On the Ethics of Treating Ebola (or refusing to)

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The Wall Street Journal reported yesterday that “far more Liberian doctors are in the U.S. and other countries than in the country of their birth, and their absence is complicating efforts to curb what has become a global health crisis.”

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The article further documents the difficulty in getting doctors to treat patients with Ebola. This is not the first time I have read about something in this line – there were also reports of staff of the Madrid Carlos III Hospital staying away due to fear of Ebola.

The topic has come up among our students too. We train at one of the nine South African hospitals that are to be the first port of call for suspected Ebola cases. What would we do if we actually had a confirmed case? Would we, as students, treat them? Mostly we think we would not (right now… read on).

In principle, I do not think it is wrong to defer treating a patient because of lack of training. For example, I have not yet been trained to do a C-section (only to assist) and so it would actually be negligent of me to attempt one on my own. But if we want to be really accurate, you cannot compare the two… because who has truly been trained to deal with something like Ebola? Very, very few people.

I do not think that med students should under any circumstances treat Ebola patients. Why? Simple. We are students. We are not employed. If we fall ill, it will not be covered as an injury on duty by the government (because we are not an employee). We do not have any insurance to cover any of the sequelae, because again, we are not officially working.

But in a few short months, we WILL be qualified, employed doctors. And what then? Then we are bound by Oath to treat. Then we cannot refuse. But again, what if I have not even been trained how to don the HazMat suit? What if I do it wrong?! I still nearly-strangle myself while gowning for surgery every once in a while (thank you to all the scrub nurses that have un-entangled me time and time again). LOOK at these photos of doctors suited up for treating Ebola. It is INTENSE.

Image via Wall Street Journal, Glenna Gordon. Please click image for original article and more photos.

So the question is, really: is it acceptable for a healthcare professional to refuse to treat a patient out of fear? I know that in the early years of HIV, many HCWs refused to treat patients with HIV out of fear. But now we know how it is transmitted and we can prevent it, so even though we are careful, nobody that I know of refuses to see such a patient.

Ebola, on the other hand: we know how it is transmitted, but preventing transmission in a healthcare setup is not quite as easy as preventing HIV. There are still cases where protocols were ostensibly followed, yet the HCWs fell ill. How? And of course, the course of illness if one contracts Ebola is so much quicker and more violent than HIV. So much less manageable.

I don’t think it is acceptable to force a physician to leave where he is working and go into a highly infectious zone. If he volunteers, sure. But coercing physicians from a different country to deal with something they may not feel equipped for can surely not be “right”?

And if a patient arrives in your casualty and you are the first point of contact? The way we have been taught is that we cannot ever deny life-saving treatment. So if the patient is exsanguinating right there, you are responsible. If the patient is relatively stable, you may organise that another physician takes over his management.

On a side-note: I am not sure that it is entirely accurate that a shortage of doctors is curbing the containment of the disease. Doctors certainly are not the only ones instrumental in the endeavour. What of lab technicians? What of the researchers? What of the pharmaceutical companies? What of the politicians? What of the infrastructure that is so severely lacking?

I know that HCWs are very reluctant to voice their concerns and just hope that they won’t ever be exposed to a situation where Ebola is real in their wards. We know that we are meant to be the passionate ones. The people who chose our careers because we wanted to help. To save lives.

But our lives are not one-dimensional. We too have families. Dreams. Lives outside of medicine. We too would like to live a few more years. We too think that we are worth more alive than dead.

I think it is a scary prospect and denying discussion on the matter by making HCWs feel ashamed of their fears, is not the way to deal with it.

As someone said to me yesterday,

“You will give your life to Medicine. But Medicine will not come to your funeral.”

I think it is pretty clear that I have more questions than answers. I would love to hear your opinion/debates/rants/ethics on the matter.

Book Review: Gracefully Grayson

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Grayson is a sensitive kid, orphaned as a baby and living with his aunt, uncle and their two children. Grayson is an artist. He loves thrift stores. He experiences his world vividly. He has undiscovered talents. He is kind.

