What would your first reaction be if you landed on an international flight and the flight attendant told you to stay in your seat because a passenger might have Ebola? Probably something along the lines of panic, call your parents, get right with the god of your choosing, try to convince the babe in the row behind you to tear one off in the lav, etc. But somehow this passenger on a US Airways flight from Philadelphia to Punta Cana swallowed down their panic long enough to roll video on the dramatic proceedings. Throughout the video, you see other passengers whipping out their phones to record the medical team as they enter the aircraft, clad in what the flight attendant warns will “look like they’re in a little bubble machine.” There is nervous laughter and murmuring among other passengers, and their fear is understandable. Although Ebola isn’t nearly as contagious as people assume it is, it is still a rising epidemic with the potential to grow if not controlled; already it has claimed nearly 4,000 lives, including that of Eric Duncan in the US. Containment procedures were triggered when the passenger in question sneezed while aboard the flight, and then claimed to have been in Africa and in contact with other Ebola patients. It was later confirmed as a hoax, as the passenger had never been to Africa, and did not have Ebola. He was just a massive pain in the ass with poor taste in jokes, another disease for which we have no known cure. Wouldn’t it be nice if every such person was removed from flights? Anyway. What is most shocking about this video is the way the passengers handle the situation: As the potential Ebola carrier was led of the craft, a girl actually booed him. “Booo,” she said, “This guy’s been on my flight since Chicago, boooo!” Other people joined in with similar derogatory comments, which is unsettling to watch knowing that they had no idea that it was a hoax at the time. On the other hand, there is definitely a feeling, watching the passengers in this video, that they aren’t super concerned. Like, they kinda get that this guy is just a jerk who is wasting everyone’s time and being generally insensitive about a genuinely scary situation. Two hours after the medical team led him off the craft, the man was screened and tested negatively for Ebola, and the other passengers were cleared to leave as well. It may have been a hassle, and lying about an Ebola threat is way out of line, but if nothing else, it’s a relief to see how seriously the threat is being taken. Airports and airline workers are taking precautions internationally to prevent the spread of Ebola. Even potential hoaxes have to be handled as thoroughly as possible. You can watch the medical team entering the aircraft here:

