Views & Reviews No Holds Barred

Courage is treating patients with Ebola

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g4987 (Published 04 August 2014) Cite this as: BMJ 2014;349:g4987
  1. Margaret McCartney, general practitioner, Glasgow
  1. margaret@margaretmccartney.com

Sheik Umar Khan, a doctor in Sierra Leone, knew the risks. “I am afraid for my life, I must say, because I cherish my life,” he said. “Health workers are prone to the disease because we are the first port of call for somebody who is sickened by the disease. Even with the full protective clothing you put on, you are at risk.”1

His words came before he contracted Ebola virus and died on 29 July.2 Three nurses he worked with had already died from the disease.3 And the World Health Organization has described this as the worst Ebola outbreak ever, with more than 660 deaths in Guinea, Sierra Leone, and Liberia.4 This highly infective virus is likely to cause death, with no vaccination and little other than supportive treatment available.

Samuel Muhumuza Mutooro, a Ugandan doctor in Liberia, died from Ebola on 1 July after likely transmission from a nurse, Esther Kesselley, who had been infected from a patient.5

Previous outbreaks have also resulted in the deaths of healthcare staff. In 2000 another doctor, Matthew Lukwiya, died in Uganda after an outbreak overwhelmed his hospital with cases. At that point some healthcare staff had already died, but Lukwiya encouraged his staff to try to manage the risk using protective clothing, and he stayed at the front line. Previously, in the hospital, he had once offered himself to a gang of local rebels as a hostage, rather than his nurses.6 An annual lecture is given in his honour. It’s not just deep respect that I have for these doctors, but unending admiration.

Another example is Benjamin Black, an obstetrician gynaecologist who writes a blog for Médecins Sans Frontières from Sierra Leone (http://blogs.msf.org/en/staff/authors/benjamin-black). His first shift, in July of this year, was horrendous not simply for the tough, quick decisions on obstetric emergencies that he had to make, but also for the difficulties in dealing with Ebola. He ends, matter-of-factly, “Balancing the care of obstetric patients against screening and protecting ourselves from Ebola and Lassa will continue to be a challenge, but this is the current context in which we are working.”7

I can understand that some nurses are reportedly striking: I would likely feel just as afraid. Some definitions of heroism or bravery call on notions of concomitant fearlessness. But surely it is the people who feel fear, yet choose to accept risk or hardship, who deserve these descriptions. In Harper Lee’s novel To Kill a Mockingbird, the protagonist Atticus Finch tells his children, “I wanted you to see what real courage is, instead of getting the idea that courage is a man with a gun in his hand. It’s when you know you’re licked before you begin, but you begin anyway and see it through no matter what.”

Notes

Cite this as: BMJ 2014;349:g4987

Footnotes

  • Competing interests: I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: I’m an NHS GP partner, with income partly dependent on QOF points. I’m a part time undergraduate tutor at the University of Glasgow. I’ve written a book and earned from broadcast and written freelance journalism. I’m an unpaid patron of Healthwatch. I make a monthly donation to Keep Our NHS Public. I’m a member of Medact. I’m occasionally paid for time, travel, and accommodation to give talks or have locum fees paid to allow me to give talks but never for any drug or public relations company. I was elected to the national council of the Royal College of General Practitioners in 2013.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

  • Follow Margaret McCartney on Twitter, @mgtmccartney

References

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