[Kobi]

I know people are really concerned about this issue. And, it isnt an easy one.

I do think we need to understand this is a process of adapting what works in the field in West Africa and what is going to fly in the American health system. Supportive care in other places is not the same as what Americans expect of supportive care in the USA.

Doctors without Borders and other such groups, as stated in Anyas post, do things or dont do things that work for them. Using a stretched plastic sheet, rather than a mattress, with the bum cut out so bodily fluids can go directly in a bucket spares health workers from exposure. Limiting of blood draws works for them. Doctors without Borders also refuse to do invasive procedures i.e. they do not ventilate people having respiratory problems, they do not do hemodialysis, they will not even operate on pregnant women because of the risk of exposure to body fluids. Ebola crisis puts pressure on human rights.

How do you think that will fly in the USA? Will patients, their families, the politicians, the media, health care providers, and risk management insurers be ok with people laying on plastic sheets with the bum cut out so they can poop and pee in a bucket? Will we be ok not intubating people who are struggling to breathe? Will we be ok not using dialysis when kidneys are failing? Are we ok with using IV's as long as we have viable veins and letting it go when we dont....or are we going to insist on central lines? Do we insist on doing everything possible and using all available technology even in the face of inevitable death? Yeah, we do and it has nothing to do with ebola.

Do Americans like being told to voluntarily quarantine themselves? Apparently not. Do Americans like being inconvenienced in any way? Hell no. Do Americans comply when told not to do things which risk exposure to other people? Seriously, we are too self centered for that.

Were mistakes made when ebola arrived in Texas? Yes. Big ones it seems. Are changes being made to adjust to the emerging reality? Yes. Big ones it seems. Are dedicated centers better equipped to deal with the overall care of people with ebola. Yes. Does this absolve local health care centers from being able to diagnose, quarantine, and provide initial care? No.

This is a process. It requires patience.