But he is not who he is. Grayson is not a little boy, even though he was born one and is known as one.

I adored Gracefully Grayson by Ami Polonsky (you should check out her blog). This book is so gently told that one’s love for Grayson just swells. I want to give her a hug and make everything better.

A few weeks ago, Stacey Ann Chin tweeted this:

Well, it’s not a movie, but Disney-Hyperion did well with this book. It is middle-grade and a quick and easy read. The dialogue is genuine and the characters are tangible. Just a group of regular people, navigating their way through some challenges, one that happens to be the issue of transgender children. Continue reading

Reviewing “Ebola” – and can we just admit that we don’t have a handle on this?

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I read Ebola: The Natural and Human History of a Deadly Virus by David Quammen. There is hardly a more current book on the matter and I am getting so many questions from friends and family that I figured I might as well inform myself a little more.

In 1976 a deadly virus emerged from the Congo forest. As swiftly as it came, it disappeared, leaving no trace. Over the four decades since, Ebola has emerged sporadically, each time to devastating effect. It can kill up to 90 percent of its victims. In between these outbreaks, it is untraceable, hiding deep in the jungle. The search is on to find Ebola’s elusive host animal. And until we find it, Ebola will continue to strike.

If you’ve been keeping up to date with the literature (or you’re a student or professional in any of the medical sciences) you might not learn too much that you did not already know.

“The current scientific understanding of ebolaviruses constitutes pinpricks of lights against a dark background.”

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Four Years Later: A Metamorphosis

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Today this blog turns four years old. Technically a few minutes to midnight yesterday, but it’s much of a muchness really. Four years ago I wrote about practising speculum exams on sim-dolls in the skills lab. I was so embarrassed to do a bimanual examination on a doll in front of my male classmates. Everything was new and scary and who would have guessed that four years later we would be effortlessly sliding speculae and doing Pap smears and getting ready for the big wide world.

I don’t even know. But it’s funny right.

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Ten Places Books Make Me Wanderlust For

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I realise that is the most awkward sentence but… YOLO. Today with Top Ten Tuesday we discuss places books have  made us want to visit, whether fictional or real. I LOVE this topic! I definitely have the travel bug and I once did a list of books that feature travel in some way. I can’t visit all the places on this list, but that doesn’t mean I don’t travel there in my dreams!

1. Hogwarts

(Harry Potter, J.K. Rowling)

This will forever and always be #1 on my list (the rest of the list is in no particular order). I so want to be in that old castle, eat in the magnificent dining hall, go through the massive library. Please please please can it exist for realsies.

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A Simple Gesture To Make Gynae Exams Less Awkward

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I’ve been on OBGYN for three weeks now. I had four weeks of OB in third year and four weeks of GYN in fifth year, and through it all the speculum examination has always been a bit of a nightmare for me. Visualising the cervix with as little as possible pain to your patient takes practice, like any other skill, but it is also very uncomfortable for most women I’ve seen. Lithotomy is possibly the least dignified position we have ever come up with. Not to mention that an uncomfortable woman in lithotomy will inadvertently tighten her perineal muscles.

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Dear Doctor, From A Med Student

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Dear Doctor

I’m writing to ask you please to not do that thing.

You know what I’m talking about.

It’s a Saturday morning, or the middle of the night on an overnight call, or whatever: it is a time of day that nobody wants to be working. And we are working. Maybe we are working on the same service, maybe I don’t know you from a bar of soap.

I am sitting in the doctors’ room writing notes for the latest patient that arrived in our care. You come in and sit next to me, looking for results on the computer or making notes for your own patient or maybe just drinking a coffee.

You see the design of my name badge so you know that if everything goes well, I will graduate by the end of the year and be one of your colleagues.

Then: you let out a long sigh and say loudly, “You know, it’s not too late to walk away and change your career.”

Crick-crick…

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