A Series of Teachable Moments

In recent days, we have learned of the first confirmed case of Ebola in the US.  A Liberian man flew from Liberia in West Africa to Brussels, Belgium, then to Dulles Airport in Virginia and onto Dallas, Texas.  He came to this country to visit his girlfriend, who is also the mother of one of his children; she has four other children, as well.  

Shortly after his arrival, he fell ill and went to the ED at Texas Health Presbyterian in Dallas to be seen.  The appropriate CDC protocols for Ebola were followed as a part of his triage as it relates to questions being asked regarding his travel.  However, the RN failed to communicate that he recently came from Liberia or the provider in the ED failed to pick up on this critical piece of information.  The patient was never admitted and subsequently discharged with antibiotics.  

Two days later, he returned to the same ED, this time via ambulance, and eventually tested positive for Ebola.  In that two-day period, he was exposed to many members of his girlfriend's family, including her five children who went to school after being exposed to the patient.  The authorities are still trying to determine the extent of the exposure including other family members, members of the community, the EMTs and unsuspecting health care providers.


Now for the teachable moments, first the communication in the ED.  I can't imagine how the intake RN and other providers feel at this point in time after not sharing or picking up on a critical piece of information regarding this patient.  The second teachable moment is with the US government allowing unrestricted travel to and from a hot zone like Liberia and other hot zones for Ebola in west Africa.  Third would be the US airlines that have not ceased travel into and out of these hot zones.  I am not sure what their reasoning is, but they have the potential of putting a lot of people in harm's way by not following the lead of other international carriers who have suspended such flights.  The reason that the US government has given for not restricting travel is the criticality of commerce to and from that region.  Really?  

I would feel a whole lot better if public health had more experience in managing Ebola exposures and preparation for ongoing exposures, which they will acquire over time but more time is needed.  With unrestricted travel to the US, there will be a burden that will eventually impact public health and health care in caring for and protecting the general public from exposure. There needs to be greater protection of Americans on the part of those who can do something about keeping us safe going forward.  There are  quite a few lessons that can be learned from this exposure; hopefully, common sense will prevail and changes are imminent.