Ebola and U.S. Hospital Chaplains: A (Deliberately) Untold Story
By Betsy Shirley | December 16, 2014
In August, Dr. Kent Brantly and Nancy Writebol, medical missionaries who were serving in Liberia, arrived at Atlanta’s Emory University Hospital. The facility was the first to treat Ebola patients on American soil, and in the early days there was no shortage of public criticism. “People responded viscerally on social media, fearing that we risked spreading Ebola to the United States,” wrote Emory’s head of nursing in The Washington Post. Later that month, a poll by the Harvard School of Public Health found that four in ten adults still feared a massive U.S. Ebola outbreak. Even as the staff performed their duties with confidence, the Rev. Robin Brown-Haithco, the hospital’s director of spiritual health, could sense anxiety among some of the personnel. So she wrote a two-page letter reminding employees what was easy to forget: why their work matters.
In her memo, distributed to the entire clinical staff, Brown-Haithco invited healthcare professionals to compare their own vocation with that of the missionaries, who followed their callings to help those in need in Liberia. “When Emory heard that same call a little over a week ago, we also knew there was only one way to respond,” she wrote. “We knew it was our ethical and moral responsibility to open our doors to receive the missionary aid workers and to provide the care we provide for all who come through our doors. We responded, not because it would bring notoriety or fame, but because it is our calling as a health care institution.”
In the days that followed, many healthcare workers talked with Brown-Haithco about their vocations. These conversations often mirrored the tone she had set in her memo, neither ignoring the risks of treating Ebola patients nor succumbing to panic. A calling doesn’t exclude fear, she explained, but fear “does not prevent us from moving with compassion toward someone in need.”
Neither does fear encourage a dull news cycle. When the Ebola outbreak began, the American public heard from doctors, nurses, public health experts, and WHO officials. Once healthcare workers were diagnosed in Dallas, we heard about PPE procedures, CDC guidelines, and airport screenings. We heard about hospital employees in New York who faced discrimination for working near an infected patient, and about the exotic dancers who started a GoFundMe account to support their voluntarily quarantine. Most recently, we heard about the $27,000 the city of Dallas spent taking care of Bentley, the beloved dog of Dallas nurse and recovered Ebola patient, Nina Pham.
But during the initial frenzy of U.S. Ebola coverage, we didn’t hear much about hospital chaplains, the members of hospital teams tasked with providing spiritual and emotional support to patients, their families, and medical staff. According to university estimates, there were 42,410 stories mentioning Emory and Ebola published between July 31 and September 22; Brown-Haithco and her chaplain colleagues were interviewed four times, including a segment with Matt Lauer that never aired.
And really, the public isn’t supposed to hear from chaplains: Chaplains are trained to keep a low profile, remaining calm in health crises, not interfering with the lifesaving work of medical personnel. Professional chaplaincy standards emphasize sensitivity, respect for boundaries, and self-awareness, managing and minimizing one’s own emotions and religious preferences to better respond to the needs of others. A chaplain’s work isn’t flashy: listening, praying, and simply being present to those who suffer.
Not to mention: the dual confines of HIPAA and clergy confidentiality limit the information chaplains are allowed to share—hardly ideal interviewees for eager reporters.
Yet, silence isn’t absence. In the five American hospitals that have treated Ebola patients, chaplains have been a key part of the healthcare team, quietly alleviating anxiety amid national paranoia, tackling loneliness amid clinical isolation, and protecting patient privacy amid intense public scrutiny. And although these chaplains have taken their responsibility to the U.S.’s 10 Ebola patients seriously, they are also mindful of the larger health crisis at hand—a global epidemic that has infected more than 18,000 people and claimed the lives of more than 7,000.
IN LATE OCTOBER, I talked with the Rev. Paul Steinke, a Lutheran pastor and chaplain at Bellevue Hospital in Manhattan. It had been a week since his hospital admitted its first Ebola patient, Dr. Craig Spencer, a Doctors Without Borders volunteer who had been treating Ebola patients in Guinea. “It’s kind of nuts,” Steinke said. “Thirteen thousand people in three African countries have Ebola; we only have one patient. There are still video trucks outside.”
As he saw it, there was nothing newsworthy about a hospital treating an infectious patient. “We’re a hospital. This is what we do. We take care of sick people,” Steinke said. He added: “And we do a damn good job of it.”
The Rev. Joyce Miller, also a Lutheran pastor, works as a chaplain at Nebraska Medical Center, which has cared for three Ebola patients to date—medical missionary Dr. Rick Sacra and NBC cameraman Ashoka Mukpo, who both recovered, and Dr. Martin Salia, a surgeon serving in Sierra Leone, who died in November. She concurred with Steinke’s assessment that much of the fear surrounding Ebola patients is unwarranted: “I’ve been in chaplaincy long enough to know that I have gone through outbreaks of HIV/AIDS, influenza, RSV, and all kinds of stuff that has scared people,” she said. “It’s scary stuff, but the biggest danger is our fear and the best way to deal with that is education. So, yes, this is another health crisis, but it’s what we do.”
And I heard this same unflappable, business-as-usual approach when I asked chaplains how best to minister to Ebola patients. “I don’t know that I see my role with an Ebola patient any differently than I do with a patient who is here for a stem cell transplant,” said John M. Pollack, a Catholic deacon and chief of the spiritual care department at the National Institute of Health Clinical Center in Maryland where nurse Nina Pham was treated and later released. “I think largely the greatest spiritual issues we encounter here are loneliness and despair. And those are universal questions that come with a rupture in health,” Pollack explained. “This is a different disease than we were used to seeing, but the spiritual issues are very much the same.”
