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Ebola Flare-Up
In March of 2014, the Ebola virus ravaged countries in western Africa, quickly becoming the deadliest occurrence of the disease since 1973. As of January of this year, there have been a total of 28,637 thousand reported cases and 11,315 thousand deaths classified as probable, confirmed and suspected. This month, yet another Ebola flare-up is ravaging western Africa.

While the full force of the Ebola spread has been contained, health professionals are still fighting to drop the number of cases to zero. This month, a total of five people have died in Guinea’s recent Ebola flare-up. Naturally, the question arises whether or not this recent flare-up will spread to the same epidemic levels that West Africa had seen in the past.

Ultimately, the major difference between this recent Ebola flare-up and the huge outbreak of 2014 is that health professionals have been closely monitoring the situation. The Alliance for International Medical Action (ALIMA) has reopened its treatment unit in Nzerekore the area most affected. UNICEF also has a team in the region providing protective equipment and medicine.

The Guinea Ebola flare-up began in mid-March when the World Health Organization was alerted to three potential deaths and two suspected cases of Ebola. The emergency coordination mechanism was then reactivated, according to the WHO’s official statement, “deploying dozens of epidemiologists, surveillance experts, contact tracers, vaccinators, social mobilizers, health promoters, and infection prevention and control experts to support the effort.”

Writing for Care2, Steve Williams notes, “It’s important to emphasize that these new cases represent a contained incident.” A similar Ebola flare-up occurred in Sierra Leone in March, but this sudden rise in Ebola incidence was declared contained by the WHO. As a response to the Guinea flare-up, WHO is tracking 816 people that have come in contact with people contaminated with the virus or virus-ridden corpses.

Liberia is also taking steps to prevent new cases. The country has decided to close its border with Guinea. Lenn Eugene Nanobe, the country’s information minister, told Reuters, “We have ordered the border with Guinea closed with immediate effect. The border will remain closed until the situation in Guinea improves.” WHO declared Liberia Ebola free last January.

Reuters reported recently that Dr. Margaret Chan, the WHO director-general, accepted the recommendations of a committee of independent experts who called for lifting any travel and trade restrictions affecting Guinea, Liberia and Sierra Leone. “The Ebola outbreak in West Africa is no longer a Public Health Emergency of International Concern (PHEIC),” Chan told a news briefing at WHO headquarters in Geneva.

Michael A. Clark

Sources: BBC, Care2, Newsweek, Reuters 1, Reuters 2, Reuters 3, World Health Organization
Photo: Flickr

Containing the Ebola OutbreakIn addressing the progress made in containing the Ebola outbreak, the World Health Organization (WHO) argues that, since July 2014, “unparalleled progress has been made in establishing systems and tools that allowed rapid response.”

From the first report of this outbreak on Mar. 23, 2014, this disease became a devastating epidemic, which led to nearly 25,000 cases and more than 10,000 deaths. Most of the deaths occurred in Guinea, Liberia and Sierra Leone.

According to the U.N. Foundation blog, “the past year of battling Ebola has exposed troubling weakness, both in the health systems of the affected countries and in the international community’s ability to respond to the health crises of this nature.”

However, this period has also shown the world both the power and potential of a coordinated, global response. WHO and its partners are now in phase three of the Ebola response, from August 2015 to mid-year 2016.

At the climax of the Ebola outbreak, it is reported that more than 800 new cases of Ebola were being reported on a weekly basis. However, in the past year, the number of reported cases has fallen in countries like Liberia — the country that has seen more Ebola deaths than any other nation.

On the ground level, WHO continues to deploy technical experts in the three most affected countries and engage not only in response but in early recovery and survivor support efforts.

A collaboration between WHO and the Global Outbreak Alert and Response Network (GOARN) has led to about 4,000 technical experts as well as Ebola vaccination teams being deployed on the ground in more than 70 field sites in the three most affected countries.

