Why would you do that?

By Rene Steinhauer | 10/13/2014

A nurse prepares to fight Ebola in Liberia.

“Why would you do that?” It’s a question family and friends ask me on occasion when I go overseas to work. However, I’ve never been asked this question with so much concern as I have been this past week.
 
Rene SteinhauerI’ve been a paramedic since 1992, a registered nurse since 2001. My ambulance work was a natural segue to becoming an ER nurse immediately upon graduating from nursing school. In 1995, I found myself working as a paramedic in Saudi Arabia, where I learned and practiced skills not normally used by nurses in the United States. Four years later, I worked in a refugee camp in Rwanda. Since then, my career has taken me to all seven continents.
 
I worked as a flight medic in the U.S. Air Force. Then I became a flight nurse in Antarctica and the United States. I have worked as a front-line combat medic with private security teams in Iraq and delivered babies by candlelight in a South American jungle. I managed disaster teams following the Asian tsunami, Hurricane Katrina, the Haiti earthquake, and Typhoon Yolanda in the Philippines. To deliver health care, I have endured extremes in both cold and heat and hiked scores of kilometers into jungles and mountains. I have been shot at, mortared, and rocketed in my sleep. Working in some of the most inhospitable places on earth, I have had a career filled with excitement, adventure, danger, and a deep sense of satisfaction—knowing that I have been able to help some of the most underserved populations on the planet.
 
About a week ago, I returned from an assignment as a flight nurse with the United Nations in Mali, West Africa. I am on vacation and scheduled to go back in early November. But it appears my return to West Africa may be for a completely different assignment. A few companies have approached me about working as a chief nurse in an Ebola treatment center (ETC) in Liberia. I have completed the first round of interviews and been shortlisted for the job. [Editor’s note: Since posting of this article, Rene Steinhauer has been appointed by AmeriCares as chief nurse in an Ebola treatment center in Liberia.] After contracts are signed by governmental agencies and companies involved, I will be officially hired and deployed to Liberia. That deployment may be as early as 20 October. I’ve worked seven days a week for the last three months and was really looking forward to a long vacation, but it appears it will be cut short. There is a job to do, and I have been asked to do it.
 
Rene Steinhauer with patientThe United States is permeated by fear of an enemy, an enemy that appears to be more deadly than al-Qaida. I have been face to face with al-Qaida and soon will be face to face with Ebola.
 
There are some similarities between the two. Both are deadly, and both are willing to attack the easiest target available. Women and children are not spared by either of these enemies. But there are significant differences. When the Ebola virus attacks, it scores a death rate somewhere between 50 and 90 percent. If al-Qaida were that efficient, it would be taking over the streets of San Francisco.
 
An impression exists that Ebola is an enemy that cannot be seen. Nothing is further from the truth. It seems to fire the most deadly “bullets,” but these bullets cannot penetrate the personal protective equipment (PPE) caregivers wear. In Iraq, it was not uncommon to be attacked while sleeping in bed. Ebola is not that effective. It is not going to walk into the room at night and drop a hand grenade. Just driving a car in Iraq could set off an IED and kill everyone in the vehicle without warning. This is not true of Ebola.
 
The virus has only one method of attack. Stopping it requires proper equipment and people who use that equipment correctly. In the presence of the Ebola virus, feeling an itch on your face and touching it can be a death sentence, but each health care worker in a Liberian ETC has a choice to touch or not touch. We have a choice to utilize proper safety gear correctly or carelessly create an opening in our bulletproof armor.
 
To be attacked in Iraq, I did not have to leave a door open to the enemy. That enemy was capable of breaking down my door. Ebola cannot open a door; we have to open the door for the virus. And if we want to stop the outbreak of the virus, we must close the door.
 
Despite the logic of what I know to be true, I cannot deny suffering great trepidation when thinking about this coming assignment. If I do everything perfectly, there is no chance of my becoming infected. But I know I am not perfect. A simple mistake can be a death sentence. As chief nurse, I will be responsible for the lives of every person working in the ETC. While most nurse managers are not confronted by the very real possibility that a nurse working in their department will die on the job, for me it is a real concern. Not only do I have to do my job perfectly, but I also need to ensure that each team member does his or her job perfectly. If not, someone is likely to die.
 
A few years ago, I worked as a disaster manager in Haiti during the earthquake. It was the toughest assignment of my life. My decisions directly affected the life and death of others, and many died. It nearly destroyed me. As I look to the job in Liberia, I worry that this assignment may be even more difficult than the one in Haiti. Triage will have to occur. Many will die in my ETC. Living through this slow death with families will be heart-wrenching. Ensuring that the health care team is providing quality care while maintaining the dignity of patients and their families will be challenging, because the more we focus on providing dignity, the more we risk staff infection.
 
But nursing is more than how many drugs and IVs we place. It is about how we care for the individual. It will be my responsibility to help the health care team balance care and safety. To deploy to Liberia without fear is like scuba diving with an empty tank. In a short time, you will not be breathing.
 
When I tell family and friends I am going to Liberia, the question is always the same: Why would you do that? I could try to explain that my background and experience make me uniquely suited to working in dangerous and stressful environments. I could explain that helping those with the greatest need has always been my first priority. But they would never understand. What they do understand is, there is no way they would take such a risk. So my answer is short and simple: “If not me, then who? Somebody has to do it.”
 
Rene Steinhauer, RN, EMT-P, is a nurse and paramedic who has worked in all corners of the world. An expert in disaster management, he is author of the book Saving Jimani; Life and Death in the Haiti Earthquake. Steinhauer can be contacted via his webpage, www.renesteinhauer.com
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