by Senator Bill Frist, MD
November 12, 2014
FoxNews

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

William "Bill" H. Frist, M.D. is an American physician, businessman, a former U.S. senator from Tennessee and the former Republican majority leader in the U.S. He is the chairman of global health non-profit Hope Through Healing Hands.

by Jen Todd, [email protected]

November 9, 2014

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

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

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

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

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

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

Roll Call

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

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

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

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

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

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

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

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

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

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

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

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

Forbes | November 1, 2014

By Bill Frist

Imagine waking up with a fever and nausea in West Africa. You would probably be equal parts curious about the cause of your symptoms, and terrified that it might be fatal. Ebola is actually the least likely cause of your fever, unless of course you had been exposed to a known Ebola case. Malaria is a much more likely cause of your fever, and now that the summer months are approaching, Lassa Fever, another type of Viral Hemorrhagic Fever, is becoming more prevalent.

You go to the local “clinic” and healthcare workers there isolate you. They draw blood and send it to a nearby city for testing. It will take days for the results to come back. You are considered Ebola positive until proven otherwise. Until then, you are put in containment with other febrile patients–some probably with Ebola. There is no space. You are crammed in with other sick patients and isolated from your family. You may feel O.K. compared to these patients, some of whom are potentially deathly ill. If you do not have Ebola now, will you have it by the time your waiting period is done?

Now imagine an alternative reality.

You wake up with the same fever and nausea. You go to a designated diagnostic site, likely the same clinic, and your finger is pricked or a small vial of blood is drawn by a trained healthcare worker. You are asked to wait in a holding room for up to three hours, but no more. Everyone in the room with you is about as sick as you are and waiting quietly and calmly. In a few hours, you have an answer: You have Lassa or Malaria or another febrile illness, or you have Ebola. From there you are triaged appropriately to the best treatment, maybe released with anti-malarial medications or other treatment.

In West Africa today, a rapid diagnostic test (RDT) would be a complete game changer. Identifying infected individuals quickly means the best use of resources, quick institution of appropriate treatment, reduced risk for spread of infection, and decrease in public panic and fear.

On October 25 the FDA approved two tests from BioFire Defense that can produce a diagnosis in two hours compared with current polymerase chain reaction (PCR) methods that generally take four hours. The new tests use patented “FilmArray” technology to identify the virus quickly.

While this is definitely a step in the right direction, it is still not the ideal solution. First, BioFire’s FilmArray tests still require someone to draw an entire tube of blood and inactivate the virus, which is dangerous. Second, the testing instrument can only process one sample at a time. One machine can process 24 tests a day, while PCR tests can run up to 70 tests a day even though they take four hours. Third, the cost is almost prohibitive. The new test instrument costs $39,000 and each test is $189 dollars. Considering multiple devices are needed, and that PCR is relatively cheap, the cost benefit analysis needs to be considered.

This is not to say I am not encouraged by the possible impact of the BioFire technology. I am especially pleased the FDA accelerated approval. But we cannot stop here.

The ideal RDT would be a quick, field-ready test, with results available within hours at a very low cost. It would not require large blood samples, would have a high sensitivity and specificity, and may even be able to detect viral RNA before a patient becomes symptomatic—at very low concentrations—to avoid lengthy quarantines.

Several groups have reached out to me to let me know that they are working to develop such a test. Promising development it happening! When these criteria are met, it will be possible to test in a maximally effective, decentralized, and distributed way.

Until then the wisest course is a coordinated containment strategy for real exposures. The only people that have contracted Ebola in the U.S. have been healthcare workers exposed to the bodily secretions of infected patients late in the disease progression. Our focus should be on people who are truly likely to have been infected. And the treatment strategy should leverage the specific hospitals that are trained in managing diseases like Ebola.

