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Bare necessities

When Donna Gallagher, MS, MA, APRN-C, ANP, FAAN, co-director of the Office of Global Health at the University of Massachusetts Medical School in Boston, was helping train nurses in Liberia, she collected sterile medical equipment — gloves, masks, gowns — from hospitals and home care agencies, packed it into duffel bags and brought it with her to Monrovia, the country’s capital. When she opened the bags for the nurses, “It was like being at Filene’s Basement,” she said, referring to the Boston department store famous for its crowds of competitive shoppers. “They would trample me,” Gallagher said. “They all wanted their own box of gloves.”

Though the Ebola epidemic has made travel to Monrovia almost impossible, Gallagher has started a campaign to collect sterile equipment and fly it to Liberia to help healthcare workers there. She recently sent nine pallets of protective equipment and is collecting more.

The Ebola crisis “is just grief upon grief, and it’s such a simple fix for people to have the tools they need,” Gallagher said. “It pains me to see people at risk because of the lack of a pair of latex gloves.”

Long before the Ebola crisis, healthcare workers in West Africa have been at risk for not having sufficient protective equipment. A study reported online Aug. 26 in the journal Tropical Medicine and International Health found that in Liberia, just over half the hospitals had protective eyewear for physicians and nurses. Only 63% had sterile gloves. In Sierra Leone, those figures were 30% and 70%, respectively, the researchers found.

“Sadly, one of the only benefits of the Ebola crisis in West Africa may be to highlight the baseline lack of personal protective equipment such as eye protection, gloves and aprons for healthcare workers,” study leader Adam Kushner, MD, MPH, stated in a press release. Kushner is an associate in the department of international health at Johns Hopkins Bloomberg School of Public Health in Baltimore.

“The lack of protective equipment is not something that came about because of Ebola,” Gallagher said. “It’s been a chronic problem,” something healthcare workers encountered with HIV, she said.

Chad Priest, MSN, JD, RN, assistant dean for operations and community partnerships at the Indiana University School of Nursing in Indianapolis, was working in Liberia until early July, just as Ebola was entering the country. He was at John F. Kennedy Memorial Medical Center in Monrovia, the country’s largest hospital, helping set up disaster planning and resilience programs. A number of the physicians and nurses he’s worked with, including one of the country’s preeminent physicians, Samuel Brisbane, MD, died of Ebola within weeks after he left.

The nurses he worked with in Liberia were well-educated and well-trained but lacked resources, he said. “What’s really needed is to protect the workforce now in Liberia,” he said.

More than a decade of civil war in Sierra Leone and Liberia, which ended in 2003, decimated the countries’ healthcare system, and rebuilding has been slow. In 2009, Liberia had 122 physicians and about 600 nurses to treat its 3.5 million people. Led by people such as Brisbane, who had practiced through the civil war, and with some help from the international community, the country was slowly building up and training its healthcare workforce.

Part of Gallagher’s work involved helping nurses and nursing students understand the importance of taking safety precautions against the spread of infectious disease, such as hand washing. “They were just at the brink of getting it,” she said.

Gallagher’s and Priest’s work in Monrovia is on hold until the Ebola epidemic is under control.

The deaths of nearly 200 West African healthcare workers from Ebola — half of them in Liberia — has exacerbated the shortage, Gallagher said. Some of those who died — including Brisbane and Abraham Borbor, MD, in Liberia and Sheik Humarr Khan, MD, and nurse Matron Mbalu Sankoh in Sierra Leone — were leading the region’s struggle to get healthcare re-established. Some had returned from living in other countries to help rebuild after the war. “It’s a hard thing to watch because people were trying very hard,” Gallagher said. “They do a lot with very little.”

After the epidemic hit in force, some West African healthcare workers went on strike or stayed home from work because they could not be guaranteed protection against catching the disease. Basic healthcare of any kind is now almost impossible to find in the region. “People are dying of ordinary things,” Priest said, such as childbirth, malaria and HIV. Ebola is “reducing the healthcare infrastructure to near nothing.”

Gallagher said she hopes that once Ebola is brought under control — something health officials are predicting may not happen until January at the earliest — the world will not forget the need in West Africa. “The rebuilding is going to need all hands on deck,” she said. “This is going to be a very long effort.”

Health experts say one of the biggest lessons the world can learn from the Ebola crisis is how it is much easier and cheaper to devote resources to build a healthcare infrastructure and properly equip healthcare workers before a crisis than it is to fight an epidemic that escalates out of control.

“We can all learn from this new epidemic and be better prepared for the next one by remembering that inexpensive protective equipment can keep doctors and nurses safe from infection — and better able to care for patients who need them,” Kushner said. “It is imperative that we make this a priority.”

By | 2014-10-13T00:00:00-04:00 October 13th, 2014|Categories: National|0 Comments

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