So a few months ago the country was enthralled with the idea of a few patients, infected with the Ebola virus, coming to the United States. Up until this point, we had been safe from Ebola due to the fact that bats can’t fly over the Atlantic. Some people were completely indifferent, while others had seen Outbreak one too many times. Most were a healthy mix, somewhere in between, but what bothered me the most was both the lack of education and the poor information that was spreading more virulently than the virus could ever hope to. First, I want to stress that I am a nurse, not a virologist, and hopefully throughout my post you will see that I am not pretending to be one. I have a Bachelor’s in Nursing and am currently a graduate student. I have worked extensively with Infectious Disease Specialists. I have been exposed to almost every infectious disease known to the modern world. I have taken courses in Biology, Microbiology, Anatomy, Physiology, Pathophysiology, Advanced Pathophysiology, Pharmacology, and an assortment of others. However, I am not and will not pretend to be an expert, just an experienced professional. When it comes to an epidemic of any sort, my first focus is on the patient, protecting and healing them, my second focus is on protecting the community. I don’t care about which strain does what, or what we can do with in lab. As a nurse, I concern myself with the current patient and future possible patients. I feel the first thing we should examine is Ebola itself. It is foreign to the US, both literally and figuratively. What it does to people and how it harmonizes with nature are both things that most westerners have little concept of. It is a virus, not a bacteria. This means that it is not its own organism. It is actually much smaller and basic than you can imagine. It is nothing more than a few pieces of DNA and some proteins. No cell wall, no cytoplasm, no metabolic functions. This is both their advantage and their downfall. Viruses require a host. For this example I will use the HIV virus. HIV gets into the human body and invades the host’s white blood cells, T4 cells to be exact but I won’t get that involved. The proteins help get the virus into the cell and those few small sequences of DNA write themselves into the host DNA. Now instead of the white blood cell attacking invaders, it is nothing more than an HIV factory. All of its metabolic functions are redirected at producing more of the virus, which pours out of the white blood cell like a sieve until eventually the host cell dies. This is why HIV infected patients have poor immune systems. The virus re-writes the DNA of the host cells. This is not something we can stop. New viruses are pouring out of the white blood cells at a rate of millions a day. We cannot filter them out. We cannot “kill” a little chunk of DNA and we don’t know enough about the human genome to correct the DNA sequences. This is why a lot of viral infections like HIV, Herpes, and Hepatitis are life long infections. HIV invades the white blood cells, Herpes invade the nerve roots, and Hepatitis invades the liver. Now that we have a better grasp of viruses, we will focus on Ebola a bit more. In tropical Africa, Ebola naturally lives in bats. It is nice to the bats and doesn’t cause them many issues. It is rumored that there are many viruses humans carry our entire lives and have no idea because they show zero symptoms. Therefore, they have never been studied. If this sounds crazy, just remember that it was in recent years the we discovered there was a virus behind cervical cancer. A virus that men can carry and spread without ever knowing they have it. Where the problem arises is that in tropical Africa, people like to eat bats. Sometimes they get infected with Ebola and it spreads. This process is called Zoonosis and can be true of bacteria or viruses. Canines carry Rabies, Armadillos carry Leprosy, Birds carry the Flu, Bats carry Ebola. When I said Westerners don’t really understand Ebola, the primary aspect that I am talking about is the patient. We don’t ever see what Ebola does. Our media is too censored, we hear how many died, and see people in haz-mat suits. Speaking of suits, we’ve all seen the pictures. Rubber gloves are adequate for AIDS and hepatitis, a simple mask stops Tuberculosis, but this requires space suits, just keep that in mind when you think its no big deal. So here is what happens when you catch Ebola, I figure you’re getting bored with reading right about now, so I’ll spice it up. First the virus gets into your system, I’ll elaborate on that later. Then, it hangs out for a few days, even up to 21, growing, multiplying at a rate of millions a day, and guess what, you’re infectious. Just like with the flu or hand foot and mouth disease, you can be spreading it to others before you show a symptom*. Remember, nurse mind set, protect the community. At first it’s not bad, little nausea, some sweating, diarrhea, much like a stomach bug. But then the virus really starts to build up in your liver and adrenal glands, after it has saturated your blood cells, the lining of your vessel, your skin, and bones. Hepatocellular necrosis occurs, which is fancy term for your liver starts to decompose.Your liver is what regulates blood clotting. This causes