Sunday, 19 October 2014

Ebola and nursing history

Christine Hallett
Professor and Director of the UK Centre for the History of Nursing and Midwifery and Chair of the UK Association for the History of Nursing


Professor Hallett
On Wednesday 15 October 2014, the Guardian newspaper reported that Will Pooley, the British nurse who had contracted Ebola virus while working in Sierra Leone, was returning to Africa to continue his work. Pooley had been brought back to his home country to be nursed in isolation, and had survived against 70% odds. He said that he could not now ‘sit in the UK and watch the people of Sierra Leone die’. Like any other reader, I was moved by his courage and professional dedication; but as a historian, I was also aware that such astonishing bravery is not a new phenomenon. It is as old as epidemic disease itself, and has most often been shown by nurses.  

During the plagues of Medieval and Early Modern Europe, it was nurses, many of them belonging to religious communities, who put their lives in danger by entering the homes of the sick - places that were shunned and avoided by everyone else.  When bubonic plague – the so-called Black Death – became endemic in the fleas carried on Europe’s black rat population, city-states were subjected to frequent outbreaks. Italy was one of the worst-affected regions. Unhygienic conditions meant that rat populations expanded rapidly and commercial travel ensured that these disease-carrying vectors could move easily from place-to-place. The bacterium, later to be known as Yersinia pestis, mutated – a new, highly virulent airborne strain appeared as pneumonic plague – a form that could be transmitted directly from person to person, with a case-fatality rate of 80%. Populations reacted by isolating sufferers. In cities like Venice and Florence, the sick were moved to isolation hospitals called lazzaretti, where conditions were appalling. ‘Attendants on the sick’ had no professional identity, did not belong to any unions and had no workers’ rights. They were as trapped as their patients. Yet stories of immense courage came out of these places of horror, and some nurses did survive. Like Will Pooley, they used the immunity conferred by such survival to continue their work.  

The Ebola virus
But those who respond with courage and compassion to the plight of populations devastated by epidemic disease are a tiny minority. The response of so-called civilized nations to the Ebola crisis in West Africa has shown that, although technology has advanced, humanity itself has made little progress.  Its ethics remain medieval. Wealthy nations seem to be putting more effort into keeping Ebola beyond their borders than into saving lives in Africa. Like (I suspect) most other British citizens, I must confess to a cowardly relief that my own safety is being given the highest priority. But, as a health professional, I also know that such efforts are misplaced.  Ebola cannot be kept at bay for long unless the epidemic is tackled at its root, in Africa.  If the compassion of Northern nations had been stronger than the false sense of security afforded by their border controls, the epidemic might now be under control and threatening no-one.

And bubonic plague is not the only world pandemic that can provide lessons. At the end of the First World War, the world’s population, weakened by four years of industrial warfare, deprivation and food shortages, experienced one of its worst-ever pandemics: the so-called Spanish influenza. Nurses in military hospitals wrote of how, on Armistice day, 11 November, 1918 - as entire populations were engulfed in the heady atmosphere of victory - they themselves could only watch helplessly as young men who had survived active war-service died horrible deaths, suffocating, their faces turning blue or black, their entire systems shutting-down. The virus killed within days, sometimes within hours, affecting people of all ages and backgrounds – but predominantly young, apparently healthy adults.  Again, it was nurses who were at the forefront of the fight against disease.  Historian, Arlene Keeling has shown how the visiting nurses of cities like New York, Baltimore and Philadelphia went into the homes of the sick and dying, taking canisters of soup to helpless victims and offering the fundamental nursing care that kept bodies alive until immune systems had a chance to react. Many of these nurses, themselves, caught the disease, and some died.

Health workers dressed to handle Ebola victims
For as long as human communities have dominated the earth, they have been at risk of epidemic disease.  However well-prepared we are, pandemics always seem to take us by surprise. Even as we stockpile vaccines against the latest strains of influenza, Ebola is poised to threaten our existence. A mutation of the virus, producing an airborne form like the pneumonic plague or Spanish flu is said by experts to be unlikely, but the longer the organism has to move, uncontrolled, from host to host, the more likely such mutation becomes. Meanwhile, it is nurses such as Will Pooley who will continue to fight a losing battle – one disease-host at a time – because his compassion as a nurse will not allow him to ‘watch the people of Sierra Leone die’.



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