USAID Impact Photo Credit: USAID and Partners

Archives for Health

A Look into the Hot Zone of Sierra Leone’s New Ebola Clinic

“Death is always difficult,” said Elizabeth Stevens, a nurse from Freetown, Sierra Leone.
At her new job, Stevens is forced to confront this stark reality every day, and in a way that she never has before.

“The first day, when I entered the [medical] ward, I was frightened,” said Stevens.  “But now it’s getting better.”

It’s been just a week since a new Ebola treatment unit (ETU) opened on December 1 in the town of Lunsar in Sierra Leone’s Port Loko district—an area with one of the highest rates of Ebola in the country. On its first day of operation, four patients were admitted to the facility being run by International Medical Corps (IMC) with USAID support. USAID provided more than $5 million for the staffing and management of the 50-bed ETU.

According to the ETU’s medical director, some of the facility’s 150 staff members were nervous to start caring for Ebola patients in spite of all the training they received. But by day three, things started coming together.

“For the first two days, you could see people’s anxiety…more of the fear of it being real,” said IMC medical director Vanessa Wolfman. “But we have a great psychosocial team to talk to staff about their fears.  Now we’re getting into a routine. Everyone’s much more comfortable and can rely on each other.”

This reliance and teamwork is evident even before the first patient is seen.  On one end of the medical complex, there’s a small group of people around emergency room nurse Lisa Woods, helping her get into the protective suit, gloves, apron, boots, and goggles that will keep her safe while treating Ebola patients.

“You don’t have any touch with the patients,” said Woods, her voice slightly muffled from the mask covering half her face; giant red goggles cover the other half. “I think that’s the hardest part, not being able to connect with my patients in a human way. Like right now there’s a 14-year-old in there, and boy, that’s hard.”

On the other end of the treatment complex, groups of men and women are washing hundreds of articles of clothing, boots, goggles, and gloves by hand. Right next to them, several people are hooking up a washing machine that was recently delivered—just in time to speed up the laundering process before more patients arrive and the ETU gets busier.

“We are really sympathetic with the patients,” said Idrissa Kamara, a nurse at the ETU. “These people are our people.  So we take great care of them because we don’t want to see them missing.”

Just then, the medical director announces that another ambulance is on its way with a confirmed Ebola patient. Idrissa and the other nurses walk out of the staff rest area, to suit up and take care of another one of their own.


12.4.14-IMC-Lunsar-ETU-one-of-few-places-where-food,-water-could-be-passed-from-safe-zone-to-hot-zone.-photo-Carol-Han-USAID-OFDA

A look into the hot zone: This is one of the few places where water and food could be passed from the safe zone to the patient areas. Orange fencing indicates the areas where staff must be wearing protective clothing. / Carol Han, USAID


12.4.14-Ambulance-delivers-new-patient-to-Lunsar-ETU.-Photo-Carol-Han-USAID-OFDA

An ambulance brings a patient to the newly opened Ebola treatment unit (ETU) in Sierra Leone’s Port Loko district, one of the areas hardest hit by the epidemic. / Carol Han, USAID


12.4.14-Look-inside-PPE-donning-area-at-USAID-supported-Lunsar-ETU-2-photo-Carol-Han-USAID-OFDA

USAID’s Office of U.S. Foreign Disaster Assistance provided $5 million dollars to staff and manage the ETU. USAID partner International Medical Corps (IMC) is running the facility. / Carol Han, USAID


12.4.14-IMC-Dr.-Lisa-Woods-at-Lunsar-ETU-in-middle-of-6-hour-shift-Photo-Carol-Han-USAID-OFDA

Lisa Woods is an emergency room nurse from San Francisco who came to Sierra Leone to work at the USAID-supported ETU.  “To give to somebody, what greater gift is that?” said Woods. Photo credit: / Carol Han, USAID


12.4.14-IMC-Lunsar-nurse-group-hero-shot-1-Photo-Carol-Han-USAID-OFDA

Most of the 150 people working at the ETU are Sierra Leonean. “All of us are working in unity,” said nurse Elizabeth Stevens (far left). / Carol Han, USAID


12.4.14-IMC-Lunsar-ETU-laundry-area-were-goggles-are-washed-1-photo-Carol-Han-USAID-OFDA

Hundreds of articles of clothing, goggles, boots, and gloves are washed every single day by hand. A newly installed washing machine will speed up the laundering process. / Carol Han, USAID


12.4.14-IMC-medical-dream-team-suits-up-for-another-round-in-clinical-ward.-photo-Carol-Han-USAID-OFDA