your blood either clot up and turn to jelly in your veins, stay liquid and bleed profusely, or a combo of both. The adrenal glands then do the same, causing your blood pressure to drop. This requires lots of IV fluids to keep your circulating volume up. At the same time inflammatory cytokines are released which causes vascular leakage. Cells don’t do a good job of holding things together so it all becomes a bloody goop. Anywhere in your body that blood vessels are shallow, like your nose, ears, gums, throat, GI tract, urethra, vagina, rectum, all start oozing fluids and bleeding because the tissues that normally keep it contained are disintegrating. So now you bleed from every orifice, including your eyeballs. Every time someone or something touches you, your tissue gets damaged which further the cycle, so a shot in the arm turn into a massive blood blister. Those who survive are left with massive scarring. Since the adrenals cannot keep your blood pressure up, and you are losing blood and fluids, we have to put IV fluids in to keep you out of hypovolemic shock. This in turn reduces your blood concentration, lowering your oxygen carrying capacity, which causes your heart to race. So you lay in bed, oozing fluids from everywhere, all while feeling like you just ran a marathon, with bloody diarrhea, oh and did I mention pain? Lots and lots of pain, but you can’t have any pain medicine because your liver and kidneys have failed. This why it pains me when I see this outbreak ONLY has a 50% death rate, when in Africa it is up to 90%…ONLY 50%. That is literally worse than cancer, and people are blowing it off. Imagine if cancer was infectious, and you lived in a country with zero cancer, and someone thought it would be a good idea to fly a few people in. I think there would be a different attitude. The biggest part of the discussion is how Ebola is spread. I will say two things on the topic, no, it is not airborne, and yes, basic hygiene plays a HUGE factor. But while on the topic of whether it is or is not airborne, the definition of an airborne contagion is one that can freely float in the air, survive lengths of time, and infect someone else. VERY few things fit in this category, most have been eradicated, Polio, Small Pox, Tuberculosis. Things that are also NOT airborne, are the flu and the cold. For the flu, you have to come into direct contact with the patients body fluids. How then, do you explain why people catch it and have no idea how. Well for one, people can spread it before they show symptoms, just like Ebola, and one other HUGE factor…droplets….let that word really sink in. The virus may not be airborne, but the droplets are. I’m going to digress for a second and get back to HIV and hepatitis, while I let droplets dwell in your mind. Everyone knows that HIV and Hepatitis are spread by blood contact, and sexual fluids, I don’t mean a drop of blood on the skin, or even a mucous membrane, it has to get INSIDE of you. This is why only gloves are required. HIV and hepatitis are not found in urine, stool (Some forms of hepatitis are, but you have to eat the stool to get infected) saliva, sweat, tears, or mucous. This is where some viruses are different. The flu gets into your mucous and other secretions, Ebola tends to stay in the blood, but remember, every one of your bodily fluids are full of blood now. So a person with the flu sneezes, and now millions of little droplets (remember those guys?) shoot out of their nose at nearly mach 1, all across the room, same for a cough, all it takes is a little microscopic droplet to land in your eye, nose, mouth, or the unlikely scenario of an open wound, and you’ve now been infected, because you came in CONTACT with their bodily fluids. I see the word contact thrown around a lot, but most people think of mass amounts of contact with blood, but what they don’t realize is that contact also includes microscopic mucous and saliva droplets, each one chock full of Ebola. Now to the second part of this, HIV only lives outside of the human body for a few seconds, maybe minutes if the quantity is high enough, Hepatitis a bit longer. That’s why you hear about the dirty needles at movie theaters and playgrounds, but never hear of an infection, before the perpetrator even leaves the theater, the HIV he left in that needle has already died. Ebola on the other hand survives quite well outside of the host, I can’t find my source again, but I believe its up to 4 days. So with all this information, lets have some role play, so that you can see exactly what this means, to a nurse, in the real world. Imagine it as a cheesy PSA or lifetime movie. You go to see your doctor because its that time of year, you need some blood drawn and refills of your blood pressure med. You sit patiently in the waiting room, thumbing a magazine while your 2-year-old plays with her toys. Like all two year olds, she touches everything, and everything goes in her mouth, toys, pens, her own fingers. She is a 22 lb drool factory and you love her to pieces. You see the doctor, get your goodies, and go home. A week later your angel starts vomiting blood and within 3 days she dies because her heart raced so fast it finally gave up while trying to maintain a blood pressure. Her eyes are blood red and demonic, her