Physicians, Nurses Desperately Needed in Ebola-Hit Areas

Troy Brown, RN

September 08, 2014

The number of physicians, nurses, and other healthcare workers caring for patients with Ebola virus infection in West Africa is woefully "inadequate," despite the heroic efforts of several governmental and nongovernmental organizations, according to many care organizations.

Healthcare workers are not the only personnel needed there; contact tracers also are needed to locate contacts of Ebola virus-stricken patients, drivers are needed to transport patients and dead bodies, and others are needed to disinfect and bury the dead.

"International Response Has Been Lethally Inadequate"

"Despite repeated calls by [Doctors Without Borders/Médecins Sans Frontières (MSF)] for a massive mobilization on the ground, the international response has been lethally inadequate," Joanne Liu, MDCM, MSF International president announced September 2 in a special briefing at the United Nations, organized by the office of the UN Secretary General and the World Health Organization. "Transmission rates have reached levels never before reported in past Ebola outbreaks, and the further spread of the virus will not be prevented without a massive deployment of specialized medical units to bolster epidemic control efforts in affected countries."

Ken Isaacs, vice president of programs and government relations for Samaritan's Purse, testified before the House Foreign Affairs Subcommittee concerning Ebola in West Africa on August 7.

"It is clear to say that the disease is uncontained and it is out of control in West Africa. The international response to the disease has been a failure, and it is important to understand that," Isaacs said.

Ministries of health in these countries simply cannot handle this crisis, Isaacs said. "If a mechanism is not found to create an acceptable paradigm for the international community to become directly involved, then the world will be effectively relegating the containment of this disease that threatens Africa and other countries to 3 of the poorest nations in the world."

Ministries of health and private nongovernmental organizations are completely overwhelmed and unable to cope with the Ebola outbreak, Dr. Liu said. Nongovernmental groups and the United Nations alone cannot implement the World Health Organization's Ebola Response Roadmap.

The World Health Organization issued this roadmap for a scaled-up response to the Ebola outbreak. The goal is to stop Ebola transmission in affected countries within 6 to 9 months and to prevent international spread.

Healthcare Workers in Dire Need

"Basically all experienced doctors and nurses can be trained to work in an Ebola outbreak," Estrella Lasry, MD, DTM&H, tropical medicine advisor, MSF, told Medscape Medical News. "We have requested mainly doctors and nurses with knowledge of measures of infection control and use of personal protective equipment (PPE) so that we can fast-track them into the MSF pool (basically so that after some training they can 'hit the ground running,' despite the fact that they go on a first mission with us and may not be familiar with all the MSF procedures).

"We also need people who can coordinate health promotion and provide psychosocial support in the countries affected by the epidemic.

"All medical staff is in shortage, and a lot of the experienced expatriates have been to the outbreak several times in the last 5 months. Furthermore, we limit the time that you can be inside the wards in full PPE to 45 minutes, which means seeing very few patients at a time (2 to 5), and therefore increases the requirements for medical staff," Dr. Lasry explained.

Triage Decisions Extremely Difficult

"At the current moment, because of the limits of human resources, we are sometimes having to decide to hospitalize only the most severe patients, who are also the most infectious, to be able to treat them and also to reduce the spread of the disease," Dr. Lasry said. "These are extremely difficult decisions to make and increase the stress on our staff. When we can, we admit all suspect cases and test them as promptly as possible."

"[At our facility], basically it is a first-come, first-serve process," George Salloum, vice president, finance and operations, Society for International Ministries, told Medscape Medical News.

Caring for Non-Ebola Patients

"All medical facilities, including the Ebola Treatment Centers (ETC), have a pretriage system, where patients are assessed as Ebola suspects or not. Ebola suspects are referred to ETC, while nonsuspects are managed in the other facilities. During an outbreak, all nonessential/nonurgent medical care is postponed, and the triage for non-Ebola suspects is done in the usual way, taking care of the patients with the most urgent needs first," Dr. Lasry explained.

"In this outbreak, given the duration and the extension, a lot of the health facilities are closed or don't have enough personnel or enough supplies to ensure infection control, which makes the management of patients outside of ETC extremely challenging and can also mean that these facilities become a way of amplifying the epidemic."

"[At our facility,] we have both a hospital and an Ebola care center, so we attempt to care for all people that come to us," Salloum said.

Protective Equipment, Supplies, Supportive Services Lacking

Isaacs cited a number of factors that are standing in the way of adequate medical care. One is the shortage of PPE. Staff members who care for patients with Ebola virus must cover their entire body with PPE that includes face masks, goggles, protective gowns, gloves, and boots. At least 120 healthcare workers have died from Ebola virus infection.

Workers at some locations have not been paid for 2 months or longer, and many have not received promised bonuses for caring for patients with Ebola virus. Staff members from at least 2 facilities have gone on strike, and more are threatening to do so if they are not paid and given adequate PPE.

Isaacs said at the time of the briefing, there was only 1 plane equipped to evacuate an Ebola patient.

When healthcare workers return home, reintegration is sometimes "awkward," as friends and family are sometimes worried they may become ill from contact with the worker, Isaacs said.

Healthcare workers who would like to volunteer in West Africa can find more information on the US Agency for International Development Web site.

Those who would like to donate to organizations that are responding to the outbreak can do so on the Global Giving Web site.

Dr. Lasry and Salloum have disclosed no relevant financial relationships.

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