Oct 03 2014
By Milca Nunez, Frist Global Health LeaderNext Monday will be our fourth week in this field experience with Project HOPE in the Dominican Republic. We are almost halfway done, so I am anxious to learn as much as possible while I am here. I do not know if I will ever have another opportunity such as this one, where I get to travel, gain university credits and earn work experience. I am thankful for being here every day, although I feel nostalgic at times. But I decided to take on this challenge so I am determined to finish strong! Last week was a very busy week full of interesting and distressing things. I will elaborate further in the following lines.
On Wednesday, September 24, a large crowd gathered at Brentwood Baptist Church in Brentwood, Tennessee, to listen to experts in the field of maternal, newborn, and child health (MNCH) with a special emphasis on healthy timing and spacing of pregnancy (HTSP). The conference hosted speakers from faith, politics, service providers, and other policy experts on these issues to lecture and engage the attendees an active discussion, including a Q & A, on the topic.
Mike Glenn, pastor of Brentwood Baptist Church and a contributor to The Mother & Child Project, opened with a prayer and a short sermon on the inkeeper in the nativity story. Perhaps, he suggests, the innkeeper tried his best to give Mary a private place to give birth to her baby boy. And that we are now poised to stand as Inkeepers to the millions of women worldwide who seek help for their maternal health.
This was followed by a interview led by Jenny Eaton Dyer, PhD, Executive Director of Hope Through Healing Hands, of Senator Bil Frist, MD, also contributors to The Mother & Child Project. Senator Frist laid the foundation for the problems we face in the field of maternal and child health and healthy timing and spacing of pregnancy, or family planning, and he encouraged everyone to advocate with their congressional representatives and senators about the issues.
Frist was followed by the Bill & Melinda Gates Foundations' Gary Darmstadt, Senior Fellow Global Development Program, and Tom Walsh, Senior Program Officer Global Policy and Advocacy. Gary presented a very data-driven survey of MNCH, showing that 11 million births worldwide occur in high-income nations with adequate medical care. But 50 million occur in low-income nations, often at home with no medical care. Sometimes even completely alone. He said, "These inequities [for moms] should not be in the world, and we all have the power and responsibility to change them."
Tom Walsh reinforced this idea from his political perspective and area of expertise by saying, "Advocacy is letting your representatives know the have support to do what they already know is right to do."
Local and national service providers hosted breakout sessions describing their work, on the ground, in maternal and child health, including family planning. Local groups Lwala Community Alliance and LiveBeyond shared about their work in Kenya and Haiti, and Compassion International, Food for the Hungry, and World Vision discussed their global work in healthy timing and spacing of pregnancies. Their anecdotes, experience, and fresh statistics really made these issues personal.
After a catered lunch and an active Q&A discussion with a panel of all speakers, including John and Avril Thomas of Living Hope Community Center in Capetown, South Africa, Jenny Dyer closed the event with "what you can do," next steps for awareness and advocacy for the Nashville community.
To find out about more events like this coming to your town in the future, follow us at @HTHHglobal on Twitter.
By Milca Nunez, Frist Global Health LeaderIt’s been only a few days since we set foot on the beautiful islands of the Dominican Republic. I could not believe it finally happened; it was so surreal. Our preceptor, Mrs. Teresa Narvaez (who is the country director for Project HOPE and the clinics), picked us up from the airport and took us to eat some “sancocho”, which is a delicately seasoned stew with spices, meat, potatoes, lemon, and avocado.
By Milca Nunez, Frist Global Health LeaderDuring this week, we attended a forum on preventing youth violence and crime. Many organizations attended to hear about the results of a survey that was conducted on various municipalities to measure people’s perception of crime in their communities. Most of the findings showed prevalence of domestic violence, homicides, gender violence, dysfunctional families, etc - all of which are linked to lack of education and lack of community and family cohesion.
Sen. Bill Frist
This post was original published at One.org.
I was shocked to learn that the largest previous Ebola outbreak occurred in 1976 in Zaire: 318 confirmed cases and 280 deaths, but the current outbreak in West Africa has exceeded 4,200 cases with 2,200 deaths and growing. According to WHO estimates, 10,000 more lives will be lost before the virus is contained.
This is terrifying, I know. I remember feeling the same urgency over a decade ago. I was working with Bono on the ground in Africa, traveling across the U.S. on a listening tour, and I ultimately went to the White House to inform then-President George W. Bush that the U.S. desperately needed to address HIV/AIDS.
That appeal worked. President Bush boldly announced the unprecedented President’s Emergency Plan for AIDS Relief (PEPFAR) during the State of the Union Address in 2003—a time when only 50,000 people in Africa had access to anti-retroviral therapy.
