Most people in Hawaii didn’t react to images on the Internet and their televisions of white body bags lined up on dirt roads in West Africa and conclude: I have to go there. Now.
Rene Steinhauer did.
As the early waves of an epic health crisis hit Liberia, Sierra Leone and Guinea last summer, the Honolulu native traveled there to see how he could help respond to an outbreak of Ebola — the deadliest virus known to humankind.
Unlike some regional medical professionals, and a few international ones, Steinhauer survived a six-week stint with an international medical team in Liberia. And he has returned to the islands.
When I reached Steinhauer by phone recently, he had just completed a mandatory three-week quarantine on his boat in Kewalo Basin. Upon his return from West Africa, he said representatives from the Hawaii Department of Health met him at Honolulu International Airport and escorted him home to his boat.
For the next 21 days, they called him twice every day, visited him in person several times a week and, given his low-risk status, told him he could shop, but encouraged him to go to stores off-hours, especially in the middle of the night.
What does it take for someone enjoying our mild Hawaiian winter to board a plane and travel across the world to surround himself with dying people at risk to his own life and return to such isolation treatment?
For one, Steinhauer knew he could be helpful. After taking part in disaster responses around the globe, Steinhauer isn’t just a trained emergency medical technician and registered nurse, he has plenty of experience in extreme medical emergencies. He’s worked for weeks at a time immersed in intense trouble spots — including the 2010 earthquake in Haiti and 2013 Typhoon Haiyan in the Philippines — that most people can only handle for brief moments on their TV.
There were brutal consequences of this necessary caution. People who showed up in cardiac arrest couldn’t be saved.
Steinhauer arrived in West Africa in November, after several days of travel and multiple plane changes.
One of the first things he learned was how to put on and take off the personal protective equipment, and how long it took to meticulously do it just right every time. Kevlar suits are often hot, but particularly near the equator, and just wearing the gear is exhausting, especially while trying to save patients in such grim circumstances.
Once dressed, Steinhauer was assigned to work in a hastily constructed Ebola Treatment Unit in the heart of the disaster in Monrovia, the capital of Liberia.
“The unit was built by the army to help provide beds to treat patients who were suffering from Ebola. But the first thing I noticed is that that floors were wooden, which made cleaning very difficult,” Steinhauer said.
To address this, waterproof plastic was placed on top of the floor, making the whole room into a slippery slide when things got wet. “Add that to the perpetually fogging goggles,” he said, and it made taking care of patients extremely difficult.
Beyond that, supplies were very limited. Even the basics, like the intravenous needles, didn’t have the safety caps that are standard in wealthy countries. Steinhuer knew to be careful given that even an accidental needle prick could lead to a very painful death.
“If someone came stumbling up to the treatment unit, staff had to do an assessment — but only after all of the protective gear was put on, which could take up to 45 minutes,” Steinhauer explained.
There were brutal consequences of this necessary caution. People who showed up in cardiac arrest couldn’t be saved. As for people who were too sick to make it to the center, whether because they were too dehydrated or in medical distress, there were no resources, like ambulances, to get them there or treat them where they were.
Even IV fluids, weren’t used routinely, because setting up the IV lines, and changing the bags took too much time to respond to people’s needs.
Given the circumstances, more than half of those infected died. The key elements of the medical response involved getting people treated early and limiting exposure to others.
Despite the horrors, there were some positive indications that might help to protect the people of West Africa from ever enduring such a devastating Ebola outbreak again. Funeral practices have changed. Instead of traditional ceremonial body-washing, the ritual now happens at protected burial sites outside of Ebola treatment units, or in designated safe areas.
Hand washing has also become ubiquitous, even in the most rural of locations. “You couldn’t go anywhere without seeing a bucket with bleach and water outside every store where everyone had to wash their hands before going inside,” noted Steinhauer.
After awareness of Ebola spread, even the smallest fruit stands on remote country roads had a bucket front and center. People understood that it was one way to limit exposure.
Steinhuer knew to be careful given that even an accidental needle prick could lead to a very painful death.
Despite the horrific scenes he witnessed, Steinhauer actually did his stint in West Africa after the health crisis peaked.
And while he was there, despite all of the precautions, he started to develop a high fever, headache, and was whisked away to another treatment unit miles from the one where he had been in charge. Although this was considered one of the best, he found himself running his own IV fluids because personnel were so limited. It turned out that Steinhauer had malaria and typhoid, which is why he was sent home to Hawaii much earlier than expected.
But before he left he tried to notify his superiors about some of the simple changes that could help to make a difference in taking care of the people still infected with the virus. Figuring out who to call was much more difficult that he expected.
“There were too many layers of people that were all there hired to do their job of managing the crisis, but when something needed to be changed, it was impossible to speak to the head at the top and let them know what was happening on the front lines.”
Steinhauer was hired by one group subcontracted by several others, and still doesn’t have any idea who was officially in charge.
In many ways, it is hardly surprising that management and coordination of such a health crisis, especially one that thrived based on the weakness of the health infrastructure in the area, was not well managed.
But Steinhauer points out that going forward, the organization and leadership of responses to such disasters needs to be better and that emergency responders in places like Hawaii improve their own skills and make where they live safer when they help with disaster responses elsewhere.
“We are far away from the federal government, and we need to know how to take care of ourselves, because it could be days to weeks before help might come if we have a true emergency.” Steinhauer says.
That is part of why, he says, firefighters, paramedics, nurses, doctors and others should get experience where their skills are needed so that “you don’t learn your first disaster at home.”