skin falls off in sheets. What you don’t know is that 3 days before your visit, someone thought they had the flu. It is October you see and they sneezed while thumbing through that very same magazine you thumbed through. The same thumb you grabbed her pacifier out of your purse with in the waiting room. The people caring for Ebola patients wear space suits, and burn the bodies, yet it still spreads. Here in America, we have much better protocols, and much better hygiene. So if it spreads, it will be contained much better. Still, it spreads prior to symptoms and survives will outside the body, just like the flu. Despite vaccines and good hand washing, thousands still get the flu every year. But while the flu kills 1-2% of its victims, Ebola kills 50% on a good day, and spreads the same way. So please, do not write it off as hype. It is a real thing and it is here. The case in Dallas has been confirmed. The patient had contact with five children and adolescents prior to admission. Those five kids attend four of the largest schools in Dallas. One sneeze and we could already have thousands of people, who don’t know it yet, infected. Thank you for reading. Please feel free to comment. * I have had a lot of comments in regards to this. I picked my words carefully, but I never imagined getting thousands of views an hour, or my article getting picked apart, but I will try to elaborate now. I said spread, the virus, I did not say you were contagious. What I meant by this, was the summation of two concepts. To fully explain everything I could write a book, but this is meant to be short and sweet. The first concept is that of a fomite. We have established that the virus can survive for an unspecified amount of time outside the host, and we have established that sneezing/coughing is a perfectly logical method of transmission. So if patient A is infectious/contagious, they sneeze on patient B, but then patient B goes home and picks up their sisters 1 6 month old, who rubs his face, and licks all over your shoulder, he could very well have just orally consumed large quantities of the virus, therefore become patient C. Patient B never got sick, the virus never entered their system, yet they are responsible for spreading the virus to someone else. This is why the 5 exposed kids are so important, there may only be a 2% chance or whatever that they’ll get sick, but if they went to school, and each rubbed up against 500 kids in the hallways, you now have 2500 exposed kids, 50 of which will statistically become infected, 25 of which will probably die. No I do not have a source for the 2%, that is just an example number used to represent the relatively low likelihood of contracting the virus if exposed. Remember, heal the patient, PROTECT the community. The second concept of this is defining “symptom”. Lets assume it means anything other than your baseline condition. That means the first signs of being contagious, are also the more mild symptoms, sneezy, achy, nausea, flu-like symptoms. So who is going to wake up, feel a little under the weather, and think,crap, I have Ebola, better get quarantined, no, THAT’S how you start fear mongering and mass panic. Again, flu season is upon us, the initial stages of Ebola are like the flu, and its human nature to be in denial, so many people, if infected, would hope its just the flu and wait it out, they are not showing symptoms indicative of Ebola, but they ARE symptomatic of something, and therefore, by the CDC definition, would be contagious. Its also normal procedure for people to be symptomatic BEFORE seeking medical care, so technically, everyone will be contagious, BEFORE knowing they have Ebola. But like I said before, I omitted this lengthy explanation because I didn’t feel it was necessary for the point of the article. ADDENDUM: Sadly, I feel the need to point out that the title of this blog is “Ebola, A Nurse’s Perspective”, not “A Nurse’s Guide to Surviving the Apocalypse”, or “How to Become an Ebola Expert in 15 minutes”. It could just as well be “Hamburgers, A Chef’s Perspective” and no one would be hounding me over grammar, a misplaced comma, or wanting citations as to why I say it should be on the grill 5 minutes per side of 7 minutes per side. The point is those things are irrelevant to the goal of the article, this is MY perspective (a particular attitude toward or way of regarding something; a point of view.) I don’t have to prove anything, the point of my article is to take what the uneducated (in a medical sense) journalists say, what the talking heads on TV say, and then let you know what the people say who are on the front lines. That’s like discrediting your grandads account of what happened when he stormed Normandy beach, because its not what your history teacher told you. Have I experienced Ebola first hand? Nope, have I experienced a WHOLE lot of other things that the majority of the population has not? You bet your ass I have, and I felt the need to take the time to hopefully help other people out a little. So please keep that in mind, I’m not perfect, but my experiences are my experiences, and I wanted to share them with you, to let you inside the head of a nurse for a minute. http://dtolar.files.wordpress.com/2014/10/o-ebola-virus-facebook.jpg?w=1272

