I was privileged to work in many different settings during my time in Ecuador giving me a wide range of exposures. First of all, there is private versus public medical care. The perception among those that seek care in the private hospitals is that they are receiving a superior service in exchange for paying for services that are free elsewhere. In some ways this is true. However, in the public hospitals international standards of care were followed.

Forbes | November 1, 2014

By Bill Frist

Imagine waking up with a fever and nausea in West Africa. You would probably be equal parts curious about the cause of your symptoms, and terrified that it might be fatal. Ebola is actually the least likely cause of your fever, unless of course you had been exposed to a known Ebola case. Malaria is a much more likely cause of your fever, and now that the summer months are approaching, Lassa Fever, another type of Viral Hemorrhagic Fever, is becoming more prevalent.

You go to the local “clinic” and healthcare workers there isolate you. They draw blood and send it to a nearby city for testing. It will take days for the results to come back. You are considered Ebola positive until proven otherwise. Until then, you are put in containment with other febrile patients–some probably with Ebola. There is no space. You are crammed in with other sick patients and isolated from your family. You may feel O.K. compared to these patients, some of whom are potentially deathly ill. If you do not have Ebola now, will you have it by the time your waiting period is done?

Now imagine an alternative reality.

You wake up with the same fever and nausea. You go to a designated diagnostic site, likely the same clinic, and your finger is pricked or a small vial of blood is drawn by a trained healthcare worker. You are asked to wait in a holding room for up to three hours, but no more. Everyone in the room with you is about as sick as you are and waiting quietly and calmly. In a few hours, you have an answer: You have Lassa or Malaria or another febrile illness, or you have Ebola. From there you are triaged appropriately to the best treatment, maybe released with anti-malarial medications or other treatment.

In West Africa today, a rapid diagnostic test (RDT) would be a complete game changer. Identifying infected individuals quickly means the best use of resources, quick institution of appropriate treatment, reduced risk for spread of infection, and decrease in public panic and fear.

On October 25 the FDA approved two tests from BioFire Defense that can produce a diagnosis in two hours compared with current polymerase chain reaction (PCR) methods that generally take four hours. The new tests use patented “FilmArray” technology to identify the virus quickly.

While this is definitely a step in the right direction, it is still not the ideal solution. First, BioFire’s FilmArray tests still require someone to draw an entire tube of blood and inactivate the virus, which is dangerous. Second, the testing instrument can only process one sample at a time. One machine can process 24 tests a day, while PCR tests can run up to 70 tests a day even though they take four hours. Third, the cost is almost prohibitive. The new test instrument costs $39,000 and each test is $189 dollars. Considering multiple devices are needed, and that PCR is relatively cheap, the cost benefit analysis needs to be considered.

This is not to say I am not encouraged by the possible impact of the BioFire technology. I am especially pleased the FDA accelerated approval. But we cannot stop here.

The ideal RDT would be a quick, field-ready test, with results available within hours at a very low cost. It would not require large blood samples, would have a high sensitivity and specificity, and may even be able to detect viral RNA before a patient becomes symptomatic—at very low concentrations—to avoid lengthy quarantines.

Several groups have reached out to me to let me know that they are working to develop such a test. Promising development it happening! When these criteria are met, it will be possible to test in a maximally effective, decentralized, and distributed way.

Until then the wisest course is a coordinated containment strategy for real exposures. The only people that have contracted Ebola in the U.S. have been healthcare workers exposed to the bodily secretions of infected patients late in the disease progression. Our focus should be on people who are truly likely to have been infected. And the treatment strategy should leverage the specific hospitals that are trained in managing diseases like Ebola.

It is hubris to think just anyone in healthcare can take care of Ebola patients and properly contain it. We have to respect the virus. But that does not mean mass hysteria, wide spread travel bans or even airport quarantines. We have to remember the science behind Ebola. It is infectious but not very contagious. It requires that bodily secretions contact mucous membranes.

While mistakes have been made in identifying and containing this outbreak, we must recognize we are fighting a disease and not each other. What we learn as we contain Ebola can be applied to infectious disease challenges in the future—both globally and at home. Today, one out of every 25 people admitted to the hospital in the U.S. acquires an infection and more than 5,000 people die of those infections each month. Early detection of infections in the hospital setting can reduce spread and save lives.

Doing thing right on Ebola will become the standard for how in the future we treat all infectious diseases. We need to keep working to get it right—to make the ideal a reality.

Sadly, I am leaving this wonderful island tonight. I cannot imagine how the time has flown by so fast. The last week was intense; activities included inputting and analyzing the data we collected, preparing for the presentation, organizing the workshop for stress management, and saying goodbye to my dear friends on the island. 

