抗擊埃博拉：觸碰的力量

Touch is the first sense that we develop in the womb， and throughout life it continues to elicit strong emotional responses， and remains a powerful way to connect to other humans. Ebola is a disease that preys on1） touch—it is not airborne， and can only be transmitted through direct contact with the bodily fluids of an infected person. This means that the only way to stay safe in the regions affected by the current outbreak （the worst in history） is to touch no one.

In Liberia， one of the countries most affected by the outbreak， this means people are estranging themselves from a key part of their culture. As the New York Times reported this weekend， in Liberia， “closeness is expressed through physical contact.” The traditional greeting is a double-cheek kiss—not possible anymore when even a few drops of saliva could expose you to the virus. Washington Post reporter Lenny Bernstein noted during his visit to the country the prevalence of a new， warier greeting： the “Liberian handshake，” bumping fully-clothed elbows.

Still， some people can’t resist comforting their loved ones. The Times story tells of a man who tried his best not to touch his mother， who was vomiting blood in her bed：

But as she grew worse， unable to keep anything down， he gave her milk， and tried to soothe her. His skin touched hers.

His mother died the next day.

Just after his mother’s funeral， Mr. Dunbar’s own forehead got hot with fever. For 15 days， he stayed at John F. Kennedy Hospital in Monrovia2）， fighting the disease. It was a fight he eventually won. But when he got out of the hospital， he found out that four of his sisters， his brother， his father， his aunt， his uncle， and his two nephews had died. His entire family， wiped out3） in days.

On Friday， Mr. Dunbar said he would do nothing different. “That’s my ma，” he said， “that she the one born me.”

People who are isolated and experience little physical contact are known as “touch hungry.” These people are often members of marginalized or stigmatized4） populations—the homeless， for example. Ebola patients are certainly isolated， immediate quarantine being the best strategy to stop the spread of the disease， and in addition to being torn away from friends and family， they are hosts5） to a virus whose very name makes people fearful.

“Any time you’re feeling alone， there’s a sense of hunkering down6）， which increases stress and fear，” says Ann Connor， an associate professor at Emory University’s School of Nursing， who has studied what she calls “intentional comfort touch.”

Touch can be a way to combat some of the fear and stress that are inherent with visiting the hospital—one study showed that patients who had their hands held during cataract7） surgery experienced less anxiety and had lower levels of the stress hormone adrenaline. With an average Ebola survival rate of 50 percent， the stress and fear of coming down with8） the disease is surely unfathomable， but hand-holding9）—without the barrier of gloves， at least—is not on the table10）.

For nurses， doctors， and other healthcare workers， Connor explains that it’s less about what they’re doing than how they’re doing it. She offers the example of getting blood pressure taken， and the difference between just “slapping on” the cuff， and doing it in a more deliberate way.

“There’s a way you can put that cuff around the person’s arm， and place the stethoscope and your other hand， that conveys more comfort，” she says. “Those are ways you can bring back people’s dignity and sense of connection.”

Connor believes this is possible， even with the intense protective gear11） healthcare workers have to wear while treating Ebola patients. Crystal Johnson， a nurse at Emory University Hospital in Atlanta who has worked with three Ebola patients describes the gear she has to wear.

“We wear disposable undergarments， scrubs， and socks， and we have a set of shoes that we only use during this time，” she says. “Full Tyvek12）， with booties， a helmet with a hood13）， and also an apron. Double gloves. And tape up everything.”

But nurses can still perform procedures in the caring， deliberate way Connor describes while wearing all this， and Johnson says that touching through the gear still makes a big difference.

“No one would come near [the patients]，” she says. “Once they get here， we’re with them. We don’t leave their side. Nancy said it best， she said she didn’t feel like she was an alien anymore， because we were able to touch， [even though] it was through the gloves and everything.”

In her review of the literature on intentional comfort touch， Connor finds that it’s beneficial for nurses as well， who feel more valuable and satisfied， and less powerless when they are able to soothe patients through touch.