Furthermore, WHO highlights that 45 laboratories have been installed since the start of the Ebola outbreak with WHO and the Emerging and Dangerous Pathogens Laboratory Network (EDPLN) supporting 29 of them. All of these laboratories have tested more than 200,000 patient samples.

The Ebola outbreak has shaken the world and caused many deaths. However, thanks to the diligence, dedication and support from volunteers, medical teams, scientists, researchers and many others who have made fighting this epidemic a mission, much progress has been made in containing the Ebola outbreak.

Vanessa Awanyo

Sources: WHO, UN Foundation Blog
Photo: Flickr

global-health
The Independent Panel on the Global Response to Ebola recently made recommendations to prevent future global health crises based on the outcomes of the West African Ebola outbreak last year.

The outbreak killed over 11,000 people in 2014, including health workers. Experts blame the slow response, lack of leadership and lack of proper training for a large number of deaths caused by Ebola.

The panel’s report was published online by The Lancet, a medical journal. Here are their recommendations:

  • The global community should come up with a strategy for strengthening health systems, including funding to help developing countries do so.
  • The WHO should publicly commend countries that report disease outbreaks promptly and shame those that delay reporting. Financial incentives to compensate countries for losses linked to transparent disease reporting should be created.
  • The WHO should set up a permanent outbreak response center with a guaranteed budget. It should report directly to the director general.
  • The WHO should name a permanent emergency committee of experts to advise it on the threat posed by outbreaks. The committee should be able to convene itself and should consider adopting a graded system of warnings. Currently, emergency committees can only declare that something is or isn’t a global emergency.
  • The UN should create an independent accountability commission that assesses response to major disease outbreaks.

Global_Health_crises
Photo: Pixabay

  • Governments, NGOs, the scientific community, and industry should develop rules for conducting research during an outbreak and a program for accelerating research between crises.
  • Research funders should set up a facility to finance development of vaccines, drugs, disease tests, and other medical necessities for diseases which the pharmaceutical industry won’t develop for on its own.
  • A global health committee should be set up as part of the UN Security Council to bring high-level attention to health issues and crises.
  • The WHO should return its focus to its core functions, concentrating on efforts that only the WHO can undertake.
  • The WHO’s executive board should establish a freedom of information policy; countries should stop earmarking the funding they provide the WHO, and countries should demand a WHO director general strong enough to stand up to the most powerful governments.

The proposed changes to responding to global health crises were categorized into five themes: preventing disease outbreaks, responding to outbreaks, monitoring and sharing data, garnering knowledge and technology through research and, lastly, global coordination to prevent and respond to outbreaks.

Marie Helene Ngom

Sources: STAT, The Lancet, BBC
Photo: World Affairs

health_conference_in_CharlestonThe Medical University of South Carolina held a two-day conference on global health to discuss partnerships and collaboration around the world.

MUSC hosted the Global Health Symposium from Nov. 3 – 4, 2015. The health conference in Charleston, presented by the school’s Center for Global Health and Department of Public Health Sciences, focused on partnership and collaboration and their importance in combating Ebola and HIV.

The current Ebola outbreak that began in West Africa last year is the biggest one since the virus was discovered, says the World Health Organization (WHO). Guinea, Liberia and Sierra Leone have been the most affected by the disease and have been monitored by organizations like the WHO since last year to ensure eradication.

HIV also presents numerous problems for impoverished countries, with 36.9 million people living with HIV (including 2.6 million children) in 2014, according to AVERT. The majority of cases are located in sub-Saharan Africa. Recent progress has been made with the availability of medicine. As of March 2015, 13.5 million affected people in low- and middle-income countries had received treatment.

Both the MUSC Center for Global Health and Department of Public Health Sciences were established to further the research and education of health issues and solutions.

The Center for Global Health is particularly concerned with collaboration for global health, which is why the 2010-2015 Strategic Plan was created. The plan emphasizes the areas of globalization, entrepreneurialism, innovation/technology and interprofessionalism as they relate to health.

