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 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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Public Invited to ‘The Mother & Child Project’ Conference with Keynote Speaker Sen. Bill Frist, MD; Brentwood Baptist Church Hosts Global Health experts encourage local involvement, lead Q&A on saving lives
Aug 25 2014
FOR INFORMATION CONTACT:
Melany Ethridge, (972) 267-1111, firstname.lastname@example.org
NASHVILLE, TENNESSEE, Aug. 25, 2014 – Former Senate Majority Leader Bill Frist, M.D., founder of Hope Through Healing Hands, and Brentwood Baptist Church Senior Pastor Mike Glenn will host a free, public conference on “The Mother & Child Project: Simple Steps to Saving Lives in the Developing World,” at Brentwood Baptist Church on Wednesday, Sept. 24.
Running 8:30 a.m. to 2:30 p.m., the event is free and open to the public. Breakfast and lunch will be provided. This faith-based conference will host a diverse panel of experts who will discuss how healthy timing and spacing of pregnancies can dramatically improve the health of women and children in the developing world.
Representatives from the Bill & Melinda Gates Foundation and other local and national speakers will come together to share their perspectives on global efforts to increase access to health services that save lives. They will lead a robust Q&A session encouraging further discussion, closing with practical ways attendees can get involved to save lives and see families thrive in the developing world.
In addition to Sen. Frist and Pastor Mike Glenn, conference speakers include:
- Dr. Gary Darmstadt and Tom Walsh, the Bill & Melinda Gates Foundation
- James Nardella, Lwala Community Alliance
- Dr. David Vanderpool, LiveBeyond
- Lisa Bos, World Vision
- Rick Carter and Terry Laura, Compassion International
- Lucas Koach, Food for the Hungry
- Jenny Eaton Dyer, PhD, Hope Through Healing Hands
- John Thomas, Living Hope
While the event is free and open to the public, registration is requested by Sept. 18, and more information is available at www.hopethroughhealinghands.org/registration-bbc or by emailing email@example.com.
This event follows a recent conversation with community leaders at Belmont University, during which Sen. Frist and Melinda Gates shared their efforts on this issue. Melinda Gates has championed a global movement to provide 120 million women with the tools and services necessary to time and space their pregnancies by 2020, in an effort to improve the health of women and children.
Hope Through Healing Hands’ Faith-based Coalition for Healthy Mothers and Children Worldwide seeks to galvanize faith leaders across the U.S. on the issues of maternal, newborn and child health in developing countries. Particular emphases include the benefits of healthy timing and spacing of pregnancies, including the voluntary use of methods for preventing pregnancy not including abortion, that are harmonious with members’ unifying values and religious beliefs.
Several faith leaders already involved in this issue have lent their voices to the coalition, and will continue to do so at the upcoming conference. As Pastor Mike Glenn stated, “The Evangelical church is often accused of loving the child and not the mother; but in doing so, we lose God’s mosaic. We believe in ‘Imago Dei,’ the dignity of every human being.”
Information about members of who have joined the coalition to-date, as well as how others can help, is available at http://www.hopethroughhealinghands.org/faith-based-coalition. Endorsements for the coalition are available at http://www.hopethroughhealinghands.org/endorsements.
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.
Note to editors: For more information, visit http://www.alarryross.com/newsroom/hope-through-healing-hands-2/.
Cultural Barriers are an Opportunity for Healthcare Diplomacy: Why we need gloves on the ground in Liberia
Aug 22 2014
Morning Consult | August 22, 2014
By Bill Frist
I remember a time in South Sudan when I was on a surgical mission trip. The shaman of a local tribe brought us a young man who was dying. The local healers had tried everything – medicines, rituals, prayers. But the one thing this man needed was forbidden in their culture. He had a deep abscess on his inner thigh in desperate need of draining. He was clearly in septic shock from bacteria in his blood from the wound as well. But in his culture, you could not puncture the body in anyway. It was considered desecration of the body.
However, he was dying. Because I was serving with a group of established medical aid officers, our methods—though foreign—were proven. The shaman and the young man were terrified, but they were also desperate.
I took my scalpel, wrapped my hand respectfully around the shaman’s hand, and together we incised the deep abscess.
The young man immediately felt better and the infection was cured with further surgery and antibiotics. He fully recovered and the shaman eventually thanked me. He was skeptical and fearful at first, but the patient lived, and the shaman was convinced to trust me.
In dealing with the largest Ebola outbreak in history we face many challenges: the rapidly fatal course of the illness and the advanced medical supportive care required for survival. We have seen that with the case of Dr. Kent Brantley, who was recently discharged from Emory University Hospital. While he did receive an experimental drug and a blood transfusion from an ebola survivor, there is no scientific way to determine if that had any impact on his course of illness. What we do know is he did well because he was contained quickly and had a known course of supportive care. The unfortunate fact is that we have no evidence that any amount of American medical resources or new experimental drugs will end the outbreak on its own.
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 the a hazmat suit. If the patient dies, and 70% do, the body must be properly disposed of because a recently deceased Ebola victim is actively shedding the virus from his skin.
