It’s been exactly one year since the CDC confirmed that Thomas Eric Duncan had Ebola. He had flown from Liberia to Dallas to visit his fiancé, and became the first person diagnosed with the deadly virus on American soil.

During his stay at Texas Presbyterian Hospital in Dallas, two nurses also fell ill with Ebola. Duncan died, but the nurses survived, as did a handful of Americans who fell ill in West Africa but were transported back to the United States for care.

The Ebola outbreak in West Africa, and its spillover into the U.S., forced hospital officials to take a hard look at their readiness for a serious epidemic.

Within months the CDC designated 55 hospitals nationwide as future Ebola treatment centers, including two in Texas: the University of Texas Medical Branch, in Galveston, and Texas Children’s Hospital in Houston.

For many of these hospitals, preparing to care for Ebola patients meant renovating rooms and increasing training and simulations for staff. But Texas Children’s has built an entirely new unit for kids — a biocontainment wing with eight beds at its facility in suburban Houston.

“A year ago in the United States, there were only twelve beds for the entire country for patients that had a need to be isolated in a biocontainment unit,” says Dr. Judith Campbell, medical director for infection control and prevention at Texas Children’s. “And, not surprisingly, zero of those beds were designated for children.”

The biocontainment unit is still under construction. Dr. Judith Campbell, a specialist in pediatric infectious disease, explains that a “pass-through window” will allow health workers to make some deliveries without having to don and doff the entire protective outfit. Carrie Feibel/Houston Public Media hide caption

itoggle caption Carrie Feibel/Houston Public Media

Campbell helped design the special pediatric unit, which the hospital began planning after Duncan’s death. The $16 million project, which includes a separate area with 10 regular pediatric beds, was paid for out of the hospital’s capital funds and $1 million in donations.

Each of the eight patient rooms in the biocontainment unit has an antechamber, where doctors and nurses will put on protective gear, gloves and ventilated hoods. After treating the child inside the room, they will leave through a separate door and enter a third room, where they strip the equipment off.

The whole time, nurses will observe through large glass windows.
“So, if there’s any question, they can say ‘Wait, stop. You need to clean your hands again.’ Or ‘Wait, stop. Let’s take this glove off more carefully,’ ” Campbell explains.

The unit has its own biosafety laboratory, so infected blood samples never have to be carried to other parts of the hospital. There’s also a separate medical waste room, where carts full of used clothing and equipment can be wheeled inside 6-foot autoclaves. And, after every shift, medical workers will shower before leaving the unit.

Hospital officials say Ebola was the catalyst for the decision to build, but the unit is designed to handle any globe-trotting superbug.

“These rooms are equipped to take care of TB, MERS, pandemic influenza, bird flu and even a pathogen that we might not know what it is yet,” Campbell says. “That’s why we wanted to build something with the highest level of isolation ability.” Before designing the unit, teams from Texas Children’s visited adult biocontainment units at hospitals in Atlanta and Omaha.

The medical architecture in the new unit is impressive, says Dr. Amy Arrington, a pediatric intensive care specialist, but staff preparation is crucial, too. The initial training included 16 hours of learning how to maneuver in the awkward biocontainment suits – while still maintaining the emotional warmth and reassurance that’s part of caring for a child.

Workers are still about a month from finishing up the 8-bed isolation unit at Texas Children’s Hospital. The unit’s goal is to provide for the special physical and emotional needs of kids with highly infectious diseases. Carrie Feibel/Houston Public Media hide caption

itoggle caption Carrie Feibel/Houston Public Media

“I describe it as a space suit,” Arrington says. The suit “has footies and arm holes and covers you up completely.” Doctors and nurses who volunteered to work on the unit had to relearn skills — such as inserting IVs while wearing the suit.

“When you put three pairs of gloves on, you (can) lose sensation in your hands because they’re so tight,” says Arrington, “But you really lose that tactile feel that as physicians and nurses is really important in taking care of any patient, let alone a child.”

Kids can be especially vulnerable to infectious diseases. During the Ebola outbreak in West Africa, children died at a higher rate than adults.

As pediatricians and parents know, sick children not only need close monitoring, but also encouragement to eat and drink, and comfort when they are scared and confused. That can be harder in a pediatric biocontainment room — the parents of a very sick child will probably not be allowed inside.

But Campbell says Texas Children’s Hospital is ready for that challenge, too. At least six doctors or nurses will be assigned to each child, and one of them will act as a family liaison. The kids will also be able to use tablet computers to talk with their families via video chat, and will be able to see them through the large windows.

The hospital is also developing a special doll that will wear a mini-version of the same biocontainment suit the doctors and nurses wear.

The goal there, Campbell says, is to soothe even the youngest kids, and help them understand, “Yes, we’re dressed up a little differently, but … their little doll has similar attire on.”

