You knew there was going to be a post on this.
Today I was trying to read the news. I say trying because it was filled with pages of exclusive interviews, stories about ebola victims’ dogs, CDC announcements, and support messages and blame for the victims in Dallas.
So here it is, the cold hard truth.
America is not ready for an ebola outbreak. It will never be ready. The reason is simple; it doesn’t have a functioning healthcare system. Hospitals in the US are not a system, they are private enterprises who all happen to follow the same rules in order to get paid by either government safety net programs or private insurance, and in the worst case, by private payers.
Like all private enterprises the most important part of US hospitals is making money. It should come as no surprise that businesses like to cut costs and take every opportunity to do it. The morality of pay for service healthcare is inconsequential to this post.
When you look at US hospitals, they operate at maximum capacity much of the time. There is no “reserve” or as we like to say in healthcare, “surge” capacity. Employees of all types are given the very minimum to keep the business functioning. Things that do not fit into the minimum requirements to function, like high level personal protective equipment, staff training for rare events like ebola, and all manner of employee safety not mandated are simply not done in order to reduce costs.
So when somebody shows up in an emergency room with flu-like symptoms and the folks there are operating beyond capacity trying to make sure patients who are not critically ill don’t have to wait more than a few minutes to see a doctor because they are in the ED because of the utter failure of the primary care practitioners, all the while dealing with heart attacks, strokes, early antibiotic guidelines, and maybe an actual acute emergency, the chances that anyone actually recognizes an ebola case is pretty close to zero. Not just in Dallas, but everywhere.
So how does the CDC figure in to all of this? Well, for one, they put out a really great website and of course in classic Office Space (yea…did you get a copy of that memo?) form, put out all kinds of instructions on what providers should do. They didn’t have a national response team in place in “Outbreak” like fashion to immediately respond and whisk those infected away to the nearest of the 4 isolation facilities in the continental US with a population of 320 million people and the world’s second largest economy. But today that announced it might be a good idea to do that. I often wonder where they get these quacks. The talking head experts over at the CDC cannot stop a resurgent anti-vaccination movement and months into an international epidemic decided maybe it might be good in the future to have people ready to go. Just in Case…Clearly they didn’t get somebody from the fire service to work there.
So everyone from the hospital to the government has latched on to the effective defense of rape culture and blames the victim. “She” didn’t follow the protocol!
Now for those of you who have never spent any time in the real world of emergency response, you can’t just write up a policy, email a video or a few pictures to people, and expect that people will magically be imparted with the psychomotor skills and experience required to actually follow those protocols. Moreover, you don’t even know if they actually work! In my career I have been involved in mitigating emergencies in natural disasters, mass casualty incidents, internal hospital disasters, and even war. There is an often quoted phrase from the military “no plan ever survives first contact with the enemy.” In every instance I have been a part of or even heard of, when the plan was made up by inexperienced people, often by virtue of their title alone, the plan fell apart within minutes and chaos was the result. Only by the efforts of outstanding individuals was any level of success, and certainly not optimal success achieved.
As I discussed on many a Facebook page and private message this week, you need to train. You need to train until the psychomotor skills are automatic and you don’t have to think about them. I don’t live in Fantasyland, I know all of this takes time and costs money. A lot of money.
Even if both of the healthcare workers die and wrongful death suits are won or settled in the millions of dollars by the families of all 3 US victims, it will still be cheaper than equipping and training for events such as these. Equipment and training for far more common scenarios is not in place. Accrediting agencies don’t make realistic demands that it is. Just a bit of smoke and mirrors and a few check boxes on paper.
In hindsight, some of the Dallas hospital staff claim the patient should have been transferred. Which I was advocating for days before their brilliant minds thought of it. (Because if you haven’t heard I am a less capable foreign doctor by virtue of my medical university not being in the USA which doesn’t play into the ethnocentric US healthcare propaganda campaign.) But let’s just take a minute and look at the forest from the trees?
Do we know of anyplace else where the healthcare system was not prepared for an ebola outbreak but probably talked about it a lot? Do we know of any other place where providers did not receive proper training or top quality equipment to deal with ebola patients? Do we know of any other place where healthcare workers were killed after being infected taking care of infected patients?
Yes we do. In Africa.
That is how awesome the US healthcare system is. It suffers from the exact same problems as the third world. The reason is slightly different. In the third world, they don’t actually have the money. In the US, in order to keep profits and stock values high, hospital administrators don’t want to spend the money.
The result is the same; acceptable losses and an insincere apology. Oh, and somebody might resign or be investigated if blaming the victims doesn’t placate the masses.
But there is another important similarity between West Africa and the USA. In fact, this similarity is what actually inspired me to write this piece; panic mongering and denial. It seems there are no shortage of “doctors” going on various TV networks using their credentials to give credit to sensational conspiracy and doomsday scenarios. Somebody should probably make an ethics complaint against these idiots or local prosecutors should bring them up on charges for inducing panic.
There is no shortage of non-medical idiots all over the news and internet giving their completely uninformed opinions about airborne transmission conspiracy theories and even some homeopathic remedies.
Just like in Africa! Imagine that.
The long and short of it is simple. The Ebola monster is not coming to get anyone in America. Even if it does get a few people, in the grand scheme, they are acceptable losses. Perhaps not to their friends and family, but to policy makers, hospital administrators, and regulatory bodies it is cheaper and easier to beg forgiveness than actually prepare for things like this. You should expect to see it again or a few more times before this particular epidemic is over.
It is convenient though, look at how many rights and morals were sacrificed when “the terrorists” were coming. Now it’s Ebola! Forget all the pressing problems and worry that the end is coming yet again! (I must beg your forgiveness for my apparent lack of concern, but I have survived quite a few world endings and I am sure I will come through this one ok too.)
I would offer some advice I once got when getting a medical examination in my younger days. While filling out the health history form, I mentioned to the nurse I did not know what a lot of the things they were asking were. She smiled at me and said “then you don’t have it.”
In that spirit and wisdom, if you don’t know that much about ebola, if you don’t see people walking around in hazardous material suits with self-contained breathing apparatus telling everyone it is going to be ok, and if you don’t hear reports of the President, Vice President, or important government officials hiding out in an undisclosed location, (which I strongly suspect to be an Argentinian brothel or some such) then you don’t have to worry about ebola. Turn the channel, surf another website.
QUIT POSTING ABOUT IT ON FACEBOOK AND MAKING THE REST OF THE WORLD DEAL WITH YOUR STUPIDITY!
If you can’t do that, at least go to church and SILENTLY pray about it.
For future reference, worry less about doomsday anyway. If/When it comes, you won’t be able to do anything about it anyway. Although if you need financial security please purchase my own personal and exclusive end of the world insurance policy. In the event of the end of the world, my company will compensate you the fair market value of all of your worldly possessions. Premiums are only $100 a month. Discrepancies can be settled by arbitration in any post end of the world established court of law.