As the Ebola crisis in West Africa escalates, with rising rates of virus transmission and deaths, global organizations are crying out for a worldwide response, including healthcare workers willing to help care for people who have the hemorrhagic disease.
But getting to one of the three countries hardest hit Liberia, Sierra Leone and Guinea to work in an Ebola treatment center is not a matter of getting on a plane and showing up at a hospital, say nurses and others involved with international aid organizations.
Understand the risks
The governmental and non-governmental groups responding to the Ebola crisis dont want people just dropping in, said 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, who has helped train nurses in Liberia. Dont get on a flight. Thats not going to help.
Volunteers should go only with a group that has a track record of protecting both its international and local workers, such as Doctors Without Borders/Médecins Sans Frontières, International Medical Corps or Partners In Health, said Elizabeth Glaser, MSc, ACRN, RN-BC, an HIV specialist who has mentored nurses in South Africa and Kenya, and is on the board of the Global Nursing Caucus. If you get infected, youre not just sacrificing yourself, youre sacrificing anybody you come into contact with.
And they should recognize what theyre signing up for, both physically and emotionally, Chad Priest, JD, MSN, RN, assistant dean for operations and community partnerships at the Indiana University School of Nursing in Indianapolis, who returned from a trip to Liberia in early July, just as Ebola was starting to infect people in the capital, said. Its not Go over there and youre an Ebola hero. Most nurses working in Ebola treatment centers are doing basic nursing care rehydrating patients and helping them manage nausea and vomiting, he said. The skills needed are less clinical and more cultural competence.
At the same time, nurses who understand the risks, are available and have the skills needed by organizations recruiting Ebola workers should apply if they can, Priest said. Theres an immense need for providers to support Ebola treatment in West Africa.
Ebola, spread through bodily fluids, kills an average of 50% of people who get it, according to the World Health Organization. So far a handful of international healthcare workers in West Africa including at least three from the U.S. have contracted it, even after reportedly taking precautions. The question Brandon Berrett, director of international human resources and recruitment for IMC, has heard most often from people thinking about going to West Africa is, What will happen to me if I get sick?
Its an important question and one for which nurses thinking of going should have a definite answer, Gallagher said. There is almost no way someone who gets Ebola will get out of Liberia, Sierra Leone or Guinea without being part of an organized group, she said. Its not like you can say, Im not feeling well, can you get the aircraft here?
Though Berrett said IMC has a plan for getting its workers out, PIH and other organizations are working with the U.S. and West African governments to establish organized evacuation procedures for international workers. Until those and other criteria are in place, some humanitarian and educational organizations that normally send medical teams to disaster sites say they will not send staff to West Africa.
Ebola is not the only thing that could affect healthcare workers safety. Monrovia, Liberias capital, is a city of about 1 million people crowded into a space suited for about 250,000, said Priest, who is part of a team helping set up disaster planning and resilience programs at John F. Kennedy Memorial Medical Center there. Schools have closed and food is getting more expensive, he said, as a result of the crisis. The security situation is in flux. Theres a real concern about the stability of the government.
Despite a slow start, the official U.S. response to the crisis seems to be growing. The U.S. military plans to build and equip 17 treatment centers in West Africa to be staffed by local and international aid workers. The Centers for Disease Control and Prevention, while not recruiting people to go to West Africa, is offering a three-day Ebola training course for humanitarian aid workers traveling to the region. The U.S. Agency for International Development has set up a website with an application form for healthcare workers interested in going to West Africa that governmental and non-governmental organizations can use, and a list of NGOs responding to the Ebola crisis. And NGOs that are recruiting U.S. healthcare workers to go to West Africa report they are getting more applications than they were a few weeks ago.
Websites of those NGOs have varying requirements for healthcare workers. France-based MSF has the strictest criteria for its Ebola workers: Six-to-eight week availability from either experienced MSF field workers, Tim Shenk, MSF press officer, wrote in an e-mail, or practicing physicians and nurses with experience working in a highly contagious ward with PPE [personal protective equipment] and knowledge of infection control and safety practices inside isolation areas while caring for patients; and experience working with viral hemorrhagic fevers.
IMC, based in Los Angeles, is recruiting individuals that are able to work with limited resources, excellent communicators and proven at knowledge sharing, including physicians and nurses with infectious diseases backgrounds for its treatment center in Bong County, Liberia, 120 miles from the capital and another center that it hopes to open in northern Sierra Leone. The centers will employ mostly local people, but IMC is hoping to hire about 200 international nurses in continuing six-week shifts for both countries, Berrett said.
Infection control, management or previous NGO experience is a plus for nurses working in West Africa, Berrett said. But more important is they have proven experience that they would succeed in that type of environment. Even without Ebola, he said, Liberia can be a harsh place. Because of the difficulty finding U.S. nurses, he said, IMC is recruiting for the first time in other countries where it works, including Kenya and the Philippines.
Boston-based PIH, which is in the process of establishing Ebola treatment centers in Liberia and Sierra Leone, has started recruiting U.S. nurses on its website for eight-week volunteer assignments. Nurses must have three years of recent clinical experience in an acute care setting, excellent communications skills, experience providing culturally sensitive and competent quality care in a stressful environment, and a proven commitment to human rights, among other qualifications, according to the PIH website.
Were hoping to get 80-to-100 nurses just for Liberia, said Sheila Davis, DNP, ANP-BC, FAAN, the groups CNO. Eventually the organization wants to employ mostly local healthcare workers, but because of an acute shortage of RNs in the country, were going to have to front-load and put a lot of U.S. people in there initially, she said.
More ways to help
Nurses have many other ways to respond to the Ebola crisis without going to West Africa, said those who work with international aid organizations. All the organizations operating Ebola treatment centers need protective equipment. PPE must be changed every hour or so, and the centers go through hundreds of the suits every day. Were doing a lot of fundraising, said Bonnie Castillo, director of the Registered Nurse Response Network, a project of National Nurses United. After reaching out to organizations running Ebola treatment centers in West Africa, we recognized that what we can do is to (raise funds) for providing PPE because thats what’s needed most, she said.
Castillo said the organization also was emphasizing the importance of protecting healthcare workers everywhere from infectious disease, including those in U.S. hospitals. We dont see this as isolated to West Africa.
Based on the reports hes heard of how the spread of Ebola keeps escalating, Priest is not sure even a large number international nurses in West Africa will stop the epidemic at this point, but some sort of response is necessary, he said. Weve let the disease go too long, Priest said. We have a moral obligation to help. [Nurses] dont have to go, but [they] have to do something. Donate money, he suggested, or write to congressional representatives urging them to support U.S. aid to West Africa. But if youre willing to take the risk, he said, you really should go.