It is hubris to think just anyone in healthcare can take care of Ebola patients and properly contain it. We have to respect the virus. But that does not mean mass hysteria, wide spread travel bans or even airport quarantines. We have to remember the science behind Ebola. It is infectious but not very contagious. It requires that bodily secretions contact mucous membranes.

While mistakes have been made in identifying and containing this outbreak, we must recognize we are fighting a disease and not each other. What we learn as we contain Ebola can be applied to infectious disease challenges in the future—both globally and at home. Today, one out of every 25 people admitted to the hospital in the U.S. acquires an infection and more than 5,000 people die of those infections each month. Early detection of infections in the hospital setting can reduce spread and save lives.

Doing thing right on Ebola will become the standard for how in the future we treat all infectious diseases. We need to keep working to get it right—to make the ideal a reality.

Sadly, I am leaving this wonderful island tonight. I cannot imagine how the time has flown by so fast. The last week was intense; activities included inputting and analyzing the data we collected, preparing for the presentation, organizing the workshop for stress management, and saying goodbye to my dear friends on the island. 

After learning about the culture and lifestyle on this south pacific island by interviewing people, we started to actually collect data with the tailored survey that would give us ideas about the stress status of the people in American Samoa. This survey was designed analyze from multiple angles the stress status of the people, including stress level, stress symptoms, access to releasing stress, risk factors, and effective coping techniques. Also, it emphasizes the fa’alavelave which means funerals, weddings, and other gatherings in which people have to donate money due to social reputation and expectation.

The target population of this research was on students and teachers at American Samoa Community College. We collected a good amount of surveys back and then analyzed the data with statistical software. Although the most common statistical software in the USA may not be available here, we finally achieved preliminary findings. My preliminary findings were presented to the land grant staff, American Samoan Community College faculties, and the people I interviewed previously. I am glad that this research provided the American Samoans a new way to look at themselves.

Although some of the college students did not feel stress from fa’alavelave personally, they did put fa’alavelave as the answer for the question, “what is the most common stressful thing the Samoan people may have?” A possible reason for this is that the all the college students’ funds come from their family; however, their families may suffer from stress of Fa’alavelave. In American Samoan society, the family will support the children economically while they are still in school. Although the economy on the island is not well developed, people donate a large portion of money for fa’alavelave, which creates tremendous stress for them.

In my stress management workshop, I demonstrated some coping techniques such as music therapy, meditation, humor therapy, and other methods to the audience. The stress management workshop provided fresh ideas for the locals and opened a window for them to explore the opportunities to manage their stress in the future. In addition, I designed some programs for the wellness center which will open later this year. The wellness center will be the first integrated place that aims to support the public health for the islanders.

Coming to the island alone is definitely not a lonely journey. I am blessed to have the chance to embrace the culture and diversity. It is a blessing to come to this exotic place and meet friendly people, to experience a different culture and gain working experience, while at the same time contributing my skills to the community. I found myself falling in love with this island, even though my contribution may only make a small difference for the islanders. This experience made me aware of how often I take for granted the ease of access to expertise in the USA. Because the island is so resource-limited, each visiting field has only one expert, one dietitian, one psychiatrist, one entomologist, or no expertise at all in many fields. My preceptor commented on my study, saying it was a unique and promising study, and he would like to continue it as a long term program for the American Samoa population. I am glad to see what I accomplished here, and hopefully I will come back some day.

 

The past two weeks were full of activities. I conducted a series interviews with the people to obtain a better understanding of the culture and guidelines for my research, including professionals in stress and mental health, as well as people who work at healthy food promotion, obesity control, agriculture, and other various areas. After summarizing my findings, I did a presentation to inform my fellows working at land grant, American Samoa Community College, to get the staff involved with this program. The relation between stress and obesity is a novel concept to most of them. Even in Samoan language, there is not a direct word for stress, and they do not conceive of the tremendous influence of stress on health. Therefore, it is of great significance for land grant to incorporate this stress management program for the American Samoa Community College’s Wellness Center when it officially opens later this year.

