Blaming the nurses


It has become a running joke that when important people mess up in some way, they look for a lowly staffer to take the blame and be fired. The supposedly incompetent intern is usually fingered as the course of the mistake and made the hapless victim of this strategy but any underling will do. Since few care what the lower-ranking people say and thus they have no voice, this charge tends to stick.

The same thing seems to have happened with the recent Ebola cases. Initial reports blamed the nurses involved for the fact that the disease was not limited to the case of Thomas Eric Duncan, the man who returned from Liberia and later died at a Texas hospital. Why the seriousness of his condition and his travel to Liberia had not been flagged earlier, why two nurses became infected, and why one of them was allowed to take a commercial flight, were all argued over and hospital and CDC officials initially pointed to laxity on the part of the nurses involved, for not properly reporting Duncan’s travel history, not taking proper precautions to protect themselves, and recklessly traveling.

But Wade Goodwyn reports in each case the nurses had behaved strictly professionally and were blameless. And nurses are furious at being scapegoated once again.

“Well, see the thing is you have to look at the culture of most hospitals,” said Deborah Burger, president of National Nurses United, who has been a registered nurse for 43 years.

“Whenever they’re trying to assign blame it always it ends up down at the nurses’ level or other health care worker,” she said. “That is not unusual for that to happen. So we weren’t surprised; we were just angry.”

I have a friend who started out as a nurse. But she was so infuriated by the way that the large female nursing staff were treated by the largely male physicians, even though nurses were the people delivering the bulk of the care to patients, that she went to medical school and became a doctor herself.

Kaci Hickox, a nurse who returned to the US after working for Doctors Without Borders in Sierra Leone, reports than upon her return she was treated like a criminal, compounded by the fact that the forehead temperature scanners mistook her flushed face as having a fever when she did not. She is now under a mandatory 21-day quarantine even though she has no symptoms of the disease and has in fact tested negative for it.

The nurses are in the front line of medical care. There are the ones with the patients all the time. They deserve a lot more respect than they get. West Africa needs a lot of professional people to help treat the disease. As Hickox says,

I had spent a month watching children die, alone. I had witnessed human tragedy unfold before my eyes. I had tried to help when much of the world has looked on and done nothing.
….

I recalled my last night at the Ebola management center in Sierra Leone. I was called in at midnight because a 10-year-old girl was having seizures. I coaxed crushed tablets of Tylenol and an anti-seizure medicine into her mouth as her body jolted in the bed.

It was the hardest night of my life. I watched a young girl die in a tent, away from her family.

With few resources and no treatment for Ebola, we tried to offer our patients dignity and humanity in the face of their immense suffering.

The epidemic continues to ravage West Africa. Recently, the World Health Organization announced that as many as 15,000 people have died from Ebola. We need more health care workers to help fight the epidemic in West Africa. The U.S. must treat returning health care workers with dignity and humanity.

Will medical professionals be discouraged from going to help because of the panic-stricken reactions of people upon their return? As Hickox says, “I am scared about how health care workers will be treated at airports when they declare that they have been fighting Ebola in West Africa. I am scared that, like me, they will arrive and see a frenzy of disorganization, fear and, most frightening, quarantine…. I sat alone in the isolation tent and thought of many colleagues who will return home to America and face the same ordeal. Will they be made to feel like criminals and prisoners?”

Comments

  1. Pierce R. Butler says

    … the World Health Organization announced that as many as 15,000 people have died from Ebola.

    Huh?

    Up to 19 October, 4,877 people had been reported as having died from the disease in five countries; Liberia, Guinea, Sierra Leone, Nigeria and the United States. The total number of reported cases is in excess of 9,900.

    The World Health Organization (WHO) admits the figures are underestimates and warns there could be as many as 20,000 cases by November if efforts to tackle the outbreak are not stepped up.

  2. raven says

    The supposedly incompetent intern is usually fingered as the course of the mistake and made the hapless victim of this strategy but any underling will do.

    Don’t laugh. It was an intern in the Department of Treasury that caused the Great Recession. Bush, Cheney, Wall Street, and the banks had nothing to do with it!!! (They are still looking for her.)

    Yeah, Texas Presbyterian dropped every ball they could. The nurses were sent in with no Personal Protection training whatsoever and a haphazard tossed together outfit of Personal Protection Equipment. MSF has an empirical procedure that works and wants two weeks of training first.

    Rumor has it that they turned Thomas Duncan away the first time because they asked the critical question. Do you have health insurance? Of course, as someone just off the plane from Liberia he didn’t. (This is just a rumor, might be true, might not be.)

  3. raven says

    We are still on a learning curve about Ebola in the USA.

    1. I understand Kaci Hickox’s feeling of being a clown in a three ring circus and being treated like a cross between a leper and a criminal. All because she was doing critically necessary work in Africa to end an Ebola epidemic.

    2. That being said, it makes sense to impose a 21 day quarantine on returning medical workers. It doesn’t have to be like a prison though. They deserve decent quarters and treatment.

