October 9, 2014 / 9:20 PM / 3 years ago

Doctors face 'collateral damage' from Ebola epidemic

NEW YORK (Reuters Health) - “Ebola collateral damage” is the term used by Dr. Thaim Kamara, chief of surgery at Connaught Hospital in Sierra Leone’s capital Freetown, to describe the disruption of routine patient care caused by the epidemic.

“Since the outbreak took its first victim in our hospital, all (non-emergency) operations and routine clinics were discontinued,” Kamara told Reuters Health by email, with emergency care disrupted, too.

Symptoms of Ebola such as fever, diarrhea, vomiting and abdominal pain occur in a range of other conditions requiring emergency surgery.

At his hospital, patients who show up at the emergency room with such symptoms risk being sent to an Ebola isolation unit, with surgery prohibited until it is clear they do not have Ebola. In the meantime, they can die from their illness, Kamara said.

Last week, anesthetists in Sierra Leone refused to treat a patient needing surgery for an abdominal infection because the patient had been vomiting and running a fever.

“This is the problem we face now. If a patient has any of the symptoms regarded as part of the case definition for Ebola, he or she may be sent to the isolation unit and kept there until the result of their test comes back,” Kamara said.

Kamara also told of a man who was admitted to one of the surgical wards with gangrene and was scheduled for an amputation. Despite no telltale signs of Ebola, the surgery was canceled and the patient placed in quarantine for 21 days.

The Ebola virus causes hemorrhagic fever and is spread through direct contact with body fluids from an infected person. The World Health Organization says Ebola had killed nearly 3,900 people as of Oct. 5 in West Africa since March in the largest outbreak of the disease on record.

Fanning fears the epidemic may spread beyond West Africa, cases are already being seen on other continents.

A NEW PROTOCOL

The American College of Surgeons this week posted a link on its website (bit.ly/1tC85Xf) to a protocol describing precautions operating room teams should take if a patient with suspected or confirmed Ebola requires surgery.

It was conceived by Dr. Sherry Wren, chief of surgery at the Palo Alto VA Hospital and a Stanford University professor of surgery. Dr. Adam Kushner, a founder and director of the humanitarian group Surgeons OverSeas, helped devise the protocol.

Among other things, it calls for all operating room personnel to use special high-tech surgical gowns, leg coverings with a full plastic film coating over the fabric - not just the foot area - full face shields, masks, double gloves and surgical hoods.

“I think that the guidelines should be followed and that all operating room personnel should have the maximum personal protective equipment,” Wren said by email.

In Sierra Leone, this equipment is not available. “We use normal fabric gowns, goggles, face masks, caps, plastic aprons, and rubber boots to protect ourselves when we are operating on any patient,” Kamara said.

Wren attributes the lack of protective equipment in West Africa to factors including supply logistics, hoarding to increase prices, diversion to black markets and insufficient funds.

Kushner, who teaches at the Johns Hopkins Bloomberg School of Public Health, said, “Aside from just the technical aspects there are many emotional and ethical issues. If such gear is not available, is it even appropriate to operate on these patients?”

Dr. Arthur Caplan, director of the Division of Medical Ethics at New York University’s Langone Medical Center, said he can understand medical personnel saying, “I‘m afraid to operate,” and each case must be weighed individually.

“For example, in the case of a woman needing a cesarean section, two lives are at stake,” Caplan said in a telephone interview. “Would I take more risk in that case? There is no simple rule.”

Kamara says his operating room staff needs training in infection control and personal protective equipment as described in the protocol drafted by Wren and Kushner.

“Our country needs help to combat Ebola for the obvious havoc it is wreaking on the people as well as the damage it is causing on surgical practice,” Kamara said. “This is not obvious to policy makers and is causing unnecessary and preventable deaths.”

Editing by Nancy Lapid, Will Dunham and Tom Brown

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