As the CDC treats the nation’s first two Ebola cases there are a lot of questions and concerns about the disease in America—Could it become an epidemic here? How contagious is it? How is it caught?

Although my medical specialty is cardiothoracic surgery, I have spent a good deal of time working on global health issues in Africa and elsewhere, and I have been in close contact with the CDC over the past week. I thought it might be useful to highlight some of the features of Ebola that make it more—and less—dangerous.

As a viral disease, Ebola follows a fairly predictable timeline.

Incubation: the time between when a person is exposed to the virus, and when symptoms start. In Ebola, that incubation period can be between 2 and about 21 days. During that time, the patient does not feel sick and research suggests that they are not contagious. (see doi:  10.1016/j.phrp.2011.04.001) There’s been concern about infected travelers spreading Ebola to other parts of the world after traveling from West Africa. That is certainly possible with a long incubation period.

Onset of Symptoms: However, once an infected person starts to feel sick, they are quickly seriously ill. There is sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhea, rash, impaired kidney and liver function.

Unlike a cold, when you could be spreading the virus and not really feel that unwell, Ebola patients know that they are sick. This is actually a good thing, because sick patients are easy to identify, isolate, and treat. Other diseases still need to be ruled out—malaria, typhoid fever, cholera—but it’s clear that the patient has a severe illness.

Transmission: Here is perhaps the scariest part. How do you get it? How did Dr. Brantly get it? How is the virus spreading between people?

Some diseases are infectious, but not contagious. Lyme Disease or Rocky Mountain Spotted Fever are transmitted from ticks to humans but cannot be spread from human to human.

Contagious diseases can be spread from person to person, but not all equally well. Chicken pox, small pox, and measles, for example, are airborne spread—meaning the virus spreads very well with each exhale. These diseases are highly contagious.

Ebola, on the other hand, is only spread through direct contact with the bodily fluids of infected patients—blood, semen, sweat, urine and other secretions. And then, that fluid needs an easy entry into the body: a shared needle, an open cut, an exposed mucous membrane. It could possibly be spread through a cough or a sneeze, but that would require a fairly large drop of mucous to be coughed into another person’s face and get into their mouth or nose or eye.

For healthcare workers in West Africa, this could be possible. With limited supplies, perhaps there is a tear in a glove, or there aren’t enough goggles to go around, or bedding is reused because there isn’t an adequate way to clean it.

If patients are being cared for at home—either because they are too far away from a medical facility, or there’s some cultural distrust of foreign aid workers—caregivers in close physical contact with sick loved ones would have no medical or cleaning supplies. There are also vast cultural issues that influence the virus’ spread, and I’ll touch on those soon.

But with supplies, knowledge, and fully-equipped medical centers, these circumstances would be much less likely to happen. For these reasons, the Centers for Disease Control (CDC) is not concerned about an outbreak in the United States.

The situation is certainly serious—and will continue to be very serious in West Africa. But although we don’t know everything about how this virus behaves and changes, we do have quite a bit of useful knowledge about how to keep it contained, and how to keep our healthcare workers at home and abroad safe.

It is good to be back in Guyana.  It has been a week since my arrival and there is a feeling of returning home.  Although I left this country when I was very young, the culture, the food, the sayings, even the hot humid climate and cooling ocean breeze are all so familiar and welcomed.

Nadine Harris

I have been working in A&E at Georgetown Public Hospital, the country’s tertiary care center, for the last 5 days.  I am amazed at the broad spectrum of pathology that we see in any given day - some of these have included cerebral malaria, snake bites, herbicide poisoning, tetanus, advanced HIV, acute myocardial infarction, infected diabetic foot ulcers, and strokes.  What is most impressive to me is how many complications I have seen from poorly controlled chronic medical conditions, many of the same disease processes that we deal with in the US.  As an internal medicine resident, I think about my own panel of patients back home and how aggressively we are taught

to manage diseases such as hypertension, diabetes, and coronary disease.  Unfortunately, this is not possible in Guyana in large part due to lack of a trained physicians to take care of these people and poor medical records (surprisingly, many of the first line drugs that we use to manage chronic illness are available here).  Guyana, like so many developing countries, continues to struggle with “brain drain” as more and more trained professionals migrate in search of a more economically secure way of life.  In the medical profession, those who are left behind do the best they can, but are often overworked and undertrained. 

Working in a developing country with so limited resources certainly requires that I adjust the way I think about and approach a disease process; this is easier said than done.  The emergency medicine residents do the best that they 

can to be aggressive in the resuscitation of very sick patients - unfortunately, often with so few ICU beds, ventilators, equipment for monitoring, it is difficult to sustain a high level of care for the critically ill and many do not survive.