Notable attendees of the conference included health experts from Tanzania, India, Croatia, The Ivory Coast, Ethiopia and Kenya, with Dr. Michael Merson as the keynote speaker.

Merson, named the director of Duke University’s new Global Health Institute, has done extensive work in the global health field, including working for the CDC and currently acting as director of the WHO’s global program on AIDS.

The fostering of communication and awareness of new successful techniques are just a couple of benefits to be yielded from holding a conference such as this one. MUSC has made itself a forum for global health discussions between experts both in Charleston and around the world.

Ashley Tressel

Sources: ABC News 4, Global Health, Coursera, WHO
Photo: Flickr

Sierra Leone Reports No New Ebola Cases
On August 17, Sierra Leone began to display signs of truly positive results — an epidemiological week had passed, and Sierra Leone reported no new Ebola cases since the beginning of the outbreak in 2014.

Efforts in Sierra Leone have now entered what is known as “Phase 3,” in which efforts are concentrated on swiftly closing any remaining chains of transmission that may remain. This procedure involves tracking down every single person who may have come into contact with the chain, monitor the subject for 21 days and immediately transfer them to a treatment center if symptoms begin to develop.

As of now, there exists only one remaining open chain that has its source in Freetown and extends into Tonkolili. The chain was carried via a young man who used to work in Freetown and returned home each month with food and money for his family.

Dr. Anders Nordstrom, WHO representative in Sierra Leone, asserts, “This is very good news but we have to keep doing this intensive working with communities to identify potential new cases early and to rapidly stop any Ebola virus transmission.”

The WHO’s Director-General, Dr. Margaret Chan, has called for reforms throughout her organization in order to facilitate future preparations for potential similar outbreaks, “including the establishment of a global health emergency workforce, an operational platform that can shift into high gear quickly, performance benchmarks and avenues aimed at acquiring the needed funding.”

As recovery in West Africa begins, it is important not to forget that the outbreak had far-reaching consequences for many vulnerable populations. For example, 70,000 Liberian children were not registered at birth during the outbreak, leaving them “vulnerable to marginalization and exclusion,” as well as unable to access social services and healthcare, without official identity documentation and at risk of being trafficked or unlawfully adopted.

In 2013, before the outbreak took place, Liberia had about 79,000 registered births. In 2014, due to medical facilities’ closures, registered births decreased 39 percent to a mere 48,000. Sierra Leone also experienced the same drop in birth registrations during the outbreak, as demonstrated in a recent registration and vaccination campaign in which 250,000 children were in need of registration.

Jaime Longoria

Sources: UNICEF, UN News Centre, WHO
Photo: Flickr

monrovia
Liberia has had a trying past couple of decades. Most recently, it was plagued by the Ebola virus, which killed thousands of people. Before this, it had suffered through a 14-year-long civil war, which had taken place just a few years after yet another civil war ended. Both wars killed hundreds of thousands of people, leaving many homeless and destitute. Lacking housing or money, many poverty-stricken Liberians have turned to living in cemeteries, many of which are in Monrovia, its capital.

Most go to the Palm Grove Cemetery. Many of these dwellers arrived when they were just children and after their parents had been killed. Some had been child soldiers. They were taken there by friends from the street who used the relative peace and security of the cemetery to indulge in marijuana, cocaine and heroin. They used tombs for shelter after smashing them open and throwing out their long-dead inhabitants.

Monrovians look upon the cemetery dwellers with distaste and fear. They are viewed as criminals and drug addicts who disrespect the graves of their families and are deprecatorily called “friends of the dead.” On Decoration Day, a public holiday when Liberians paint and adorn tombs, conflict always erupts between the tomb dwellers and the families of the tombs’ rightful owners.

