In Cities With West African Populations, Hospitals and Residents Gear Up for Ebola
By PAM BELLUCK
New York Times
OCT. 16, 2014
Hospitals in cities with large West African populations are bracing for the first patients with Ebola, a prospect that no longer seems so far-fetched, ramping up screening, protections for hospital staff, and efforts to encourage people to report symptoms and take precautions.
At the same time, leaders of West African communities have been telling people how to stay safe and have been seeking assurances that doctors and nurses will not refuse to treat them if Ebola arrives.
On Thursday, the recently formed Minnesota African Task Force Against Ebola met with the state Health Department and representatives from the Department of Justice to discuss how to handle potential Ebola cases and to address community concerns that health care providers will refuse to treat those patients.
“Doctors will be afraid of being exposed, nurses will panic,” said Abdullah Kiatamba, chairman of the task force. “People are worried, ‘What if I go to the clinic and they don’t treat me because I’m a West African?’ ”
“Relations between the medical community and the West African community actually needed to be improved in the first place, and a case of Ebola will worsen that,” he added. “It will reverse a lot of progress that has been made.”
Urgency has grown since news that two nurses were infected with Ebola in Texas and that federal guidelines may have been too lax.
Now, Rhode Island Hospital, the biggest medical center in a state with a West African community of about 20,000 people, plans immediately to isolate and test anyone with any Ebola symptoms, even without a fever, if the person has traveled anywhere outside the country in recent weeks.
“Even Canada,” said Dr. Leonard Mermel, medical director of the hospital’s department of epidemiology and infection control. “We’ll whisk away more people than we need to.”
In the Minneapolis area, home to the largest Liberian community outside Liberia, Hennepin County Medical Center is doing four-hour drills with fake patients and “focusing on everything, including ‘No, that’s not a big enough wastebasket,’ ” said Dr. John Hick, the medical director for emergency preparedness.
Hospitals that serve many of Philadelphia’s 15,000 or so West Africans are so far not going much beyond the guidelines issued by the Centers for Disease Control and Prevention, a hospital official said.
But Rhode Island Hospital has, even planning to have an employee observe all staff activity in the isolation rooms, peering through a window and giving guidance via intercom to ensure that procedures like inserting intravenous tubes are conducted without infecting employees.
New York City, with West African communities in the Bronx, Staten Island and Harlem, designated Bellevue as the place where 11 public hospitals would send Ebola patients, but other regions are not necessarily following suit.
In Rhode Island, Dr. Michael Fine, the state Health Department director, said that “there are pluses and minuses” to having a designated Ebola hospital. “You have the expertise, but on the other hand, you’ve got the risk” of employees getting infected while transferring patients, he said.
In Minneapolis, Dr. Hick said he hoped the five or six largest and best-equipped of the area’s 30 hospitals would act as Ebola treatment sites.
Kristen R. Ehresmann, director of infectious disease epidemiology, prevention and control for Minnesota’s Health Department, said a dry run of sorts occurred in April, when a hospital successfully treated and contained a case of Lassa fever, which is somewhat similar to Ebola.
Many hospitals in these communities are debating how and whether to add protective gear.
In Philadelphia, Dr. Neil Fishman, associate chief medical officer at the University of Pennsylvania Health system, said so far masks, gowns and double layers of gloves seemed sufficient. Additional layers and extras like duct tape can increase infection risk, he said, because they are harder to take off.
Officials at Montefiore Medical Center, in the Bronx, are wondering whether to have the emergency room triage nurse stand behind a protective shield, even though that nurse would not need to touch patients.
Rhode Island Hospital has replaced standard gowns for employees working with patients in isolation with extra-long surgical gowns because the regular gowns left “a little bit of a gap” on the legs, Dr. Mermel said.
He prescribed shoe covers and knee-high or thigh-high leg coverings, long-sleeved gloves over short gloves, and respirator face masks.
Only about 15 ambulance teams are available to aid Monrovia, a city of nearly 1.5 million people, where hundreds of new Ebola cases are reported each week.
And after Ebola hit Texas, Dr. Mermel ordered full body suits, hoping to train employees to use those by next week. “That’s the plan as of today,” he said. “That could change tomorrow.”
Leaders of West African communities are trying to keep their members safe and prepared.
Worried about both infection and stigma, Mr. Kiatamba and the Minneapolis task force have been using even stronger language than the Health Department in pressing community members not to go to Africa to help.
“We’ve been to churches, to mosques, and we tell people: ‘Look, traveling there is not helpful. Guess what, if you go to Africa and you come back, you could be part of the problem, not part of the solution,’ ” Mr. Kiatamba said.
In New York, there is also concern about being denied care, especially among those who are not legal immigrants and lack health insurance, said Dr. Aletha Maybank, associate commissioner of the Center for Health Equity, who is organizing town hall forums on Ebola to start on Friday.
The city is also distributing posters and palm cards in French, Arabic, Spanish and English, with the legend, “Am I at Risk?” followed by the warning signs of Ebola.
