Editor’s Note: RN and paramedic Rene Steinhauer is working as the chief nurse in an Ebola treatment 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 — Working with Ebola is unlike any nursing or paramedic job in the world. A measurement of success is directly proportional to resources, and as many as 50 percent of our patients may die.
Failure can result in the death of the nurse or another healthcare worker. Here in West Africa, even our time outside of the Ebola Treatment Unit (ETU), is different than anywhere else I have worked.
Pure food and water
Every bite of food and every drop of water must be pure. For many of us working in the ETU, travel to foreign lands is common and trying the local cuisine is part of the adventure. But if an Ebola nurse is stricken with a common gastrointestinal illness, it is going to be a disaster. Ebola mimics many different illnesses, from malaria to norovirus. Since rapid Ebola screening is not yet available, any GI illness is suspected to be Ebola.
Hands-off patient assessment and care
There is no touching in the ETU. Nurses and paramedics are caring professionals who believe in the healing power of touch. We hug, we shake and hold hands, we cross barriers with strangers and coworkers with touch that physically demonstrates our compassion.
In Liberia, we do not touch anyone.
There are no handshakes. There are no hugs. Not with the locals and not with each other. Even married couples do not touch. Not on duty or off duty. They even have separate bedrooms. Every person is a potential danger.
When we care for our patients in the ETU we touch and hold their hands, but through three layers of gloves, a white Tyvek suit and goggles so fogged it is impossible to recognize the nurse.
Never before have I better understood the significance and trust associated with a gesture as simple as a handshake or hug. I have been here for about a month, and I will be here for many more months. That seems to be a long time to be without touch.
Ebola illness is not an emergency
There is no such thing as an Ebola emergency. I recently heard a saying, “We are not in a hurry to die.” Ebola care is not highly technical, but it must be well coordinated.
Rushing in the ETU is likely to lead to mistakes such as needle sticks or falls that disrupt the personal protective equipment (PPE) or splashes that seep beyond or through the PPE. The patients occasionally seize, but while we want to work rapidly, to a casual observer, the pace of the action is painfully slow.
Minor mistakes can have catastrophic results
In the course of our work we will have few opportunities to recover from any mistakes. Even the most minor pitfall can lead to death. If I fall ill from a poor choice of food or water I will find myself isolated and quarantined for days. There will be no one to replace me.
Individual failure can have dire consequences
For those of us on the front lines in this war on Ebola, we recognize the importance of the safety guidelines we must adhere to with vigor. We cannot work here without considering the consequences of our actions are much more than a worst-case scenario for an individual. An individual failure will ripple through the outbreak response and reduce the effectiveness of everyone involved. The end result is more graves behind our ETU.
Living in a world unlike any other
Those who choose to do this work are living in a world unlike anything they have ever previously experienced. I had not considered all of this before arriving here. I don’t know how this will all come to a resolution, but I do know this: when I get home, I will need a hug.
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.