Ebola in the USA: 'We're afraid'

Her fear is great as well as her outrage: Jowita Lynn has worked as an emergency room nurse for ten years and knows the harsh business of emergency medical care. Yet never has she felt more vulnerable than now since the unexpected infection of two colleagues in Dallas with the Ebola virus:

"We are lacking critical equipment; we are lacking training and practice to treat these patients," she told Deutsche Welle.

One senses that she is not only reflecting on the harsh criticism leveled at her union and the rising discontent Americans have expressed in polls with the crisis management, health authorities and hospital directors. It is personally very serious for her. With big eyes and a firm voice she said, "we are afraid, we are not prepared."

Lynn works for the Catholic Providence Hospital in Washington, DC. With more than 400 beds, it is one of the larger Hospitals in the US capital. In the hospital's mission statement, it indicates that it wants to provide its patients with the best possible care, and that in the spirit of Christian "joy, diligence, and respect." But Lynn is not so sure. First and foremost she sees little respect and concern of the hospital leadership for the employees. "Honestly, I don't believe that management is taking the whole Ebola thing seriously," she said.

About a hundred kilometers away in Baltimore, Hugh Hill has been working for many years as the head emergency physician at Johns Hopkins Bayview Medical Center. He believes some of the nurses' complaints are justified. It is quite possible that there are no appropriate protective clothes and safety devices at some hospitals, he admitted to Deutsche Welle. "That will be quickly resolved," he assured. For Hill and his own hospital, he assures that they are prepared for a possible first Ebola patient. "When the news of the outbreak came, we reacted with screenings and asked the people about their travels. After the case in Dallas we quickly checked our safety measures, made further plans and began last week to train our employees on the correct use of protective clothing and how to clean rooms."

Training began too late

Hill admitted, however, that his hospital began too late with the training in protective measures. Relatively late after the infection of the first nurse in Dallas they realized that they had to do more. "We really thought that the protective measures already in place would be enough," Hill said, trying to explain the delays. "We had to learn that this virus is highly infectious and patients have an incredibly large amount of the virus in the body, especially shortly before their death."

According to Hill, the Johns Hopkins hospital practices the so-called "buddy system" with its medical personnel, in which three employees are involved when the health worker puts on his or her protective clothes. "One who reads the rules and ensures that the protective clothes are put on and taken off in the prescribed way. A second, who is also wearing protective clothes and does nothing else but ensure that no one is contaminated." The third is finally the only caregiver who comes into contact with the patient.

Hill is not sure if other hospitals also practice this time-consuming protocol. Elsewhere, the prescribed measures are sometimes projected on the walls to be read aloud, in an attempt to ensure every detail is thoroughly observed. Putting on gloves is an example: "Now put on the gloves and pull them over your wrists."

Harsh criticism of US disease control authorities

Hill's hospital had "unfortunately until now not practiced" this and still needs time in order to train the entire staff. So far, six emergency medical employees have been trained (as of October 16). By the end of next week there are expected to be "hundreds" in the whole hospital.

Hill feels adequately supported by the Centers for Disease Control and Protection (CDC) in Atlanta, as well as the hospitals and local healthcare authorities which have provided recommendations.

Jowita Lynn sees it differently. The ability to implement the CDC recommendations is not guaranteed. "The CDC changes its views constantly. And my hospital hasn't even managed to implement the original rules, let alone the following ones." Lynn comes to a harsh judgement. "We have nothing with which we can work with."

Furthermore, her hospital in Washington only given the CDC recommendations as a printout with no guidance or training on how to implement them.

'We are learning as we go along'

In contrast, Hill understands the changing recommendations of the US disease control authorities. "We are learning about this virus as we go along. And I think all experts in the US say that we need to readjust our attitude to the disease after what we have experienced in Dallas."

Only four hospitals in the US have the highest possible safety standards, including those in Atlanta and Washington, to which now both Ebola patients have been moved. Other large hospitals also have good but "not perfect" capabilities to isolate patients, according to Hill. Since the four highly-specialized hospitals only have a limited number of beds available, hospitals such as Hills are challenged to prepare as best as possible. According to Hill, there is no unified approach in the United States and every hospital is working alone to prepare for the emergency.

The Johns Hopkins Hospital in Baltimore, for example, has agreed on the following procedure: Anyone who comes to the emergency rooms is asked about possible trips. If someone has a fever or malaria-like symptoms that could possibly be caused by Ebola, they are to be immediately moved to the isolation ward. "We then call our local health department, our own special team for infectious diseases and notify the specialized team from Johns Hopkins to send their people to us within an hour."

Failures are always possible

It will never be perfect, Hill points out. "We can only approach perfection," he said. He understands fully that people in the US are concerned, but notes that he and his co-workers will continue coming to work, even if they now are even more aware of the danger.

"This is my work, this is my life, this is what makes me who I am," Hill said. A few years ago he had explained to his family during a similar situation, "that dad won't be home for a few days. And in some extreme case it can also be that he never will come home again."