抗击埃博拉:触碰的力量
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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发，随后蔓延至美国、印度等地，不断升级的疫情让全世界都绷紧了神经，极高的致死率令人闻之色变。对于这种主要依靠接触传播的病毒，隔离无疑是最有效的防护手段，但它却切断了患者与外界的联系，给患者和医护人员带去无尽的心理压力。平日里，我们不经意间的一次触碰可能微不足道，但在疫区，人与人之间的触碰却有了传递温暖、重塑希望的力量。
触觉是我们在母亲子宫中最早形成的感觉，在人的一生中，它会持续引发强烈的情感反应，并且一直是我们与其他人建立关系的有效方式。埃博拉是通过触碰致人传染的一种疾病――它不随空气传播，人们只有直接接触感染者的体液才会被传染。这就意味着在目前疫情爆发（史上最严重的一次）的地区，保证安全的唯一办法就是不要触碰任何人。
在受到疫情冲击最严重的国家之一――利比里亚，这意味着人们正在背离一项重要的文化传统。据《纽约时报》本周末的报道（编注：英文原文发表于2014年10月7日），在利比里亚，“人们通过身体接触来表达亲密关系”。当地传统的问候方式是亲吻双颊，而在仅仅几滴唾液就可能使人接触到病毒的当下，人们再也不可能采用这种问候方式了。《华盛顿邮报》的记者伦尼・伯恩斯坦在前往该国探访时注意到，当地正在盛行一种新的更为谨慎的问候方式――“利比里亚式握手”，即碰撞完全用衣服裹住的手肘。
不过，有些人还是会忍不住去安慰自己所爱的人。《纽约时报》的报道讲述了一名男子如何尽量不去触碰他那在病床上吐血的母亲：
但随着病情恶化，她无法再进食。于是他喂她牛奶，并设法安慰她。他的皮肤碰到了她的皮肤。
第二天，他的母亲过世了。
刚办完母亲的葬礼，邓巴先生自己的额头也因为发烧而变得滚烫。他在蒙罗维亚的约翰・F・肯尼迪医院住了15天，与病魔搏斗。他最终赢了这场战斗。但是出院时，他却发现自己的四个姐妹，还有兄弟、父亲、叔叔、婶婶和两个侄儿都已去世。短短几天，他的整个家就毁了。
邓巴先生在周五表示，如果让他重新选择，他依然会那样做。“那是我妈妈，”他说，“是她生了我。”
那些与世隔绝、很少与人发生身体接触的人被称为“渴望触摸者”。他们常常是一些被边缘化或蒙受污名的人――无家可归者就是其中一例。埃博拉患者显然也处于一种隔绝状态，立即隔离是阻断该病传播的最佳方法。这些患者不仅被迫与家人、朋友分离，还携带着一种令人闻之色变的病毒。
“每当人感到孤独时，都会有种想蜷缩起来的感觉，而这会增加紧张和恐惧。”埃默里大学护理学院副教授安・康纳说道。她称自己的研究课题为“有意的安慰性触碰”。
触碰可以在一定程度上消除人们去医院时必然会感受到的恐惧和紧张――一项研究指出，在进行白内障手术时，握住病人的手可以减轻他们的焦虑感并降低其应激激素肾上腺素水平。埃博拉患者的平均存活率为50%，感染埃博拉带来的紧张和恐惧肯定是难以言说的。但是，握手这种表示关怀的举动――至少是不戴手套的握手――并不在人们的考虑之列。
康纳解释说，对于护士、医生和其他医务工作者而言，这更多的是关于怎么做，而非做什么的问题。她以量血压为例，指出了只是“啪的一声套上”袖带和更为从容的做法之间的差别。
“在为患者套上袖带、安放听诊器以及摆放你的另一只手时，你是能通过某种方式向患者传递更多安慰的，”她说，“通过这些方式，你可以挽回患者的尊严，使其重新感觉到与他人的联系。”
康纳认为，即使是在救治埃博拉患者而必须穿着严密的防护服时，医疗人员也有可能做到这一点。曾经参与救治三名埃博拉患者的亚特兰大埃默里大学医院的护士克丽丝特尔・约翰逊描述了她必须要穿的装备。
“我们要穿一次性的内衣、防护服和袜子，还有一双救护期间专用的鞋子，”她说，“用的全部是特卫强材料，有短靴和带面罩的防护帽，还有一条围裙和两副手套。全用胶带封起来。”
不过，即便是在这样全副武装的情况下，护士们依然可以像康纳说的那样，以关怀和从容的态度实施医疗程序。约翰逊表示，隔着防护服触碰患者仍能起到很大作用。
“没人愿意接近[患者]，”她说，“他们一入院，我们就和他们待在一起。我们一直守护在他们身边。南希形容得最恰当，她说她不再觉得自己是个异类，因为我们可以触碰，[尽管]是隔着手套和重重防护。”
在研究了关于有意的安慰性触碰的文献之后，康纳发现这样做对护理人员同样有益。当护理人员可以通过触碰来安抚患者情绪时，他们能从中获得更多的价值感和满足感，无能为力的感觉也会减轻。
“在很长一段时间都是我们陪伴患者左右，因为有时候他们不能和自己的家人交谈或接触，”约翰逊说，“从一开始，我们就有了非常紧密的联系。”
问题是，在西非医护人员已经出现短缺，许多医护工作者已经殉职，埃博拉感染病例已接近7500例，死亡病例接近3500例，而且这些数字还在继续增长。在这种情况下，医护人员可能根本就没有时间也没有精力去从容地有意安抚某位患者。他们要做的工作实在太多了。
“当危机爆发时，护理人员多少会感到有些无助。”康纳说。那时，医护人员可能会采用更加“实用的触碰”――迅速、生硬、注重实效，“因为他们自己也感到对局势失去了控制”。
这并不是说人们就不能适当做出调整以度过最艰难的时期。“人类有极强的适应能力。”康纳说。目前也已经出现了一些调整的迹象――比如击肘问候等等。不过，康纳并不愿意就西非的情况做出推测。疫情最严重的几个国家――几内亚、塞拉利昂和利比里亚――在最近几年都饱受内战及战后多年来紧张局势的蹂躏。而现在，埃博拉又爆发了。
“我不确定他们还有多少调整的空间，”康纳说，“现在的情况就好像是他们在已经倒下后又挨了一记重拳。”