Rather than provide an area for the homeless to live in, President Johnson Sirleaf simply put up walls around the cemetery in 2007 to keep them out. Just a few months later, however, people had already breached the walls to live in the cemetery once again. Now the walls serve to better hide the dwellers and their activities rather than keep them out.

Prostitution has also become commonplace behind the cemetery’s walls. Some women and girls are only able to survive through sex work. They are afforded no protection from the police, who often rape them themselves. Unwanted births are commonplace.

Many diseases also run rampant. Ebola was just another problem to add to a list of illnesses that included ones such as tuberculosis and diarrhea.

Hope may yet be around the corner for these cemetery residents. Last year, the British charity organization, Street Child, began to work with them, setting up counseling sessions, schools and rehab centers. However, many roadblocks stand in the way of their progress. It is extremely difficult for many residents to even consider weaning themselves off their dependency on drugs. Sometimes, drugs make them aggressive and hostile, which makes it hard for people from Street Child to engage with them.

The outbreak of Ebola also set back efforts. Schools were banned, as were public gatherings. Street Children also started redirecting efforts to the 2,000 children orphaned because of Ebola. Officials have been hostile to Street Children’s efforts in cemeteries, calling their residents a “lost cause.”

Now that Ebola has largely disappeared in Liberia, Street Children is ready to make a renewed effort to help the cemetery dwellers. To the charity organization, small successes have boosted their belief that these people can be saved from a lifetime of poverty and dependency.

– Radhika Singh

Sources: Independent, BBC 1, BBC 2
Photo: Independent

Fighting_Ebola
When the Ebola virus attacks the human body, the symptoms include muscle pain, vomit, fever and unexplained hemorrhage. While these symptoms are tragic and often fatal, there are no surprises when it comes to the virus itself—we know what it looks like and we can visibly see the damage it leaves in its wake. When the Ebola virus attacks an economy, however, as it did in Liberia in 2014, we know little about the exact symptoms and even less about the treatments available to combat it.

Until 2014, Chid Liberty, the founder of fair trade clothing manufacturer Liberty and Justice, had run his operations out of his native Liberia with ease. This changed almost overnight with the Ebola outbreaks of 2014.

“We had built the company up to a 500,000 orders per month and in a flash we were out of business,” Liberty said in an interview with Madame Noir. “The Ebola epidemic left us and the hundreds of workers and families that were depending on us stranded without income.”

Our economies are just as vulnerable as our immune systems, and can succumb to Ebola just as easily. It is estimated by the World Bank Group that nearly 50 percent of working adults in Liberia lost their jobs after the outbreak. However, Liberty refused to close his doors at the behest of the disease. Instead he turned his ingenuity into a tonic for the symptoms of Ebola and founded UNIFORM, a company based in Liberia dedicated to making affordable school uniforms for children who had been forced to leave school due to Ebola.

Liberia already has one of the lowest rates of primary education enrollment rates in Africa. According to The Global Economy website, an average of only 53.85 percent children reported having completed primary school between 1978 and 2011.

School attendance often incurs costs far beyond those of just tuition—the prices of books, the inability to work a salaried job, and even the cost of the mandatory uniform act as considerable deterrents to struggling families. The uniforms especially act as barriers to school attendance. Abdul Latif Jameel confirmed this in his 2009 study in Kenya, in which he discovered that providing children with free uniforms reduced school absenteeism by 44 percent and decreased dropout rates (particularly among girls) by a third.

Liberty’s UNIFORM brand has embraced the challenge of mollifying the effects of Ebola on the education of Liberia’s children. Their kick starter campaign, which has $174,760, has already given away 7,000 new school uniforms, all of which are being manufactured by small factories throughout Liberia (Madame Noir).

“I am very proud to be working on such a project,” said Ms. Annie Blamo to the UN Ebola Response team. Blamo is a worker in the Monrovian Liberty and Justice factory who has been manufacturing uniforms for the N.V. Massaquoi school, Blamo’s eight-hour days paid off when her son returned to school in early May. “We are so happy for what this factory has done for the children at the N.V. Massaquoi school and their name will be forever remembered.”