There is just so much that we take for granted in the U.S.  I met a 17 year old girl who was brought in to A&E by her parents with 6 months of a progressive motor weakness and spasms that left her wheelchair bound and in sign

ificant pain.  She had been in and out of the hospital, with essentially negative work up including lumbar puncture, plain films and CT head.  She had seen a private neurologist and needed a MRI.  Due to the cost she has not yet gotten the test and even with her consultant advocating her case to the ministry of health, the outcome is still pending.  Getting such a simple test that is so easily accessible to us in the U.S. seems an almost insurmountable hurdle to overcome in the work up of her disease.

It is humbling experience to be here and is a great reminder of what a privilege it is to be able to practice medicine and to serve those who need the most help.  I am constantly being reminded to how much I don’t know and how much I can learn from my patients.

Touch, the dog

Aug 04 2014

Senator Frist is working with the Old Friends Dog Sanctuary to create a dog statue to auction off for their fall fundraiser. His dog, Touch, started out blank, but thanks to some local students, Touch is becoming complete little by little.
 
 
At HTHH, we understand the power of touch. Every hand print, every contribution, is coming together to make Touch who he'll be, and we believe that everyone has a part to play in global health. For some of us—like the FGHL—our role is international. These health services students are actively working in Country and Country and other places around the world to improve health services and train health leaders. They are truly healing hands, touching lives around the world. 
 
For others of us, we’ll leave our mark not by traveling abroad, but by advocating for those who need our help. Touching lives through our voice. 
 
Follow Touch’s story with Senator Bill Frist on Facebook or at BillFrist.com

During the time that has passed since my last report I have been focusing my attention on the Tennessee Radon project. As I mentioned before I really have become interested in this particular project. Through my contacts I have been able to acquire short term radon tests to distribute throughout the community. Thus far I have received scores on 15 of the 20 test kits I have sent out. A safe radon rating for your home under is 4 pCi/L, so far ever test I have gotten back has scored under “1” pCi/L which is great! It has been rewarding to be able to go into the community and pass out the short term radon test not only because I can get data to record, but also because I can talk with the participants and help them to understand the major affects radon can have on their health. I feel like I am truly making a difference in some of these peoples’ lives and helping them understand what could be happening in their home is an eye opening experience for most.

Now that we are more than halfway through with the field experience semester the projects I have been working on are nearing completion. The only projects left are wrapping up of the data collected with TN radon, TV lobby, and Smokeout Day (which is Nov. 15). Looking back and seeing how far I have come since day one of my internship is really unbelievable. At the start of my internship I thought it would drag on forever and that I would get nothing accomplished. Now I can say that I was completely wrong, I have worked on numerous projects that not only helped me to complete my curriculum but also helped the community in one way or another and I feel like time has flown by and that I need more.

The date of our final presentation, when we show all that we have worked on, is approaching fast, and I can not be more excited and nervous all at the same time. I can not wait to show my fellow classmates and mentors all that has been done during my internship, but also to show them what a need there is in rural healthcare and communities.

As I hope you’ve heard, there is an outbreak of the Ebola virus in Western Africa right now, particularly in Liberia. Two American aid workers, Dr. Kent Brantly with Samaritan’s Purse and Nancy Writebol, a volunteer working with the faith group Service in Mission, were recently infected.

I’ve been discussing the situation with the Centers for Disease Control, and I wanted to write a little bit about the transmission and natural history of the virus.

Ebola is a type of viral hemorrhagic fever (VHF). Four families of viruses cause VHFs, and Ebola is from the family Filoviredae. Dengue fever, Yellow fever, Crimean Congo fever, Hantavirus and Lassa fever are other types of VHFs you may have heard of.

Humans are not a natural vector for the Ebola virus, so outbreaks occur after a human comes in contact with an infected animal such as a monkey, pigs or especially bats. Human-to-human spread then occurs through contact with bodily fluids such as urine, secretions, blood, stool or contaminated medical equipment.

Ebola is not technically contracted by respiratory contact with an infected individual, but aresolization of secretions—for example, a coughing patient—can cause spread of the virus. Therefore, barrier precautions like gloves and gowns as well as airborne precautions like masks and goggles (to prevent absorption through the cornea of respiratory droplets) are necessary to prevent transmission. For healthcare workers, infection is almost exclusively the result of a tear or other weakness in their protective barriers.