Anemona Hartocollis contributed reporting from New York, and Jon Hurdle from Philadelphia.
 |
| Ebola virus illustration. |
New York Times
OCT. 16, 2014
Hospitals in cities with large West African populations are bracing for the first patients with Ebola, a prospect that no longer seems so far-fetched, ramping up screening, protections for hospital staff, and efforts to encourage people to report symptoms and take precautions.
At the same time, leaders of West African communities have been telling people how to stay safe and have been seeking assurances that doctors and nurses will not refuse to treat them if Ebola arrives.
On Thursday, the recently formed Minnesota African Task Force Against Ebola met with the state Health Department and representatives from the Department of Justice to discuss how to handle potential Ebola cases and to address community concerns that health care providers will refuse to treat those patients.
“Doctors will be afraid of being exposed, nurses will panic,” said Abdullah Kiatamba, chairman of the task force. “People are worried, ‘What if I go to the clinic and they don’t treat me because I’m a West African?’ ”
“Relations between the medical community and the West African community actually needed to be improved in the first place, and a case of Ebola will worsen that,” he added. “It will reverse a lot of progress that has been made.”
Urgency has grown since news that two nurses were infected with Ebola in Texas and that federal guidelines may have been too lax.
Now, Rhode Island Hospital, the biggest medical center in a state with a West African community of about 20,000 people, plans immediately to isolate and test anyone with any Ebola symptoms, even without a fever, if the person has traveled anywhere outside the country in recent weeks.
“Even Canada,” said Dr. Leonard Mermel, medical director of the hospital’s department of epidemiology and infection control. “We’ll whisk away more people than we need to.”
In the Minneapolis area, home to the largest Liberian community outside Liberia, Hennepin County Medical Center is doing four-hour drills with fake patients and “focusing on everything, including ‘No, that’s not a big enough wastebasket,’ ” said Dr. John Hick, the medical director for emergency preparedness.
Hospitals that serve many of Philadelphia’s 15,000 or so West Africans are so far not going much beyond the guidelines issued by the Centers for Disease Control and Prevention, a hospital official said.
But Rhode Island Hospital has, even planning to have an employee observe all staff activity in the isolation rooms, peering through a window and giving guidance via intercom to ensure that procedures like inserting intravenous tubes are conducted without infecting employees.
New York City, with West African communities in the Bronx, Staten Island and Harlem, designated Bellevue as the place where 11 public hospitals would send Ebola patients, but other regions are not necessarily following suit.
In Rhode Island, Dr. Michael Fine, the state Health Department director, said that “there are pluses and minuses” to having a designated Ebola hospital. “You have the expertise, but on the other hand, you’ve got the risk” of employees getting infected while transferring patients, he said.
In Minneapolis, Dr. Hick said he hoped the five or six largest and best-equipped of the area’s 30 hospitals would act as Ebola treatment sites.
Kristen R. Ehresmann, director of infectious disease epidemiology, prevention and control for Minnesota’s Health Department, said a dry run of sorts occurred in April, when a hospital successfully treated and contained a case of Lassa fever, which is somewhat similar to Ebola.
Many hospitals in these communities are debating how and whether to add protective gear.
In Philadelphia, Dr. Neil Fishman, associate chief medical officer at the University of Pennsylvania Health system, said so far masks, gowns and double layers of gloves seemed sufficient. Additional layers and extras like duct tape can increase infection risk, he said, because they are harder to take off.
Officials at Montefiore Medical Center, in the Bronx, are wondering whether to have the emergency room triage nurse stand behind a protective shield, even though that nurse would not need to touch patients.
Rhode Island Hospital has replaced standard gowns for employees working with patients in isolation with extra-long surgical gowns because the regular gowns left “a little bit of a gap” on the legs, Dr. Mermel said.
He prescribed shoe covers and knee-high or thigh-high leg coverings, long-sleeved gloves over short gloves, and respirator face masks.
Only about 15 ambulance teams are available to aid Monrovia, a city of nearly 1.5 million people, where hundreds of new Ebola cases are reported each week.
And after Ebola hit Texas, Dr. Mermel ordered full body suits, hoping to train employees to use those by next week. “That’s the plan as of today,” he said. “That could change tomorrow.”
Leaders of West African communities are trying to keep their members safe and prepared.
Worried about both infection and stigma, Mr. Kiatamba and the Minneapolis task force have been using even stronger language than the Health Department in pressing community members not to go to Africa to help.
“We’ve been to churches, to mosques, and we tell people: ‘Look, traveling there is not helpful. Guess what, if you go to Africa and you come back, you could be part of the problem, not part of the solution,’ ” Mr. Kiatamba said.
In New York, there is also concern about being denied care, especially among those who are not legal immigrants and lack health insurance, said Dr. Aletha Maybank, associate commissioner of the Center for Health Equity, who is organizing town hall forums on Ebola to start on Friday.
The city is also distributing posters and palm cards in French, Arabic, Spanish and English, with the legend, “Am I at Risk?” followed by the warning signs of Ebola.
Anemona Hartocollis contributed reporting from New York, and Jon Hurdle from Philadelphia.
No comments:
Post a Comment