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.”
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.
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.”