Today 12.8 million people have access to these drugs, and PEPFAR has provided HIV testing and counseling to 57 million people. In 2011 alone, PEPFAR provided services to prevent mother-to-child transmission of HIV resulting in over 240,000 babies born free of HIV.
This is what the U.S. is capable of.
Today, Ebola is ravaging West Africa thanks to a confluence of circumstances. But the important message is, that we can address these circumstances, and we are not in this predicament for lack of a vaccine or anti-viral drug. The real issue are the significant cultural barriers to containing the outbreak, and lack of medical infrastructure in West Africa.
For example, people are avoiding treatment because of a widespread local doubt that Ebola even exists. There is fear that medical workers—foreign and local—are spreading the virus. Families do not want their loved ones to die in isolation, so they choose to keep them home.
Additionally, when an individual succumbs to the virus, burial practices of washing and kissing the body and then reusing the burial mat further spreads the disease because the recently deceased Ebola victim is actively shedding the virus from her skin.
For these reasons, changing culture by working within the culture will be imperative to our success. With HIV/AIDS, PEPFAR collaborated with traditional medical practitioners to deliver education and training, while also building an infrastructure that was sustainable. With HIV there were cultural practices like using leeches for bleeding that increased transmission of HIV outside safe sex practices or reusing needles. We had to address those practices in a culturally sensitive way.
We are also faced with a tragic lack of resources. The medical supplies and personnel needed to offer the routine intensive care necessary to support someone through a hemorrhagic fever like Ebola simply do not exist in West Africa.
President Obama has just announced an escalation of military involvement in Liberia only. He has committed 1,700 beds, to training of 500 health care workers and sending 400,000 home treatment kits. This will all be deployed by the Department of Defense via “command and control,” meaning they will deliver and direct the use of the resources to treat the sick.
While this is a major commitment, it is only for Liberia, but I suspect once we have boots on the ground, we will escalate even further.
As a former member of the Senate Foreign Relations committee, I have spent a lot of time dealing with the tension between our responsibility to protect and the sovereignty of foreign nations. There are myriad issues at play.
Specifically, military involvement in humanitarian efforts must always be approached carefully. I truly believe that global health is a vital diplomatic instrument to strengthen confidence in America’s intent and ability to bring long-term improvements to citizen’s lives in other nations. The fight for global health can be the calling card of our nation’s character in the eyes of the world.
I also agree that our military comprises brilliant and compassionate minds and state of the art resources. But use of the military instead of an NGO or an organization like USAID comes at a price. There is always a tension between giving aid and the deeply instilled training to maintain order especially in a humanitarian situation when the rules of engagement prevent the military from firing unless fired upon.
We can win hearts and minds with military help, but we must do it in the right way – by building a sustainable infrastructure and empowering West Africans to continue the work. The commitment to build facilities and train local personnel is a good start.
Without containment, this epidemic will become a pandemic. The World community including the U.S. needs to help. However, help needs to be culturally sensitive and build lasting solutions. We cannot fish for them, we must teach them to fish.
Bill Frist, M.D is a nationally acclaimed heart and lung transplant surgeon and former U. S. Senate Majority Leader. Dr. Frist represented Tennessee in the U.S. Senate for 12 years where he served on both the Health and Finance committees responsible for writing health legislation. Dr. Frist was the former Co-Chair of ONE Vote ’08 and his leadership was instrumental in the passage of PEPFAR.
Sep 15 2014
Sen. Bill Frist
As the Ebola situation in West Africa progresses, we are dealing with increasingly complex medical and cultural challenges. I addressed some of the cultural issues in a Morning Consult column last month, and highlighted the importance of identifying infected patients:
The only solution is prevention, which relies on containment and isolation. The sick must be rapidly identified and contained. Their contacts must be followed for 21 days so they can be rapidly isolated, should they develop symptoms. Their care must be delivered in a hazmat suit. If the patient dies, and [50%] do, the body must be properly disposed of because a recently deceased Ebola victim is actively shedding the virus from his skin.
But thus far, identification has not been straightforward. In its earliest stages, Ebola looks like other diseases: malaria, typhoid fever, cholera. It’s clear that these patients are sick, but it’s not clear that they are infected with Ebola virus. During the incubation period, the infected individual may not show any symptoms at all.
Currently, public health workers try to work backwards from a very sick patient. Who lives with them? Who is in their community? Where have they traveled? Who may they have had contact with over the past month? Find those individuals. Follow their health for the next month. If anyone gets sick, the process starts over.
An early, precise diagnosis would be a game changer for this process.
- We could separate infected from uninfected patients immediately—before they are contagious. Even in locations without sophisticated quarantine facilities, physical separation of Ebola patients from others would cut down on cross contamination within clinics and communities, and better protect one of the hardest hit groups: health workers.