The pediatric isolation unit is to be ready to accept patients in late October, with a formal ribbon-cutting expected in November.

This story is part of NPR’s reporting partnership with Houston Public Media and Kaiser Health News.

As a doctor who provides medical care to Boston’s homeless population, James O’Connell and his colleagues are used to working in unusual locations. “We are basically visiting them in their homes, which are often under bridges, down back alleyways [and] on park benches,” O’Connell tells Fresh Air‘s Terry Gross. “It’s been an education for us over these years.”

O’Connell is president of the Boston Health Care for the Homeless Program, which provides health care services at over 65 sites, including adult and family soup kitchens, detoxification units and corrections facilities. He writes about his practice in a new memoir, Stories from the Shadows: Reflections of a Street Doctor.

O’Connell has been caring for Boston’s “rough sleepers,” or homeless, since 1985. He says that homeless patients suffer from the same chronic and acute illnesses as the general population — with one crucial difference. “What we see … frequently, are regular issues that have been neglected for years and years,” he says. “So we see the natural history of illness that is usually interrupted by good preventive care.”

Over the years, O’Connell has seen the ravages of untreated frostbite, AIDS and diabetes, as well as the effects of profound isolation and extreme loneliness. But he has also witnessed a courage and resourcefulness in his patients.

“These are people who are nameless and faceless when they are sitting out in the street,” he says. “But when you get to know them, they are stories of great courage, of struggles against unbelievable adversity. … I think I probably would’ve been a broken person had I lived through what they lived through.”

Interview Highlights

James O’Connell is the president of the Boston Health Care for the Homeless Program. He is also an assistant professor of medicine at Harvard Medical School. Roger Farrington/BHCHP hide caption

itoggle caption Roger Farrington/BHCHP

On suspending judgment

I remember what came across is that whatever I thought of someone, when I first met them or first walked by them, it rarely panned out once I got to know them, and the stories that emerged from these people, what they have lived through and as you learn, each one is very different from another, but each one has a remarkable story. … I hope in these stories what emerges is the real resilient spirit of people who have really, really been dealt a bad hand in life and suffer from all those social determinants of poverty.

On the result of homeless people not receiving good preventive health care

We … see the end stage of many things. We often see pneumococcal pneumonia, for example, which probably should’ve been treated on Day 1 or Day 2; by Day 7 or Day 8 it can be very, very devastating. …

As we learned the hard way … these are people who were struggling to survive outside on the streets. They’re interested in just being safe today or just getting the next meal or just getting a bed for the night. Taking care of an infection in their foot or diabetes or their hypertension is way down the list of priorities, which, of course, is really difficult for us doctors who think that should be the top of the list.

On the extreme illnesses he’s seen

We see dramatic things that I never saw in medical school or often even in the textbooks. During this past year [we] have watched a man who had been outside for a very long time who has a pretty difficult psychotic disorder who got frostbite on both feet, really severely, came into our respite facility where we cared for him and he elected to not do surgery, and we spent the past year watching his feet fall off from auto-amputation, which is what happens at the end stages of frostbite. Most of our staff, including our nurses, had never seen anything as dramatic as that.

We will also see tuberculosis, things that you would be used to seeing in a Third World country much more than an inner city of a very medically rich world. We see all of the end stages of AIDS neglected because people were not able to get to treatment. … If you are caring for a homeless population, you are really seeing the really both exotic illnesses as well as the end stages of chronic, common illnesses.

On hidden homeless communities

Even after I had been doing this job for almost 15 years thinking I knew every nook and cranny of the city of Boston, somebody pointed out to me that there were 20 people living in a tunnel under Copley Square. …They came out only at nighttime; they spent their days down in the tunnels. And I remember going down there and meeting all these people for the first time and being stunned that most of them had been there the whole 20 years that I had been out. We always think we know a lot, but we keep our minds open to finding there’s always a new place where someone can be.

On trauma homeless women face

For women to get to the streets we know that the journey is one that is very complex and almost always full of unspeakable trauma — sexual, physical and emotional trauma — and, so, by the time women are on the streets, they are really suffering, and those who become pregnant often feel despair, discouraged, feel they have no place to go, and feel very attached to having the baby safely and in a good way.

So we found that pregnancy often is not only alarming for the women, but it’s a place where they can actually take stock of their lives and try to come in, so we always try to provide as much service … gentle service as we can to anyone who is pregnant on the street, so they can deliver a good baby and hopefully hang on to that baby.

Unfortunately, many of the women, if you speak to them on the street, have had many children, all of whom they’ve lost to social services, because they were unable to stop using or they had no place to bring the baby once the baby was born. There’s an awful lot of trauma among the women on the streets about the children they have lost and mourn.