ebola virus

Facing Ebola with courage

When Ebola came calling, Emory was ready, thanks to years of planning and investments.

No doubt about it, Ebola is a scary disease. It brings a deadly fever, constant diarrhea, and heartbeat irregularities. Even patients with the best care are at risk of dying before their bodies are able to develop antibodies to fight the often fatal infection.

So it was no wonder that questions arose last fall when Emory agreed to treat an American medical missionary who had contracted the disease in Liberia. Worries spread that Emory's health care teams would inadvertently expose others in the hospital, or even the general population, to the virulent virus. Headlines and newscasts pounded the fear drum.

Fear is not an easy emotion to counter, but Emory chose to live the values articulated in its 2005-2015 strategic plan, Where Courageous Inquiry Leads. "It's just this," says President James Wagner, "when we were asked to take care of these patients who were infected with Ebola, the questions we had to ask ourselves were, could we care and support these patients, and could we do so safely. We didn't say we could cure them, and we didn't say that we were the only facility with the means to care for them. We approached the opportunity with confidence and humility. That's the way it should be."

In a Washington Post editorial, Emory's Chief Nursing Officer Susan Grant echoed Wagner's conviction. "We can either let our actions be guided by misunderstandings, fear, and self-interest, or we can lead by knowledge, science, and compassion," she wrote. "We can fear, or we can care."

Emory chose to care, and its decision has led our community down paths of research, discovery, and health care. It has drawn on ethics, history, anthropology, environmental studies, and religion to inform a deeper understanding of the responsibility to use our resources for good.

A plan for the decade

Behind Emory's compassion were years of planning and preparation for just such an event. The strategies laid out in Where Courageous Inquiry Leads were drafted almost a decade before the Ebola crisis in West Africa landed at Emory. With initiatives to recruit and retain a distinguished faculty, improve health worldwide, and explore new frontiers of science, the plan laid a strong foundation to amass the expertise needed to take on Ebola.

For example, it allowed the development of a Global Health Institute to improve health worldwide and establishment of the International Association of National Public Health Institutes (IANPHI), which strengthens the capacity of national public health institutions worldwide to handle crises like the Ebola outbreak. The plan nurtured the Institute of Developing Nations (IDN), which unites research and action to help solve complex global development challenges.

Where Courageous Inquiry Leads enabled Emory's Center for Ethics to extend ethical inquiries to health and science. In the health sciences schools, it supported research and vaccine development for infectious diseases from TB and malaria to HIV/AIDS and bacterial meningitis. Strategic investments in Emory College allowed departments from African studies and anthropology to religion and history to develop a depth of expertise that informs the role of cultural differences in epidemics.

"When you look at our medical response to Ebola, you see that it was built on years of investments in our programs in infectious diseases and biosafety, a close relationship with CDC, bringing world-class hires onto our faculty, and attracting grants that together allowed us to be able to say 'yes' to these patients when they needed help," says David Stephens, vice president of research at Woodruff Health Sciences Center, who co-chairs the Emory Ebola Task Force. The task force has brought together experts from across the university to consider biosafety, infection control, preparedness and response, research, education, crisis communication, ethics, and institutional policies on travel.

Practice, practice, practice

In 2002, when the U.S. Centers for Disease Control and Prevention (CDC) contracted with Emory to build a special isolation unit for handling potential infectious diseases that its staff might encounter, Bruce Ribner helped set up the protocols and procedures. Twice a year for the 12 years since, Ribner, medical director of Emory Hospital's Serious Communicable Disease Unit, has run drills with health care teams to prepare for such an emergency outbreak. He was named recently as a TIME magazine person of the year.

Still, "if all we had done was train twice a year for 12 years, we wouldn't have been ready," says Susan Shapiro, associate dean of the Nell Hodgson Woodruff School of Nursing. "Our work began years ago with the adaptation of the Care Transformation Model." One of the goals articulated in Emory Healthcare's strategic plan, this model eschews a typical hierarchic structure for delivering care and instead draws on teams with wide-ranging expertise -- doctors, nurses, social workers, chaplains, pharmacists, ethicists, and others with special expertise.

