1. Kennedy, Maureen Shawn MA, RN, FAAN


Could a better health care system in West Africa have saved lives?


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Two years ago this month, the largest Ebola epidemic on record began in Guinea and quickly spread throughout West Africa, hitting the neighboring countries of Liberia and Sierra Leone the hardest. At this writing, the most recent situation report from the World Health Organization indicates that as of October 11, 2015, no new cases of Ebola virus disease (EVD) had been reported for two consecutive weeks. But the toll was considerable: since the outbreak began, those three countries counted a total of 28,454 cases and 11,297 deaths, with health care workers accounting for 513 of those deaths. Outside of these countries, there were just 36 cases and 15 deaths.

Figure. Maureen Shaw... - Click to enlarge in new window Maureen Shawn Kennedy

In facing the crisis, local and international health care workers have labored under harsh conditions. This month's cover photograph speaks to this, showing nurse Elie Kasindi Kabululu caring for a patient in the Democratic Republic of Congo (see On the Cover for his story). He'd sent me several photographs of his hospital and said he was looking to "twin" with a U.S. hospital that might help with resources. Even without explanation, one can see from the photograph that Kabululu's workplace is resource poor. His patient lies on a rubber sheet atop a makeshift table; the sheet covering him is ragged, as is the towel hanging by the door. Kabululu's gloves don't fit tightly at the wrist, so they offer him little protection. We chose this image in part to call attention to a feature article by RN Deborah Wilson, who writes about her experience managing a Liberian Ebola treatment unit for Medecins Sans Frontieres (MSF) for five weeks in 2014.


Wilson describes the Spartan conditions under which she and other nurses-MSF volunteers as well as local Liberian nurses-worked to provide care to those stricken with EVD. She writes about the lack of proper equipment for care and testing, of even basic equipment we take for granted (such as electric lights by which to start ivs), of the struggle just to keep patients clean and hydrated-conditions that evoke those Florence Nightingale faced in the Crimea. The article is an absorbing read, not only for its clinical information, but also because it addresses some of the broader socioeconomic factors that allowed EVD to spread rapidly. These include weak central governments straining to rebuild nations after years of civil conflict, the absence of public health system infrastructures, scant resources, and populations living at bare subsistence levels.


I was reminded of Wilson's experience and Kabululu's situation when I attended the annual meeting of the American Academy of Nursing in October. The academy's Living Legends program honors nurses whose work has lasting impact "on the provision of health care services in the United States and throughout the world." One so honored this year, Afaf Meleis, is a nurse scientist known for her international work on behalf of women and children and her contributions as a researcher and an educator. At the ceremony Meleis spoke eloquently about her journey, asking us to imagine "What if?" What if her parents hadn't supported her desire, as a young girl in Egypt, to go to school? What if they hadn't supported her emigration to the United States to continue that education? What if she hadn't met the many people who had inspired and mentored and collaborated with her?


I can't help but think: What if there had been reliable laboratories in Guinea and Liberia and Sierra Leone, where test results might have shown early on that it was the Ebola virus they were dealing with and not malaria or some other tropical virus? What if there had been basic sanitation services and running water? What if the nurses had had adequate personal protection equipment? What if leaders in more developed countries and the global health community had responded earlier to the crisis, instead of waiting until a few EVD cases arrived in their own countries? And now that an effective vaccine seems to be a real possibility-what if we had put more resources into this effort sooner, instead of acting only when Ebola seemed to threaten us?


In too many places in the world, nurses like Elie Kabululu strive to provide patient care with little to go on except their education and their commitment, bolstered only occasionally by outside aid, usually from nonprofit and charitable organizations. At this time of year, many of us consider donating to worthy causes. Please consider donating to those organizations that provide such aid-our colleagues worldwide desperately need our support.