Mandatory reading for those afraid of Ebola in the USA

“Oh My God Ebola has made it to the USA!”

If you do nothing else about Ebola, read this specific article, which came my way from the twitter feed of Atul Gawande:

From here in Kathmandu, it’s not always easy to learn what “the man in the street” of the USA is thinking when it comes to the news. My attention perks up when USA media starts talking about bedside conditions in hospitals in Low Income Countries, because that is what I work on every day, and it’s why I am here in Nepal with an NGO.

Living as an expat

I don’t watch TV when here. Oh, I caught the World Cup, on tape delay. But not much else. I get a whiff of the news from Twitter, FaceBook, and the web. But in the interest of full disclosure, I am a follower of dailykos, and though I expect the left-leaning news to be truthful, I know enough to realize that they put their own spin on events.

Ebola and the first rule of public health

But the hysteria in the USA news media about Ebola is difficult to ignore, and it reinforces something known as the first rule of public health: “don’t do or say anything to alarm the general public”

The main thing that keeps these diseases under control is a sense of “we’re all in this together,” and if we adopt an “every man for himself” mentality, we leave the women and children behind when we scramble to whichever symbolic life boat serves as an escape route. Or even worse, we find a scapegoat to kill. It’s simple really. Oh, and wash your hands.

the real problem? problem number one is –

The real problem is the lack of investment in health infrastructure, especially public health infrastructure, in the low income countries of the world. Here in Nepal, cholera is endemic ( meaning that it is always here at a low level) as opposed to epidemic. We can’t get rid of it, but we can control it. How? when a person gets admitted to the hospital, we are careful to clean every flat surface that might get contaminated. it’s only when we stop cleaning things that these diseases get out of control, in a hospital setting. That was true in Africa – reports indicated that when there was diarrhea everywhere, is when the staff refused to go to work. they fixed it by massive cleaning. It’s not rocket science. Oh, and don’t go around kissing any dead persons on the lips.

problem number two is –

I’ve written two books on the subject of day-to-day bedside care in hospitals in Nepal – The Hospital at the End of the World (nonfiction) and The Sacrament of the Goddess (fiction).  Each has given me a sort of cult following among other nurses and doctors (nurses especially) who are thinking of doing similar things. But neither has been a best seller. Now it’s entirely possible that they could be better-written than they are, but I have concluded that one main factor preventing my appearance on Oprah has been the search for a happy ending among the American public. Nobody wants to read another children-are-dying book, and if you mention Sally Struthers who used to appear in all those dismal commercials appealing for money, they are tapped out. There is a deep mindset that there has got to be an ending in which the problems are solved, because that’s the only way we can all get up again in the morning. This is true of every book written by Christian missionaries I think, but also for those written by secular New York Times columnists (Nicholas Kristof comes to mind). Americans never want to read about a problem unless an easy solution is presented right alongside. We live in a fantasy world, existing just beyond our borders, inhabited by Boogie men and evil characters. Or else Albert Schweitzer. The more black-and-white it can be, the better.

The truth is, we need to work on these things every day, methodically and carefully, throughout the world, even when there is no epidemic occurring.

So – wash your hands. and kiss your children good night when you tuck them into bed…..



About Joe Niemczura, RN, MS

These blogs, and my books, and videos are written on the principle that any person embarking on something similar to what I do will gain more preparation than I first had, by reading them. I have fifteen years of USA nursing faculty background. Add to it fifteen more devoted to adult critical care. In Nepal, I started teaching critical care skills in 2011. I figure out what they need to know in a Nepali practice setting. Then I teach it in a culturally appropriate way so that the boots-on-the-ground people will use it. One theme of my work has been collective culture and how it manifests itself in anger. Because this was a problem I incorporated elements of "situational awareness" training from the beginning, in 2011.
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