In addition to five physicians, 21 nurses, and a host of supportive staff who served on the team were spiritual care colleagues, led by George Grant, executive director for spiritual health across Emory Healthcare. "Rather than firefighters on the periphery, we were central to the preparation, sustainment, and engagement of the whole team," Grant says. A cadre of chaplain residents took care of the caregivers 24/7, giving them relief and respite from the inherent stress associated with treating such a dangerous infection. They introduced supportive programming for the staff, patients' families, and when they began to recover, the patients themselves. They also worked outside the unit alongside other staff chaplains to reassure the other 590 patients in the hospital that they were safe. "Emory ministered to these patients both physically and spiritually," Grant says.

Beyond the isolation unit

Ebola did escape containment from the isolation unit at Emory but not in the ways that some had feared. Instead the epidemic has spread throughout the curriculum. A class on Complex Humanitarian Emergencies taught by Elizabeth Downes has connected nursing and public health students via Skype with CDC nurses in Liberia to share the boots-on-the-ground perspective. Ebola has been the subject of grand rounds in medical and public health departments. And faculty and students are exploring associated ethical questions in classes campus-wide, including in the Emory Center for Ethics.

Director Paul Wolpe lists a few of these: What is our responsibility as health care leaders, as a university, and as individuals with relative privilege to respond to local and international crises? How should Emory position itself as a leader of Ebola treatment in the United States? As an institution of higher education, what structures do we need to protect our people -- students, health care staff, and faculty -- who want to go to West Africa to volunteer? "Everyone on the Task Force has taken these questions very seriously," Wolpe says.

The beginning of the spring semester saw the launch of the Emory Ebola Faculty and Community Discussion Forum. The forum brings the strategic theme of "creating community" to the forefront, inviting faculty, students, and community partners to explore multiple and integrated dimensions of the impact of Ebola. It grew from an idea of nursing professor Deborah Bruner -- inspired by her service as co-chair of Emory's Commission on Liberal Arts (CoLA), which proposed cross-university engagement connected to events that impact Emory. On April 9, President Jimmy Carter will join participants to consider Ebola in the context of democracy, human rights, and public health.

Most sessions will include input from representatives in Liberia. "It is wonderful that we have this high-level care available in the United States," Bruner says, "but the real challenges are in Africa. The most important outcome for the forum for me is to be engaged in West Africa."

Her wish aligns with the emphasis placed on global health in Where Courageous Inquiry Leads. For example, thanks to IANPHI connections, the CDC was able to find partners in West Africa who could guide them to priority need areas to mitigate the Ebola crisis there, including transport of blood samples to laboratories. IANPHI has funneled funds from the Bill and Melinda Gates Foundation for Ebola-related education and prevention in Cameroon and Guinea, and they have assisted National Public Health Institutes in Liberia, Guinea, and Sierra Leone and a second ring of neighboring countries to identify urgent needs for the donor community.

Spreading lessons learned

Although the Ebola epidemic was slowing by February in West Africa, its impact on Emory and in turn Emory's global outreach on disease surveillance and control continue. A new grant program administered by IANPHI is creating new national public health institutes in Morocco and the African Union and strengthening institutes in Colombia, Ethiopia, Ghana, Guatemala, and Mozambique. These CDC-like institutions better position countries to prevent disease outbreaks such as Ebola, recognize them early, and institute control measures, says Jeffrey Koplan, vice president for global health at Emory.

In another effort of global outreach, Emory will release a massive open online course on Ebola through Coursera this spring. Moderated by Carlos del Rio and Dabney Evans from the Hubert Department of Global Health, the approximately 12 hours of online content will range from clinical care to cutting-edge research presented by Emory faculty, CDC staff, and other outside experts.

The Center for Ethics also is recruiting a scholar to lead a program in the ethics of global health, thanks to support from the Hilton Foundation. The program's goal is to incorporate ethical thinking and principles into global health studies that spread across the university and out into the world, says Wolpe.

In a CNN editorial in fall 2014, Wolpe pointed to the presence of two global epidemics -- the first, the troubling spread of Ebola virus in poor countries in Africa. But the second, even more dangerous, epidemic, Wolpe argued, is "a spreading lack of compassion. The second epidemic seems harder to contain than the first, but it is every bit as important."

Emory is answering the second epidemic with the compassionate action articulated in Where Courageous Inquiry Leads and demonstrated by our community every day. "The Ebola event allowed the world to see who we are," says Wright Caughman, executive vice president for health affairs. "What I hope the world saw was our commitment to our mission of research, teaching, and patient care and to our values. We strive to improve and live those every day."