By Cathryn Domrose
On Sept. 1, 2014, Deborah Wilson, RN, left her Massachusetts home a hero, headed for Liberia to work at an Ebola treatment unit run by Doctors Without Borders/Médecins Sans Frontières. Her boss and co-workers at Berkshire Visiting Nurses Association in Pittsfield supported her journey and cheered her courage. But when she returned home about a month and a half later, two weeks after Thomas Eric Duncan became the first person diagnosed with Ebola in the U.S., the disease had become an around-the-clock news item and the nation was paralyzed with fear.
Some friends refused to visit Wilson at home and criticized her decision to go to West Africa. Medical colleagues assumed she’d be quarantined. Neighbors tried to have her and her boyfriend evicted from their building, she said, and anger toward her increased after she spoke out in support of other healthcare workers returning to the U.S. after treating Ebola patients. “Everyone was so proud of me when I left,” Wilson said, “but when I came back it was like I was selfish, not selfless, because I was bringing Ebola back to the United States.”
If another epidemic were to break out in a far corner of the world, where the health infrastructure was almost non-existent and international resources and clinicians were desperately needed, the fearful response in the U.S. probably would not be much different, said Sheila Davis, DNP, ANP-BC, FAAN, chief nursing officer at Partners In Health, a Boston-based global health organization that deployed U.S. nurses and other healthcare workers to care for people affected by Ebola in Liberia and Sierra Leone. “I don’t think we as a country learned much from this other than learning about [how to protect] our own facilities within our own country.”
U.S. hospitals spent lots of money and resources training nurses and other healthcare workers how to isolate and care for Ebola patients in the U.S., and how to protect themselves, she said, but very few responded to international calls for clinicians to travel to West Africa, even after the crisis subsided somewhat. “Many people had to quit their jobs to go with us,” she said.
Partners In Health trained and deployed about 200 expatriate physicians, nurses and other health professionals, and hired more than 2,000 local workers to care for patients in West Africa, in partnership with government health ministries there. Some clinicians are still there, working with governments and local community groups to strengthen health systems in Liberia and Sierra Leone.
Pat Daoust, MSN, RN, director of nursing at Massachusetts General Hospital’s Center for Global Health, said institutions across the country had varying responses. Some told workers they could go for four-to-six weeks, others said they couldn’t find people to fill in for them during the time it would take them to get trained, get to West Africa, then spend 21 days at home making sure they were disease-free. At Mass General, though many clinicians wanted to go to West Africa, the hospital did not encourage them mainly because of concerns about the lack of a system that would support them if they became sick. Ultimately, only a handful were able to go, Daoust said.
Wilson’s boss initially told her she couldn’t be spared the time off, but changed her mind after watching news coverage of people dying from Ebola.
Though the Ebola epidemic was not in an area where Partners In Health normally worked and the organization does not consider itself a disaster responder, the group could not ignore what its leaders saw as a moral imperative to get clinicians to West Africa, where local health workers were overwhelmed and dying, Davis said. But Partners In Health did not send people until systems were in place to make sure they were properly trained and safe. An important lesson from the epidemic was that the safety of healthcare workers sometimes comes at the expense of caring for sick people, Davis said. “We had to decide: If it wasn’t safe to go in, we couldn’t go in.”
Supporting clinicians to go abroad to care for patients with a dangerous, highly infectious disease, ensuring their safety while they are away, and making sure everyone is safe when they return home is a complex and difficult process, Daoust said.“I think institutions have to sit down and say, ‘How are we going to respond as a global front if this happens again?’”
Daoust said things to think about include deciding who are those properly qualified to go, what organization are they going with, who is responsible for getting them home if they should become sick, who will cover for them while they are away and who will pay the various costs associated with their mobilization.
The overwhelming response of staff who wanted to go to West Africa, Daoust said, has sparked Mass General to create an official protocol for supporting clinicians who want to respond the next time a similar crisis occurs. “The first priority is for the safety of the employee.”
Wilson said she understands U.S. fears surrounding Ebola. In Liberia, she managed a 120-bed Ebola treatment center, overseeing care for about 80 patients a day at its peak use. She wore personal protective equipment and followed every safety protocol as she helped deliver babies and cared for people covered in vomit and diarrhea. She didn’t worry about getting sick until after she returned home and the second of two nurses who had cared for Duncan was diagnosed with the disease. Then she was sure she had Ebola. “I had the first panic attack ever in my life,” she said. “Even my irrationality arose. There’s a very real human fear of the plague, but how we respond ends up ostracizing people.”
Hospital preparations and drills in the U.S. are important, Wilson said, because nurses and others need to be prepared and feel safe caring for patients during any epidemic. Daoust said a colleague working in Liberia told her drills similar to those in the U.S. were sorely needed in West African countries so they would remember how to use the supplies and protective equipment they had received during the epidemic and now had stockpiled. “I think it’s good that we’re prepared,” Wilson said, but she believes the fear and the focus on preparation in the U.S. took away attention from West Africa, where Ebola was far more deadly because of poverty and lack of resources like running water.
International support before the crisis
One of the most important lessons for the global community, Davis said, is the need for global healthcare organizations to partner with health ministries and local governments before a crisis, and offer support to build healthcare networks that include trusted community health centers and schools for physicians and nurses.
For years, clinicians have been trying to get the global community to focus on strengthening health systems, Daoust said. The Ebola epidemic was a horrific reminder of what can happen when a deadly and highly infectious disease strikes a region with a weak health system. “I now hear more about building health systems than I’ve ever heard,” Daoust said. “I don’t think people got the bigger picture (before Ebola) and now they are.”
After killing more than 11,000, the Ebola epidemic has subsided. Though sporadic cases continue to appear in Liberia, Guinea and Sierra Leone, health officials have been able to contain them. But, Wilson said, the U.S. media and public health community have not publicized that the reason dire predictions of an Ebola outbreak here never came close to coming true is because the U.S. had things West Africa did not — a strong public health system, well-equipped facilities, and a highly trained and educated health workforce.
“After all the craziness, after all the panic, not one single person apart from the two nurses who cared for Thomas Eric Duncan ever contracted Ebola in the United States.”
Cathryn Domrose is a staff writer.
To comment, email firstname.lastname@example.org.