After learning about the culture and lifestyle on this south pacific island by interviewing people, we started to actually collect data with the tailored survey that would give us ideas about the stress status of the people in American Samoa. This survey was designed analyze from multiple angles the stress status of the people, including stress level, stress symptoms, access to releasing stress, risk factors, and effective coping techniques. Also, it emphasizes the fa’alavelave which means funerals, weddings, and other gatherings in which people have to donate money due to social reputation and expectation.

The target population of this research was on students and teachers at American Samoa Community College. We collected a good amount of surveys back and then analyzed the data with statistical software. Although the most common statistical software in the USA may not be available here, we finally achieved preliminary findings. My preliminary findings were presented to the land grant staff, American Samoan Community College faculties, and the people I interviewed previously. I am glad that this research provided the American Samoans a new way to look at themselves.

Although some of the college students did not feel stress from fa’alavelave personally, they did put fa’alavelave as the answer for the question, “what is the most common stressful thing the Samoan people may have?” A possible reason for this is that the all the college students’ funds come from their family; however, their families may suffer from stress of Fa’alavelave. In American Samoan society, the family will support the children economically while they are still in school. Although the economy on the island is not well developed, people donate a large portion of money for fa’alavelave, which creates tremendous stress for them.

In my stress management workshop, I demonstrated some coping techniques such as music therapy, meditation, humor therapy, and other methods to the audience. The stress management workshop provided fresh ideas for the locals and opened a window for them to explore the opportunities to manage their stress in the future. In addition, I designed some programs for the wellness center which will open later this year. The wellness center will be the first integrated place that aims to support the public health for the islanders.

Coming to the island alone is definitely not a lonely journey. I am blessed to have the chance to embrace the culture and diversity. It is a blessing to come to this exotic place and meet friendly people, to experience a different culture and gain working experience, while at the same time contributing my skills to the community. I found myself falling in love with this island, even though my contribution may only make a small difference for the islanders. This experience made me aware of how often I take for granted the ease of access to expertise in the USA. Because the island is so resource-limited, each visiting field has only one expert, one dietitian, one psychiatrist, one entomologist, or no expertise at all in many fields. My preceptor commented on my study, saying it was a unique and promising study, and he would like to continue it as a long term program for the American Samoa population. I am glad to see what I accomplished here, and hopefully I will come back some day.

 

The past two weeks were full of activities. I conducted a series interviews with the people to obtain a better understanding of the culture and guidelines for my research, including professionals in stress and mental health, as well as people who work at healthy food promotion, obesity control, agriculture, and other various areas. After summarizing my findings, I did a presentation to inform my fellows working at land grant, American Samoa Community College, to get the staff involved with this program. The relation between stress and obesity is a novel concept to most of them. Even in Samoan language, there is not a direct word for stress, and they do not conceive of the tremendous influence of stress on health. Therefore, it is of great significance for land grant to incorporate this stress management program for the American Samoa Community College’s Wellness Center when it officially opens later this year.

Communicating with the local community made me aware of the friendly and hospitable characters of the local people. Gradually, I felt myself getting more and more used to the local culture and passionate about corresponding with the locals. Due to the culture difference, the reasons for stress and obesity of the local people vary from those in the United States. Designing tailored questionnaires for the local people provides better understanding of our research.

Diet is extremely important for obesity and stress management, especially for the population which over-consumes food. Every Sunday, Samoan people wake up very early to prepare the umu-- a traditional cooking method in Samoa. The foods from the umu are tasty and served in large amounts. Cooking food in the umu demands time and effort, so people usually overeat after they spend so much effort in preparing it. Last weekend, we had a health affair to promote healthy food and introduce the way to produce healthy food. In our venders, we made healthy smoothies and showed people the method to make it with milk, fruits, cereal, and oats. In addition, we encouraged people to get more involved with physical activities, so we held a dance contest in which people danced and had fun together and at the same time gained the knowledge of healthy behaviors. 

Next week, after finishing our tailored questionnaire, we plan to spread our survey to the target population to collect data.

FOR INFORMATION CONTACT:

Melany Ethridge, (972) 267-1111, melany@alarryross.com

NASHVILLE, TENNESSEE, Oct. 27, 2014 – On November 21, former Senate Majority Leader Bill Frist, M.D., founder of Hope Through Healing Hands; J. Stephen Morrison, Ph.D., Senior Vice President at the Center for Strategic and International Studies; William Schaffner, M.D., professor of Preventive Medicine in the Department of Health Policy at Vanderbilt University School of Medicine; and Sten H. Vermund, M.D., Ph.D., Director of the Vanderbilt Institute for Global Health will lead a roundtable on Ebola that will take place at Vanderbilt University Medical Center, Light Hall Room 208, 2215 Garland Ave., in Nashville, from 10-11:30 a.m. The forum is jointly sponsored by Hope Through Healing Hands (HTHH), the Center for Strategic and International Studies (CSIS), and the Vanderbilt Institute for Global Health (VIGH). It will be on-the-record, and open to media.

