat, she practiced breathing, in
and out, as if the training wheels were being taken off her bicycle.
"I felt that I was drowning," she said, "like somebody was
pushing me under water."
Her doctors stood over her, the only colleague they had managed
to save. "Keep going, otherwise all our work will be wasted," she
said they told her. "That made me stronger. That made me feel that I
was living for other people."
At home with her husband, she has two small daughters to raise.
She also has two grown sons. At work she has newborns to care for.
"I want to go back and see my friends and start my life again,"
she said. "I like my work. It's a happy job." A few days ago, one
month after she was discharged, a doctor checked her lungs and found
severe scarring. He could not tell her how well she would heal or
how long it might take.
At the end of the interview, as her 7-year-old daughter jumped
rope outside, Ms. Men limped to a dresser to fetch a certificate
from a long-distance race.
It will not be enough for her to walk again, she said. Ms. Men is
a competitive runner.