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Nursing and the Harvard-LSHTM Independent Panel on the Global Response to Ebola

By Elizabeth Glaser Moderator Emeritus | 24 Nov, 2015

This is letter that I intend to send to The Lancet:

On Sunday, the Harvard-LSHTM Independent Panel on the Global Response to Ebola issued a report in The Lancet suggesting reforms to avoid repetition of a similar disaster in the future. The “interdisciplinary” panel did not see fit to include any members with a background in nursing despite the vital role of our profession in the global response, our knowledge of operational aspects of public health, and the ongoing sacrifices those in nursing have made at the front lines of the outbreak.

Respectfully, who speaks now for the nurses in Sierra Leone, Liberia, Guinea, the United States, Europe, and the African Union who cared for those with Ebola? Who speaks for the nurses whose lives were sometimes placed at risk during the outbreak through the hubris of politicians, administrators, and, yes, physicians?

When the policy makers, researchers, and high level clinicians are gone, there will still be nurses serving in remote posts in Central and West Africa, placing their lives at risk for Ebola, HIV, and Tuberculosis for want of masks, goggles, gloves, bleach, or, simply, running water.

If we wish to avoid a scenario similar to the current West African Ebola outbreak, there must be a radical shift in how we approach global health policy. The old, failed hierarchies must be abolished and new voices must enter the discussion. There is no longer any excuse which can justify the omission of our profession. Therefore, to move towards enduring change, members from nursing, the largest single professional health care cadre on the planet, must be included from the very beginning in all policy design and reforms.

Elizabeth

Attached resource:

Replies

 

Janine Bezuidenhoudt Replied at 2:40 AM, 24 Nov 2015

Thank you for sharing this Elizabeth. I agree with you. We always overlook the nurses, and they are the ones who are actively taking care of the patients, and being most hands-on when caring for a patient. Thank you for speaking up, and advocating for nurses. We need to start investing more in our nursing profession.

Kind Regards

Janine

Deborah McSmith Replied at 6:41 AM, 24 Nov 2015

Brava!

*Deborah McSmith, MPH*
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*"One of the simplest paths to deep change is for the less powerful to
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Ralueke Ekezie Replied at 9:29 AM, 24 Nov 2015

I think we really need to work on who speaks for and represent us in general, I mean internationally and otherwise. Our ICN is recognized by WHO but in most cases we only follow their footsteps in dictating what and where or to what extent we get involved, rather than our body showing them the way. Individual advocates will try but it will not be enough. I am not trying to criticise but to Encourage the nursing bodies to do more and most importantly unify in order to dictate for those who work with us in our fields. Until then, they will only see us as followers and will hardly call us to the table.
RegardsRalueke Ekezie RN, RONCEOBlue Torch Home Care LimitedSkype:

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Elizabeth Glaser Moderator Emeritus Replied at 12:13 PM, 24 Nov 2015

Ralueke,
You are correct, we have to make them care. When we are treated as a passive group , it does not help bring about change in health systems. So let's try to act. We have our numbers if nothing else.

If you agree with the letter then please cut and past the content, add you own name and contact information, and then email it to the following people:
Corresponding author:
Dr Suerie Moon


Editor: Richard Horton


Deputy Editor: Astrid James

Elizabeth Glaser Moderator Emeritus Replied at 12:35 PM, 24 Nov 2015

Here is revised template using the emails for ( Dr Suerie Moon); (Dr Peter Piot); ( Dr Richard Horton); (Dr Astrid James) :

Dear Dr. Moon, Dr. Piot, Dr. Horton, and Dr. James,

On Sunday, the Harvard-LSHTM Independent Panel on the Global Response to Ebola issued a report in The Lancet suggesting reforms to avoid repetition of a similar disaster in the future. From all appearances, the “interdisciplinary” panel did not see fit to include any members with a background in nursing or midwifery despite our vital role in the global response, our knowledge of operational aspects of public health, and the ongoing sacrifices those in nursing have made at the front lines of the outbreak.