VHF viruses are dangerous because they are highly contagious, have a high rate of infectivity with low doses of exposure and high rates of complications and death. Therefore, it is important to recognize the signs and symptoms to quickly isolate potentially infected individuals. First, the individual’s travel history is important if not already in an endemic area. Second the timing is helpful to raise suspicion. The incubation period is a few days to weeks. The illness begins with fever and muscle soreness, low blood pressure, red eyes and a rash (specifically, petechial hemorrhages).  The constellation of these symptoms with potential exposure is enough to warrant immediate quarantine.

The virus then attacks blood vessels all over the body and increases vessel permeability resulting in fluid loss and bleeding. The fluid and blood loss causes shock and disorders of the clotting system resulting in hemorrhage from mucous membranes as well as in internal organs such as the gastrointestinal tract and lungs. While there are experimental drugs under research and being used in Liberia today, the only known available treatment at this time is supportive care.  Supportive care includes fluids, blood products, blood pressure and respiratory support and possibly comfort measures.

The key to survival of Ebola is immediate and sufficient isolation of infected individuals and treatment with aggressive supportive care in an intensive care setting. Once patients have stabilized they are no longer infectious and can be taken out of quarantine. The virus is so rapidly fatal that naturally occurring outbreaks can be contained if patients are quickly isolated and effective barrier and airborne precautions implemented.

There are some experimental drugs for Ebola, but none have completed clinical trials and some have only been tested in lab animals. Many are arguing that the most advanced of these treatments be made available to the sick, even though they haven’t been fully tested yet. One such serum was administered to Ms. Writebol. Dr. Brantly has had a blood transfusion from a boy who survived the virus, in hopes that some antibodies to the virus may be transferred.

Much of the outbreak problem in West Africa can be attributed to lack of knowledge about the virus to recognize and immediately quarantine the sick, as well as the cramped facilities where the healthcare workers were operating. West Africa has never seen Ebola before, and most healthcare facilities are not properly equipped to handling the kind of quarantine needed.

The Centers for Disease Control is currently working to send in personnel and supply support to help contain the virus. Dr. Friedan, the director of the CDC, has little fear of spread to the U.S. due to quarantine posts at all points of entry. He also predicts it may take up to six months to completely contain the virus in Liberia, but he’s confident of eventual success.

Join me in praying for all of the infected individuals and the healthcare workers on the ground and abroad that are making efforts to help contain the outbreak.

Numerous projects and learning experiences have arisen during my time at Roan Mountain Medical Center. I've learned you always have to be flexible. Originally I planned on working more with the patients and the administrative side of health care here at the Medical Center, but after a few weeks I learned there are more areas that I can reach out into.

One of the first projects that I worked on is an Internet survey. During this project I not only developed the survey using skills I have learned, but I also got to administer it. After going out into the community and recording results from the survey the data showed some people use the Internet for health information, but not a large amount. A surprising discovery from the data was an assortment of people young and elderly in this rural area still use home remedies regularly. After receiving this information I now plan to research home remedies and become better educated on home remedies and the out come when using them.

Also during my internship I have developed a health observation bulletin board. On this board I put up monthly health events that are going on with information about the topic and contact information. I know this seems like I very ineffective way to spend some of my time but I feel that it is providing awareness about current health issues. I have also made multiply contacts with different organizations that help to provide information packets on the topics that I can give out to our patients

The most recent project that I have been working on is Tennessee Radon. Earlier when I mentioned being flexible this is what I was referring to. I never thought that my time at Roan Mountain Medical Center would be spent working on an environmental issue. It turns out this project has become my favorite and I have been able to make numerous contacts from local to state level concerning Radon in the Roan Mountain area. I am very excited about this project because I feel like it will be the one to impact the community most.

As to update you about my interaction with the staff, it is still limited but I have made progress. I am now familiar with each employee and their day to day tasks, and I think my relationship with them will only grow as my projects start to develop more.

I would like to keep acknowledging and thanking all the people that are making this opportunity possible for me. Thank you Big Kenny and the LoveEverybody Foundation, Dean Wykoff, and Mr. Baylor.  

We arrived safely in Nairobi and stayed at the Mennonite Guest House.  The next morning we ate breakfast with missionaries from all over the world in different stages of their calling around Africa.  Kijabe’s reputation is well known and they wished as well as we were picked up and driven to Kijabe via a road that had terrible slums juxtaposed with sweeping views of the Rift Valley. 

Joe Schlesinger

We toured the hospital and got settled in our lodging for the month and got sign-out from the ICU as one of us was on-call the first night.  It took adjusting to drugs and equipment that were foreign to us.  All of the patients did well overnight leading into our first day in the operating rooms, or “theatres,” as they are called.

