Being a nurse during the worst Ebola outbreak of mankind history

Ebola has been considered one of the most harmful illnesses amongst the virus-borne ones. The damage caused by its virulence is made even worse if its epidemic potential is considered. The 2013–2016 outbreak in West Africa was a tragic event that shown clearly the harm power of such a virus. According to Coltart, all other previous outbreaks combined did not make so many deaths as this unprecedented case. Moreover, the range of countries affected by this outbreak was particularly wide since it reached three nations with an aggressive index of transmission — Sierra Leone, Liberia, and Guinea. Besides those countries, other seven reported isolated cases but with a non-sustained transmission: Nigeria, Mali, Senegal, Spain, the UK, the USA, and Italy.

Responses to the outbreak and outcomes

Since the 2013–2016 Ebola outbreak was unique in the number of victims and in its geographical dispersion, a survey about the responses employed against an event of this magnitude and the respective impacts over the reached outcomes may bring relevant lessons to be applied in order to minimize the possibility of arising new incidents. In this way, Coltart presented a list of responses that, if effectively implemented, can be act as a barrier against the Ebola transmission. The former two ones depend on national or even international initiatives, while the latter one corresponds to a local action.

1. Early identification and recognition of outbreak. This response makes possible to avoid the spread of chains of transmission generated by population mobility. Since affected individuals are hindered to move to uncontaminated areas, the virus becomes confined to a restricted zone. This procedure can abort the endemic event before it turns into an outbreak. In the case of 2013–2016 epidemic, the early cases arose in an area that embraces the boundaries of the three most affected countries. As the borders control in this region is flawed, the outcomes reached by this response against the event proved to be ineffective.

2. Effective collaboration and coordination between national and international players, with sound governance. Time is a crux for the development of an outbreak. Fast diagnosis, efficient patient transportation, and complimentary clinical analysis are some of the actions that require a fluid interaction amongst the involved nations and they can be decisive for blocking an imminent outbreak. Particularly, those actions allow the people can be early warned through public campaigns. This result was not attained in the 2013–2016 Ebola epidemic because of the lack of infrastructure found in the countries where the outbreak started.

3. Improved community engagement. Without a strict community involvement, any response to an outbreak is doomed to failure. Especially in regions where the trust in community leaders is greater than in the government, this action plays a key role in fighting against disease transmission. Regular meetings with communities aiming to become people aware of safe practices are effective provided that local culture and customs do not be affected. This response reached important outcomes by the 2013–2016 Ebola outbreak since the burial practices of the local population constituted a serious risk for the epidemic advance.

Social-cultural and other local issues are critical for the effectiveness of any response during an event of proportions such as the last Ebola outbreak. Mirazimi presented examples of how those questions can jeopardize the implementation of control interventions. In a general way, local people had the customs of touching and washing the body of a deceased. Such a practice meant a high contamination potential. Moreover, people from distant areas and regions were used to attend exposed funerals, which facilitated the disease spreading. Another aspect reported by Mirazimi was the incipient level of knowledge about the disease and the feelings of fear related to possible trying of domination from the government or international organizations. Those issues were the background for incidents that complicated the efficacy of the implemented responses. As related by the author, during the Ebola epidemic “a group of individuals looted equipment and potentially contaminated materials from an isolation facility in a quarantined neighborhood”. Besides, according to the author, misinformed families tended “to hide relatives and friends infected with EVD, to avoid being shunned by their own communities”.

Impacts from Professional Nursing

What happened in West Africa underscored the necessity to put a focus on the health systems in countries that suffering from lack of infrastructure. This is a manner to protect not only local people but also humanity in a general way. The deficiencies of health care system in the Ebola outbreak zone were soften by the work of community health workers together with nongovernmental international organizations (NGOs). This partnership made possible that crucial actions could be carried out so that to outreach trustful information and to teach the population about safe practices. According to Perry, the United Nations Population Fund (UNFPA) was a NGO that played a key role in provide health care services during the Ebola outbreak. The authors highlight that this synergy between community health workers and UNFPA provided “important information about Ebola and searching for active cases and contacts, and they helped local religious leaders to expand their education and outreach strategies, especially in efforts to reduce transmission during funerals and burials”.

Considering the relevance of both community health services and NGOs for the establishment of effective responses during events like the Ebola outbreak, a way to promote improvements in those control interventions could be by greater utilization of the professional nursing in those organizations. This assertion relies on the fact that nurses are responsible for up to 80% of the total health services in different types of institutions around the world (Sagar, 2015). Yet according to Sagar, 2015, “the number of nurses is critically proportional to effective health promotion, health maintenance, and prevention of diseases”. Underscoring how the potential of such professionals could be better tapped the author list four activities in response to the challenges generated by Ebola Virus Diseases (EVD). Those actions, which are intrinsically related to professional nursing practice, are listed below:

• Generation of high quality level of information for Health Care Workers and the public;
• Creation of safe environments for all involved ones involved with health care activities besides the promotion of hands-on training;
• Accommodation of life-saving requirements for promoting safety protocols;
• Monitoring focused on the identification of gaps that lead to EVD transmission.

During those critical epidemics, professional nurses play a crucial role in order to offer the best support possible and available for patients besides keeping strict attention with regard to safe practices. In this way, disregarding the number of layers composing each personal protective equipment, a paramount role for every nurse is “to provide human and safe touch that is intentional, deliberate, and meaningful in order to offer comfort, connection, and care to the patients”. This double responsibility to take care of yourself concomitantly to the patient caring must be present in every action taken by nurses, especially when the background is a disease outbreak. In fact, another fundamental role played by nurses in context of epidemics is to carry out “assessments, intervention, and promotion, among others, for the health and safety of their patients and society”. Nevertheless, this constitutes just one-half of the role. According to the Kollie, another half is the obligation “to apply to themselves the same health maintenance and promotion strategies, use the health care services when needed, and refrain from unnecessary risks to their health and safety”.

Even when nurses act beyond the formal boundaries established by your profession, they give relevant contributions to the effectiveness of each response against an epidemic event. In the case of the Ebola outbreak, besides their typical activities, nurses were also engaged in unmask distorted information and to make them accessible to the public in general. They faced the manner as control systems had been prepared and questioned how the knowledge about the crisis had been managed. Such an incisive and dedicated posture contributed to a more soften acceptance of the control measures by the population. The way as nurses were been seen by people and media during the epidemic endorses this outcome. According to Hall & Kashin, nurses were been considered heroes as published by one of the media stories: “these health-care heroes can find spiritual strength in their calling to aid others who are most in need”.

Barriers to overcome

The 2013–2016 Ebola outbreak challenged international efforts to control and eliminate it. Throughout all actions and responses that were implanted in the epicenter of the epidemic, some barriers turned the initiatives harder to be established. Loignon pointed out three of those more evident barriers:

• The insufficiency of material and human resources in Ebola treatment units (ETUs);
• ETU organizational structure limiting the provision of supportive clinical care;
• Delayed and poorly coordinated policies limiting the effectiveness of global and national responses.

The authors have not limited their research to only point out such barriers. Instead, they assert that the main way to deal with these barriers is by addressing them in the inter-outbreak period. The goal would be to promote “community trust and engagement through long-term capacity building of the healthcare workforce and infrastructure”. According to them, this action “would increase both health system resilience and ability to handle other outbreaks of emerging diseases”.