The United States is engaged in a two front war against Ebola – at home, and abroad in Liberia, Sierra Leone and Guinea. The four roundtable speakers will open with remarks on key dimensions of the Ebola crisis: the evolving U.S. approach to preventing, detecting and responding to cases entering the United States; the U.S. military-led mobilization in Liberia and the broader international effort under UN coordination; the exponential growth of the epidemic itself in West Africa and critical steps to break the chain of transmission; and accelerated efforts to develop new technological tools, e.g. a rapid diagnostic test, vaccines, and treatments.

A lively, interactive conversation will follow, into which Muktar Aliyu, M.D., Associate Director for Research for the Vanderbilt Institute for Global Health and James E. Crowe, Jr., M.D., Director of the Vanderbilt Vaccine Center, will be invited to add their thoughts. Over the course of the conversation, special consideration will also be given to what future changes will be needed in U.S. approaches, both to domestic public health capacities and the long-term scientific research agenda, and to post-Ebola reconstruction in West Africa, including investments in basic health services.

A big part of infectious disease control is investing money in the right places, ideally at the source of the problem as early as possible, changing habits and having the right targeted response, Frist explained. “If we had invested one-tenth of what people think we have invested, we wouldn’t be in this position,” he said.

“Ebola is a modern plague, which sorely tests U.S. leadership at multiple points. It requires grappling with considerable unknowns, and preserving the confidence, trust and support of the American people,” Morrison commented. “We are just at the front end of a long process of thinking through the strategies that will work most effectively in this two front battle.”

Sten Vermund adds, “I write this from rural Mozambique where clinics have no running water or hand sanitizer; the spread of Ebola virus from West Africa to other under capacitated regions would be catastrophic. We must control it where it emerged.”

Hope Through Healing Hands is a Nashville-based 501(C) 3 nonprofit with a mission to promote improved quality of life for citizens and communities around the world using health as a currency for peace. Senator Bill Frist, M.D., is the founder and chair of the organization, and Jenny Eaton Dyer, Ph.D., is the CEO/Executive Director.

The Vanderbilt Institute for Global Health fosters multidisciplinary research, teaching, and service activities linked to health and development in resource-limited settings of the developing world, and forges a collaborative environment through multidisciplinary approaches rooted in academic research and training, and pragmatic community partnerships. This effort enables the establishment of a research and development agenda that informs training and capacity building programs throughout Vanderbilt University in the area of global health.

The Center for Strategic and International Studies (CSIS), based in Washington, D.C., is a non-partisan, independent non-profit institution that concentrates on U.S. policy approaches to defense and security, regional stability, and transitional challenges ranging from energy and climate to global health and economic integration.

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Note to editors: For more information, visit http://www.alarryross.com/newsroom/hope-through-healing-hands-2/.

The Frist Global Health Leaders (FGHL) program affords young health professional students, residents, and fellows the opportunity to serve and train abroad in underserved communities for up to one semester. In doing so, they will bolster capacity in clinics in need of support as well as offer training to community health workers to promote sustainability upon their departure from these communities. As part of the program, they blog about their expereinces here. For more information, visit our program page

Not too many things happened during this time period, I continued reading literature regarding baseline survey of early child development in developing countries, talked with people in the community, identify key issue which I need to add into the survey; attended monthly hub meetings, tried to understand their responsibilities for supporting our core mission: promoting overall health status of vulnerable children in Munsieville.

I went into several child care centers in shack area with Betty, to observe how they take care of young kids. There is an ongoing research project in Thoughtful Path. Similar to a typical case-control study, they select teachers from some child care centers, provide them professional training and materials (case group), in the meantime, only consulate were provided to teachers in other child care centers (control group). So we go into these centers, observe teacher’s, children’s action, document them and see if kids from case group have better performance in daily life and in school. I believe kids from case group will have much better performance for sure. Flyers, posters and books are everywhere, teachers always remind children to behave healthy, and use puzzle game for brain development. However, in  control groups, untrained teachers in these centers basically do nothing but just feed kids breakfast and lunch, children were playing on their own, and teachers (or you can say housewives) just watch TV or do their own stuff. It is really sad seeing these, as an international charity organization, we dedicated to do our best providing best service to promote local people, but for evaluation purpose, we can’t fully help some of them. This makes me feel so bad and heartbroken.

YiHi blog

One of the critical issues in shack area is fire. Paul told me that every week there is a shack burnt down, although we are focusing on early childhood development, we can’t just see people suffering and do nothing. So, in a weekend, collaborating with a Baptist church from Randfontein (a city near Munviesille), we brought many food and living essentials to families whose house have recently been burnt down, and build new home for them. I am not good at constructing, but was doing my part: painting and help moving stuff from here to there.  

