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It’s Just a Little Ebola …

Going back to the basics is important no matter what the medical scenario -- including in the latest epidemic
Health workers outside Connaught Hospital after the arrival of a patient with symptoms of the Ebola virus in the city of Freetown, Sierra Leone,  August 4, 2014. (photo credit: AP/Youssouf Bah)
Health workers outside Connaught Hospital after the arrival of a patient with symptoms of the Ebola virus in the city of Freetown, Sierra Leone, August 4, 2014. (photo credit: AP/Youssouf Bah)

Recently, I spoke with an acquaintance who was complaining about the time it would take to get an MRI scan. The earliest appointment was a month off, which was felt to be totally unreasonable. We live in a reality where there is the ready expectation that medical care and the associated technology will be available to us 24/7.

Here in Israel, perhaps one of the most difficult decisions in medicine is made every year by a group of dedicated professionals, regarding what medications, devices and procedures will be included in the basket of healthcare goods, funded by the government. There are treatments that may cost hundreds of thousands of dollars a year that do get clearance. Of course, for each such treatment, there are potentially thousands of people who do not get access to care that would otherwise have its cost covered.

I do not in any way minimize the pain and suffering of those who desperately need care that they cannot afford and is not covered by universal insurance. But I must admit that a recent article that I read put a very different spin on the whole issue of available healthcare.

In a WHO update which was commented on in the Annals of Internal Medicine, the author relates how 240 healthcare workers have been infected with the Ebola virus since the recent outbreak began. Half of these individuals have died. One area heavily hit by this disease is the country of Liberia which has a total of 51 physicians for its entire population. Many of these doctors and other health workers died as well from Ebola.

The obvious question is why. It has been well described in the news that two Americans who were infected with Ebola were brought back to the United States, put in isolation and begun on treatment. At this moment, these two individuals are still alive. But in the developing world, there is a scarcity of protective equipment that would shield healthcare workers from infection. Even when such equipment is available, the healthcare workers do not always follow proper procedure in putting the equipment on. In other words, even in those cases where the technology exists to avoid the spread of the infection, people are still becoming infected and dying.

What can be done to improve the situation? It strikes me, and many others, that for all of the money that is poured into projects in the developing world, someone would find a method to disseminate critical medical information, such as how to protect oneself from becoming infected with Ebola. The widespread availability of smart phones even in the developing world has definitely improved the transfer of information to hundreds of millions if not billions of people. Nevertheless, critical medical information about any and all types of diseases still often does not get to the necessary targets.

As I have discussed before in this blog, it seems that there is resistance to learning about basic and critical medical interventions that could save a tremendous number of lives. Now, I am not talking about Liberia but rather about many top medical facilities in the United States. The simple act of the doctor washing his or her hands before seeing a patient is far too often passed over. For the patient who subsequently becomes infected with a resistant bacteria and dies, it really doesn’t matter that they are not in Liberia and not being exposed to Ebola. When the patients in an ICU suffer an infection due to a breach in basic protocols, the subsequent avoidable death is just as much a tragedy as it is in Liberia.

I am not a psychologist and would not pretend to understand why it is that educated and intelligent individuals ignore basic protocols. Is it because of the cowboy attitude? Is it exhaustion? Is it laziness? It is hard for me to believe that those medical professionals in Liberia were acting with disregard when treating Ebola patients. The physicians there knew full well what the risks were of becoming infected. In the developed world, I still fail to understand how a doctor can claim to have any true concern for the welfare of patients when he or she breaches basic infectious disease rules on a day-to-day basis. Doctors who do not wash their hands cannot claim ignorance as to the significance of doing so; the value of hand washing is known to all members of the medical community. But there seems to be some type of universal problem, both in the developing and developed world, when it comes to the basics of healthcare.

I have also previously discussed various approaches to monitoring physicians and other healthcare providers to ensure that they do the basics such as washing their hands. Attention to check lists have been shown in multiple medical papers to reduce the risk of minor to catastrophic human error. You don’t need a supercomputer to fill out a form. But it seems that you do need one to make sure that everyone is following the rules.

Doctors, especially, complain of a future where computers and automation will control their behavior. Doctors also worry that in such an automated future, the humanity of medicine will be lost. As far as I can tell, it is exactly this humanity which is leading to many needless deaths. Freedom of choice is a basic tenet of the human condition. But abuse of this freedom hurts others. It strikes me that some freedoms will have to be curtailed for the benefit of the patients who trust us with their lives.

So, in summary, whether in Liberia or New York city, there is a critical need for education of the medical staff and enforcement of protocols to prevent avoidable deaths. Of course, in Liberia and other parts of the developing world, there is a desperate need for basic clean water and medical equipment. But once these items are available, the staff still need to use them properly to benefit their patients.

Thanks for listening

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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