DiversityNursing Blog

A Nurse Decides to Get Hands-On in the Ebola Zone

Posted by Erica Bettencourt

Mon, Jan 19, 2015 @ 11:03 AM

By ANEMONA HARTOCOLLIS

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Lindsey Hallen is in the bug spray aisle at REI, the outdoor equipment emporium in SoHo, looking for exactly the right mosquito repellent to take to West Africa’s Ebola zone, when her phone rings. Three ascending tones, the personal anthem of an emergency room nurse, captured in a ringtone called “Summit.”

“Hello?” she says, pulling the phone out of her jacket pocket. Then in an aside, “I think this is them.”

Ms. Hallen listens, pacing back and forth along the aisle, as her gaunt face takes on the same wide-eyed look of concentration it assumes as when she works in the emergency room at Lenox Hill Hospital in Manhattan. Total Focus. Matter of Life and Death.

Since the latest Ebola outbreak entered public consciousness, most accounts of United States health workers have focused on the ones returning; the missionaries who were airlifted out and brought back from the brink of death, or Craig Spencer, the young doctor cured of the virus at New York City’s premier public hospital, Bellevue Hospital Center in Manhattan, while much of the city held its breath.

Now Ms. Hallen, a 31-year-old nurse with two years’ experience working with critically ill patients in this country, is going the other way, heading to West Africa to fight an epidemic that has sickened 21,000 people and killed more than 8,000.

“Why?” her friends and colleagues invariably ask when they find out what she is doing. Why would a relatively young, untested nurse want to risk putting her life in jeopardy to help save people living thousands of miles away, people sick and dying of a brutal, bleeding, contagious fever?

The question annoys her. Her reasons are instinctive, from the gut. You feel driven to do this or you don’t. The thinking only comes later.

“Why not?” she replies. “Why not me?” So the phone call shakes her. The woman on the other end of the line is a recruiter for Partners in Health, the Boston organization that is sending her to West Africa. Instead of Sierra Leone, as had been planned, the group now wants her to go to Liberia, the woman says. Ebola cases there have fallen, but they need people who can rebuild the shattered medical system, teach about controlling infection. She won’t have direct contact with patients. Yes, she can still go to Sierra Leone if she wants to, and take care of patients there. The final decision is up to her.

So the choice is this: Be an instructor, safe, teaching other people how to wear a protective suit, or be the one wearing the suit. She is given a day to decide.

Ebola officially reached American shores on Sept. 30, when Thomas Eric Duncan, a Liberian visiting family in Dallas, tested positive for the virus. Preparing for a possible onslaught, Lenox Hill Hospital set up a room within the emergency department where Ebola patients would be isolated. The staff had to be trained in wearing protective gear, the stifling, fluid-proof layers that include bootees, gloves, gowns, goggles and face shields. The more Ms. Hallen learned, the more she wanted to know. She volunteered for advanced training. She started lingering on the website of the Centers for Disease Control and Prevention. “I was looking at the case numbers and I started to become a little obsessed with everything that was going on over there, and how it was impacting us here,” she said.

She spoke of her newfound interest to her older sister, Kimberly, a real estate photographer, who sensed that this was more than a casual attraction. “She texted me saying she had volunteered to train how to handle Ebola if it came to New York City,” Kimberly recalled. “In the back of my head, I was like, ‘Oh, God, I feel like this is going to expand into her wanting to do a little bit more.’ But I kind of put it away. Maybe not.”

“She’s always been like this ever since she was little,” Kimberly Hallen said. “She was always the one who was trying to find the next fun thing to do. She was bored so easily.”

Lindsey Hallen, a slight blonde with eyes that shift from green to blue depending on the weather and her mood, grew up in suburban Cheshire, Conn., and was a communications major in college, but not a very serious one. “I was very social and that was what I cared about,” she said. After graduation, she moved to Hawaii, without knowing anyone or even having visited. “I was amazed how well everything fell into place,” she said.

She worked at an animal clinic and went to South Africa on an unpaid internship in wildlife conservation. After two years, she moved to Boston, where her sister lives, and began working at Global Vision International, the organization that had sponsored her internship. Her job sent her to South Africa, Guatemala and Costa Rica, to make sure projects were running smoothly. As a memento, she wears three bracelets on her right arm made of twisted copper and brass that she bought at street markets in South Africa. She never took them off, but she had to leave them with her sister before departing for Africa.

