In the summer of 2014, as I was preparing to fly to West Africa as an emergency responder to the largest Ebola outbreak in history, I sat in my room consumed with fear. I felt like a kid again, standing on the high dive for the very first time, about to plunge into the pool far below.
And while that fear dissipated somewhat over the coming weeks as I worked with Liberian and international colleagues to launch a new Ebola treatment center in Bong County, Liberia, it never went away entirely. My experiences in Liberia taught me that courage is not the absence of fear — it is doing what you know you must even when you are terrified.
Hundreds of thousands of health workers across the United States and the world are learning that same lesson, or will quite soon.
Courage alone won’t be enough. You will also need to take care of yourselves — and each other — to make it through the Covid-19 pandemic. First and foremost, get enough rest. Second, remember to eat. Exhaustion and hunger magnify stress.
Taking care of yourself also means that you must first protect your own health when you are tending to your patients. This means taking those extra few minutes, no matter the urgency of the situation, to be certain that you put on your protective equipment correctly, and that your team members have done the same. Be even more careful when you remove the equipment so you don’t contaminate yourself or others in the process.
You are a precious and limited resource, and you must act the part.
An unexpected lesson I learned from fighting Ebola was that as stressful as it was working in a treatment center in Liberia, coming home was far worse. In Liberia I had the camaraderie of my fellow health workers, all of us working together to defeat the virus. At work, you will be a hero. Perhaps Time magazine will someday recognize you, like it did the Ebola fighters, as its Person of the Year.
But when you come home, you will be a vector, a pariah. Your friends and family may shun you. You may even begin internalizing this sentiment, thinking of yourself as dirty or unclean, feeling guilty about exposing your loved ones to the possibility of being infected with the novel coronavirus. Never mind the data about asymptomatic transmission being rare — the amygdala doesn’t understand statistics.
If you’ve never had to provide health care in a resource-limited setting, you may find yourself learning what it means to ration care. You may be surprised to learn that rationing is rarely very rational. Your hospital or department of health or professional society may have developed guidelines, yet you will find them difficult to apply to the unique circumstances of the patient in front of you. It will always be harder to take someone off a ventilator than put someone on one, regardless of who needs it most.
And your decisions may be affected by your own implicit biases about who deserves care the most, rather than who needs it the most. This doesn’t mean you are a bad person or unprofessional: I have seen superb health workers in resources-constrained settings across the planet do the same — including myself. The only way you will be able to protect your patients from your own biases will be to recognize them in the moment.
If you are not a health worker, but happen to know one, you also have an important role to play by supporting them through this pandemic. A few years back, I gave a talk to a group of naval officers about my experiences fighting Ebola in West Africa. Afterwards, one of the participants came up to me and said, “Thank you for your service.” As a civilian, no one had ever said that to me before, and I was surprised by how deeply they affected me. If you’re unsure how best to support the health workers in your life, a simple thank you may go a long way.
Finally, we must all keep in mind that this too shall pass, though perhaps not as quickly as we might want it to. While I was working in Liberia, a truck pulled up one day with gravel to cover the floor of our treatment center. Underneath the front windshield someone placed a banner meant to read “No Condition is Permanent.”
As bad as it was, the Ebola epidemic in West Africa would have been far worse without the efforts of all the health workers on the ground. After two long years, it finally came to an end.
Covid-19 will, too.
Adam Levine, M.D., is an emergency physician, associate professor of emergency medicine, and director the Center for Human Rights and Humanitarian Studies and the Division of Global Emergency Medicine at Brown University in Providence, R.I.