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Surgery in the time of Ebola: A conversation

In the first chapter of their book, Operation Ebola, Stanford surgeon Sherry Wren, MD, and her Johns Hopkins colleague Adam Kushner, MD, MPH, write something startling: There are no universal guidelines on how to do surgical operations on patients in the middle of a health crisis like Ebola. "This absence of formal guidelines, which still exists at the time of writing this book, demonstrates what we believe is the lack of the public health community's understanding of the role surgical care plays in any crisis," note the authors.

In the middle of infectious disease outbreaks like Ebola, what many of us may not consider is that surgical needs continue. People are in car accidents and in need of care. Patients still suffer from other injuries such as obstructed labor or perforated stomach ulcers. Yet in the time of Ebola in West Africa, surgeries often stopped as health-care workers feared they too would contract the deadly illness. And for those who did carry on, the reality was stark: Nine hundred health-care workers were infected with Ebola during the latest crisis in 2016 and more than 500 died.

As Wren told me in this 1:2:1 podcast, she and her co-editor Kushner set out to make their point that changes are needed by telling stories of health-care workers in the field during the Ebola crisis. They hope to stir appropriate authorities in the World Health Organization or U.S. Centers for Disease Control and Prevention to step forward and promulgate universal guidelines for the protection of medical professionals.

"The EVD (Ebola Virus Disease) outbreak in West Africa seems to have abated and a global crisis averted, for now, " they write. "We believe that now is the time to discuss and plan for what happens when the next infectious disease outbreak confronts us. Are we not morally obligated to provide surgical care to those in need but also to ensure that health-care workers throughout the world have access to PPE (personal protective equipment) to minimize their risk of contracting the disease from the patients they are treating?"

The book's chapters presents stories from best-of-class locations like the Nebraska Biocontainment Unit that received an ill physician from Liberia and from lower-resourced places like the maternity ward in Sierra Leone operated by Doctors Without Borders that had to close after being overwhelmed by cases and after officials believed they could no longer guarantee obstetrical care in the middle of the crisis. In another chapter, health-care workers report that in the Princess Christian Maternity Hospital in Sierra Leone, EVD units "did not routinely have anesthesia or surgical staff present. Therefore, EVD-suspected patients who needed surgery suffered delays in their preoperative workup and management."

Wren and Kushner write they're hopeful that rapid testing and the promise of a vaccine maybe someday eradicate Ebola or lessen its threat. Yet, emerging infectious disease outbreaks aren't within the control of human beings. They'll continue to occur, and the public health community must, in the words of the authors, "recognize the needs of surgical patients, something that continues to be woefully lacking in international discussions about emerging infectious disease outbreaks."

Previously: Sherry Wren, MD: a surgeon's road homeHow to keep safe while operating on Ebola patients and All hands on deck: Doctor answers call to work on largest Ebola epidemic in history
Photo by Max Aguilera-Hellweg

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