After three years, she wanted to grow. She thought about veterinary school, but she also wanted to travel. “Nursing came to mind as a perfect middle ground,” she said. Now, after two years in the E.R., the dread that she has done something wrong no longer wakes her at night. She can rattle off the medical script for an alcoholic with the shakes, a child with the flu or an elderly woman with a broken hip like someone reciting a Social Security number.

There has to be more to life than the three-block dash from her Upper East Side brownstone studio to the 8-a.m.-to-8-p.m. shift at Lenox Hill, and back.

The Ebola patient in Dallas died on Oct. 8, having set off a rapid chain of events. Two nurses who treated him fell ill, shaking confidence in the United States health care system. In mid-October, several New York hospitals volunteered to be Ebola treatment centers, including a sister hospital to Lenox Hill. On Oct. 23, Dr. Spencer, recently returned from Guinea, was rushed to Bellevue and tested positive. The next day, Kaci Hickox, a nurse returning from Sierra Leone through Newark Liberty International Airport, was forced into quarantine because of public officials’ fears.

Rather than being frightened, Ms. Hallen was swept away. Ebola was her 9/11, the disaster that nourished her sense of purpose.

Scrolling through the C.D.C. website, she came across a link to an application form for medical volunteers willing to go to West Africa, kind of like a universal college application online.

She recalls sending it in a few days after Ms. Hickox returned. Her first response, from Partners in Health, arrived on Halloween night. She sent back an email as she dressed for a Halloween party. She was not a sexy witch, or even a nurse. She wore a $12 zombie suit with a zipper splitting her face.

Still, she didn’t really think it would happen. And she assumed that even if she were selected, she would not be paid, and she could not afford that. But Partners in Health agreed to pay for her travel, expenses and medical insurance, as well as provide a stipend that would cover most of her lost salary for nine weeks; six weeks in West Africa and three weeks upon her return, during the disease’s incubation period. As a single person, she didn’t have to worry about disrupting anyone else’s life.

The agency also agreed to pay for her evacuation if she contracted Ebola — a further reminder of the dangers.

Her mother, Laura, cried when she heard the news. Her father, Dan, “had a million questions” but was proud of her.

“I think that she’s got the right mentality to perform in this type of environment,” Mr. Hallen said. “I guess what I would liken it to is firefighters that rush into a burning building when everyone else is running out. All I can say to that is, thank God for them. Where would we be without them?”

That mentality is not widely shared, the numbers suggest.

Since November, about 1,300 people have applied to travel to West Africa through Partners in Health, and about 360 have been hired, Sheila Davis, chief of the agency’s Ebola response, said. She said she was still looking for people with the right “humility,” but the number of applicants has declined as Ebola has moved off the front pages.

North Shore-LIJ Health System, the hospital network that includes Lenox Hill, has 54,000 employees. Ms. Hallen is only the second one to go to West Africa to treat Ebola, Joseph Moscola, the system’s chief of human resources, said. An informal survey of other New York City hospitals found few if any volunteers at most of them.

At some hospitals an internal debate rages over whether highly trained specialists should be volunteering to do menial work in African field hospitals or can make a better contribution at home, perhaps by doing Ebola research.

“Major academic institutions, you would think, would be those who would be pushing it,” Ms. Davis said. “But it’s the opposite. It’s definitely been Middle America, and California, but not the numbers you would think in Boston and New York.”

In preparation for Ms. Hallen’s trip, Partners in Health sent her a packing list. Mostly it is similar to a list for summer sleep-away camp: shampoo, toothbrush, underwear. But not entirely. She will need a headlamp, in case the electricity goes down, and some fancier clothes to wear for Embassy events. Also, styptic pencils to stanch cuts, and tampons, for nosebleeds, ominous inclusions in an environment where bodily fluids may be deadly. Ms. Hallen has scratched out the word “condoms.” She has enough contagion to worry about, she said. She trades email with other volunteers. Bring washable shoes, they say. Dried fruit, nuts and granola bars, to break the monotony of rice and beans.