    3. This is part medical necessity. One doc, Spencer has already come back and gone Ebola positive. Did he infect anyone else? We will find out within 21 days.

    4. It’s part security theater. The big problem is panic and ignorance in these epidemics. It causes the general population to make poor choices and makes things worse. Anything that reduces this is worth a lot.

    5. I would also limit travel to the three West African nations to necessary for the cause only. Who wants to go on a beach vacation to Liberia right now anyway? I can see why Liberians want out but so what. One guy fled to Nigeria, infected 20 and killed 8. Not good.

  4. raven says

    A “travel ban” whatever that is, is basically suicide.

    1. We need to stop this epidemic ASAP and limit it to those three countries in West Africa.

    2. To do so, we have to get people in and out of the region, lots of trained people and also supplies. Including food since their economy has collapsed.

    3. The proximal vector and reservoir for Ebola right now is…humans. It could spread everywhere on this planet and start outbreaks. If that happens, we in the USA would always be at risk.

    That happened once already. An obscure monkey virus, SIV, evolved into HIV and went worldwide. We aren’t ever going to get rid of it.

    4. The wild card is…evolution. Emerging diseases adapt to their new host, i.e. humans. It’s entirely possible that Ebola could do the same. And we know from previous viruses that 10,000 patients is enough. It took SARS less than that. We are over that line right now.

  5. ekwhite says

    Raven: according to the CDC and other authorities, the quarantine doesn’t make sense. It just encourages people to lie and to go underground to evade the quarantine. New York and New Jersey have made a political move, not an effective healthcare move.

  6. raven says

    Raven: according to the CDC and other authorities, the quarantine doesn’t make sense.

    Yeah I saw that. I just disagree completely.

    1. I gave my reasoning above so won’t repeat it.

    2. Suppose I came back from West Africa after working with the US army or MSF on Ebola patients. Who would I infect? Close contact. My friends, family, and relatives. My parents are very old. They wouldn’t last more than a few days with Ebola.

    Would I mind being quarantined? Not at all. I’d do it myself.

    These health care workers are true heroes and they are risking a lot. They deserve a quarantine under the best of conditions. One guy is suggesting a good hotel with a good room service.

    3. We, the world and the USA, have been behind the curve while dropping balls since March, 2014. It’s appalling.

    And how has that worked out, so far?

    It’s time to treat this as what it is. A world health emergency that requires the people, money, and equipment to stop it ASAP. You think it is bad now. If we do what hasn’t worked yet, in 6 months this is going to look like a picnic. The people on the ground know this and have for months. The ruling classes are slowly realizing it too.

  7. raven says

    I’ll add here, that I’ve been monitoring the situation is West Africa as much as anyone can from the USA.

    The efforts there are slowly ramping up. Really slowly.

    There is no indication yet, that they’ve made any difference. None. I was trying to be optimistic but that is getting harder and harder.

  8. Nick Gotts says

    #5, #6, #7, #8,
    Now, do I have more confidence in the opinion of raven, pseudonymous blog commenter without (AFAIK) any medical qualifications, or in that of an organisation able to call on the expertise of some of the world’s top epidemiologists?

    Tricky one.

  9. raven says

    Nick Gotts = Troll.

    There are always a few lurking on Freethoughtblogs.

    You win. When the trolls show up, I realize the thread has died and stop wasting my time.

  10. Nick Gotts says

    raven’s definition of a troll: someone who disagrees with raven’s opinion that raven’s pontifications should be regarded with the utmost seriousness.

  11. raven says

    Concerns mount over US Ebola quarantine
    .By Naomi Seck

    She is being kept outside the main hospital building, with only a hospital bed, a non-flush chemical toilet and no shower. She has only been allowed to wear paper scrubs and has not been told how long she will have to remain isolated.

    “When I arrived, I was not symptomatic, and that Friday they tested my blood, and I am negative,” all signs she is not contagious, Hickox told CNN’s “State of the Union.”

    I will have to say that this is outrageous and counterproductive.

    There is a lot of room between isolating someone for 21 days and putting them in a prison cell. She isn’t sick. She isn’t contagious. The vast majority of these returning medical workers, who are vitally necessary and heroes, will never go Ebola positive. Made to wear paper scrubs? It would make no difference if she wore her own clothes. This is cuckoo.

    They could and should put them up in a nice hotel with good room service, cable TV, and an internet connection. It would cost a little but an out of control Ebola epidemic is going to cost a lot.

    PS: Nick Gotts, you are a creepy stalker and IMO, potentially dangerous. Go stalk someone else. The fence is down around the Pharyngula troll reservation again and they sometimes get out and roam Freethoughtblogs.

  12. Anton Mates says

    “Whenever they’re trying to assign blame it always it ends up down at the nurses’ level or other health care worker,” she said.

    My friend recently took a medical ethics class with a mixture of medical and nursing students. The students had to act out various scenarios; in one, they were talking to the family of a patient who almost died because they overlooked a medication allergy listed on his chart.

    The way most of the medical students handled it? “So, it seems one of the nurses made a mistake with your uncle’s medication….”

