After Ebola

One major lesson learned: Ongoing training is important

By Amanda Spake

NINA PHAM was the first nurse at the Texas Health Presbyterian Hospital Dallas intensive care unit assigned to treat Thomas Eric Duncan, a traveler from Liberia, who became the first person diagnosed with Ebola in the U.S.

According to a lawsuit filed in March by Pham against the hospital and its parent company, Texas Health Resources, Pham had no in-service training or guidance about Ebola when she was assigned to care for Duncan. When asked how to prevent becoming infected, Pham says she was given printouts from a Google search on the Internet.

As Duncan’s condition worsened, Pham and other nurses assembled makeshift personal protective equipment, according to the lawsuit. They found Tyvek or hazardous material suits, and added a personal respirator, which they covered with a blue gown. The nurses themselves tried to dispose of these gowns, gloves, sheets and other waste contaminated by Duncan’s constant diarrhea and vomiting, according to the lawsuit.

'No risk' of Ebola 

In a meeting with the hospital administration and a representative from the Centers for Disease Control and Prevention after Duncan’s death, Pham says she was assured she was at "no risk" of contracting Ebola. Three days later, she woke up with a fever of 100.6 degrees. By midnight that day, she had tested positive for Ebola. 

It was not until Duncan died and both Pham and Duncan’s night nurse, Amber Vinson, were infected and fighting for their lives, that the American healthcare infrastructure began to take seriously the threat that this virus—and other serious infectious diseases—pose to all health professionals, including those working in U.S. healthcare facilities. 

The public health infrastructure is crucial to ensuring “there is a linchpin for coordinating actions that address threats of infectious disease or of disaster, and that includes tracking activity and coordinating response,” says Kelly Trautner, director of AFT Nurses and Health Professionals. As Nina Pham’s experiences highlight, Trautner adds, “Relying on private corporations to address the health and safety of the community is not the way to do it.”

Improving the way the healthcare system handles serious infectious diseases requires frontline workers—nurses, aides, waste handlers, ambulance drivers, EMTs—to be involved in setting policies and planning response and training. “Our experience with Ebola demonstrates that when the employers sat down with our nurses and other healthcare leaders,” they found there were processes that needed to be addressed, “whether it was in care delivery, or other areas necessary for keeping the public safe,” Trautner notes.

'We don't know what's coming'

John Brady, a registered nurse and AFT leader at Backus Hospital in Norwich, Conn., says it makes sense that the people dealing with a disease in a hospital are those who understand best how to address it. “Why do you want a bunch of people in suits sitting around an office to decide on the protocol for handling Ebola or any serious infectious disease? You don’t.”

There are flaws in the way the healthcare system functions that make the lessons of Ebola difficult to implement, Brady adds. “Healthcare tends to crisis manage. … We did training about eight years ago for smallpox, anthrax, and other then-currrent biological threats, because there was funding for training to deal with weapons of mass destruction. So, when the governor of Connecticut mandated training healthcare workers to handle Ebola, we went to get our hazmat suits out of storage, but they’d just been thrown in a box. They were useless.”

Connecticut hospitals did some training on Ebola after the governor’s mandate. Brady believes it made those who participated in the training more aware of how all infectious diseases should be handled. “We don’t know what’s coming along. There is a possibility of a serious influenza epidemic, for example. So, one of the major lessons learned from Ebola is this: Ongoing training is important, and we should have it for all infectious diseases.”

Ongoing training often suffers from competing priorities for funding. “Ideally, facilities would continue to keep ongoing training and profiency of their workforces at the top of the priority list for addressing threats like Ebola,” says the AFT’s Kelly Trautner. “The reality is that the pressures of the health industry tend to result in shifting focus to the next crisis, and often that’s budget and funding, and not optimal patient-care processes or the safety of our workers.”

Infrastructure investment needed

Without greater investment in the healthcare infrastructure at the national, state and local levels, not only will ongoing training be abandoned, but so will educating the public about infectious diseases. “Unless we invest in public health infrastructure, education of the public is not going to happen,” Trautner emphasizes.

The need for public education on infectious diseases is a major lesson of Ebola that has yet to be learned. Once Ebola reached U.S. shores, the public—and many politicians—reacted with blind panic, leading to discrimination and stigmatization of anyone who had traveled anywhere in Africa, even those risking their lives to stop Ebola’s spread.  

Dr. Craig Spencer, the American physician who volunteered in West Africa, and on his return to the U.S. found he had contracted Ebola, experienced this stigmatization firsthand. “After my diagnosis, the media and politicians could have educated the public about Ebola,” he wrote in the New England Journal of Medicine. “Instead, they spent hours retracing my steps ... and debating whether Ebola can be transmitted through a bowling ball.” 

Spencer recovered, as did nearly all Ebola patients treated in the U.S. Yet, he is still sickened by the ongoing Ebola stigmatization and the nation’s lack of focus on public health preparedness. “Instead of being welcomed as respected humanitarians, my U.S. colleagues who have returned home from battling Ebola have been treated as pariahs,” he wrote in the NEJM. “We all lose when we allow irrational fear … to supersede pragmatic public health preparedness.”

Kelly Trautner could not agree more. “We must have an environment where stakeholders feel encouraged to help one another address threats to public health.”

Healthwire, Summer 2015 Download PDF (976.21 KB)
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