On August 7th we heard compelling testimony from Dr. Ken Isaacs, Vice President of International Programs and Government Relations at Samaritan’s Purse about the cultural barriers to containment. He testified before the House Committee on Foreign Affairs and related his recent experience.
Containing the Ebola outbreak requires not only the right medical tools, but a sensitive understanding of the culture in which it is flourishing.
Contributing to Ebola’s virulence are the cultural traditions around the veneration of the dead. Dr. Isaacs mentioned this in his testimony, and I later discussed this practice with the Center for Disease Control. They explained the local ritual further:
A deceased community member’s body is rinsed, wrapped in clean cloth and rolled in a mat of palm tree branches. A coffin is used if the family can afford it. The body is then buried in a community cemetery and the burial cloth may be kept as a memento of the deceased. During the process mourners will kiss and touch the body repeatedly.
These traditions are an important part of community and family mourning. But they can also be deadly to those in close contact with an infected body. Dr. Isaacs testified his staff had been threatened with violence when they attempted to collect bodies for sanitized burial.
Further testimony revealed that there has even been doubt about the virus’ existence among the local medical community. Dr. Isaacs told the story of a well-respected and educated Liberian physician who visited the facility in Monrovia and examined patients without protective gear, mocking the existence of the virus to his colleagues. He passed away in Nigeria a week later.
Certain groups have even assaulted containment centers with looting and violence. Why? The incident in West Point Liberia was driven by both fear of having a containment center in their community as well as a complete disbelief that the virus is real – total confusion begetting total chaos.
The United States has a role to play here, but we must move forward carefully.
Starting in 2003 with PEPFAR, the President’s Emergency Program for AIDS Relief, healthcare as a mechanism of diplomacy has become a more prominent part of our foreign policy. However, foreign policy is a dance, a negotiation of shared goals and identification of conflicts between nations. Even when the goal seems clear – to stop an Ebola outbreak for example – there is always an inherent tension between cultures, a worry about ulterior motives, a distrust of the unknown and sometimes a memory of the U.S.’s past use of health initiatives as cover for military operations.
But distrust and the cultural barriers can be overcome, as I saw with the young patient in South Sudan. While that was a single incident and this is an outbreak, the underlying principles are the same: We have to be physically present. We have to prove that our strange customs and beliefs can save lives. It’s an extension of what doctors have always tried to do with scared and vulnerable patients—be at the bedside, listen, and heal.
Ebola is more rapidly fatal than HIV, and has no specific treatment. But like HIV, it is a viral illness, spread through close contact that is often exacerbated by cultural beliefs and practices. PEPFAR was successful in reducing AIDs related mortality by 33% from 2005 to 2012 and it was the result of a coordinated and targeted effort to provide treatment as well as education. It required “boots on the ground” to integrate with the culture and build trust.
Today West Africa is facing a devastating illness in a culture of distrust and mis-education. The rest of the world is working in the face of budgetary constraints and fear of personal exposure. Add in the poor press about experimental drugs with access limited to Americans, and the fog of suspicion thickens. While USAID has already committed $14.55 million in emergency funding, this money has not bought the needed trained professionals and supplies to accomplish containment. A recent Kaiser Family Foundation report noted only $13 million of the $46 million needed in Liberia and Sierra Leone has been received.
This is a time for the United States—government, NGOs and all—to seize the mantle of global health as a vital diplomatic instrument to strengthen confidence in America’s intent and motives. Everything we do on the global stage sends a message. This is an opportunity for the U.S. to be a global leader, build trust, and show that we can break down cultural and communication barriers and align for a common goal. But to do this we need to go to West Africa with sensitivity as well as knowledge, and it needs to be a priority because it is the only way to stop the outbreak.
For some, this is a terrifying proposition, but so is the devastation of the population if Ebola is not adequately contained. We have the resources to safely fight the virus. We understand transmission and containment. But putting that knowledge to work in West Africa means putting trained and funded intervention where it’s needed most: at the bedside.
One of the best things about healthcare delivery in Guyana is that it is nationalized. Care is free and available to every citizen. It is financed and managed through the Ministry of Health working together with regional and local government. There is an independent private sector. However, despite a national health system, there are several gaps in the delivery of health care in Guyana.
Chronic diseases, such are hypertension, diabetes and heart disease, are becoming more prevalent in Guyana and currently there is not an infrastructure in place to help manage this growing problem. Patients are presenting to the emergency department at advanced stages at which time there may not be great treatment options available. Unfortunately the regional health center, which would ideally be the place for primary care, is not very equipped. There is usually just one physician available to staff a large local population and he/she may not be well trained to manage chronic disease. The availability of equipment such as blood pressure cuffs, glucometers, monofilaments, debridement tools for diabetic ulcers are often in limited supply. Lab testing and monitoring are usually not available. The idea of routine screening and preventative medicine is nonexistent. Ancillary staff, if available, is also not well trained.
While most patients living along the coast have access to some sort of health care, whether through regional health centers or the local emergency department, those who live in the interior have little to no access. This is largely because of the sparse population and difficult terrain. The population comprises mostly of indigenous people and miners - in emergency situations, they travel for days to the capital to receive care.
