by Senator Bill Frist, MD
November 12, 2014
FoxNews

When crisis strikes, the world looks to the United States for leadership. And that holds true for public health emergencies.

As the Ebola epidemic takes its toll in West Africa, we are witnessing our exceptional national character in action.

Thousands of Americans — civilian, military and private citizens — are selflessly deploying to the front lines in Liberia, Guinea and Sierra Leone. They are working to halt the virus’ spread, save lives and keep us safe at home. Unsurprisingly, no country is doing more; this is the spirit, the can-do ethos that sets our country apart and makes us the indispensable nation.

Even while the virus rages on, we are seeing glimmers of hope. In Liberia, where the U.S. response has been concentrated, some counties have experienced fewer cases, just as the transmission rate appears to be slowing. But now is not the time for complacency; we saw similarly hopeful signs earlier this year, only to realize they were illusory when the virus roared back, ultimately invading Liberia’s largest city and capital, Monrovia. All the while, Sierra Leone and Guinea today remain in the throes of the outbreak.

That is why it is critically important for the United States to remain on offense. To this end, the Obama administration last week requested $6.2 billion in emergency funding from Congress for the Ebola response.

This request supports what we know we must do to counter this disease: tackle it on the front lines, fortify our domestic health infrastructure, pursue vaccines and therapeutics and improve our capacity for rapid diagnostic testing, among other key steps.

Some of these funds would be spent at home, while part would go toward the international response. But to be clear, every single dollar would help protect the American people from this threat, which must remain the priority.

Some have urged for the imposition of a travel ban to protect against additional Ebola cases reaching our shores. As a doctor, however, I know that our strategy must be guided by science. And as a former U.S. senator, I strongly believe we must not institute policies chock full of unintended consequences. A travel ban would run afoul of both principles.

As a practical matter, there are no direct flights between the United States and West Africa. And approximately two-thirds of those traveling from the region to the United States are U.S. citizens or legal permanent residents. Impeding their access to this country — their country — would upend the Constitution in the name of fortifying against a threat that has claimed exactly, though sadly, one life on U.S. soil.

Experience also tells us that a travel ban would make us only more vulnerable. Travelers from the region, regardless of nationality, are subject to stringent screening protocols in West Africa, at many transit points in Europe and again upon landing in the United States. Any ban would incentivize would-be travelers to mask their point of origin, take irregular travel routes and evade the robust screening measures now in place.

The Obama administration has made this argument, but this is not a partisan finding. The administration of George W. Bush — during whose time in office I served as the Republican Senate majority leader — also deemed travel bans to be ineffective in the face of communicable disease. This is about sound science and smart policy, not politics.

All the while, we know the most effective way to protect the American people is to extinguish this fire at its source. The U.S. military is playing a major role in doing so, but the U.S. and international response must appropriately remain civilian-led.

Since the first Ebola cases were reported last spring, hundreds of American health care workers have heeded the call to serve in West Africa. And we will need many more to follow in their footsteps in order to control this epidemic.

I’ve spent a lot of time over the years personally delivering medical and surgical care throughout Africa. So I agree with President Obama when he commends those doing what he termed “God’s work” in West Africa. To be sure, we owe them our collective gratitude. But we also must not deny them the support and backing they need to fulfill their mission, to protect the American people and to keep themselves safe.

The axiom holds true that we must isolate Ebola, not countries. And the dedicated and brave Americans who serve on the front lines will be key to helping us do so.

William "Bill" H. Frist, M.D. is an American physician, businessman, a former U.S. senator from Tennessee and the former Republican majority leader in the U.S. He is the chairman of global health non-profit Hope Through Healing Hands.
H. would probably be at the top of her class no matter where she went to medical school. Like most of the Ecuadorian medical students I have had the privilege of working with she is curious, dedicated, and focused. She attends a prestigious medical school and has had the opportunity to complete clinical rotations at some of the largest hospitals in Cuenca and Quito. Her dream is to study internal medicine.

by Jen Todd, jtodd1@tennessean.com

November 9, 2014

Doctors, professors and former Senate Majority Leader Bill Frist invite the public to discuss the base of worldwide fear: Ebola.

“Ebola is a modern plague, which sorely tests U.S. leadership at multiple points,” said J. Stephen Morrison of the Center for Strategic and International Studies in a statement. “It requires grappling with considerable unknowns, and preserving the confidence, trust and support of the American people.”

The two along with William Schaffner, professor of Preventive Medicine in the Department of Health Policy at Vanderbilt University School of Medicine, and Sten H. Vermund, director of the Vanderbilt Institute for Global Health, will begin the conversation, addressing four points.

These subjects are: the U.S. approach to cases entering the United States, the mobilization in Liberia, the growth of the epidemic in West Africa and how to stop transmission, and efforts to develop new vaccines and treatments.

Then, Muktar Aliyu, associate director for research for the Vanderbilt Institute for Global Health, and James E. Crowe, Jr., director of the Vanderbilt Vaccine Center, will jump in to consider what changes need to be made in the U.S. approaches, both short and long-term.

The free event is open to the public and begins at 10 a.m. Nov. 21 at Vanderbilt University Medical Center, Light Hall Room 208, 2215 Garland Ave.