- We could dramatically decrease the virus’s geographic spread. Incubation takes 2 to 10 days, and usually that means the person is positive but not yet symptomatic. We believe that a patient isn’t contagious until the fever starts, but a rapid diagnostic test could identify a carrier before symptoms appear, and before they travel and risk spreading the virus.
- We could focus on post-exposure drug development. Identifying carriers before they feel ill would let us treat them early. Some drugs have already shown great efficacy if they are given immediately. Zmab is a drug designed as a prophylactic. It’s shown to be 100% effective in primates if given within 24 hrs of exposure and 50% in 48 hours. Other similar treatments could be extremely effective if we know who to give them to.
- Health care workers that have been exposed to Ebola can be quarantined for up to 21 days, and often they have not been infected. In an area with a severe shortage of trained medical personnel, the loss of any workers is disastrous. An early diagnostic test would let those medical professionals continue to safely treat their patients if they have not been infected.
The situation in West Africa is complex for so many reasons, and a rapid diagnostic test would not be an ultimate solution, but it could be the tipping point we need to stem the tide of new cases.
Sep 15 2014
Sep 08 2014
J. Stephen Morrison
As September opened, a striking consensus had emerged among global health leaders that the Ebola outbreak in Liberia, Sierra Leone, and Guinea has transmuted into a colossus that continues to gather force: It is "spiraling out of control" (Dr. Thomas Frieden, Director of the U.S. Centers for Disease Control and Prevention, CDC); “We understand the outbreak is moving beyond our grasp” (Dr. David Nabarro, Senior UN System Coordinator for Ebola Disease ); Ebola is “a global threat” that “ will get worse before it gets better, and it requires a well-coordinated big surge of outbreak response” (World Health Organization Director General Dr. Margaret Chan); “Six months into the worst epidemic in history, the world is losing the battle to contain it. Leaders are failing to come to grips with the transnational threat” (Dr. Joanne Liu, Doctors Without Borders (MSF) International President).
Ebola in West Africa has overwhelmed the containment and treatment measures attempted thus far, and is seriously threatening nearby and neighboring states. (A separate Ebola outbreak is underway in the Democratic Republic of Congo, DRC.) Research and development of treatments and vaccines has accelerated, but the speed with which the Ebola virus is mutating has complicated the quest to identify new tools quickly. No tested or approved therapies exist. Vaccine testing has begun, but it is uncertain when or if a viable vaccine will become available. In the future, any viable vaccine will become effective only if people are immunized on a mass scale.
Up until now, high-level global statesmanship has been absent, and the modest, late steps taken to control the outbreak have failed to stop its alarming, exponential growth. As Ebola in West Africa charges ahead, it may finally stir world leaders to initiate the large-scale international security actions and other measures – quick disbursement of funds, mobilization of thousands of health workers, arrival of medical products and protective equipment – essential to arrest this catastrophe. If not, we should prepare for the worst: a runaway Ebola epidemic of an ever more massive scale in Africa.
As of August 28, the World Health Organization (WHO) estimated 3,069 cases with 1,552 deaths, over 40% emerging in the previous three weeks. By middle of this week, those numbers climbed to over 3,500 and 1,900, respectively. Over 240 health workers have become sick with Ebola, half of whom have died. This stark, upward, exponential trajectory is set to continue. WHO now freely admits that official numbers “vastly underestimate” reality and that the actual figures may be two to four times these levels. Total cases may soon reach 20,000, but there is no reason to believe it will stop at that level. Accordingly, in its new action plan, WHO called initially for international commitments of $489 million, almost five times the $100 million it proposed in late July. By this week, Dr. Nabarro claimed the requirements have reached $600 million but “could be a lot more.”
A tragedy for West Africa, the Ebola crisis has been a humiliating
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David J. Olson
Last November, at an event associated with the International Conference on Family Planning in Addis Ababa, Ethiopia, I was struck by a public comment from a representative of the U.S. Agency for International Development (USAID): “With almost 90% of people globally professing a faith, it doesn’t make sense to do family planning without the faith community.”
I was bowled over by this statement. I checked up on the claim, and found that, according to the Pew Research Center, 84% of the 2010 world population of 6.9 billion is considered “religiously affiliated.”
So the point was valid, and I would go even further: We in global development should be partnering more with the faith community in allareas of global health. After all, if the faith community can work on family planning – fraught with all of its social, cultural and religious baggage – it should also be able to work effectively on less controversial issues like malaria, diarrhea, water and sanitation. Especially in places like Africa where people have a high level of confidence in their religious institutions.
Ray Martin, who is stepping down as executive director of Christian Connections for International Health (CCIH) August 31 after 14 years on the job, knows as much as anyone about this issue (Full disclosure: I serve on the board of CCIH).
“While it is gratifying to me over a five-decade career in global health to observe...
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