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.

Schola Prophetarum

Language in the Global Health Arena for HIV/AIDS and Family Planning

Oct 10 2014

Eating lunch outside the refectory of Vanderbilt Divinity School, back around the turn of the millennium, I remember stumbling across the stone etching of Schola Prophetarum, the School of the Prophets. I am sure all who have passed through the halls of the Divinity School may have reflected on their potential role as a prophet in our community, society, and our world. That is our legacy.

I had the unique opportunity during my time at Vanderbilt to work with a prophet-like figure, Bono, the co-founder of the ONE Campaign and the lead singer of the band U2. As he was traipsing across Middle America in 2002 during the Bush administration, galvanizing faith communities with his organization, DATA, I raised my hand to help. I spent the next six years with a brilliant rag-tag team of activists in Washington, DC. working together to promote awareness and advocacy for extreme poverty and disease, namely for HIV/AIDS in Africa. I served as the national faith outreach director. In 2002, less than 50,000 people in Sub-Saharan Africa had access to anti-retroviral medication (ARVs) that could save their lives from HIV/AIDS. Today, more than 12.9 million people have access to ARVs, thanks to the legislation of PEPFAR and the Global Fund to Fight AIDS, TB, and Malaria. More specifically, thanks to the American taxpayers. We have turned the tide.

Bono took a unique approach then by reaching out and pleading that faith communities take the lead on this issue of HIV/AIDS, in spite of the issue being at the heart of the culture wars of the 1980s. He stood outside the walls of the Church as an Irish rock star, but his language and zeal and authentic Christian beliefs allowed him to serve as prophet-esque leader inspiring faith leaders and people in the pews to love our neighbors, albeit an ocean away. And I had the unique opportunity to strategize, implement, and create language for him and the organization that I hope offered a prophetic voice on behalf of some of the most vulnerable populations around the world.

Today, that opportunity to create new language and a fresh perspective for a prophetic voice in the global health arena has arisen again.

Family planning, like HIV/AIDS has found itself in the throes of cultural battles. It is often misunderstood as including abortion, which even today, 40 percent of Americans believe it should be illegal in all or most cases.[1]But planning families doesn’t have to mean abortion. In fact, it makes abortions less likely. When discussing family planning in the developing world, we discuss with the public that the Helms Amendment of 1973 prohibits the use of US foreign assistance to pay for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortion.

Jennifer Dyer speaking with Senator Bill Frist

I now serve as executive director of Senator Bill Frist, MD’s Nashville-based global health organization, Hope Through Healing Hands. Recently, we have partnered with the Bill & Melinda Gates Foundation to build the Faith-based Coalition for Healthy Mothers and Children Worldwide to promote awareness and advocacy for maternal, newborn, and child health with a special emphasis on healthy timing and spacing of pregnancies, or family planning in developing nations. 220 million women around the world say they want to avoid their next pregnancy but they don’t have the education, services, or access to contraceptives to do so. Melinda has made this a priority for her and for her Foundation.  As have we.

Senator Frist and I have been traveling across the United States once again, not unlike what we did over a decade ago for HIV/AIDS, to talk about family planning with faith leaders in churches, nonprofits, and academic communities. We also have been talking with religious and cultural leaders including artists, authors, and athletes. And we are building endorsements for the coalition with momentum.

Our goal is to create a new, more meaningful language to talk about the importance of family planning. Right now, to create a “big tent” approach welcoming Catholics and conservatives alike, we use language like “healthy timing and spacing of pregnancies.” These issues are at the nexus of other global health challenges, including combating extreme poverty, keeping children in schools, promoting gender equality, improving maternal and child health, and preventing mother-to-child transmission of HIV/AIDS. We can all agree that healthy timing and spacing of pregnancies saves lives.

If a woman can better time her pregnancy in a developing nation, between the ages of 18-34, her rate of surviving the complications of pregnancy and childbirth rises dramatically. For instance, she is 10-14 times more likely to survive childbirth between the ages of 20-24. And if she can space those children, just three years apart, the child is twice as likely to survive the first year of life.

Senator Frist and I do not stand inside the church as leaders of faith. But we have longstanding relationships and the expertise to challenge many in the faith community to rethink its stance on family planning, particularly for those in the developing world. We may not have the rock star status of Bono, but the education from the School of the Prophets still infuses my own writing as we create strategy and language for a renewed dialogue across the spectrum of faith communities. We hope to proffer a prophetic voice with a clarion call to save the lives of millions.

We invite you to join us. Learn more at HopeThroughHealingHands.org.

Fox News | October 8, 2014

By Bill Frist

Wednesday morning brought sad news that Thomas Duncan, the Ebola-infected patient in Dallas, has passed away. It also brings heightened scrutiny of our nation’s strategic plan for dealing with Ebola in the U.S.

Ebola is undoubtedly a frightening disease. In West Africa -- without appropriate medical facilities and staff -- it is spreading at a truly alarming rate.

And now the disease is here. At home. A geographic spread that was nearly inevitable considering our global movement is sparking questions about what to do next. The CDC and other public health officials are walking a fine line: being realistic about a serious risk while belaying panic.

One individual must coordinate the efforts of key agencies and players to facilitate centralization of American resources to function synergistically and improve impact and speed.

It’s not an easy puzzle; global health issues never are. But the same steps we’ve been advocating for in Africa are applicable here.