Paul Steinke agreed. He said the best way to care for any patient is the “old-fashioned, chaplain-talking-to-patient” approach. The only real trick was doing that within isolation guidelines. Chaplains, like patients’ family, could not interact with Ebola patients face-to-face due to the intense training required to meet CDC requirements. The chaplains instead turned to technology. Due to HIPAA, none of the chaplains could confirm whether they had contact with Ebola patients, but Pollack said that “in the event that we had a patient in isolation where it would be unsafe for a chaplain to work with a patient, then we would use Facetime or Skype.” Other chaplains indicated that if an Ebola patient wanted to speak with a chaplain they would use the telephone.
But chaplains weren’t the only ones who wanted to minister to the patients. As attitudes about treating Ebola patients shifted from national anxiety to approval, the chaplains were faced with a new problem: how to handle the well-meaning community groups who wished to show their support for Ebola patients—often in ways the hospital could not accommodate.
Steinke said someone mailed him a box of stones inscribed with words like “hope” and “faith” and requested that the stones be delivered to the Ebola patient in isolation. But quarantine procedures made the sender’s request impossible. And besides, people don’t want inspirational rocks, Steinke said. “People in the hospital want a connection with a human being that can talk to them.”
At Emory, Brown-Haithco reported there were church groups, especially among Atlanta’s Liberian Christians, that wanted to host prayer vigils in the hospital’s small, interfaith chapel. She ultimately had to turn all the religious groups away. “We wanted to protect our campus and protect our other patients and our other families and their privacy,” Brown-Haithco told me. The hospital chapel was intended primarily for patients and staff, not the city. She encouraged groups to pray for Ebola patients around the world—at their own churches.
During the Ebola ordeal, Emory’s hospital administration invited chaplains to join their leadership team meetings—something the chaplains described as “unprecedented.” The Rev. George Grant, who oversees spiritual health throughout the Emory network, said the chaplains’ inclusion points to a growing acceptance of integrative healthcare, a model that considers patients’ mental and emotional wellbeing alongside physical needs. His chaplaincy staff encouraged the hospital administration to be sensitive to the medical personnel’s emotional needs and to the Ebola patients’ faith traditions. “There’s something about persons of other disciplines gathering together and having those disciplines cooperate, collaborate toward this whole person health perspective,” Grant said. “That took us into another kind of level of care that Emory heretofore has not been about.”
Dr. Arthur Kleinman, a physician and anthropologist at Harvard, said that the growing inclusion of chaplains—religious professionals—in mainstream healthcare isn’t so unusual. He cited the large number of programs dedicated to spirituality and health at a number of elite universities. “We’ve become more fluid in moving back and forth between values and professions, between technical practices and moral practices,” he said. “And I think it’s not surprising then that rather the separate the sacred and the secular, we’re more comfortable seeing them connected.”
IN ATLANTA, SHORTLY AFTER Brantly was declared Ebola-free, a local news station produced a three-minute segment focusing on the role of divine intercession in his recovery. “Instead of getting down on himself, going into a depression, he looked to a higher power: his faith,” says the reporter, as the camera slowly pans to a church steeple on the Atlanta skyline. “People here in Georgia, the U.S., and around the world prayed with him.” The segment, entitled “Power of Prayer,” featured a snippet from Brantly’s press conference, in which he said, “God saved my life—a direct answer to thousands and thousands of prayers.”
Brown-Haithco, who was also interviewed for the segment, was frustrated with the shallow portrait of prayer the segment seemed to offer. If prayer is powerful when a patient recovers, what do we say when a patient prays but still gets sicker? As professionals caring for the critically ill, hospital chaplains are all-too-aware that prayer doesn’t guarantee medical miracles. Prayer is “not just the traditional form of prayer where we have our hands together and we’re on bended knee, praying to a deity,” Brown-Haithco said. “For us, prayer is about accompaniment. It’s about journeying with people in critical and dark times.”
Ultimately, this kind of prayer is the heart of a chaplain’s work: they don’t try to heal people—they leave that to the medical staff. Instead, chaplains simply listen to people who are suffering and give them a place talk about what they’re experiencing. “I think once that pain is able to be expressed to someone who is able to listen, I often think the pain dissipates,” said John Pollack. “I wouldn’t say that it goes away completely, but I would say that it’s a sharing of the burden.”
Chaplains know that the world does not share Ebola’s burden evenly. “We have been barely touched by Ebola in this country,” said Miller at Nebraska Medical Center. “My pain is that this is very much a crisis in Africa and we don’t see one quarter of the coverage of what’s happening there, except maybe some fear-mongering stuff that we should seal our borders and that will fix the problem—and it won’t.”
Pollack pointed to the high level of medical care that has boosted Ebola survival rates in the U.S. and Europe. “There is a troubling sense of inequity that it’s not also the same case for the people who are suffering with this in West Africa,” he said. He praised the “compassionate response of caregivers,” like Doctors Without Borders volunteers who traveled to West Africa and N.I.H’s own staff who volunteered to serve in the isolation unit. “That’s a tremendously courageous thing to do and it really does come from a place of compassion, which in my view really emanates from God.”
Brown-Haithco agreed. When I asked her where she has seen God, she responded: “Right smack in the middle.” She cited the doctors and nurses at Emory who volunteered to treat Ebola patients even though there was no known cure. “They walked voluntarily into that situation with their own fear,” she said. “But they went anyway.”
Betsy Shirley writes about religion, faith, and social justice. She studies American religious history at Yale Divinity School. Follow her @BetsyShirley.
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