Confronting Ebola fears [Commentary]

Monrovia, Liberia — We sat in a waiting room of a health clinic here, talking about our fears. As a midwifery and nursing educator working in Liberia for Jhpiego, a Johns Hopkins University affiliate, I had been asked to help update health workers on the critical skills and interventions essential to managing Ebola cases. I was prepared to talk about the disease — what it is, how to care for patients and how to prevent it from spreading.

But before I could do that, I knew we had to talk about how terrifying the job is.

A nurse sitting across from me spoke candidly about his first experience with an Ebola patient — he didn't want to have any physical contact with the person, he was so terrified.

And he wasn't the only one.

Once he opened up, the other health providers told similar stories. They fear that by caring for Ebola patients they will get the disease. They worry about putting their families at risk. They are depressed. Some don't want to come to work. Others can't eat due to stress; a few actually feel physically ill.

I remember early on in the outbreak I heard that 17 people — health workers and other patients — were exposed to Ebola because a pregnant woman came into a health facility, bleeding and in obvious distress. The team that assessed her suspected the bleeding was due to a pregnancy-related issue and sent her to the maternity ward. The health care providers on the ward were exposed to a significant amount of blood before they realized she might have Ebola.

This is what I tell the health workers sitting around the room: "Your fears are understandable. Your behavior is not unusual when you are faced with so many deaths, especially those of health workers like you."

I cared for children impacted by violence and loss through the Liberian civil war and know that sudden mass death is too much for many people, especially the death of coworkers who are like family. I understand well that in the midst of clinical training — talking about proper hand washing; disinfecting instruments; wearing gloves, masks and other protective gear; proper disposal of contaminated equipment and waste; and other procedures to prevent infection — psychosocial care for the health workers is also vital.

We need to help the helpers, who are courageously saving lives and providing quality care to those who need it most, here in Liberia for Ebola victims, and across the world.

At the end of each training — after the health workers have pledged to talk to each other daily to manage their fears together — I have a slide that asks what they will do in different situations. I ask them to make a commitment to promoting strict adherence to infection prevention measures, working together to strengthen their skills and educating the community on safe and healthy practices.

Here in the United States, this is what you can do: You can continue to advocate for and support programs to scale up the numbers and build the capacity of health workers.

Ebola-affected countries like Liberia are among 83 nations worldwide that the World Health Organization last year reported to have below the minimum ratio of health workers needed to provide basic health services to a population.

The dedicated midwives, nurses and other health professionals with whom Jhpiego has worked in Liberia and across West Africa over the past decade can't afford to lose any more colleagues to fear or disease. The need for strategic investment in frontline health workers, whether they live in Abuja or Zanzibar, cannot be overstated as a key to lasting health for women and families in developing countries.

Marion Subah is the senior technical advisor for Jhpiego in Liberia. She splits her time between Monrovia and her home in Cockeysville, Md. Jhpiego, a global health nonprofit organization based in Baltimore, works in more than 30 countries around the world to prevent the needless deaths of women and their families. Her email is

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