UNIFORM’s kick starter campaign will continue to accept donations until July 16, 2015.

Emma Betuel

Sources: Ebola Response, Madame Noire, Poverty Action Lab, Time Dotcom
Photo: New York Post

fight_ebolaThe Ebola outbreak in West Africa continues remains a major public health concern worldwide. In the face of this tragedy, technology provides great hope in managing the disease and providing aid to individuals and healthcare providers. Many technologies are on the forefront of fighting disaster, but the most valuable tool to fight Ebola is probably in your pocket.

Africa has experienced a boom in cell phone ownership in recent years, which has extended to West Africa. As a result, cell phones are providing patients and families of patients with services such as ebola hotlines. Cell phones also allow health workers to be paid electronically, allow clinics to flag when they’re low on supplies and allow individuals to resolve rumors of ebola by texting local radio stations.

Eric King, an innovation specialist who worked with USAID’s Disaster Assistance Response Team in Liberia, said, “among the technological tools that have amplified the Ebola response, arguably none has been more helpful than the mobile phone.”

And it’s not just helpful for individuals. Cell phone companies collect “call data records,” which manage caller identity and the time of the call, along with being able to identify the customer’s location. These records, held by CDRs, are highly valuable to epidemiologists.

But cell phones have been most valuable in fighting Ebola in the hands of health care workers. The mHero program uses information to bring together people making a difference in coordinating a response to this crisis.

The mHero program brings cell phones together with many services. These services include the iHRIS program, a human resource tracking service used within the health sector of 19 countries, along with UNICEF’s SMS platform and information sharing systems such as OpenHIE and DHIS 2.

The mHero programs bring all of this together to allow key text messages to be sent to heath workers internationally, even in remote areas where there is traditionally less access to cell phone service. Having access to this large database of information allows for messages to be targeted to health workers in relevant locations.

According to intrahealth, mHero is also useful to government officials, who can use it to conduct monitoring processes along with data analysis and surveys. The service, which launched in Liberia in September, represents perhaps a major victory in the fight against Ebola.

Information is power. Cell phones are an accessible technology which provide people worldwide with information. It should be no surprise, then, that cell phones are an incredible source of power in responding to the Ebola crisis.

Andrew Michaels

Sources: Intrahealth, Harvard, The Economist, USAID
Photo: Empower Magazine

spike_in_malaria_cases
Researchers have determined that the continued prevalence of the Ebola epidemic within the West African nation of Guinea has substantially reduced the efficacy of programs designed to fight malaria, leading to a spike in malaria cases.

A report recently released by Guinea and published in the Lancet Infectious Disease Journal claims that an estimated 74,000 cases of malaria went untreated in 2014 due to the closure of many medical facilities and the continual fear of citizens to access areas potentially infected with Ebola.

While the death toll from the Ebola outbreak within Guinea currently stands at 2,444, health officials have now offered long-term predictions that a decrease in malaria treatment during this time period will provide a higher record of malaria fatalities than Ebola.

Dr. Mateusz Plucinski, who participated in authoring the Lancet report, assembled a team of researchers and disease control experts to travel to Guinea in order to determine how the Ebola epidemic had affected efforts to combat malaria. After sampling 60 health facilities within high-frequency Ebola districts and 60 facilities within districts unaffected by Ebola, the team was able to observe startling figures.

Within the areas most strongly affected by the Ebola outbreak, outpatient attendance in health facilities for malaria treatment decreased by nearly 50%. In the 60 surveyed districts with high frequencies of Ebola, the number of treated Malaria cases decreased by over 65%.