In Guyana, there is very little support for persons with mental health disorders or substance abuse. During my short time in Guyana, there were more than a handful of persons presenting with suicide attempt, often with paraquat, a freely available but deadly herbicide. At a public health level, there needs to be better regulation of who has access to these poisons as this is an easily preventable cause of morbidity and mortality. There is poor education about mental illness among the population as well as among providers. If a patient survives a suicide attempt, he/she is discharged from the hospital without any resources or treatment to address with underlying mental illness. Substance abuse, specifically alcohol, is never addressed. Training providers as well as the development of a psychiatric unit or treatment center will be a small step to help address this growing problem.
One of the largest challenges to health care delivery in Guyana is the lack of an integrated health information system. Medical records are completely on paper and patients’ charts do not go with them throughout their contact with the medical field. The medical record is not used to support decision making. For example, if a patient presents to the ED with hypertensive emergency, a new chart is made up for the admission. Even though the same patient presented a week prior with the same issue, the record is not automatically included and there is no way to use information about their previous treatment to guide treatment decisions now. In addition, the contents that make up the medical record are sometimes sporadic and often incomplete.
There are many areas that need to be built up for the health care system in Guyana to become what it needs to be. There needs to be programs in place for advance training of physicians and compensation and work plans that keep these well trained physicians interested in staying in Guyana. Local health centers need to become the first line for screening and management of chronic diseases. Also, within the public health sector education programs need to be developed that teaches local population about disease, mental illness and a healthy lifestyle.
In Guyana, there appears to be a commitment by the government to improve the overall healthcare delivery system. With the monetary support and partnership with many foreign agencies, Guyana is slowly on its way to delivering the care its people need.
Originally published by the New York Times
Matt Cone writes about teaching students about global issues in the classroom, with a special nod toward Senator Bill Frist. Cone is a teacher at Carrboro High School in North Carolina.
Of the more than 8,000 class periods that I have taught, one stands out as my favorite — not only for what happened in the class but also for how it transformed my teaching. The class took place in the fall of 2004 and what strikes me about it now is how primitive it was by today’s technological standards. Indeed, the entire class consisted of the students sitting in a circle, staring at a speakerphone, and engaging in a dialogue about global health with a guest on the other end of the line. Fortunately for us, the guest was Dr. Paul Farmer, a path-breaking physician who co-founded the organization Partners in Health and who is the subject of a book the class had read, “Mountains Beyond Mountains.” For forty minutes, the students peppered Farmer with questions about Haiti, about how to best use one’s talents to address global health issues, and about how he had worked with Republicans and Democrats to ramp up global health funding.
As soon as we hung up, it was immediately apparent that the talk had lit a fire under the students: they not only wanted to track down the books and films that Farmer had referenced, but they also wanted to form a global health club. I returned home that night and told my wife, “I need to find a way to do this more often.” Over the past ten years, I have pursued having students study complex global issues in depth and then engage in discussions with a range of experts. The good news is that teaching about global issues through the use of technology and expert speakers is far easier than one might expect, it has great appeal for teenagers, and it frequently leads to learning that extends far beyond the classroom.
Thanks to the Internet, exposing students to global issues and to experts who work on them has never been easier. When I started my career, finding articles and videos on international issues was an arduous process that required hours of sleuthing and juggling VCR tapes; today it is possible with just a single computer to find and within minutes share information about even the most underreported international news stories. So, for example, if my class wanted to know more about the recent Ebola outbreak in West Africa, we could accomplish the following within a single period: find articles about it online, locate websites to track the disease’s spread, set up Google Alerts to keep us abreast of the latest news, and reach out to experts in public health, journalism, history and government who could help us to understand the issue in greater depth. Since staging a dialogue with Paul Farmer a decade ago, we have been fortunate to arrange dozens of meetings or Skype calls with a wide range of experts that includes Muhammad Yunus, Jim Yong Kim, Laura Bush, Colin Powell, Jeffrey Sachs, Noam Chomsky, Bill Frist, Dan Ariely, Paul Collier, Alan Mulally, Christy Turlington, Adam Hochschild, Peter Singer and many more.
Learning about global issues through the use of technology and expert speakers appeals to teenagers for two reasons. First, it’s not “busy work.” When students know that they are reading chapters from a macroeconomics text so that they can prepare for a wide-ranging dialogue with Jeffrey Sachs, they are eager to prepare as thoroughly as possible. Students appreciate that when they speak with an expert, they are able to ask critical questions and engage in an intellectual give-and-take with someone who (usually) treats their questions and opinions with respect. In fact, this goal of critically examining the issues and approaches that we are studying is one that is modeled by the experts with whom we speak. So, for example, my students spoke with Sachs and heard his ideas about why foreign aid can provide the big push that lifts nations out of poverty, and we also spoke with one of Sachs’ most vocal critics, Nina Munk, whose book “The Idealist” maintains that much of Sachs’ efforts have failed. Similarly, my students met with World Bank President Jim Yong Kim on the same ...
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With the current ebola crisis in West Africa, Senator-Doctor Bill Frist weighed in at The Costa Report on critical aspects of the outbreak.