“We are their companions for a long time， because they sometimes aren’t able to talk with or touch their family members，” Johnson says. “We become really close from the start.”

The problem is that in West Africa， where there’s already a shortage of healthcare workers， where many healthcare workers have died， where there have been nearly 7500 cases， nearly 3500 deaths and counting14）， health workers may just not have the time or mental bandwidth15） to take a deliberate moment to intentionally comfort one patient. There’s just too much to do.

“When there’s a crisis， you feel somewhat powerless as a nurse，” Connor says. Healthcare workers may then have a more “instrumental touch”—quick， brusque， utilitarian， “because they feel out of control themselves.”

That’s not to say people can’t adjust， and pull through even the worst situations. “Humans have an enormous capacity for adaptation，” Connor says. And there’s been some adaptation already—the elbow bumps， and all. But Connor is reluctant to speculate when it comes to West Africa. The most affected countries—Guinea， Sierra Leone， and Liberia—have all suffered recent civil wars， and all the stresses that linger on for years afterward. And now， Ebola.

“I’m not sure how much adaptation they have left，” Connor says. “It’s almost like they’re being hit while they’re already down.”

2014年2月，埃博拉病毒在西非爆發，隨后蔓延至美國、印度等地，不斷升級的疫情讓全世界都繃緊了神經，極高的致死率令人聞之色變。對于這種主要依靠接觸傳播的病毒，隔離無疑是最有效的防護手段，但它卻切斷了患者與外界的聯系，給患者和醫護人員帶去無盡的心理壓力。平日里，我們不經意間的一次觸碰可能微不足道，但在疫區，人與人之間的觸碰卻有了傳遞溫暖、重塑希望的力量。

觸覺是我們在母親子宮中最早形成的感覺，在人的一生中，它會持續引發強烈的情感反應，并且一直是我們與其他人建立關系的有效方式。埃博拉是通過觸碰致人傳染的一種疾病——它不隨空氣傳播，人們只有直接接觸感染者的體液才會被傳染。這就意味著在目前疫情爆發（史上最嚴重的一次）的地區，保證安全的唯一辦法就是不要觸碰任何人。

在受到疫情沖擊最嚴重的國家之一——利比里亞，這意味著人們正在背離一項重要的文化傳統。據《紐約時報》本周末的報道（編注：英文原文發表于2014年10月7日），在利比里亞，“人們通過身體接觸來表達親密關系”。當地傳統的問候方式是親吻雙頰，而在僅僅幾滴唾液就可能使人接觸到病毒的當下，人們再也不可能采用這種問候方式了?！度A盛頓郵報》的記者倫尼·伯恩斯坦在前往該國探訪時注意到，當地正在盛行一種新的更為謹慎的問候方式——“利比里亞式握手”，即碰撞完全用衣服裹住的手肘。

不過，有些人還是會忍不住去安慰自己所愛的人。《紐約時報》的報道講述了一名男子如何盡量不去觸碰他那在病床上吐血的母親：

但隨著病情惡化，她無法再進食。于是他喂她牛奶，并設法安慰她。他的皮膚碰到了她的皮膚。

第二天，他的母親過世了。

剛辦完母親的葬禮，鄧巴先生自己的額頭也因為發燒而變得滾燙。他在蒙羅維亞的約翰·F·肯尼迪醫院住了15天，與病魔搏斗。他最終贏了這場戰斗。但是出院時，他卻發現自己的四個姐妹，還有兄弟、父親、叔叔、嬸嬸和兩個侄兒都已去世。短短幾天，他的整個家就毀了。

鄧巴先生在周五表示，如果讓他重新選擇，他依然會那樣做?！澳鞘俏覌寢?，”他說，“是她生了我。”

那些與世隔絕、很少與人發生身體接觸的人被稱為“渴望觸摸者”。他們常常是一些被邊緣化或蒙受污名的人——無家可歸者就是其中一例。埃博拉患者顯然也處于一種隔絕狀態，立即隔離是阻斷該病傳播的最佳方法。這些患者不僅被迫與家人、朋友分離，還攜帶著一種令人聞之色變的病毒。