She picks up her mosquito net at REI and jokes that she might use it to keep away the cockroaches in her apartment. Last night she slept with a hat on, haunted by a woman who had arrived at the emergency room with ear pain. The diagnosis: a cockroach stuck in her ear canal.

At the checkout counter, the brooding, longhaired salesman examines her basket and asks where she is going. “Sierra Leone or Liberia,” she replies.

“You should read this book,” he says, and on a scrap of paper writes the name Peter Piot, author of a memoir about the discovery of Ebola and AIDS.

The next night, she writes an email to the recruiter from Partners in Health. Deletes it. Writes it again. Presses “send” at 11:42 p.m.

At 10 a.m. Saturday, she was scheduled to fly to Sierra Leone, to care for people who are sick and dying of Ebola.

Source: www.nytimes.com

Topics: illness, sick, Ebola, outbreak, West Africa, epidemic, nursing, nurse, disease, medical, patients, hospital, treatment

A Nurse's Story: On The Front Lines Of Ebola Outbreak

Posted by Erica Bettencourt

Wed, Aug 13, 2014 @ 11:42 AM

By NAOMI CHOY SMITH

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When Doctors Without Borders nurse Monia Sayah first arrived in Guinea in March, she couldn't have known she would witness the worst Ebola outbreak in history. Back then, there were 59 confirmed deaths from Ebola, a virus which can be fatal in up to 90 percent of cases. The death toll in West Africa has since soared to 932, the World Health Organization said Wednesday. In Guinea, where the first cases were reported in March, Ebola has killed 363 people.

"The fear is palpable," Sayah said, speaking to CBS News in New York after returning from her latest assignment. "People are very afraid because they never know if Ebola's going to hit their family or their village."

Because of the fear and stigma associated with the virus, Sayah said many infected people are choosing to hide their illness and often don't check in to treatment centers until it is too late. By that point, there is very little Sayah and her colleagues can do. They try to rehydrate the patients and administer antibiotics. But there is no proven treatment for Ebola, though an experimental drug is currently being tested.

Concerns have also been growing for the safety of medical workers in the field. A leading doctor died in Sierra Leone last week. A Nigerian nurse who treated that country's first Ebola victim died from the virus, Nigerian health officials said Wednesday, and two American medical missionaries infected with Ebola in Liberia are still battling the virus at Emory University Hospital in Atlanta.

But Sayah, who has spent a total of 11 weeks in Guinea, said she is not afraid. She and her colleagues take strict precautions to limit their risk of exposure. Before entering a high-risk zone, they suit up in head-to-toe protective clothing including gloves and goggles. "You do have to follow the rules," she said, "but accidents do happen."

She has to limit the amount of time she spends in the infected area. It's hot under the protective clothing, and exhaustion and dehydration are serious concerns. "The risk is you could faint, you could fall. You do not want to fall in a high-risk area," she said. "Maybe your goggles will move up and your eye will be infected."

Working so closely with patients at death's door has taken a personal toll. Sayah described the anguish of stepping outside a treatment facility to take a quick break from the intense heat, only to find that her patient had died in those ten minutes she was away. "It was really hard for me to know that they had died alone," she said, "not with someone holding their hands and reassuring them."

Sayah recalled the "hectic" challenges of setting up some of the first international treatment facilities for Ebola patients. By the end of May, she said, the medical community thought they had almost contained the virus. But soon after she left Guinea, another cluster of infected patients was found in another village. The virus was spreading like wildfire.

Several factors are contributing to the spread. The virus has an incubation period of up to 21 days, according to the WHO, and in West Africa the population is highly mobile, moving easily across porous cross-country borders. Traditional burial ceremonies in which relatives have direct contact with the body can also play a role in the transmission of Ebola.

Sayah found that many local communities distrust the healthcare system and foreigners. "Some have said we brought the Ebola to them," she said. "It's very difficult to contain the outbreak when communities are not cooperating." There were instances of infectious patients leaving the facility, she said, and many weren't receptive to the idea of isolation -- a crucial step in containing the virus.

During her breaks from the field, Sayah stays in touch with her colleagues on the front lines, hoping for the slightest bit of good news. Just this past week, she heard some. One of the patients who'd been under her care was discharged from hospital, apparently free of the virus.

