Here is a simple experiment everyone can try, and as a matter of fact, I bet you that Elizabeth Hasselback and the hate-filled fearmongerers at Fox News who are pushing for quarantine of West Africa would not be able to complete it successfully. I want to see them do it on camera.
it goes like this - The Clean Glove Contamination Challenge
Put on some clean medical gloves, the kind that health workers use.
then try not to touch your face. or a bic pen. or a counter top. Or if you do, keep track of what exactly you did touch, so that you will remember not to touch it later after the gloves are off.
Then do some task, such as preparing a meal of more than one course, but remember - you can't touch the refrigerator door with your gloved hands.
If you touch yourself accidentally, you "lose"
How did you do?
we'll allow you to self-report in a survey, just below the orange genome of the Ebola virus as viewed by an electron microscope......
And now for Ebola
The skills used to protect yourself from Ebola if you are a health worker, are several steps of difficulty beyond the simple game above. In USA every nursing student is taught this, and the equipment is plentiful and available.
The skills can be mastered after a bit of practice and gentle remindering, and in USA in nursing school we often play a game of how to develop "hand awareness" so as not to touch yourself with contaminated gloves. (even if you do not harbor a fatal pathogen, you will often have unappealing body fluids on those gloves - who wants those in your hair?)
Sentinel Event
If any person in USA develops Ebola, this would count as a "Sentinel Event" if you ask me.
And likewise, there will be procedures in hospitals for decontaminating places where an infected person has been. Books of standards. training of staff. You can bet that the Joint Commission for Accreditation of hospitals is now working overtime to see that future "Sentinel Events" such as inadvertently developing an infection are identified and dealt with. There is no question in my mind that this will be the American response.
Now for a glimpse into the Low Income Countries of the World
I have made six trips to Nepal, and I have written two books on the subject of how bedside care is conducted in a Low Resource Setting - The Hospital at the End of the World and The Sacrament of the Goddess. I'm here in Asia now, on a year-long project to improve acute care skills of nurses and doctors. I have a nursing license in both USA and Nepal. So - from here I have a few observations.
First, there is a learning curve for western medical people who come to the Low Income settings of the world. Many American medical schools allow their students to have a summer elective in a Low Income Country, but don't really know how to coordinate the student's experiences with the kind of knowledge that would come from a professional in the development field. The student often is hampered by language barriers, and the student settles for accumulating whatever clinical "pearls" can be gathered.
Next, there is a tendency to completely overlook the contributions of nurses in hospitals, and I mean this in all seriousness. For example, the female Spanish health worker who has contracted the virus has been variously described as a "nurse," "nurse's aide" or "nurse's helper" - even within one recent BBC report. These job descriptions are not interchangeable. an actual nurse, for example goes to school for years; a nurse's aide may have on-the-job training or no training at all.
Also, the system of care is different than in USA. In Many Low Income settings in the developing world, the nursing staff is stretched very thin - one nurse for thirty patients. Their job is to give medications, assess the patients, and see that the doctor's orders are carried out. They do not feed or bathe the patient or change incontinence - the patient's family is expected to do all those things. When these tasks require a higher level of skill, every one needs to be retrained.
Many hospitals do not have one-patient-only bathrooms, nor do they have intensive care units or such things as ecg monitoring. If the patient has a respiratory arrest, they will not be put on a ventilator - they will die. Don't assume that a "Hospital" in a Low Income country has the same stuff that a USA hospital would.
And Why not send doctors?
My main point is, doctors are not the ones who deal with the kind of systems thinking that will be required to help these places adapt to the new challenge. It's nurses who do that sort of thing. From the acute care viewpoint, the systems that now need to be in place are ones which, in a USA hospital, would be implemented by nurses. It's no accident that a student nurse from West Africa was able to develop procedures to treat her own family and not get infected - this video went viral and deservedly so. It's nurses we need to send, not doctors. And in the long run, we need to develop more national expertise among USA nurses to able to function in acute care settings of Low Income Countries, for this very purpose.
Right now, the US Army does have nurses who can do this. The people there know that this is a challenge of logistics, training and procedures. We don't need House, M.D. - we need Florence Nightingale.
Oh, and yes, we need to send medical anthropologists.
In USA we get to view TV shows like Call The Midwife or The Knick and think that we are somehow separated by time from these settings, and insulated from ever dealing with infectious disease. We have been through HIV, SARS, Anthrax scares, and H1N1 and we will get through it. We have the national systems in place to respond and bring resources to bear. The small countries in the Low Income areas of the world, do not.
for more detailed descriptions of typical bedside challenges in Low Resource settings, you are invited to read one of my books or to follow my blog.