Valantina is the granddaughter of my host family in Riobamaba.  The family is middle class and well educated, both parents having attended university.  As is common in Ecuador, Valantina’s parents started having children very young and continue living with their parents.  Before the recent death of my host mother’s mother, four generations had lived in the house.  Valantina is 9 months old and the delight of the entire family.  As you will note in the pictures she is generally healthy and adorable.  There are some things that her family does that help her grow and stay healthy.  Though her mother is in college full time, Valantina has never received formula.  Her mother frequently breastfeeds at the table or in public places.  This is common practice in this provincial capital and during the Easter parade, there were women openly feeding their children as they marched through downtown, an unlikely sight in the U.S.  After I moved to Cuenca I noticed that more babies were drinking formula from bottles.  Multiple people explained that this as a consequence of wealth.  Cuenca is more affluent then Riobamba and formula is considered proof of economic security, an unhealthy trend.  I was fascinated by these changes because they seemed opposite to what I have observed in the U.S. where it is often well educated, more privileged women who tend to have the control over their lives that allows them to breastfeed. 

The hospital has a well respected neonatal intensive care unit as well at both inpatient and outpatient services for women and children. One case in particular stuck with me. A woman came in after a failed home delivery. She had delivered her first 6 children at home but subsequently lost 2 of them to respiratory illness within the first 2 months of life. She had been laboring since the day before and kept saying, ‘I can’t, I can’t’. She knew something was wrong and that this did not feel like her other deliveries.

Roll Call

By Bill Frist and Jenny Eaton Dyer Nov. 5, 2014, 6:20 p.m.

With the advent of the few Ebola cases that have emerged in the U.S., Americans and the global community can and should turn their attention to the plight of fragile health care infrastructure in poor countries. This outbreak is a stark reminder that our own health and prosperity is directly linked to that of the developing world. Foreign aid is a catalyst for building healthier families and communities — and in turn, helping our own.

Too often, health systems in poor countries are ill equipped to handle public health crises, or even provide basic primary health care services including, immunizations for children; the treatment and prevention of infectious diseases such as HIV, tuberculosis and malaria; and other life-saving interventions such as access to contraceptives.

The Ebola crisis is showing us once again how critical it is to invest in functioning public health systems in developing nations, so they are able to increase access to the information and tools people need to protect their own health and the health of their loved ones. Importantly, these systems must be designed to reach and meet the needs of women and girls.

Two years ago, leaders from around the world came together to commit to an ambitious goal: By 2020, 120 million more women and girls in the world’s poorest countries would have access to the information and tools they need to make the best decisions, harmonious with their values and beliefs, in planning their families.

We are already seeing results. Today, Family Planning 2020 — the movement that carries this global effort forward — launched its second annual report on progress made toward this goal.

In 2013, more than 8.4 million additional women and girls had access to contraceptives compared to 2012, across 69 of the world’s poorest countries. Access to contraceptives averted an estimated 77 million unintended pregnancies. And the lives of more than 125,000 women and girls were saved from complications related to unintended pregnancies.

Hope Through Healing Hands partnered with the Bill & Melinda Gates Foundation one year ago to champion a spectrum of issues related to maternal, newborn and child health, with a special emphasis on healthy timing and spacing of pregnancies, or international family planning. If women have access to an array of contraceptive methods, including fertility awareness, we can save and improve the lives of millions.

Nearly 1 in 39 women die in Africa from complications related to pregnancy and childbirth, making it a leading cause of preventable death. Yet if women can better time their pregnancies between the ages of 18 and 24, they can exponentially affect their chances of survival. For instance, women who give birth between the ages of 20 and 24 are 10 to 14 times more likely to survive than those who have babies when they are younger. And by giving women the means to space the births of their children by at least three years, newborns would be twice as likely to survive their first year. We could drastically reduce maternal and infant mortality with better access to information and services for healthy timing and spacing of pregnancies.

With a focus on the mother-child orbit of health, we cut to the nexus of global health challenges to address extreme poverty, access to education, gender equality and infectious disease. Economically, healthy timing and spacing of pregnancies, and access to contraceptives, is one of the best investments a country can make in its future. Contraceptives are cost-effective and deliver big savings in health care costs and social programs. For each U.S. dollar spent on helping women plan their families, governments can save up to $6 on health, housing, water, and other public services.

The Ebola outbreak is a tragedy and has already claimed the lives of thousands. It will take serious intervention to stop its further spread and interrupt transmission. As we consider how best to respond, let’s also consider how best to strengthen the infrastructure of health systems in poor countries, and how to provide simple interventions, like family planning, to save the lives of millions of mothers and children around the world.

Bill Frist, M.D., is a former senator from Tennessee. Jenny Eaton Dyer, Ph.D., is the executive director of Hope Through Healing Hands.

I spent one week at a Sub-Centro de Salud (public health clinic) in the town of E. Valle, about a 30 minute bus ride from Cuenca. The town is quite small but the catchment area includes a large number of families working small plots of land on steep slopes. The clinic itself is new and clean. It houses three general practitioners, one dentist, a pharmacy, a pediatrician, psychologist, vaccination center, and room for x-rays and ultrasound. In an office there is a map of all the households, their inhabitants and risk factors.
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.

 

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