ABSTRACT
The nurse’s dilemma in the case study above arose from an external human threat: advancing enemy troops. At times, the threat is non-human; a tsunami, a tornado, an earthquake, or at the other extreme of size, a pathogen. When Kikwit General Hospital (Democratic Republic of Congo) admitted patients suffering from Ebola haemorrhagic fever (EHF) in 1995, the staff did not forget the decimation of the 1976 Ebola outbreak in the small town of Yambuku, where 11 of the 17 hospital workers were infected and died. EHF is an acute viral illness with a lethality rate ranging from 50 per cent to 90 per cent. In Kikwit, most of the healthcare workers fled the hospital, leaving their patients behind. When Dr Tom Ksiazek of the Special Pathogens Branch of the Centers for Disease Control and Prevention (USA) arrived at Kikwit General Hospital, he
found a facility bereft of clinicians but with patients, still living, sharing beds with corpses. For those doctors and nurses, the duty of care did not extend to such drastic situations.
