This articie was originally published at Forbes.com

The size and spread of this Ebola epidemic is simply unprecedented. 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 4,400 cases with 2,300 deaths and growing. According to WHO estimates more than 20,000 more cases will occur before containment is achieved.

I, and many others, have written about the need for more resources and healthcare infrastructure. Hopefully the U.S. commitment of 1700 beds, training of 500 healthcare workers and 400,000 home treatment kits will offer much needed help and reduce the mortality rate from 50%.

But stemming the tide of this epidemic will not happen with only the commitment the President has made. Treating the sick is imperative, but as the number of cases grows exponentially, we have to take a closer look at why – we are failing at contact mapping and containment, and for three very good reasons.

First, there are cultural barriers to containment such as distrust of Western medicine, commitment to local burial practices, and a lingering disbelief that the virus exists. These barriers prevent containment procedures from being implemented and sanitary burials from being practiced.

Second, there is fear of the disease and what identification and isolation means. “Virus hunters,” public health workers skilled in contact mapping of exposures, are having a difficult time finding the sick because of the fear. People hide, change their address, and have even thrown rocks at aid workers. People do not want to be isolated and taken away from their families to wait out the incubation period and possibly die alone in makeshift clinic far from home.

Finally, we do not have a way of rapidly identifying the virus in the field. Current practice for fever in countries like West Africa is to rule out and treat the things that are more common, easily identified and more easily treated with the assumption that if the patient does not improve, a viral hemorrhagic fever is the diagnosis of exclusion. In West Africa, malaria or bacterial infections are the more likely more treatable diseases, so the practice is to rule out malaria and possibly use empiric antibiotics before assuming Ebola.

We have rapid detection tests (RDTs) for malaria that can and are being used in the field. The problem is the sensitivity and specificity are not adequate to definitively diagnose malaria. And even given this practice of diagnostic rule out, the truth remains that a negative test for malaria does not necessarily mean a positive test for Ebola and visa versa. We need diagnostics that are more definitive.

There are many types of tests for Ebola. Isolating the virus provides the most sensitive and specific diagnosis, but requires transport of biohazard material to a BSL-4 lab, of which there are few in the world. Alternatively there are reverse transcription polymerase chain reaction (RT-PCR) and quantitative PCR, which are both very sensitive and specific, but again require a lab. Newer tests include antigen and antibody identification using ELISA, and a nanoparticle microscopy system termed the Single Particle Interferometric Reflectance Imaging Sensor (SP-IRIS), which can digitally identify virons based on size. (ACS Nano. 2014 Jun 24;8(6):6047-55.)

There have been improvements in diagnostic ability in Sierra Leone that have improved care immensely, but all of these tests must be performed in a lab and that lab may not be local. It could take days to get results back. We need a test we can deploy rapidly in the field and have results in under an hour.

A very rapid test would be game-changing for Ebola. Let’s look at triage in a clinic. Everyone comes in the front door together and waits together. Most people have a fever, but they aren’t sure why. Most likely, it’s another endemic infection like malaria, typhoid or shigella. An RDT could quickly identify patients needing quarantine from those who do not. The benefit here is threefold: fast and early quarantine to separate patients at risk for infecting others making the rest of the hospital safer; replacing fear and anticipation with knowledge; and a more efficient use of quarantine resources because they are saved for people with known Ebola infections.

An RDT would also allow healthcare workers to confidently come to work knowing they are not infected. It would also prevent unnecessary quarantine of these most-needed personnel for the 21 day incubation period.

The same would hold true for exposed individuals. Given the lack of clinics and isolation units, public health workers are offering more home-based care. This requires isolation of people in their homes for up to three weeks.  A RDT would allow appropriate use of those resources.

An RTD could also be used at borders and airports for health officials to safely allow or restrict access from a country with a known outbreak, enabling the delivery of much-needed supplies, workers, and resources safely.

Finally, when this outbreak is contained, having an RDT would help more quickly identify new outbreaks in the future, facilitating early containment and guiding the use of prophylactic drugs, like Zmab, if available.

I want to impress upon you this is not conjecture. The reasons above make logical sense, but experts can also use mathematical modeling studies to show the effect of adequate containment versus rapid detection. Containment is certainly effective and has worked during all outbreaks in the past, but diagnostics either on site, off site, for all febrile patients or even just healthcare works can make a significant impact on the size of an outbreak.

An RDT—a new test or an adaptation of what we have—would not only be a massive step towards controlling this outbreak, I think it is the only step that will ultimately prevent this tragic epidemic from becoming a pandemic.

During 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.
It’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.

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.

Take action. Support these four organizations to help fight the Ebola outbreak. 

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.

September 17, 2014

ONE

By Bill Frist

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.

Click here to watch our Mother & Child Project video.
The Mother and Child Project:
Helping Families in the Developing World
Keynote Speaker: Former US Senate Majority Leader Bill Frist, MD
Host: Senior Pastor Mike Glenn
This faith-based conference will host dynamic speakers talking about the critical global health issues of maternal and child health, with a special emphasis on the benefits of healthy timing and spacing of pregnancies as a life-saving mechanism in the developing world. Local and national speakers will come together to talk about their special work as service providers in countries around the world, caring for mothers and children worldwide. We will lead a robust Q&A session with all the speakers encouraging further discussion. And the conference will close with practical, simple steps for how YOU can save lies and help families thrive in the developing world. 
Wednesday, September 24, 2014
8:30-2:30 pm, Brentwood Baptist Church
7777 Concord Road, Brentwood, TN 37027
Breakfast and Lunch included
Speakers
Gary Darmstadt, The Bill & Melinda Gates Foundation
Tom Walsh, The Bill & Melinda Gates Foundation
James Nardella, Lwala Community Alliance
Dr. David Vanderpool, Live Beyond
Lisa Bos, World Vision
Rick Carter & Terry Laura, Compassion International
Lucas Koach, Food for the Hungry
Jenny Eaton Dyer, PhD, Hope Through Healing Hands
John Thomas, Living Hope
Questions?
JCrain@HopeThroughHealingHands.org
This conference is free and open to the public. Advance Registration is requested by Thursday, September 18.

Read my earlier Ebola primer and a look at what we know about how the virus behaves.

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.

  1. 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.
  2. 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.
  3. 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.
  4. 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.

Ebola's Hard Lessons

Sep 08 2014

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

Read the rest of this story at Smart Global Health.

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...

Read the rest of this article at GlobalHealthTv.com

FOR INFORMATION CONTACT:

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

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 jcrain@hopethroughhealinghands.org.

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.

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

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