Communicating with the local community made me aware of the friendly and hospitable characters of the local people. Gradually, I felt myself getting more and more used to the local culture and passionate about corresponding with the locals. Due to the culture difference, the reasons for stress and obesity of the local people vary from those in the United States. Designing tailored questionnaires for the local people provides better understanding of our research.

Diet is extremely important for obesity and stress management, especially for the population which over-consumes food. Every Sunday, Samoan people wake up very early to prepare the umu-- a traditional cooking method in Samoa. The foods from the umu are tasty and served in large amounts. Cooking food in the umu demands time and effort, so people usually overeat after they spend so much effort in preparing it. Last weekend, we had a health affair to promote healthy food and introduce the way to produce healthy food. In our venders, we made healthy smoothies and showed people the method to make it with milk, fruits, cereal, and oats. In addition, we encouraged people to get more involved with physical activities, so we held a dance contest in which people danced and had fun together and at the same time gained the knowledge of healthy behaviors. 

Next week, after finishing our tailored questionnaire, we plan to spread our survey to the target population to collect data.

FOR INFORMATION CONTACT:

Melany Ethridge, (972) 267-1111, [email protected]

NASHVILLE, TENNESSEE, Oct. 27, 2014 – On November 21, former Senate Majority Leader Bill Frist, M.D., founder of Hope Through Healing Hands; J. Stephen Morrison, Ph.D., Senior Vice President at the Center for Strategic and International Studies; William Schaffner, M.D., professor of Preventive Medicine in the Department of Health Policy at Vanderbilt University School of Medicine; and Sten H. Vermund, M.D., Ph.D., Director of the Vanderbilt Institute for Global Health will lead a roundtable on Ebola that will take place at Vanderbilt University Medical Center, Light Hall Room 208, 2215 Garland Ave., in Nashville, from 10-11:30 a.m. The forum is jointly sponsored by Hope Through Healing Hands (HTHH), the Center for Strategic and International Studies (CSIS), and the Vanderbilt Institute for Global Health (VIGH). It will be on-the-record, and open to media.

The United States is engaged in a two front war against Ebola – at home, and abroad in Liberia, Sierra Leone and Guinea. The four roundtable speakers will open with remarks on key dimensions of the Ebola crisis: the evolving U.S. approach to preventing, detecting and responding to cases entering the United States; the U.S. military-led mobilization in Liberia and the broader international effort under UN coordination; the exponential growth of the epidemic itself in West Africa and critical steps to break the chain of transmission; and accelerated efforts to develop new technological tools, e.g. a rapid diagnostic test, vaccines, and treatments.

A lively, interactive conversation will follow, into which Muktar Aliyu, M.D., Associate Director for Research for the Vanderbilt Institute for Global Health and James E. Crowe, Jr., M.D., Director of the Vanderbilt Vaccine Center, will be invited to add their thoughts. Over the course of the conversation, special consideration will also be given to what future changes will be needed in U.S. approaches, both to domestic public health capacities and the long-term scientific research agenda, and to post-Ebola reconstruction in West Africa, including investments in basic health services.

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, Frist explained. “If we had invested one-tenth of what people think we have invested, we wouldn’t be in this position,” he said.

“Ebola is a modern plague, which sorely tests U.S. leadership at multiple points. It requires grappling with considerable unknowns, and preserving the confidence, trust and support of the American people,” Morrison commented. “We are just at the front end of a long process of thinking through the strategies that will work most effectively in this two front battle.”

Sten Vermund adds, “I write this from rural Mozambique where clinics have no running water or hand sanitizer; the spread of Ebola virus from West Africa to other under capacitated regions would be catastrophic. We must control it where it emerged.”

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.

The Vanderbilt Institute for Global Health fosters multidisciplinary research, teaching, and service activities linked to health and development in resource-limited settings of the developing world, and forges a collaborative environment through multidisciplinary approaches rooted in academic research and training, and pragmatic community partnerships. This effort enables the establishment of a research and development agenda that informs training and capacity building programs throughout Vanderbilt University in the area of global health.

