Editor’s Note: RN and paramedic Rene Steinhauer is working as the chief nurse in an Ebola treatment unit in Liberia. He is sharing dispatches with EMS1 readers and asking for your ideas and support. The views expressed are his own.
By Rene Steinhauer RN, EMT-P
LIBERIA, West Africa — If you are listening to the news about Ebola, it must be difficult to determine what is happening out here, and it would seem as if the outbreak is under control.
I arrived in Liberia just over two weeks ago (early November). I have been receiving intensive training in managing Ebola and the proper use of personal protective equipment (PPE). My team is currently working under a mentorship program in another Ebola Treatment Unit (ETU). We will soon open our own new ETU with the capacity for managing 100 Ebola patients.
Almost as soon as I arrived, we started hearing rumors that the number of cases was dropping. Not long afterward, those rumors were confirmed. There are still plenty of cases, but the numbers are dropping. A few ETUs have been empty and have even laid-off staff. I am uncertain if we will open our ETU and find we have no patients for whom to care?
Answering the call to care for Ebola patients
When I first started working on a plan to get here we were expecting an outbreak that would take thousands of healthcare workers to break. I chose to be one of those thousands. And it looks like it worked.
I had been working in Mali, West Africa when I first heard about the Ebola outbreak. The news was disturbing as the number of patients with Ebola outnumbered the number of available beds to treat the virus.
Sick and contagious patients were driving around in taxis and being refused entrance into hospitals and ETUs that were already overcrowded. Patients were dying in the street and on the front steps of the ETUs. Because there were no beds, the dead and dying continued to transmit the illness. The nation was in panic. But in just a few months, much of that has changed.
ETU status as of November 16, 2014
In Liberia, numerous ETUs have been set-up and many more are in development. At this time there are more than 300 Ebola patient treatment beds in the country with nurses, doctors and medical supplies waiting to be used.
Is the outbreak over? Has the Ebola Army won a decisive battle?
Most certainly those who have served in Liberia before I arrived won a major battle against Ebola. They treated the ill and created more beds for those who needed it. But at an ETU in Bong County, there is ample evidence that while a battle may have been won, the war against Ebola is still underway and the enemy will fight to the death.
The ETU in Bong is more than half full. New patients are arriving every day.
It is hard to know why they have so many patients, but it may be because they are actively sending teams into remote regions looking for patients. They have ambulance teams that drive more than four hours into the bush looking for and gathering those who are ill. Each day the ambulances return with more patients.
A few days ago a medical team was sent by helicopter to evaluate a community, take blood samples, and return. These medical professionals have chosen not to wait until the enemy strikes at the gate; rather they are looking for Ebola in the jungle.
A new approach to battle Ebola
When there is an absence of Ebola patients we will know the war is over, but until then, we must take a new approach to our battle plan.
One of the most important factors related to this battle is a fundamental change in the way we look at resources. Currently, daily reports are easily found that describe the number of new and suspected cases. However, few reports describe the number of available beds for casualties.
If we have 500 new cases and 600 available beds, then the news is bad, but it is not catastrophic. On the other hand, if we have 500 new cases and 10 available beds, the news is catastrophic. The reason this outbreak was so severe was because there were no available treatment beds and the contagious individuals returned to the community to die. They had no other option.
Setting up our ETU
As our ETU is set up, I find myself wondering if we will have any patients at all? We do not have an ambulance service planned yet, but perhaps that is something we will consider. There is word of making mobile ETUs to get to infected villages that are unable to get to the city. Perhaps we may need to find a way to get mobile. Or perhaps we need to find ways to get the Ebola patients moved to our ETU. At this time, we have yet to make such plans. Our first step is to finish building the ETU and become operational.
Our ETU is not far from the international airport in Monrovia. Perhaps we need to look towards our neighbors in Guinea and Sierra Leone and start bringing their patients to our empty ETUs. I know they continue to have new patients, but I have no idea if they have enough beds. I suspect they do not.
When floating this plan, the first negative reaction was from my own team who said the government would never import Ebola patients through its borders. But there needs to be a fundamental understanding that Ebola does not recognize borders. Liberia has been importing Ebola since the beginning, and will continue to do so as long as infectious people live along the border.
An organizing cross-border response is needed
There has been a lull in the fight. The Ebola army is strong today. But the enemy is coming up with new ways to attack. It is time for us to stop defending the capitol and take this battle to the jungle. It is time to take the battle across borders. As long as three countries continue to fight the battle and individual nations, a successful outcome is questionable. But if these three countries can learn to ignore the borders and fight as a single unified force against this disease, a successful outcome is ensured.
About the author:
Rene Steinhauer RN, EMT-P is the chief nurse of an Ebola treatment unit in Liberia. He is the author of Saving Jimani; Life and Death in the Haiti Earthquake. Available now in print and kindle versions from Amazon.com. You can contact Steinhauer with ideas and support by email at rene@renesteinhauer.com.