Ebola outbreak: Are we failing our medical heroes?
Upon returning to the United States from Liberia early last month, physician and anthropologist Paul Farmer described the shallow response in the West to the current Ebola outbreak as a "terrorism of poverty."
Since then, Harvard University -- where Farmer works -- and other organizations have imposed tough travel restrictions from the United States to any West African nation displaying evidence of the disease. These new guidelines make it inconvenient, if not virtually impossible, for clinicians to offer their expertise in confronting a global health crisis. They also impinge upon what many doctors consider to be the crux of their Hippocratic discipleship -- including the surgeon who died Monday morning in Nebraska after contracting Ebola while working in Sierra Leone. At the same time, we're seeing other health care workers from the West, who have voluntarily devoted their skill and attention to Africans dying of Ebola, be stigmatized upon returning to their home countries. We ought to be thanking rather than disparaging those who travel to West Africa to fight this disease.
Ebola has been recognized to be among the rare group of biological agents with "potential to pose severe threat to public health and safety," but we as of yet have not developed appropriate policy and procedures to mitigate the risks of contacting and caring for Ebola victims. The response of the U.S. government to both the epidemic and to volunteers working under the auspices of nongovernmental organizations, such as Doctors Without Borders, has been flat-footed and contradictory between the federal and state authorities. Recently, the governors of New Jersey and New York decreed that any health care workers returning from West Africa be quarantined in isolation for 21 days whether they show symptoms of Ebola.
This decision represents a departure from guidelines by the Centers for Disease Control and Prevention and the "balance test" that usually governs standards for quarantining. The possibility (however faint) that one might become sick and, therefore, infectious trumps one's civil rights and liberties during their period of well-being. Although many believe that this policy was developed to quell the public's anxiety, it has had the effect of stigmatizing responders and burdening them with the blame of bringing this "plague" to our shores. Many in the media and the public have been quick to criticize Kaci Hickox, the nurse New Jersey Gov. Chris Christie quarantined despite her lack of symptoms and having twice tested negative for Ebola. The sympathies of 4 out of 5 people polled are with Christie (and now his counterpart in Maine), not Hickox.
Together, these developments beg the question of what the criteria for good governmental and institutional leadership are -- and what they should be. Shouldn't our institutions remove the obstacles from health care workers wishing to exercise the deep altruistic motivation embedded in their profession in an organized manner (Doctors Without Borders)? Health care workers who volunteer to care for Ebola-stricken patients are rare. If we fail to appreciate them upon their return home, we risk discouraging the future participation of clinicians who come from already resource-strapped organizations.
In tone, at least, the travel bans and quarantine impositions cropping up across the country signal an abdication of humane attention to an alarming global emergency, and are a strategically poor way of addressing it. CDC director Tom Frieden has said it's in America's self-interest to dispatch our most sophisticated medical resources and personnel to West Africa to effectively prevent a pandemic. If he is right, then not only was Dr. Craig Spencer fighting the good fight with Doctors Without Borders, but he also was protecting Americans by trying to help contain the disease where it is most prevalent. Spencer contracted the disease while in West Africa but is now Ebola-free and has returned to his life in New York City.
A commitment to supporting individuals who help with a problem "over there" should go hand-in-hand with the responsibility of our institutions to mitigate the risk by providing appropriate procedures and safety equipment. The return of physicians like Spencer is often met with tremendous anxiety by the public and media; if they fall ill as a result of their exposure, they're ostracized. Some grant that Spencer should be esteemed for his heroic sacrifice, but also point out that this sacrifice is part of the risk he knowingly assumed when he decided to go to Guinea. Yet these same voices express voluble outrage when it's discovered that benefits -- such as health care -- are not being fulfilled for our citizens who have gone to fight wars with archetypal weaponry.
While health care workers themselves want no praise or special treatment when they voluntarily travel to West Africa to fight Ebola -- they know the risks of their sacrifice and would resist the label of "hero" -- we nevertheless owe them a hero's welcome when they return from their altruistic mission. Albert Camus, one of the great moral thinkers of the 20th century, probes the extent of this "paradox of heroism" in his classic work, "The Plague." Camus' stoic protagonist, Dr. Bernard Rieux, decides not to follow his family to safety so that he can stay behind and fight a pestilence from which he might die. However, Rieux interprets his sacrifice to be no sacrifice at all, but rather a decision based on logic and decency, something he sees as a required part of his job. Rieux lives by the consequences of his decision, and so, say some, should health care workers like Spencer. But Camus raises the question: does someone who risks their personal well-being to fight disease deserve heroic commendation, despite what that individual thinks of his or her own actions?
Like Camus' fictional Dr. Rieux, the real Dr. Spencer and his colleagues were fulfilling the most basic tenets of vocational calling as they understand them. For this, we owe them our gratitude. But we owe them something more. Because Ebola is still a disease about which little is known, we ought to give clinicians our nation's arsenal of resources as they do their work on the front lines and medical treatment should they succumb to infection. This should require enacting new American governmental policy that, at least, includes incentives for health care workers to go to West Africa to fight this disease; a formal expression of thanks upon return by state and federal officials; and protections against undue quarantining, with assurances that if quarantining is warranted, it will be implemented as humanely as possible. Taking infected health care workers to the United States or other Western nations, where they can receive the highest level of care, is the best and most effective solution we can offer. Ebola is the type of virulent infection that is multiplying quickly and could dwarf other recent epidemics, but we have the opportunity to drastically reduce the chances of such a thing occurring.
It is on the basis of less dependable logic and evidence that we have sent American troops to foreign lands in the name of defending and spreading democracy. Giving to the world in the name of compassion is the right idea. But perhaps it is an idea better implemented by the lending of our most dedicated medical personnel and supplies than by the more familiar deployment of soldiers and armaments.
Andrew M. Flescher, associate professor of preventive medicine and English at Stony Brook University, is working on his fourth book, "The Organ Shortage Crisis in America." Benjamin J. Luft, a physician, is the Edmund D. Pellegrino professor of medicine at Stony Brook University School of Medicine and medical director of the WTC Health Program at Stony Brook.