The Center for Strategic and International Studies (CSIS), based in Washington, D.C., is a non-partisan, independent non-profit institution that concentrates on U.S. policy approaches to defense and security, regional stability, and transitional challenges ranging from energy and climate to global health and economic integration.

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

Equipped with the knowledge of public health learned from my college and an enthusiastic heart, I came to American Samoa, the southern territory of the USA nearly three weeks ago. There are so much differences here, culture, family structure, work regulations, personal habits, traditional ceremonies, views of the world, just to name a few. Fa’asamoa, which means the Samoan way to do things, influences every corner in this place. In addition, the natural beauty is pristine and fabulous. However, behind the gorgeous attractions, there are tremendous public health problems here. 

From the first time I arrived here, I saw the trash spread around the road. This is not because of the residents, but the stray dogs. The stray dogs are almost everywhere. They knock down the trash can and look for food, leaving a mess and walk away. Also, being scared by bitten by the stray dogs is a main reason that people do not excise outside and do not allow their children to do it. There is one time more than 10 dogs tried to surround me! People here even joke as “if you never get bitten by a stray dog, you don’t really live in American Samoa”.

From my point of view, except for the most salient public health problem—obesity, people have stress behind their normal smiling face. One prominent culture burden is the Fa’alavelave, in which people have an obligation to show respect through gift-giving when involved in an event such as a funeral, a wedding. People here live in a bi-cultural environment that is reflected in the conflict between the traditional Polynesian life style and Americanized procedure. Furthermore, people have much more obligation in church than people in the USA mainland. The changing economy and family chores are other stressors for the local people.

Through talking and interviewing people, I collected valuable information to better know about the local culture and tailor interventions for the community. Dr. Biukoto in Lyndon Baines Johnson hospital is the only psychiatrist on the island (not anymore, because he already left). Last week I did an interview with him to get a depth insight about the mental health on the island. Besides, I went to community with my coworkers, serving food stand, promoting healthy diet and conducting interviews. 

In general, I am glad that my college and Hope Through Healing Hands Foundation provide me this fantastic opportunity to come and help the local people. I am looking forward to my next work.

Not too many things happened during this time period, I continued reading literature regarding baseline survey of early child development in developing countries, talked with people in the community, identify key issue which I need to add into the survey; attended monthly hub meetings, tried to understand their responsibilities for supporting our core mission: promoting overall health status of vulnerable children in Munsieville.

I went into several child care centers in shack area with Betty, to observe how they take care of young kids. There is an ongoing research project in Thoughtful Path. Similar to a typical case-control study, they select teachers from some child care centers, provide them professional training and materials (case group), in the meantime, only consulate were provided to teachers in other child care centers (control group). So we go into these centers, observe teacher’s, children’s action, document them and see if kids from case group have better performance in daily life and in school. I believe kids from case group will have much better performance for sure. Flyers, posters and books are everywhere, teachers always remind children to behave healthy, and use puzzle game for brain development. However, in  control groups, untrained teachers in these centers basically do nothing but just feed kids breakfast and lunch, children were playing on their own, and teachers (or you can say housewives) just watch TV or do their own stuff. It is really sad seeing these, as an international charity organization, we dedicated to do our best providing best service to promote local people, but for evaluation purpose, we can’t fully help some of them. This makes me feel so bad and heartbroken.

YiHi blog

One of the critical issues in shack area is fire. Paul told me that every week there is a shack burnt down, although we are focusing on early childhood development, we can’t just see people suffering and do nothing. So, in a weekend, collaborating with a Baptist church from Randfontein (a city near Munviesille), we brought many food and living essentials to families whose house have recently been burnt down, and build new home for them. I am not good at constructing, but was doing my part: painting and help moving stuff from here to there.  

Always feel good for helping people.   

YiHe blog

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