Ben Affleck is a great guy. Say no to bigotry and hate.

Che, I agree there are still challenges for the average person in the Somali region, but we can't ignore the progress the state has made during Iley's tenure.

The Somali National Army needs to celebrate this milestone. Best Eid present to the Somali people. Al-Shabab will have a hard time regrouping again after losing its biggest command and control center.

What does this have to do with "72 virgins"? Anything to mock Islam right?

The place needs some greens saxib.

Thank you for the great read. It was fascinating to know that Egal has outmaneuvered everyone in Somaliland.

Bravo! Bravo!

Joornaaladda Norway ayaa helay sawir-muujinaya Ninkii isku qarxiyay Magaaladda Buula-Buurde ee galaaftay nolosha Saraakiil-sare oo Ciidamadda AMISOM ee Dalka Jabuuti ka tirsan. Ninkan ayaa taagan gadaasha-dambe ee Reysalwasaarihii hore ee Norway Stoltenberg,waxaana Sirdoonka Norway ee PST ay sheegeen inay ku fashilmeen,ninkaas inay ka ilaaliyaan inuu sawir la galo R/wasaaraha,iyagoo qirtay inuusan ku jirin liiska dadka qatarta ah,maadaama uu ahaa Oday 60-jir oo aan laga fileynin inuu is-qarxiyo,isagoo aaminaya wacdiga ay dhagta ugu shubeen dhalinyaradd yar-yar ee Kooxda Alshabaab. Doodda ugu badan Dalka Norway ayaa maanta noqotay sidee ku dhacday ninkan oo loo yaqaan Ninkan Odayga ahaa ee loo yaqaan C/laahi Axmed Cabdille,laguna naa-naasii jiray (C/laahi-Dheere)inuu sawir la galo R/wasaarihii Norway Stoltenberg.

The Somali National Army is doing a great job. Alshabab should never ever be allowed to establish a base again in a major Somali town. Let us make their lives difficult.

Khayr, if we stay silent when feeling sick with a highly contagious disease, we bring harm to the very people we want to help us; family members, friends, doctors, nurses etc. It is not arrogance. It is common sense saxib.

If the patient volunteered to disclose facts to healthcare officials at the hospital, Duncan would have still received the same kind of care he is getting today. If I was caring for an Ebola patient, it would not be difficult for me to isolate myself and let healthcare responders know ahead of time I was exposed to the disease . It is reckless and wrong to stay silent, in my humble opinion.

Alshabab spent a significant amount of resources on Baraawe. This is a great news.

Lying bastard. If you are sick you should tell healthcare officials so that they can give you better care and better protect themselves and others.

The first America-diagnosed Ebola patient now has more troubles heaped upon his feverish shoulders. Liberia has announced that they plan to prosecute the man for lying on his airport questionnaire. The man, Thomas Eric Duncan, has answered two questions during the screening process claiming that he had not come into contact with an individual infected with Ebola. However, this was not accurate. Duncan’s landlord’s daughter, who was reportedly pregnant, in Liberia was stricken with Ebola during his residence. Duncan, along with her family members, brought her to a hospital hoping to provide her with life-saving care. However, they were unable to have her admitted to the facility and brought her back home. There, it is reported that Duncan helped bring her back inside the family home, where she shortly passed away. On Liberia’s health screening for airline passengers it is asked whether travelers have cared for a patient stricken with Ebola or with the bodies of those who have died of the virus. Duncan negatively answered both questions, which is the cause behind the Liberian government’s accusations that he has perjured himself. Liberia has restricted travel out of the country for those who may be carrying the Ebola virus in order to prevent the spread of the virulent virus. However, it is unclear whether Duncan is guilty of knowingly lying on his travel documentation. Initially, the family believed that the young woman was not suffering from Ebola, but rather had serious complications from her pregnancy. Neighbors in Liberia claim that Ebola was not suspected until much later and it is unclear whether Duncan ever knew that the young lady had been infected with Ebola. As he had not yet begun to demonstrate symptoms of Ebola, he was likely not contagious during his travels from Liberia. While virulent, Ebola can only be spread through bodily fluids, which means that many individuals may not suspect they have been exposed to the virus as they have not had prolonged contact with an infected person. Whether this Duncan will be able to mount a defense against the perjury charges with this information is not yet known. During his stay in Texas, Duncan stayed with a local family of four. This family has been placed under quarantine, as they have had close contact with Duncan as he became symptomatic while in their home. Law enforcement is maintaining a presence outside of the family’s home in order to enforce the strict quarantine and will regularly deliver groceries and daily necessities to the home. The household will be receiving regular testing as well, in order for them to receive prompt treatment if they are infected. This will last 21 days, which may be some of the longest days in this household’s life, in order to ensure safety. Health officials in Texas have noted that as many as a hundred individuals may have been exposed to Ebola, but they also stated that the vast majority are not at high risk for infection. Persons infected with Ebola are only contagious after they begin to demonstrate symptoms of the illness and Duncan began to feel ill well after his flight to the United States. This number may have been lower if Duncan had been diagnosed sooner. Physicians at the Dallas hospital where he initially sought treatment believed he had a typical viral infection and were only able to properly diagnose him after receiving positive Ebola test results on his blood work.