  13. raven says

    Huffpo:
    CUOMO GIVES AN INCH
    Andrew Cuomo Defends Ebola Quarantines

    New York Gov. Andrew Cuomo (D) and New York City mayor Bill de Blasio (D) announced new quarantine guidelines on Sunday evening for patients who may have been exposed to Ebola.

    The new guidelines will allow health care workers who have had contact with patients infected with Ebola to stay at home for 21 days, rather than at a medical facility. The health of those individuals would be monitored throughout that period.

    Cuomo already blinked. This is more like what should be done. It is in fact, what they were supposed to do all along.

  14. Holms says

    #13 raven
    There is a lot of room between isolating someone for 21 days and putting them in a prison cell. She isn’t sick. She isn’t contagious. The vast majority of these returning medical workers, who are vitally necessary and heroes, will never go Ebola positive. Made to wear paper scrubs? It would make no difference if she wore her own clothes. This is cuckoo.

    They could and should put them up in a nice hotel with good room service, cable TV, and an internet connection. It would cost a little but an out of control Ebola epidemic is going to cost a lot.

    She is negative for ebola. She was tested, and the test was negative. Yes, negative. She does not have ebola. They know this, because they checked and she was negative. for. goddamn. ebola.

    SHE DOES NOT HAVE EBOLA AND THERE IS NO UNCERTAINTY THEREFORE SHE DOES NOT NEED TO BE QUARANTEED.

    PS: Nick Gotts, you are a creepy stalker and IMO, potentially dangerous. Go stalk someone else. The fence is down around the Pharyngula troll reservation again and they sometimes get out and roam Freethoughtblogs.

    Nick Gotts is not a stalking nor a trolling you, you simply can’t brook disagreement. He spelled it out clearly: qualified epidemiologists are more believeable than anonymous, credential-less commentators on the subject of epidemiology.

    No doubt I am now considered a troll by you.

  15. AsqJames says

    Holms @16,

    I may be wrong, but I think the test is for anti-bodies rather than viral infection. You can be infected but test negative for up to 21 days (the incubation period).

    That said, I disagree with Raven (and the Governors of NJ, NY & IL) too. Ebola patients are not infectious until they are symtpomatic, so isolation during the incubation period is pointless. And if it deters people from honestly reporting their contact history, it could be counter-productive.

    I’m no public health expert, but from all I’ve read it seems the most important factors in reducing the threat in Western countries are:
    1) Information – We need as complete a picture as possible of who might have come into contact with symptomatic ebola patients.
    2) Monitoring – We need all those identified in 1 to be alert to the potential onset of symptoms. They need to be checked in with regularly, but that could be a simple 5 minute phone call each day (“What’s your temperature been over the last 24 hours? Any headache? Diarrhoea? Sore throat? Anything else you’re concerned about? OK, I’ll call you tomorrow.”)
    3) Isolation & Assessment – As soon as any symptoms of concern are noted, get the patient into an isolation ward, and monitor & assess them until ebola is confirmed or they are declared healthy. This is not going to be 21 days. If it’s a false alarm, it’s unlikely to be more than a day or so longer than the symptoms last. If not, they’ll neither want to, nor be able to, go anywhere else.

    I’m no expert, so the details (timing, what symptoms to ask about, etc) may be wrong, but I think the underlying principle – a proportionate and realistic approach which the target population (people who’ve already witnessed the havoc in west Africa first hand) are most likely to buy into and comply with – is correct. Anything (like disproportionate denial of basic liberty) which is likely to reduce their level of compliance is counter-productive. And to be clear, that means: increases the likelihood of the disease being spread more widely.

    If any of that is wrong, feel free to say so (and why). I won’t call you a troll :-).

  16. moarscienceplz says

    the forehead temperature scanners mistook her flushed face as having a fever when she did not.

    This is just stupid. A fever reported by a forehead scanner should be the signal to use an oral thermometer, NOT as an unimpeachable evidence of illness in and of itself.

  17. lanir says

    I would be much happier if there were less talk of unnecessary quarantines and more talk of how to make sure we contact people who have returned. If they’re supposed to get their temperature taken twice a day (random info I heard about this – may not be entirely accurate) then I’d be a lot more impressed if there were talk of having these people report to hospitals or having someone sent to their residences to get this done for 21 days after their return.

    When you have the details and you know how things work it’s not rocket science. There are no unknown variables here. Don’t be afraid, be informed. The latter lets you take every practical and necessary step to keep yourself safe; former gives any blowhard with a semblance of a comforting idea free reign to take you for a ride. There are an awful lot of people willing to do that just now. Call it first world problems if you want to be honest. We have the flat out LUXURY to be afraid of this rather than be responsible. That doesn’t mean we shouldn’t be responsible anyway. I’m not a healthworker so I’m saved from making the incredibly difficult decision about whether to go over there. But I do make enough to donate to MSF and I have.

    Think about it and do what you can.

  18. Mano Singham says

    lanir,

    The recommended CDC protocol is that as long as people are asymptomatic, to recommend that they not travel widely and have someone from the local health authority come and take their temperature twice a day,

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