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Another Ebola Outbreak Provides an Occasion for Reflection

Cunningham, Tim, DrPH, MSN, RN

AJN The American Journal of Nursing: January 2019 - Volume 119 - Issue 1 - p 11
doi: 10.1097/01.NAJ.0000552588.00224.5b
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Nurses can counter fear with a more humane, science-based response.

Tim Cunningham is an assistant professor of nursing and director of the Compassionate Care Initiative at the University of Virginia, Charlottesville. He volunteered with Partners in Health during the West Africa Ebola outbreak. Contact author: tdc8h@virginia.edu. The author has disclosed no potential conflicts of interest, financial or otherwise.

Figure.

Figure.

Fatmata was dying and she wanted to get home. Blood surged from her left temple, a result of falling from bed. When she saw us, she ran toward what she thought was the exit of the Ebola treatment unit. Joanne and I pursued her. Our eyes were the only visible sign of humanity through the layers of plastic and latex that made up our ghastly personal protective equipment (PPE). To the world, Fatmata (not her real name) was a pariah; to us, she was our patient. Complying with the mandatory quarantine imposed by the Sierra Leone government, we had to pull Fatmata down from the fence that separated our “Red Zone” from the rest of the world. We carried her back to her bed, but no amount of Valium would keep her still. It was only when we brought her son to her arms that she grew calm. He also had Ebola. With her son near her, she died.

The Ebola epidemic in West Africa (2014–2016) was the largest in history. More than 11,300 people died—including more than 500 health care workers. As Ebola has resurfaced in the Democratic Republic of Congo (DRC), we have the opportunity as a nursing community to reflect on the last outbreak, during which geographical ignorance, cultural insensitivity, and fear bred a sense of otherness. Ebola patients were stripped of their humanity by the media and Western health systems. What could we as nurses have done differently?

Ebola, like HIV–AIDS, was once labeled by Western medicine as a disease of minority groups. Though discovered in 1976 in DRC (then Zaire), limited research had been invested in it until the West Africa outbreak occurred. During that outbreak, Ebola crossed national borders as it infected more than 28,000 people. The world finally paid attention, but Ebola was initially perceived as a somewhat mythical contagion, thought to only affect people in the African continent. Poor people. Black people. Other people.

Although only six of Africa's 54 countries saw cases of Ebola, care providers in the United States judged and stigmatized patients from the entire continent. The simplistic notion that “Ebola was in Africa” revealed that many people in the United States are unfamiliar with Africa's diverse geography. Patients who had traveled from an African country like Egypt (where there were zero reported cases during the outbreak, versus 11 in the United States) and presented to EDs with non-Ebola-like symptoms were sometimes treated as if they had Ebola. Imagine seeking care for a simple laceration and being sent to an isolation room, treated only by providers in PAPR hoods and head-to-toe PPE.

In West Africa, the situation was far worse. Many Ebola survivors reported having been treated like animals. Survivors I met in Sierra Leone told me that care providers in some Ebola treatment units threw food and water at them and refused to touch them (even while wearing PPE)—all for fear of contracting the disease.

As during the early days of HIV–AIDS, it was not just patients who were disrespected. Ebola nurses were mistreated, ridiculed, and stigmatized. U.S. quarantine policies were inconsistent from state to state and were determined, in some cases, by politicians and not scientists. Fear inspired aggression toward caregivers who volunteered to treat Ebola patients. We have not made substantial progress in the fight against infectious diseases when we let fear create stigma about caregivers doing their jobs. History urges us to do better, and we can.

The next time, we can encourage our colleagues, peers, and students to investigate the cultural setting of a disease or outbreak. We can practice listening and asking questions first before reacting. And ultimately, we can advocate for each other by respecting the bravery of our nurse comrades willing to face the unknown in efforts to save lives. Countless nurses in the DRC have been doing just that.

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