Always feel good for helping people.   

YiHe blog

Equipped with the knowledge of public health learned from my college and an enthusiastic heart, I came to American Samoa, the southern territory of the USA nearly three weeks ago. There are so much differences here, culture, family structure, work regulations, personal habits, traditional ceremonies, views of the world, just to name a few. Fa’asamoa, which means the Samoan way to do things, influences every corner in this place. In addition, the natural beauty is pristine and fabulous. However, behind the gorgeous attractions, there are tremendous public health problems here. 

From the first time I arrived here, I saw the trash spread around the road. This is not because of the residents, but the stray dogs. The stray dogs are almost everywhere. They knock down the trash can and look for food, leaving a mess and walk away. Also, being scared by bitten by the stray dogs is a main reason that people do not excise outside and do not allow their children to do it. There is one time more than 10 dogs tried to surround me! People here even joke as “if you never get bitten by a stray dog, you don’t really live in American Samoa”.

From my point of view, except for the most salient public health problem—obesity, people have stress behind their normal smiling face. One prominent culture burden is the Fa’alavelave, in which people have an obligation to show respect through gift-giving when involved in an event such as a funeral, a wedding. People here live in a bi-cultural environment that is reflected in the conflict between the traditional Polynesian life style and Americanized procedure. Furthermore, people have much more obligation in church than people in the USA mainland. The changing economy and family chores are other stressors for the local people.

Through talking and interviewing people, I collected valuable information to better know about the local culture and tailor interventions for the community. Dr. Biukoto in Lyndon Baines Johnson hospital is the only psychiatrist on the island (not anymore, because he already left). Last week I did an interview with him to get a depth insight about the mental health on the island. Besides, I went to community with my coworkers, serving food stand, promoting healthy diet and conducting interviews. 

In general, I am glad that my college and Hope Through Healing Hands Foundation provide me this fantastic opportunity to come and help the local people. I am looking forward to my next work.

Many things have happened since the last reporting period. We have been able to facilitate more health education discussions for Proyecto Alerta Joven, which has been one of my favorite activities to do. We did a short course on values and how they are interrelated with occupations, like responsibility and honesty.

This article first appeared in Dallas Morning News

William H. Frist,  the doctor and former Senate Majority Leader, has broken his self-imposed silence with a few words of perspective about the current Ebola outbreak.

In West Africa, the crisis could easily last into next spring. In the United States, it is  much more containable. And while he says the virus is very “cagey,” scientists have a good understanding of how it is transmitted, know that this outbreak isn’t any different than any other Ebola outbreak and the odds that this virus has somehow mutated is “very, very unlikely.”

So what went wrong in Dallas? In some ways, it is also what went wrong in West Africa. Diagnostics are still too slow, meaning that samples were sent off to a lab somewhere and weren’t returned for a couple of days. There wasn’t a rapid enough response. And of course, the consequences years of underfunding global infectious diseases are also a factor in a virus that has been an issue on the African continent now reaching American soil.

Frist estimates that 23,000 people will die of the flu this year, and in America less than “10 will die of Ebola, hopefully just one.” And while every death is tragic, the reality is that protocols have to be strictly established and followed. “This is not contagious virus like flu,” he said.

Frist, in town to champion global investment for sensible family planning policies in underdeveloped countries, said the world response to HIV/AIDS showed the value of  a global response. While the Ebola crisis in West Africa has lasted longer than he anticipated, he wants people to know that he is confident it will NOT spin out of control in the United States even though it might seem that public uncertainty is trumping established science.

Frankly, I think Frist is right in so many ways. A big part of infectious disease control is investing money in the right places, ideally at the source of the problem as early as possible, changing habits and having the right targeted response. “If we had invested one-tenth of what people think we have invested, we wouldn’t be in this position,”  said Frist.

I know a key part of changing the trajectory of HIV/AIDS infections was the development and delivery of effective new drugs to patients. In the United States, those drugs saved lives. And, in Africa, drugs that reduced the transmission of HIV/AIDS from mother to child were integral in the battle. And that’s why Frist’s work is so important.

Frist, who is working with Hope Through Healing Hands in Nashville, wants to apply those principles to global family issues. We have all heard the stories of how a woman in an undeveloped country who delays childbirth has a greater chance to get an education and avoid a life in poverty. But there are other benefits — life itself. About 1 in 39 women in sub-Saharan Africa die of pregnancy complications. Simply spacing pregnancies at least three years apart dramatically increases over survival rates.

The overarching message is that the global health agenda must be just that — global. Generational poverty, infectious diseases and even infant/mother survival rates in Africa should concern us in the highly industrialize United States because the consequences can be just a plane ride away.

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