The Ebola Outbreak: How Nurses Are Helping

By Dean Bobbie Berkowitz, PhD, RN, FAAN

October 6, 2014

As a school of nursing with a global perspective and commitment, Columbia Nursing is extremely concerned about the Ebola epidemic that is now spreading with such horrifying rapidity and devastation in West Africa.

The humanitarian dimensions of the outbreak are staggering: According to a projection model released by the U.S. Centers for Disease Control and Prevention (CDC) in late September, 1.4 million people in West Africa will become ill with Ebola by late January if the infection rate stays the same as it was in August. But this only hints at the enormous fear, agony, and distressing physical consequences that the disease creates in communities and families throughout Guinea, Sierra Leone, and Liberia.

The Ebola virus spreads chiefly through contact with bodily fluids. It begins with vague, feverish symptoms until patients worsen, often including bleeding from the eyes, nose, and mouth. Its incubation period is between two and 20 days. There is no approved vaccine or treatment, although experimental drugs are now being tried in a limited number of cases.

What is unfolding in these countries is a tragic, textbook example of a public health crisis affecting populations living in deep poverty—exacerbated by political strife, devastated economies, and lethargic bureaucracies. Extensive cross-border traffic and easy connections between rural communities and densely populated cities have helped spread the contagion. The health systems in all three countries suffer from a shortage of trained health care workers and depleted supplies, made worse by many years of civil war and conflict. And while the epidemic began in Guinea in December 2013, then spread to neighboring countries, the governments of these countries—and the international community—have been slow to recognize and react to the crisis. Entrenched community practices around tending to the sick and preparing bodies for burial have also contributed to the disease’s spread. In addition, public fear has created a separate crisis, as families and communities shun or banish those who have been in contact with victims of the disease. In Liberia, which has a recovery rate of 42 percent, many of the survivors of the disease are viewed as pariahs and are virtually “untouchable.”

For our school, which approaches the nursing profession in a global context, the predicament of health care workers in West Africa—many of them our nurse colleagues—is of particular concern. Nurses and midwives are the primary providers of health care in most African countries. They offer indispensable service as the main source of disease education, prevention, and treatment to the community. Without adequate supplies to tend to the sick and dying—rubber gloves, goggles, and protective suits—they have been torn between a commitment to their patients and the need to protect themselves. Many who have chosen to fulfill their mission have died as a result, including nurses, who have the highest mortality among all health care providers working to stop the disease.

The United States and other nations have pledged additional supplies and personnel to help address an epidemic that President Barak Obama has called a “global security threat.” But for this epidemic to subside it will require health care volunteers—many of them nurses—to go door-to- door, to educate entire communities about how to prevent and protect themselves from the disease. This is the kind of work nurses excel at. And more nurses will be needed and require training if the battle against Ebola is to be won.

As of today, Medicins Sans Frontiers (Doctors Without Borders), having put out a request for volunteers, has reported that it is at capacity and no longer accepting health care professionals to volunteer for West Africa. But funds to purchase gloves, masks, protective suits, and other resources are still needed. The American Nurses Association has partnered with the International Medical Corps  to collect funds for this purpose.

Closer to home, Jennifer Dohrn DNP, CNM, assistant professor of nursing, has begun her twice-weekly Global Health Equity class by reviewing health care updates posted by NGOs, governmental agencies, and news organizations. For Dohrn and her 45 nursing students, the Ebola virus epidemic in Western Africa is “more than a teaching moment. It is a teaching necessity.”

Lively and often tense debate among Dohrn’s students has become a hallmark of the class: How can the World Health Organization do better? What steps can and should the affected countries take to better educate their citizens on the virus? Is containment of people (often by military personnel) an effective method to control the spread of the virus? And if containment is implemented by governments, how can community education be maintained as a central focus?

Dohrn directs the discussion to probe the complex interconnections between the spread of the virus and the political, social, and public health systems in these countries; their histories of civil war; and the other health burdens, such as malaria and maternal mortality, already prevalent among the population. The class also discusses models for how the global health community can provide much-needed and timely support.

For Columbia Nursing, which views and practices nursing in a global context, the Ebola epidemic represents a tragic case study for demonstrating to our students, by example, what we consider to be the responsibility of nurses on behalf of people in need.

This article originally appeared on the Columbia Nursing website.