I like DK, Tallaabo, Tillamook and Galbeedi. Safferz is also my girl.

The legacy of colonialism still haunts us.

Thanks to Neil Moxham for sending us this fantastic image, which we had to share here. In a recent article on legendary Dublin prankster The Bird Flanagan, his supposed escapades at the 1907 International Exhibition in Herbert Park were discussed. It was said that The Bird stole a child from an exhibition, with Flann O’Brien later recounting that “The Bird stole the baby of the wild man of Borneo from the latters straw house or tent and smuggled it into the snug of a pub in Ballsbridge”, while Ulick O’Connor claimed he “returned it to the French pavilion, as a gesture against the decline in the French birth-rate.” In reality, it was a Somalian Village at the International Exhibition. The International Exhibition was an incredible spectacle, which ssentially brought the world to Dublin, with tents and exhibitions from all over the world. In his book The Biggest Show in Town: Record Of The International Exhibition, Dublin 1907, Ken Finlay dug deep on the exhibition using primary sources from the time. One of those sources tells us of the Somali village, described thus: A party of Somalis has been imported from British Somaliland, which is situated in the north-east of Africa. This village has been erected to represent the huts in which the natives live in their country. A schoolroom has also been built in which Somali children will be thought their lessons. Somalis are a nomadic race, and live chiefly by the rearing of herds and goats and sheep. They are Mohammedians by religion. John Cavendish has written about this peculiar spectacle, noting that: This stand proved to be of huge interest to the 2,751,113 visitors in all during the six months that the exhibition lasted. So much so, that it became the most profitable stand, earning £9,601 in sales of its pottery and other native goods. You can only imagine how distressing the situation must have been for younger members of the community who were essentially put on exhibition for Dubliners to gawk at. This newspaper report from 14 May 1907 shows that rumours of ill-health existed during the period of the International Exhibition for example:

ABU DHABI // The son of Saudi Arabia’s crown prince was among the pilots who carried out attacks against ISIL militants in northern Syria this week. Photographs released by the official Saudi Press Agency yesterday showed eight Saudi air force pilots at an undisclosed location after returning from the mission. The pilots included Prince Khaled bin Salman, son of Crown Prince Salman bin Abdulaziz Al Saud. Dressed in flight suits, the beaming pilots posed for a group photo in front of a fighter jet parked in an airplane hanger. Two of the pilots were also seen sitting in a two-man fighter jet, and there were additional shots of the pilots examining helmets and other equipment in a dressing room. The fighter jet was marked with the crossed swords ensign of the Royal Saudi Air Force. “My sons, the pilots, fulfilled their obligation toward their religion, their homeland and their king,” SPA quoted Crown Prince Salman as saying. He was “proud of the professionalism and bravery” of the Saudi air force men, he said. Saudi Arabia, along with the United States, the UAE, Bahrain, Qatar and Jordan carried out the air strikes after forming a coalition along with dozens of other states to fight ISIL. Some of the countries only provided logistical support. The release of the photographs underlined how Saudi Arabia is stepping up its public role in regional defence. The kingdom and its religious leaders have been particularly vocal against the ISIL threat. Last month it hosted a conference in Jeddah to help build the coalition against the extremists.