The staff comprises one MD anesthesiologist and in our case, two anesthesia residents, missionary and local surgeons, surgery residents, KRNA (the Kenyan version of a CRNA), and anesthesia students.  Patients present with late-stage disease, terrible trauma, and for obstetric emergencies without previous prenatal care.  One could take care of a neonate with a tracheoesophageal fistula followed by a patient after a road traffic accident followed by a C-section.  The steep learning curve of anesthesia is addressed with intense didactics combined with a sick and varied patient population.  The KRNAs and students do a great job.  However, there is not insignificant morbidity.

I had the pleasure to oversee a few operating rooms, help the KRNAs and students perfect there neuraxial anesthesia techniques, discuss pharmacology and physiology, and teach them approaches to regional anesthesia that they have not seen before.  The way they gather around and pay attention exhibiting their willingness to learn is refreshing.

After the first day, we brought two heavy suitcases of medical supplies to the anesthesia workroom as most of the equipment is donated.  It caused me to step back and realize the amount of equipment we use in America and how we take many things for granted at our institution.

Joe Schlesinger Surgery

Everyone at Kijabe has been extremely welcoming and the missionary spirit of providing excellent medical care in the midst of educating the local medical staff is encouraging for the future.  All of this paired with the beautiful land, delicious food and chai, and local wildlife seen on our weekend hikes prepare us for a busy week next week in the operating theatre.

Over the past two weeks, I have continued to work on the research paper on the status of the Framework Convention on Tobacco Control (FCTC) supply strategies in the African Region as reported by the Parties to the Convention. My plans to have the first event of the employee community service program in March have been stalled. We also had an unfortunate incident in Brazzaville on the 5th of March. A fire started at a military arms depot and set off a series of explosions killing more than 150 people and leaving thousands displaced. This sad event was felt at the office as many workers lost their homes. As a result, things were a bit slow at the office this week. The event has been postponed to April to allow time for things to settle back down.

However, I have been able to make contact with two Units- Human Resource for Health; and Planning, budgeting, monitoring and evaluation.Ifeoma and Ogwell The Human Resource for Health Unit is engaged in ensuring an available, competent, responsive and productive health workforce in the African region to ensure improved health outcomes. The latter unit enables the effective and the efficient implementation of the WHO managerial framework through the development of regional policies, systems and tools.

The mission of these two units was explained to me and I was given materials to read in order to have an understanding of their work. I am hoping to do a rotation in those units soon.  

Ifeoma OzodiegwuBrazzaville!!!!I can’t believe I am finally here! After weeks and months of applications and planning and finally a twenty-two hour journey from Johnson City in Tennessee, I have arrived and I am ready to do some public health. Driving into town from the airport, the driver with the World Health Organization, the Organization  with whom I would be working with during my  three  month stay, showed some of the remarkable places in town.  He pointed out the President’s residence, the ministry of defense and biggest market in the area known as Marche Makelekele. “Marche” means market in French which is the widely used language in Congo Brazzaville. I completed a  three month intensive course in French about four years ago and as a result I am able to understand the language. However, I have difficulty speaking because I have been out of practice for those four years. Right across from Brazzaville was Kinshasa. The two capital cities are separated by a huge river known as Djoue. Congo Brazzaville is a small country located in Central Africa. It houses the African Regional Office of the World Health Organization (WHO).  This is my internship affiliate organization.

My duties as an intern involves, primarily, monitoring and evaluation of country compliance to the Framework Convention on Tobacco Control (FCTC) as well as production of tobacco control country report cards. The WHO FCTC is the first negotiated treaty under the auspices of the WHO and a regulatory strategy to address additive substances. It focuses on cutting off the demand and supply of tobacco products within countries. However, apart from the above mentioned duties, I also get to do rotations in other departments in order to get a well-rounded field experience.

Having arrived on a weekend, I had the opportunity to rest and recharge my batteries in order to be ready for my first week as an intern. On Monday morning, I was at the office bright and early. I got introduced to my supervisor, Dr Nivo Ramanandraiben and my preceptor, Dr Ahmed E. Ogwell Ouma. My preceptor is the Regional Advisor on Tobacco Control. I also met other members of the Tobacco Control Team. I was briefed on my duties and by Tuesday, I set to work by trying to understand and extract the information in the FCTC Parties Reports. Countries that have acceded to, ratified and agreed to implement the articles of the FCTC are known as Parties. The agreement to implement these articles is known as entry into force.  These Parties are expected to produce implementation reports two years and five years after entry into force. In the African region, 41 out of the 46 countries in the region have entered into force. Each Party report is 47 pages long and that would be keeping me busy for the next two weeks.