Dr. Franco Pagoni of the WHO Global Malaria Program explained in a recent interview that a significant rise in untreated malaria cases has placed additional stresses on a national healthcare system already spread thin by the Ebola crisis. Dr. Pagoni argues that the most effective solution to an increase in recorded malaria cases is to incorporate malaria prevention, detection and treatment methods with medical practices currently being used to treat the Ebola outbreak.

Guinea has had some reason to celebrate in recent months, as their control over the Ebola crisis has grown tighter due to an increase of international aid efforts and stronger government health programs. While cases per week in Guinea were recorded in the hundreds at the start of the year, recent data from WHO found only 10 weekly cases.

As reported cases of Ebola within West Africa continue to decrease, heath officials must again turn their attention to programs designed to control malaria, a disease which is responsible for claiming over half a million lives each year.

– James Thornton

Sources: The Lancet, BBC
Photo: Flickr

Fighting_Ebola_in_Sierra_LeoneIt is the holy month of Ramadan in Sierra Leone and attendance at religious services was up from the rest of the year on Friday. Sermons provide the best platform for educating the general population about the Ebola epidemic and religious leaders are using faith to fight Ebola in Sierra Leone.

In a country that has witnessed Ebola’s devastating effects, religious leaders from all walks of life have come together to work to end the epidemic. Of the 27,479 confirmed cases of Ebola reported by the World Health Organization, over 13,000 have been reported in Sierra Leone.

The Freetown-based NGP, Focus 1000 came up with the idea to use interfaith dialogue to educate citizens about the dangers of Ebola.  In a country that is 78 percent Muslim and 21 percent, Christian, it has been one of the most successful means of combating the deadly disease.

One of the main causes of the unprecedented spread of Ebola was the lack of understanding that Ebola spread through bodily fluids even after the victim had died. Muslim and Christian burial rites composed of family members washing the deceased patients. Coupled with mistrust of the government and aid worker’s body disposal protocols, it created a situation where infections were being passed along routinely.

Ramadan Jollah, the chief Imam of the Jam’iyatul Haq Mosque in Freetown explained, “Sierra Leone has a clear understanding of what religion really is — that religion is not there to create problems between people but instead to bring people together.” Together, Muslim and Christian leaders have used their anointed trust to help their communities follow health protocols.

The Imam has used verses of the Qur’an to appeal to Ebola prevention tactics. The Qur’an allows Muslims who are martyred to be buried in their clothing without being washed. He quotes the Prophet of Islam imploring Muslims to wash their hands regularly.

Similarly, Reverend Christiana Sutton-Koroma addresses her congregation in a small church. The Reverend quotes passages from the Bible’s Book of Numbers – prohibiting people from coming into contact with corpses that can infect them.

She dispels myths of burial washing and also avoiding seeking care in case of infection.  Members of her congregation take her message very serious and many go home to spread the message to their families, friends, and neighbors.

International NGOs such as World Vision have followed suit, creating venues for Muslim leaders to address Christian congregations and vice versa.  It is not uncommon in Sierra Leone to have multi-faith families.  Christians pray for their sick Muslim neighbors in churches and Muslims pray for their Christian counterparts in mosques.

The tactics are working. Sierra Leone, while having the most cases of confirmed Ebola, has also the least mortality percentage in comparison to their neighbors in Guinea and Liberia.  New cases have begun to rapidly decline.  In May 2015, the country declared itself Ebola-free for the first time.  Although it did not last long, progress is being made.

USAID has pledged to send the US $126 million to the three countries-Liberia, Sierra Leone, and Guinea- to strengthen their health care systems by providing crucial support such as vaccines and vitamins.  The United Nations says US 88.1 million dollars is needed to support the “last mile” of the international response to the Ebola outbreak in West Africa.  Foreign Aid, coupled with faith, is fighting Ebola in Sierra Leone, and together they are winning.

– Adnan Khalid

Sources: Al Jazeera, Ebola Deeply, USAID, World Health Organization, World Vision International 1, World Vision International 2
Photo: Caritas