But the situation on the ground remains dire, and Sayah hopes to see a greater response from the international community.

Despite the challenges, Sayah said she will return to West Africa to fight the outbreak. "When you're there and you see how much needs to be done," she said, "there is not a question of 'should I go back or not?'"

Source: www.cbsnews.com

Topics: virus, Ebola, outbreak, infected, nursing, deaths

Second American Infected With Ebola

Posted by Erica Bettencourt

Mon, Jul 28, 2014 @ 12:28 PM

By Joe Sutton and Holly Yan

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A second American aid worker in Liberia has tested positive for Ebola, according to the Christian humanitarian group she works for.

Nancy Writebol is employed by Serving in Mission, or SIM, in Liberia and was helping the joint SIM/Samaritan's Purse team that is treating Ebola patients in Monrovia, according to a Samaritan's Purse statement.

Writebol, who serves as SIM's personnel coordinator, has been living in Monrovia with her husband, David, according to SIM's website. The Charlotte, North Carolina, residents have been in Liberia since August 2013, according to the blog Writebols2Liberia. They have two adult children.

On Saturday, Samaritan's Purse announced that American doctor Kent Brantly had become infected. The 33-year-old former Indianapolis resident had been treating Ebola patients in Monrovia and started feeling ill, spokeswoman Melissa Strickland said. Once he started noticing the symptoms last week, Brantly isolated himself.

Brantly, the medical director for Samaritan Purse's Ebola Consolidated Case Management Center in Monrovia, has been in the country since October, Strickland said.

"When the Ebola outbreak hit, he took on responsibilities with our Ebola direct clinical treatment response, but he was serving in a missionary hospital in Liberia prior to his work with Ebola patients," she said.

Deadliest Ebola outbreak

Health officials say the Ebola outbreak, centered in West Africa, is the deadliest ever.

As of July 20, some 1,093 people in Guinea, Sierra Leone and Liberia are thought to have been infected by Ebola since its symptoms were first observed four months ago, according to the World Health Organization.

Testing confirmed the Ebola virus in 786 of those cases; 442 of those people died.

Of the 1,093 confirmed, probable and suspected cases, 660 people have died.

There also are fears the virus could spread to Africa's most populous country, Nigeria.

Last week, a Liberian man hospitalized with Ebola in Lagos died, Nigerian Health Minister Onyebuchi Chukwu said.

Lagos, the largest city in Nigeria, has a population of more than 20 million.

The man arrived at Lagos airport on July 20 and was isolated in a local hospital after showing symptoms associated with the virus. He told officials he had no direct contact with anyone with the virus nor had he attended the burial of anyone who died of Ebola.

Another doctor infected

Confirmation of the death in Lagos came after news that a doctor who has played a key role in fighting the Ebola outbreak in Sierra Leone is infected with the disease, according to that country's Ministry of Health.

Dr. Sheik Humarr Khan is being treated by the French aid group Medecins Sans Frontieres -- also known as Doctors Without Borders -- in Kailahun, Sierra Leone, agency spokesman Tim Shenk said.

Before falling ill, Khan had been overseeing Ebola treatment and isolation units at Kenema Government Hospital, about 185 miles east of the capital, Freetown.

Ebola typically kills 90% of those infected, but the death rate in this outbreak has dropped to roughly 60% because of early treatment.

Spread by bodily fluids

Officials believe the Ebola outbreak has taken such a strong hold in West Africa because of the proximity of the jungle -- where the virus originated -- to Conakry, Guinea, which has a population of 2 million.

Because symptoms don't immediately appear, the virus can easily spread as people travel around the region. Once infected with the virus, many people die in an average of 10 days as the blood fails to clot and hemorrhaging occurs.

The disease isn't contagious until symptoms appear. Symptoms include fever, headache and fatigue. At that point, the Ebola virus is spread via bodily fluids.

Health workers are at especially high risk, because they are in close contact with infected people and their bodily fluids. Adding to the danger, doctors may mistake the initial stages of an Ebola infection for another, milder illness.

Source: www.cnn.com

Topics: virus, World Health Organization, Ebola, outbreak, West Africa, deadly, infected, doctor

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