U.S. Could Learn Lessons From Africa's Ebola Response

MELISSA BLOCK, HOST:

We're going to hear now from an American doctor who spent three weeks in Sierra Leone last month treating Ebola patients. He's Dr. Lewis Rubinson, an intensive care physician at the University of Maryland Medical Center. He's also specialized in disaster preparedness.

LEWIS RUBINSON: So I obviously had anxiety, but this is also work that I've been doing for my entire career, both in terms of health care system response as well as had done work on viral hemorrhagic fevers from my background in bio-defense and bio-security. So I thought if not me then who? And clearly they needed additional people to assist.

BLOCK: And how much training did you have before you went to Sierra Leone, about personal protection?

RUBINSON: Personal protection I'd been teaching almost all of my career. But honestly, the personal protection equipment that we use there, which is mostly applying World Health Organization and MSF principles for PPE, were more extensive than anything I had seen before. And when you get there, you're not trying to re-create the wheel. You get there, you meet people who've been doing it successfully, you know that Doctors Without Borders has been responding to Ebola for 20 years and there's been a lot of different thought and implementation and lessons on what personal protective equipment to use. So while I did jump right in, I had excellent buddies teaching me each step of the way. And again, it wasn't like I was unfamiliar with it, but you still need to learn the processes that they want to employ.

BLOCK: Well, as you think about seeing patients again at the University of Maryland Medical Center and think about preparedness around the country, what lessons have you brought back from your experience in Sierra Leone that might apply in this country, which obviously is seeing nothing on the scale of what's going on in West Africa?

RUBINSON: There are nearly 6,000 hospitals in the U.S. It wouldn't have made sense to me that every single facility would have the ability to be honestly prepared. It doesn't mean that there doesn't need to be an appropriate level of the ability to identify patients and provide early treatment and keep staff safe. I think that's really on every institution because we can't control where patients present. But I think out in West Africa, we got very, very good at being 100 percent all of the time. You had to. In the U.S. there's no technological fix for this. We can't buy a widget and just solve it and give it to the hospital and say, you're prepared right now. Most of this is about diligence, it's about discipline and it's about 100 percent adherence. And I think, again, that's very hard to imagine that every facility could do that. Not because they aren't good facilities, it's just there are other priorities that they need to be taking on at the same time. Again, every facility needs to be able to identify the patient, take care of the patient early, keep the staff safe, but I think it's very hard to imagine that every facility would be good at managing a patient throughout their course of the disease, especially if they get very sick, like had happened in Dallas.

BLOCK: That does raise all sorts of questions though. Even in those initial stages, as you say, you can't control where a patient might present. Staff would need to be protected even in those early phases and you're saying it's unreasonable to expect that every facility, every staff worker, would know the protocols and be fully protected. So there do seem to be a lot of gaps there.

RUBINSON: No, I think that's fair. But it's not an all or none, Melissa. You know, if you're focusing on early identification and isolation, most of that's going to come through the emergency department or entries from the community. That's where you can concentrate a lot of your teaching, right? It doesn't need to be every single worker in every single site. So while I think clearly it would be best if we had a strategy to teach everyone and to keep them adherent, I think what we've learned from many other things as there's a tradition of knowledge and there's only so much training you can do. So if you concentrate your training on your high-risk areas - because we're still only talking about eight patients, you know, over just under 1 million hospital beds. Focus on the infrequent but high consequence. That area is mostly going to be your emergency department and other entrances from the community. Do very good teaching for those people and then do regional planning to try and see if there are places that are willing to go beyond that to make sure that all of their processes are in place to be able to care for a patient from day one all the way through to the end of their hospitalization.

BLOCK: Dr. Rubinson, thanks very much for talking with us.

RUBINSON: Sure. Thank you, I appreciate it.

BLOCK: That's Dr. Lewis Rubinson, an intensive care physician at the University of Maryland Medical Center in Baltimore.

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