Respectfully, who speaks now for the nurses in Sierra Leone, Liberia, Guinea, the United States, Europe, and the African Union who cared for those with Ebola? Who speaks for the nurses and midwives whose lives were sometimes placed at risk through the hubris of politicians, administrators, and, yes, physicians that underestimated the extent of the outbreak?

When the policy makers, researchers, and high level clinicians are gone, there will still be nurses serving in remote posts in Central and West Africa, placing their lives at risk for Ebola, HIV, and Tuberculosis for want of masks, goggles, gloves, bleach, or, simply, running water.

If we wish to avoid a scenario similar to the current West African Ebola outbreak, there must be a radical shift in how we approach global health policy. The old, failed hierarchies must be abolished and new voices must enter the discussion. There is no longer any excuse which can justify the omission of our profession. Therefore, to move towards enduring change, expert members from nursing, the largest single professional health care cadre on the planet, must be included from the very beginning in all policy design and reforms.


Sincerely,

Margaret Chirgwin Replied at 2:24 PM, 24 Nov 2015

Elizabeth I would just like to suggest you change the following paragraph:

When the policy makers, researchers, and high level clinicians are gone, there will still be nurses serving in remote posts in Central and West Africa, placing their lives at risk for Ebola, HIV, and Tuberculosis for want of masks, goggles, gloves, bleach, or, simply, running water.

From a public health perspective this statement really is not correct. Neither HIV nor TB really has much to do with masks, goggles, bleach or simply running water. In most developing countries just about everyone is exposed to TB and in fact a very large proportion will have latent TB that may or may not activate during their lifetime. Active TB is a result of a individual's immune system for one reason or another not keeping the TB at bay. It is a disease of poverty and overcrowding and health workers are not at higher risk in this environment than others. HIV is a known risk to health workers because of their possibility of exposure to blood and gloves probably would reduce this risk but not masks, gloves, bleach or simply running water.

I do agree with the need to have nurses involved in policy development but I think it is not actually particularly helpful having a swipe at the medical hierarchy. In my experience in West Africa nurses mostly work in hospitals - they do not man remote health posts - these usually have Community Health Officers or medical assistant if they are lucky and who are trained differently from nurses and in fact CHOs and MAs are probably the groups who need to be involved more than nurses. The biggest problem in these countries is a lack of money, quality drugs, investigations and all types of health worker. I actually found at Kerry Town, and I suspect it would have been the same elsewhere, that the rich world/first world view of what a nurse should/could do was putting significant risk into the system as what a nurse in England is trained to do is not what a nurse in Sierra Leone was trained to do. Yes this is the product of the medical hierarchy but as nursing roles in hospitals need the skills the nurses are trained to undertake I question the need to train them differently. I do not want an ideological debate here but there is a drain of all types of health workers - nurses and doctors mainly - to the first world and so many of these country are beginning to choose to train lower types of health professionals because we are less likely to steal them. This battle between nurses and doctors is not helpful and is not needed in the developing world - they have enough problems without this. We in England are now training "Health Care Assistants" because the roles that used to be done in England by State Enrolled Nurses still need to be done but nurses are now too highly qualified university graduates to do the jobs. These HCAs are not as well trained as the SENs - I would far rather have the SENs back but for some reason the nursing profession wants to do what doctors do and not these jobs that were previously done by nurses. I could go on but really I think you need to question why you feel that the medical hierarchy is the problem here. Actually hierarchical teams work quite well!

Margaret

Elizabeth Glaser Moderator Emeritus Replied at 11:46 PM, 24 Nov 2015

Dear Margaret,
There are more risks to health care workers than Ebola. Nurses are at risk for HIV and Hep B when they do not have personal protection, especially when assisting a woman in child birth. Nurses and patients are at risk for disease when there is no method to efficiently clean a health post. They are at risk for respiratory infection when there is no way to mask a patient at high risk for TB. If we cannot assure that staff are protected from common occupational exposures, how can we be assured that they will be safe from exposure to Ebola or other emerging infectious disease?

Since your other points are specifically relevant to nursing beyond Ebola, I would encourage you to post your thoughts in the Nursing and Midwifery community.