Dream Team: A group of nurses suit up to go into the patient ward during their six-hour shift. It takes teamwork not only to work with patients, but to get dressed for duty. “It’s really been a great experience,” said Lisa Woods (right). / Carol Han, USAID


12.4.14-IMC-Nurse-Idrissa-2-photo-Carol-Han-USAID-OFDA

“These people are our people,” said Idrissa Kamara, a nurse at the ETU. “So we take great care of them because we don’t want to see them missing.” / Carol Han, USAID

ABOUT THE AUTHORS

The Ebola Disaster Assistance Response Team (DART) is overseeing the U.S. Ebola response efforts in West Africa. The DART includes staff from across the U.S. Government, including USAID’s Office of U.S. Foreign Disaster Assistance (OFDA), the U.S. Centers for Disease Control and Prevention (CDC), and the Departments of Defense and Health and Human Services.

Ending Extreme Poverty in Asia through Universal Health Coverage

A woman in the Philippines receives a tetanus shot during a pre-natal visit. / HealthPRO

A woman in the Philippines receives a tetanus shot during a pre-natal visit. / HealthPRO

The 2010 World Health Report on Health Systems Financing and the unanimous endorsement of Universal Health Coverage (UHC) by the United Nations in 2012 have paved the way for rich and poor countries alike to take a closer, more critical look at how raise resources and improve access to health services, particularly for the poor. Asia is home to 3.9 billion people and accounts for a third of the global economy. Despite the region’s robust economic growth, almost two thirds of those in extreme poverty still live in Asia.

While there are many paths that a country can choose to get out of poverty, mobilizing domestic resources towards the health sector – in the form of Universal Health Coverage policies that seek to increase access to services especially for the poor – is a sound and sustainable investment that can lead to great economic returns. These reforms that empower the poor are critical because poor health and health shocks are leading causes of chronic poverty and impoverishment.

An Indonesian patient awaits further instructions during a check-up. / USAID

An Indonesian patient awaits further instructions during a check-up. / USAID

Rapidly growing Asian countries, Bangladesh, Indonesia, Thailand, and Vietnam have shown that improving health indicators and reducing extreme poverty are clearly linked. Declines in infant and child mortality rates in these countries preceded periods of strong and sustained economic growth.

Clearly, an agenda to end extreme poverty must include UHC goals.

Ill health prevents the poor from climbing out of poverty and can impoverish the near poor. When a household member falls ill, this can mean diminished labor productivity. In addition, households often make catastrophic financial outlays paid for by selling their assets, reducing their consumption, dipping into their savings, or borrowing at high interest rates for seeking health care.

High rates of out-of-pocket spending, a highly regressive way of financing health systems, create financial barriers to accessing health care., This financing represents 36 percent and 61 percent of the total health spending in developing East Asia and Pacific and South Asia regions, respectively.

Pupils in Vietnam's Bac Giang Province take part in a USAID deworming project . /  Richard Nyberg, USAID)

Pupils in Vietnam’s Bac Giang Province take part in a USAID deworming project . / Richard Nyberg, USAID)

UHC reforms come in different shapes and sizes. Some common characteristics include improving revenue collection mechanisms so that they are fair and affordable;, helping people move away from paying for health services out of pocket and toward prepayment and risk pooling; improving value for money with strategic purchasing;, and targeting the poor through subsidies.

Many of these reforms across Asia have increased access and utilization of health care, provided financial protection, as well as improved health care outcomes.

Countries such as China and Bangladesh successfully piloted schemes. In Bangladesh, the pilot voucher program to improve maternal and child health successfully increased pre-and post-natal care and facility-based deliveries, while reducing out-of-pocket spending and the costs of these services, and decreasing neonatal mortality rates by a third to almost half in home-based interventions. Bangladesh has adopted UHC as a national policy goal and USAID is providing assistance to support implementation of their health financing strategy.

Vietnam and Indonesia have reached partial coverage of their populations by around two thirds, and have recently taken additional steps to expand their coverage.

Analysis of various UHC schemes in Vietnam (public voluntary health insurance, social insurance and the health care fund for the poor) showed that they had improved financial protection – significantly decreasing spending for the beneficiary insured and providing evidence of positive impacts on their nutrition indicators. And in January of this year, Indonesia set out on the path towards UHC with the goal of covering its entire population of 250 million people by 2019.

The dynamic economic environment in fast-growing Asia means that the role of donors like USAID and the development assistance architecture will need to evolve as well.