First we have to understand this disease. Ebola is contagious, but far less so than small pox or HIV. It is transmissible only through direct contact with bodily fluids from an infected person: blood, vomit, urine, feces, saliva and other secretions. As we have seen with the effort in Dallas and the Ebola workers who were brought home, ability to contain and treat in U.S. medical facilities makes a widespread, uncontrollable outbreak extremely unlikely.

I am not minimizing the potential lethality of Ebola. But a response to Ebola needs to be tailored to the natural history of Ebola.

We know that containment is paramount, and isolation is the most important part of an Ebola strategy. But there is no way to isolate everyone in West Africa with a febrile illness given the variety of endemic viruses and infections to the area.

To really stop the spread of the disease—to get ahead of it—we need a rapid diagnostic test (RDT) that can be deployed on the ground, not in a laboratory. A test that facilitates appropriate quarantine of those with disease and release of those without. Not only will this allow us to focus resources, it will also help build trust and allay fears.

The same test could be used at home as well to quickly evaluate travelers and potentially prevent another case like the one in Dallas. Without an RDT, there will always be a window between when the patient becomes contagious, and when we can confirm a diagnosis. Precautionary quarantines and travel restrictions can help, but they will not replace accurate and timely diagnosis.

While we are waiting on a potential test, we must efficiently leverage the resources we have to offer.

Senators Rob Portman, R-Ohio and Lamar Alexander, R-Tenn., have urged President Obama to appoint a single administration official to coordinate the U.S. strategy to contain and combat Ebola. I agree that one individual must coordinate the efforts of key agencies and players to facilitate centralization of American resources to function synergistically and improve impact and speed.

The Centers for Disease Control (CDC), the Department of Homeland Security (DHS), Customs and Border Protection (CBP), and others will have crucial roles to play. They must present a united effort.

The death of the first patient diagnosed with Ebola on U.S. soil should not herald panic. But it is impetus to make sure we disseminate the most accurate information, that our response plan is coordinated and thoughtful, and that our nation’s best minds are focusing on a solution.

The importance of speed cannot be understated. Time is not on our side.

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.

Meet Touch

Oct 08 2014

Have you had a chance to meet Touch? This dog is changing lives and we're so excited to watch what he and Senator Frist are doing for our kids. If you haven't seen it already, watch this video now. This is such a special story:

Next Monday will be our fourth week in this field experience with Project HOPE in the Dominican Republic. We are almost halfway done, so I am anxious to learn as much as possible while I am here. I do not know if I will ever have another opportunity such as this one, where I get to travel, gain university credits and earn work experience. I am thankful for being here every day, although I feel nostalgic at times. But I decided to take on this challenge so I am determined to finish strong! Last week was a very busy week full of interesting and distressing things. I will elaborate further in the following lines.

On Wednesday, September 24, a large crowd gathered at Brentwood Baptist Church in Brentwood, Tennessee, to listen to experts in the field of maternal, newborn, and child health (MNCH) with a special emphasis on healthy timing and spacing of pregnancy (HTSP). The conference hosted speakers from faith, politics, service providers, and other policy experts on these issues to lecture and engage the attendees an active discussion, including a Q & A, on the topic.

Mike Glenn, pastor of Brentwood Baptist Church and a contributor to The Mother & Child Project, opened with a prayer and a short sermon on the inkeeper in the nativity story. Perhaps, he suggests, the innkeeper tried his best to give Mary a private place to give birth to her baby boy. And that we are now poised to stand as Inkeepers to the millions of women worldwide who seek help for their maternal health.

This was followed by a interview led by Jenny Eaton Dyer, PhD, Executive Director of Hope Through Healing Hands, of Senator Bil Frist, MD, also contributors to The Mother & Child Project. Senator Frist laid the foundation for the problems we face in the field of maternal and child health and healthy timing and spacing of pregnancy, or family planning, and he encouraged everyone to advocate with their congressional representatives and senators about the issues.

Frist was followed by the Bill & Melinda Gates Foundations' Gary Darmstadt, Senior Fellow Global Development Program, and Tom Walsh, Senior Program Officer Global Policy and Advocacy. Gary presented a very data-driven survey of MNCH, showing that 11 million births worldwide occur in high-income nations with adequate medical care. But 50 million occur in low-income nations, often at home with no medical care. Sometimes even completely alone. He said, "These inequities [for moms] should not be in the world, and we all have the power and responsibility to change them." 

Tom Walsh reinforced this idea from his political perspective and area of expertise by saying, "Advocacy is letting your representatives know the have support to do what they already know is right to do."

Local and national service providers hosted breakout sessions describing their work, on the ground, in maternal and child health, including family planning. Local groups Lwala Community Alliance and LiveBeyond shared about their work in Kenya and Haiti, and Compassion International, Food for the Hungry, and World Vision discussed their global work in healthy timing and spacing of pregnancies. Their anecdotes, experience, and fresh statistics really made these issues personal.

After a catered lunch and an active Q&A discussion with a panel of all speakers, including John and Avril Thomas of Living Hope Community Center in Capetown, South Africa, Jenny Dyer closed the event with "what you can do," next steps for awareness and advocacy for the Nashville community.

To find out about more events like this coming to your town in the future, follow us at @HTHHglobal on Twitter.

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.

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