Reactivated PPE Portrait Project strengthens human connections in the COVID-19 crisis

Artist and Gold Foundation grantee Mary Beth Heffernan’s work that began during the Ebola crisis has found a new urgency and widespread adoption now.

COVID-19 patients are isolated in so many ways, and even the faces of those caring for them in hospitals are hidden behind masks and face shields. To build connection, physicians, nurses, and other healthcare professionals are adding large photos of themselves to the front of their disposable gowns, so patients can see the faces of those who are caring for them.

This moving display of humanism isn’t new, but it has been reactivated with new urgency to address the COVID-19 pandemic. Adding photos to the front of protective suits started 5 years ago during the Ebola crisis, when Gold Foundation grantee Mary Beth Heffernan saw an unmet need for human connection in a similar crisis that required PPE (Personal Protective Equipment) and patient isolation.

Mary Beth Heffernan applies a PPE Portrait to the front of nurse Zoe Dewalt’s protective suit in  Liberia in 2015 during the Ebola crisis. The PPE Portrait Project is now in use during the COVID-19 pandemic. (Photo credit: Marc Campos, Occidental College)

“The harm of not seeing a human face for days on end cannot be underestimated,” Mary Beth Heffernan, a Los Angeles-based artist and Occidental College art and art history professor, told the Gold Foundation in 2015.  “At a moment when patients are already experiencing abject physical suffering, the isolation, facelessness, and lack of touch make them feel abandoned by humanity.”

This deep concern moved her to design her PPE Portrait Project to show the faces of healthcare workers carrying for Ebola patients in Africa. The Gold Foundation helped fund her initial work, and she traveled to Liberia in 2015 with printers, ink, cameras, sticky labels, and a plan: To take photos of health workers and adhere sticky labels with those photos to their gowns so that patients could, for the first time, see their caregivers’ faces.

Her PPE Portrait Project was a success. Both the patients and the healthcare workers involved in the project in Liberia reported feeling more human.

In the five years between her work in Africa and the COVID-19 pandemic, Ms. Heffernan has been actively trying to make such photos a best practice for medical isolation – in any case in which patients only see their healthcare team behind masks. Hospitals that she approached were initially not very receptive – but COVID-19 has changed that.

“Before, there wasn’t a sense of urgency about patient isolation and the harm caused by solely seeing your healthcare workers in masks. Now I think it’s painfully obvious why isolated patients benefit from seeing the faces of their caregivers,” Ms. Heffernan said recently.

Dr. Cati Brown-Johnson, a researcher at Stanford University, brought the PPE Portrait Project to Stanford Health Care, where it is now being implemented at their COVID-19 primary care and testing sites, and expanding beyond. 

Dr. Cati Brown-Johnson, a Stanford research scientist, was one of the first to read about the PPE Portrait Project’s work in the Ebola crisis and reach out to Ms. Heffernan in the COVID-19 pandemic. Dr. Brown-Johnson studies compassion and humanism in medicine. She had seen a documentary that included Ms. Heffernan’s work and was moved to replicate the project in the current pandemic. She first tried it at one of Stanford’s drive-through testing sites.

The PPE Portrait Project is now being implemented across Stanford Health Care at their COVID-19 primary care and testing sites, and is expanding to non-COVID wards, including inpatient palliative care. More care sites have begun working with Ms. Heffernan, including UMass Memorial Health Care and the University of Southern California’s Keck School of Medicine.

Ms. Heffernan has also seen all sorts of ad-hoc variations of the PPE Portrait Project in use. While any efforts to strengthen connection are helpful, her experience working with the World Health Organization Case Management Team in Africa during the first iteration of the PPE Portrait Project yielded clear parameters for optimal implementation.

For example, photos are most easily experienced by the patients when they are photos of faces taken straight-on, not a side view, and the healthcare worker is smiling warmly.

Ms. Heffernan considered laminating the photos and cleaning them after each use, but that proved problematic. Anything stiff with hard corner could potentially damage the gown, and repeated use of cleaning chemicals could affect the lamination. Also, the high gloss of conventional lamination made the portraits difficult for patients to see. Instead, she recommends using matte surface sticky labels, which are available as four large labels on one 8.5×11 sheet of paper. Each label becomes a one-use photo that can be peeled off and stuck on the gown, and disposed of with the gown.

The labels can be stored with the rest of the PPE supplies in the donning area, so that adding a photo is just part of the process of preparing to enter a patient’s room or isolation ward.

Dr. Brown-Johnson is also freely sharing guidelines for the PPE Portrait Project and offering a sign-up form for researchers and other partners interested in collaborating with her, and Stanford has launched a webpage with PPE Portrait Project tips. In addition, she has begun testing the effects of the PPE Portrait Project. For example, she asked nurses at one Stanford testing site to use pilot the PPE Portraits for a week, using a day-on, day-off cadence, and surveyed and interviewed nurses and patients.

The Gold Foundation hopes to help the PPE Portrait Project spread more rapidly to aid in care during the COVID-19 pandemic.

“Attaching photos to PPE is such a simple, low-tech tool – yet it can transform those precious moments of care at a time when patients are sick, scared, and feeling alone,” said Dr. Richard I. Levin, President and CEO of the Gold Foundation. “We were so glad to support Mary Beth Heffernan and her brilliant idea in her initial PPE Portrait Project work. We urge all hospitals to adopt this practice, so that both patients and healthcare teams can benefit.”

The Gold Foundation plans to keep updated on the PPE Portrait Project and continue to share the latest news and evolutions with its Gold community.

“I’m so grateful for the Gold Foundation supporting the project at its inception,” said Ms. Heffernan. “It was an enormous boost at the time and I am buoyed by the Gold Foundation’s ongoing help in advancing the project in the COVID context and beyond.”