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Ebola, Infection Control, and Religious Freedom

What do chaplains have to do with biological, viral threats? Military and health care chaplains have generally been on the front lines in the critical care and urgent emergency medical response to these new infectious agents.
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Ebola is a global health care disaster, threat to national security, and, for some, and a threat to religious freedom.

Taking care of the sick and less fortunate is a tenet of all major global religions. Faith groups originally founded our hospitals as part of their mission. Texas Presbyterian hospital where the first person in America with Ebola died is also the same hospital where the first American became infected.

The recent infection of several American physicians and other health care workers was the result of a faith community mission to Africa, to help where the help is needed the most. Medical missionaries have a long tradition of service from founding hospitals and medical schools in China to Africa, whether the threat is a new or known infectious disease, or response to a natural or human-caused disaster -- the earthquake in Haiti or the AIDS pandemic. There have been many lessons learned and one needs to remember wisdom gained from the service, and sacrifice, of those who have gone before us.

What do chaplains (spiritual care professionals) have to do with biological, viral threats? Military and health care chaplains have generally been on the front lines in the critical care and urgent emergency medical response to these new infectious agents as well as preparing necessary emotional and spiritual support. Be not afraid, but be informed.

Airport health care screenings are nothing new. Remember SARS? After HIV was identified and the public was educated about it's transmission and "containment", knowledge lessened anxiety.
Public Health working with global media shared the advances in the identification of the virus that caused AIDS and how one could prevent the transmission through the exchange of bodily fluids, needle exchange, and, the vital dialog about religious practice. Therefore, what we learned about AIDS helped us when we had the SARS outbreak a little over a decade ago. We now eat chicken and eggs without fear though properly cooked.

As soon as the CDC and the World Health Organization could mobilize and identify the cause and source of the SARS virus, an action plan was made to contain and treat the virus. However, a passenger(s) who flew transcontinental transmitted the SARS virus from China and Southeast Asia to Canada. Walls have doors.

At the same time, after the September 11th attacks on our nation, weapons of mass destruction/terrorism concerns also included biological and chemical weapons. All hazard plans for preparedness and response became a regular part of local emergency response and also our health care industry. Medical centers regular practiced emergency response drills along with first responders from police and fire departments which extended from national, state, and local stakeholders to including our military, now tasked with protecting the homeland.

Hospital chaplains are trained regularly about PPEs (Personal Protective Equipment) and regularly wear it when visiting the extremely vulnerable in Pediatric Neonatal, Oncology, and other Intensive Care Units. Fear of infecting a patient as well as a patient infecting a health care worker or visitor created an essential standard of care and practice in these acute settings.

I called the pastoral care director of the Toronto hospital that cared for majority of SARS patients during that 2002 outbreak in Canada that started in China. I asked about reflections made and best practices in the weeks after the crisis passed.

My colleague shared that the initial email request and follow-up phone call came somewhat as a surprise. When one is in the eye of the hurricane, one's focus in where it needs to be -- there, in the moment, and not focused on rebuilding, but on merely surviving, hour by hour, day by day.

Initially, the hospital management had made the decision to dismiss all non-essential personnel from the acute care campus; doctors and nurses would shelter in place for the treatment and care of their critically ill patients. Chaplains were among those excluded from the critical care core group until after the first day quarantine. What was experienced was a spike in anxiety by both health care workers and patients. There was no one inside the bubble to deal with the profound emotional and spiritual issues identified in those early hours. Highly credentialed health care chaplains, who are clinically trained and board certified, know how to be the non-anxious presence whether in the health care arena or heat of battle. War on AIDS. War on SARS. War on Ebola.

The chaplains in the Toronto medical center were invited back for their essential specialties; support the staff and support their patients dealing with unimaginable anxiety.

But, the quarantine for SARS was broken. The cultural and religious practices of one of the nurses compelled him to attend Saturday evening worship services in his local congregation, which potentially exposed upward of another 120 persons to the virus that caused SARS. Normally, the threat of exposing others is cause enough for public health and local law enforcement to prevent a larger potential health care risk, but, in this instance, few could imagine this scenario. How could a health care professional defy the quarantine? There are those who believe that their faith will protect them from infection and transmission. However, there were Toronto congregations that cancelled worship services and developed a telephone tree to deliver meals to elderly or homebound.

On September 11th, I was chaplain educator on staff at a Washington, DC hospital, where a number of burn victims from the Pentagon were brought for critical care. A disaster plan was implemented that called for hundreds of patients to be discharged to make way for those more critically injured. Thousands showed up to donate blood, to help in any way possible, and, there was one local faith group that wished to 'lay hands' on the burn victims for their immediate healing and end to their suffering. While balancing a respect for all religious traditions, a hospital chaplain affirmed the religious belief and intent of the group, and offered a distant conference area, for the group to pray for those so critically injured in the attack, but also took the opportunity to explain the importance of infection control. The vulnerability of burn victims to infectious agents mandated a sterile environment, a non-negotiable.

For these, and future epidemics, we need both science and faith. There are generals, who will not go into battle without the presence of chaplains, and there are physicians that understand the treatment of the whole patient, treatment not only of the physical ailment or injury, but also the emotional and spiritual support included in the plan of care. We have a mission and duty to prevent future disasters.