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The risks of performing surgery during the Ebola outbreak

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Beyond the death toll from Ebola across West Africa (3,865 deaths out of 8,033 confirmed cases according to the latest World Health Organization estimates), the outbreak of the deadly virus has also caused serious complications to the provisions of other types of health care. People seeking access to health care for treatment of malaria cannot get help, pregnant women cannot get assistance delivering babies, and people cannot get access to routine immunizations.

Take surgery for example, which carries extraordinary risks for doctors who choose to operate in the affected West African countries. As Ebola is primarily transmitted through the bodily fluids of infected persons exhibiting symptoms, patients who are in need of life-saving surgeries such as amputations, appendectomies and c-sections, are at risk of being turned away if they exhibit signs of vomiting or fever. Additionally, Sierra Leone was already suffering from a shortage of surgeons, as in 2008, only 10 surgeons were practicing at 10 out of 17 government civilian hospitals.

"The problem we face now, if a patient has any of the symptoms regarded as part of the case definition for Ebola, he or she may be sent to the isolation unit and kept there until the result of their test comes back. This may take days to happen, so if the patient is indeed having a surgical problem, may die while waiting for the Ebola test result," said TB Kamara, chief of surgery and hospital care management at Connaught Hospital in Freetown, Sierra Leone.

Kamara said that the problem specific to surgical operations has not been recognized by the Emergency Operations Center (EOC), the nerve center for the Ebola response in Sierra Leone. He added, "Due to inadequate protective equipment … the surgeons find it morally difficult to pressure others to accept patients who have been reviewed and booked for surgeries by them.

On Tuesday, the American College of Surgeons released a surgical protocol for operating on patients with possible or confirmed cases of Ebola. Written by Sherry M. Wren, professor of surgery at Stanford, and Adam Kushner, an associate at Johns Hopkins Bloomberg School of Public Health, the  protocol calls for special surgery equipment, including double gloves, full face shields and surgical hoods. Additionally surgeons must have what is termed as "AAMI Level 4" surgical gowns and drapes, which are made of material that have been proven to be impervious to liquid and viral penetration. The protocol also recommends that surgeons use keep the use of sharp instruments to a minimum, and employ alternative cutting methods  like electrocautery instead of scalpels to minimize the risk of transmission.

The protocol has been circulated to the West African College of Surgeons (WACS), College of Surgeons of East, Central and Southern Africa (COSECSA), Pan African Association of Surgeons (PAAS).

Wren said there has not been an organized call for more surgery specific resources, but that the U.S. Centers for Disease Control and Prevention is reviewing the protocol.

As to whether the protocol would be adopted by organizations like MSF or WHO? Wren said, "knowing their culture they will create their own guideline and not adopt someone else's."

Related: How Ebola outpaced the world's response