Individual countries and the region at large will need to grapple with growing migrant populations and the need for portable schemes that ensure access for migrant labor populations across porous borders. A large and growing informal sector, individuals not covered by the labor and social security provisions, will continue to test how countries communicate expanded coverage to remote and often marginalized communities. Equally as important will be the question of how to finance and address the changing mix of population health needs arising from demographic trends and the emergence of non-communicable diseases.

As many of the developing countries in Asia continue to grow, they will have sufficient resources to afford a basic package of health services for their entire population; however, governments tend to under-invest in their health sector relative to their economic potential.

As a result, oftentimes as countries grow wealthier, public health systems fall further behind.

In Asia and globally, growing domestic resources represent a critical window of opportunity where countries must have the vision and courage to strategically direct this increased wealth towards the health sector so that development dollars are crowded out.

By financing policies that focus on increasing equity and access to quality essential health services – the aim of universal health coverage – countries will be taking concrete steps towards the bold vision of ending extreme poverty.

ABOUT THE AUTHOR

Kristina Yarrow is a Senior Health Technical Specialist in the Asia Bureau, backstopping technical areas specific to health systems strengthening and research such as health financing, UHC, and implementation research.

Caroline Ly is a Health Economist in the Bureau for Global Health’s Office of Health Systems.

RELATED LINKS:

The Intersection of HIV/AIDS and Gender-Based Violence: A Critical Connection

A mother plays with her child while waiting for services at Jose Maria Cabral y Baez Hospital in Santiago, Dominican Republic. Health workers and supervisors from this hospital participated in a workshop and supportive site supervision system designed and delivered by the Directorate of STI/HIV/AIDS (DIGECITSS), the health services network (REDES), and CapacityPlus to improve the quality of services to eliminate mother-to-child transmission of HIV and congenital syphilis. / Wendy Tactuk, courtesy of CapacityPlus and IntraHealth International

A mother plays with her child while waiting for services at Jose Maria Cabral y Baez Hospital in Santiago, Dominican Republic. Health workers and supervisors from this hospital participated in a workshop to improve the quality of services to eliminate mother-to-child transmission of HIV. / Wendy Tactuk, courtesy of CapacityPlus and IntraHealth International

This week we mark World AIDS Day. Appropriately, it occurs during the Sixteen Days of Activism Against Gender-Based Violence. Why so appropriate? Because we know that gender-based violence (GBV) prevention and response are critical to effectively treating and reducing the spread of HIV. Though not always self-evident, the connection is clear.

For me, the linkages were driven home during recent conversations I had with health experts in Ghana. While discussing our health programs, I casually asked how important attention to GBV was within efforts to treat and stem the spread of the HIV.  As soon as I asked the question, the room’s atmosphere changed palpably. Everyone sat up and leaned in. People began speaking all at once, tripping over one another to respond. The passion was tangible and the analysis compelling. It was all the more persuasive because it is backed up by research.

In Ghana, the HIV rate is low and declining, though the rate is 15 – 20 times higher for key populations at risk of contracting HIV, which include female sex workers (FSWs) and men who have sex with men.

GBV is particularly common among female sex workers (FSWs), 24 – 37 percent of whom are HIV-positive. How do GBV and HIV rates correlate and relate, and how do we bear that in mind in our work to prevent and treat the infected?

A traditional leader discusses multiple concurrent partnerships, a key driver of HIV in Zambia, during a November 2013 training on HIV/AIDS leadership messaging in Kanyembo Chiefdom in Luapula Province / JSI/SHARe II

A traditional leader discusses multiple concurrent partnerships, a key driver of HIV in Zambia, during a November 2013 training on HIV/AIDS leadership messaging in Kanyembo Chiefdom, Luapula Province. / JSI/SHARe II

Many of my conversations in Accra focused on how to help people change behavior to decrease the risk of transmitting the virus and to increase the likelihood of seeking testing and treatment. The experts discussed how much more difficult it is for a woman or a man to negotiate condom use with an abusive partner.

The victim is less likely to try to persuade the abuser to use protection. The perpetrator is less likely to listen. The practitioners also talked about how victims of gender-based violence have less self-esteem and a lowered sense of self-worth. As a result, victims of abuse don’t believe they have the “right” to receive health services. It is much harder to coax people who face GBV or who fear violence or abandonment to seek services, test for HIV, or to successfully access or adhere to treatment.