I am very fortunate to be given an opportunity to intern with the Tobacco Control Unit of the WHO for the next twelve weeks and want to thank Hope Through Healing Hands and the Niswonger Foundation for their scholarship support.   I will keep everyone “posted” so be on the lookout for my next blog report.  In the meantime, here is where you can find me.  

 

For more information:

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

Or: Kate Etue (615) 481-8420 (m)

NASHVILLE, TENNESSEE, July 14, 2014 – Former U.S. Senate Majority Leader Bill Frist, M.D., founder of Hope Through Healing Hands, and Melinda Gates, co-chair of the Bill & Melinda Gates Foundation, today, led a community conversation on “The Mother & Child Project: Simple Steps to Saving Lives in the Developing World,” on the campus of Belmont University.

This was the first public event held by the Faith-Based Coalition for Healthy Mothers and Children Worldwide, a joint partnership of Hope Through Healing Hands (HTHH), a Nashville-based global health organization, and the Bill & Melinda Gates Foundation.

More than 250 individuals representing the faith community, global health NGO and higher-education sectors throughout greater Nashville attended the discussion, hosted by Belmont University. U.S. Olympic figure skating champion Scott Hamilton, who with his wife Tracie is an active global health advocate, moderated the event.

“As I began to talk with women around the world, it became very clear to me the spacing and timing of pregnancies we take for granted in the U.S. is a matter of life and death for them,” said Gates. “So I got very involved in contraceptives, because it truly starts the cycle of life, where they can feed their children, get their children in school, and honestly, not die themselves.”

Sen. Frist agreed, saying, “Contraception is a pro-life cause.” He went on to explain that, “…if you delay first pregnancy to 18 years old, you can increase survival in countries where 1 in 39 women die in childbirth, and cut the chance of children dying by 30 percent, enabling them to stay in school and become productive members of families.”

“Second, if you can push out the interval between pregnancies to three year period, the child is twice as likely to survive the newborn stage.”

Today, more than 200 million women in developing countries want the ability to plan if and when they become pregnant, but lack access to information about planning their families. Increasing access to a range of contraceptive options, and providing women with the ability to time and space their births is critical to improving the health of mothers and children.

At the event, Gates reflected on her upbringing in Dallas, Texas, where she attended Catholic parochial school from grades K-12, and confirmed she remains a practicing member of the Catholic Church. While Gates recognizes the tension between her work and the Church’s position on contraceptives, she has found common ground on healthy timing and spacing of pregnancies, even though organizations embrace different tools to achieve it.

Sen. Frist expressed his support for Melinda’s efforts, explaining that the Faith-based Coalition for Healthy Mothers and Children Worldwide has a critical role to play in engaging members of the faith community to help disseminate this simple message.

He likened this initiative to a similar movement of Americans in 2002 that shared a vision with houses of worship across all faiths, which lead to the support and eventual funding of PEPFAR, the largest health initiative in history that turned the tide on the HIV/AIDS. 

“The millions of people dying of HIV/AIDS worldwide led to a major U.S. tax-payer led movement to save lives, resulting in more than what is now 12.9 million individuals currently on anti-retroviral medicine,” he said, noting we can do it again on what is becoming another global pandemic, saving over 287,000 women’s lives each year. 

The Faith Based Coalition on Healthy Mothers and Children Worldwide’s mission is to galvanize support among faith leaders across the U.S. on the issues of maternal, newborn and child health in developing countries. The coalition will place a particular emphasis on the  benefits of healthy timing and spacing of pregnancies, including access to a range of contraceptive options, in alignment with its members’ unifying values and religious beliefs. 

Several faith leaders already involved in this issue also participated in the program by echoing their support of this new initiative.  “The best way to see change in Africa is to change the lives of African mothers,” said Steve Taylor, recording artist and filmmaker.

Jena Lee Nardella, co-founder with Jars of Clay of Blood:Water Mission, shared their experience in the global fight against HIV/AIDS.  “We were inspired not by the statistics, but by the compelling stories.  As a Church, let’s not forget to tell the story, but make it personal.”

Mike Glenn, pastor of Brentwood Baptist Church, added, “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.”

“It all comes down to the mother and child nexus and the healthy timing and spacing of births,” Sen. Frist concluded. 

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.  Sen. Bill Frist, M.D., is the founder and chard of the organization, and Dr. Jenny Eaton Dyer, Ph.D., is the CEO/Executive Director.

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