Elizabeth

David Cawthorpe Replied at 1:02 PM, 1 Dec 2015

Rosling discusses how Ebola spreads
https://www.youtube.com/watch?v=KkMiQmjRAoM

How to beat it!
http://www.bbc.com/news/magazine-32017211

We have only posted a list of resorcses and information.
http://www.internationalgme.org/NewsAndEvents/IGME_News.htm

Abubakar Danlami Balarabe Replied at 2:52 PM, 5 Dec 2015

Dear Margaret Chirgwin, I read your response and some of the issues you raised, however, I disagree with you that nurses only work in hospitals in the developing countries. I worked in Rwanda where you find nurses working in most of the primary health care centers in the remote areas. It may interest you to know that, the maternal and child mortality rate is coming down in that country. This is due to early referral on identifying ominous signs during pregnancy or at the onset of labour by the nurse/midwife.
Currently, I am working in northern Nigeria where we have the CHOs you are referring to, and even  in the southern part of the country you find nurses in primary health care centers. However, these nurses/midwives are compelled to work under these CHOs which you admitted are less qualified. This means they can overrule the decision of the nurse/midwife to refer a patient appropriately, and is a source of serious conflict which adversely affect the patients. In my view it is the CHOs that are trying to do what the doctors are doing.In contrast, northern Nigeria has fewer nurses/midwives,thus, the primary health care centers are mainly managed by the CHOs. As such, the bulk of infant and maternal mortality in Nigeria is in the north. It may interest you to know that, due to these anomalies Nigeria account for 13% of global maternal and infant mortality!(www.thisdaylive.com). It is in view of this the government now introduced community midwifery.
As regard to response to epidemics, those mobilized are mainly doctors and nurses as the CHOs have no training for such events, however, they are often used for non clinical activities. Their training is based on a "standing order" to treat minor ailments and refer. I don't know whether you have references apart from immunization and other preventive activities where they are mobilized to care for victims of epidemic/disaster camps.
Lastly, I do agree with some of the points you mentioned.
Best wishes.
Abubakar Danlami Balarabe.

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Fekadu Aga Replied at 1:22 AM, 11 Dec 2015

Thank you Elizabeth for bringing up this important issue. It is clear that nurses and midwives are the back bone for the healthcare system. The ebola crisis has demonstrated this reality. Thus, any health system reform effort adamant to acknowledge this fact is ready to fail again. There is a need for radical change in the way we think about healthcare system. The old hierarchical hegemonic mind-set need to be replaced by shared leadership thinking that facilitates team spirit and collaboration. Nurse and midwives are the majority in the healthcare system. So is enormous their contribution to the population health outcome. It is day dreaming to think of bringing real change without the meaningful participation of the majority.

Fekadu Aga (from Ethiopia

Elizabeth Glaser Moderator Emeritus Replied at 4:29 AM, 11 Dec 2015

Dear Fekadu,
We agree. In that spirit I reached out to other nursing leaders and we were able to get a number of colleagues , including nursing leaders from Liberia, to sign on to the letter. We even had a few physicians contact us to ask if they could sign on , which was lovely. I submitted it as correspondence to The Lancet and am hopeful that they will give it a fair consideration.
The importance of nursing has been highlighted during the Ebola epidemic. I hope from this tragedy some good can come and some justice for the women and men that work so hard yet are given so little voice.

Elizabeth
.

Judy Phillips Replied at 6:51 AM, 11 Dec 2015

You are an angel! Thank you Elizabeth!
Judy
Judy Phillips, DNP, FNP-BC, AOCN

Elizabeth Glaser Moderator Emeritus Replied at 10:19 AM, 11 Dec 2015

Judy,
I am no angel.
This initiative has gotten momentum because everyone has responded in kind,
It is a group effort and you are part of what has made it work.

Elizabeth

This Community is Archived.

While this community is no longer active, we invite you to review and recommend past posts and resources. Membership for this community is closed, but we hope you'll join us in one of the many other communities on GHDonline.

Moderators of Ebola Response and GHDonline staff