“每當人感到孤獨時，都會有種想蜷縮起來的感覺，而這會增加緊張和恐懼?！卑Ｄ锎髮W護理學院副教授安·康納說道。她稱自己的研究課題為“有意的安慰性觸碰”。

觸碰可以在一定程度上消除人們去醫院時必然會感受到的恐懼和緊張——一項研究指出，在進行白內障手術時，握住病人的手可以減輕他們的焦慮感并降低其應激激素腎上腺素水平。埃博拉患者的平均存活率為50%，感染埃博拉帶來的緊張和恐懼肯定是難以言說的。但是，握手這種表示關懷的舉動——至少是不戴手套的握手——并不在人們的考慮之列。

康納解釋說，對于護士、醫生和其他醫務工作者而言，這更多的是關于怎么做，而非做什么的問題。她以量血壓為例，指出了只是“啪的一聲套上”袖帶和更為從容的做法之間的差別。

“在為患者套上袖帶、安放聽診器以及擺放你的另一只手時，你是能通過某種方式向患者傳遞更多安慰的，”她說，“通過這些方式，你可以挽回患者的尊嚴，使其重新感覺到與他人的聯系?！?/p>

康納認為，即使是在救治埃博拉患者而必須穿著嚴密的防護服時，醫療人員也有可能做到這一點。曾經參與救治三名埃博拉患者的亞特蘭大埃默里大學醫院的護士克麗絲特爾·約翰遜描述了她必須要穿的裝備。

“我們要穿一次性的內衣、防護服和襪子，還有一雙救護期間專用的鞋子，”她說，“用的全部是特衛強材料，有短靴和帶面罩的防護帽，還有一條圍裙和兩副手套。全用膠帶封起來?！?/p>

不過，即便是在這樣全副武裝的情況下，護士們依然可以像康納說的那樣，以關懷和從容的態度實施醫療程序。約翰遜表示，隔著防護服觸碰患者仍能起到很大作用。

“沒人愿意接近[患者]，”她說，“他們一入院，我們就和他們待在一起。我們一直守護在他們身邊。南希形容得最恰當，她說她不再覺得自己是個異類，因為我們可以觸碰，[盡管]是隔著手套和重重防護。”

在研究了關于有意的安慰性觸碰的文獻之后，康納發現這樣做對護理人員同樣有益。當護理人員可以通過觸碰來安撫患者情緒時，他們能從中獲得更多的價值感和滿足感，無能為力的感覺也會減輕。

“在很長一段時間都是我們陪伴患者左右，因為有時候他們不能和自己的家人交談或接觸，”約翰遜說，“從一開始，我們就有了非常緊密的聯系?！?/p>

問題是，在西非醫護人員已經出現短缺，許多醫護工作者已經殉職，埃博拉感染病例已接近7500例，死亡病例接近3500例，而且這些數字還在繼續增長。在這種情況下，醫護人員可能根本就沒有時間也沒有精力去從容地有意安撫某位患者。他們要做的工作實在太多了。

“當危機爆發時，護理人員多少會感到有些無助。”康納說。那時，醫護人員可能會采用更加“實用的觸碰”——迅速、生硬、注重實效，“因為他們自己也感到對局勢失去了控制”。

這并不是說人們就不能適當做出調整以度過最艱難的時期?！叭祟愑袠O強的適應能力?！笨导{說。目前也已經出現了一些調整的跡象——比如擊肘問候等等。不過，康納并不愿意就西非的情況做出推測。疫情最嚴重的幾個國家——幾內亞、塞拉利昂和利比里亞——在最近幾年都飽受內戰及戰后多年來緊張局勢的蹂躪。而現在，埃博拉又爆發了。

“我不確定他們還有多少調整的空間，”康納說，“現在的情況就好像是他們在已經倒下后又挨了一記重拳?！?/p>