A 2010 study of FSWs in Karnataka state, south India, confirmed what the Ghanaians explained to me; fear of partner violence prevented women and girls from seeking health services and from asking their partners to use condoms. The study found that condom use was some 20 percent lower those who had been beaten or raped within the last year compared with those who had not faced such violence.

The experts I spoke with also mentioned how gender-based violence cements relationships in which one partner is clearly dominant; they discussed how that feeling of dominance can give the abusive partner a sense of invincibility, reducing his or her willingness to practice prevention.

If you don’t believe you are vulnerable to harm or disease, there is no need to protect yourself. A 2014 study in South Africa supported this contention. The study, which considered women and girls attending four health centers in Soweto, found that abusive relationships with high levels of male control were “associated with HIV seropositivity.” In relationships where men had a great deal of power or where violence was frequent, researchers found that females were less likely to request condom use and had about a 12 percent greater likelihood of being HIV-positive.

Sometimes, the statistics were actually pretty astonishing.  A 2012 study in Moscow, Russia found that FSWs were more than 20 percent more likely to be HIV-positive or to carry a sexually transmitted infection (STI) if they experienced client violence. In addition, over forty percent of FSWs who were coerced into sex with the police were STI/HIV infected. Researchers concluded that reducing the risk of infection would require decreasing client, pimp and police abuse and coercive behavior.

A 2013 WHO systematic global review and analysis of studies across different HIV epidemic settings underscored the association between GBV and HIV, finding that intimate partner violence increases the risk for HIV infection among women and girls by more than 50 percent, and in some instances up to four-fold.

There are two bottom lines to the research and experiential data. First, reducing and responding to gender-based violence should be a key tool in efforts to prevent the spread of HIV. Second, additional research is needed to understand those violence-reducing interventions that best reinforce HIV prevention and treatment.

USAID has seen important dividends from integrating GBV prevention and response into HIV and AIDS programs in collaboration with the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). In Tanzania, USAID has supported development of National Management Guidelines for Health Response and Prevention to GBV, which provide a framework to guide comprehensive management of GBV survivors.

The Guidelines have led to training of health care providers and roll-out of a GBV register at health facilities across the country. In Zambia, USAID with PEPFAR funding, is collaborating with the British Department for International Development (DFID) and six government ministries to strengthen the response to GBV; this includes doubling the number of one-stop centers in several provinces, reaching 5 million adults and children with preventive messages, assisting 47,000 survivors, and training 200 police and justice sector personnel through 2018.

All told, USAID has contributed significantly to important results under PEPFAR; in FY2013, 2.5 million people in 12 countries were reached by efforts to address GBV and coercion, and an additional 800 health facilities began offering GBV screening, assessment and/or referrals to service providers.

The connection between gender-based violence and HIV infection is unambiguous. The data combined with the experience and perspectives of field experts make it clear. As we renew our commitments this week both to combat the spread of AIDS and to prevent GBV, let’s recognize and ensure that programs address the intersection. It could make the difference between the success and failure of efforts around the world.

ABOUT THE AUTHOR

Carla Koppell is USAID’s Chief Strategy Officer. She was formerly the Agency’s Senior Coordinator for Gender Equality and Women’s Empowerment. You can follow her @CarlaKoppell

U.S. Opens New Ebola Clinic in Liberia

Liberia is in the midst of a building boom to help control the spread of Ebola. In support of the Liberian Government’s Ebola response strategy, the United States is in the process of constructing 15 Ebola treatment units (ETUs) in this hard-hit nation. Across the country, teams of workers are busy moving dirt, laying concrete, trucking in construction materials, and erecting large white tents.

The first ETU to be built and staffed by the U.S.—in the city of Tubmanburg—started receiving patients on November 18. Now, a second ETU supported by the United States is operational in the city of Kakata, about 45 miles northeast of Monrovia. Built by the organization Save the Children with support from USAID, the ETU is being run by International Medical Corps (IMC), which is also managing another ETU in Bong County, Liberia.

Members of USAID’s Ebola Disaster Assistance Response Team (DART) visited the site on November 22, joining a Liberian delegation that included the Assistant Minister of Health and county health officials. Below is an inside look at the USAID-supported ETU, including those areas that are currently off limits to cameras now that the facility is open to Ebola patients.

11.22.14-Kakata-ETU-sign-photo-credit-Justin-Pendarvis-USAID-OFDA About an hour’s drive northeast of Monrovia, in the heart of Liberia’s rubber cultivation belt, the second Ebola treatment unit (ETU) in Liberia to be constructed and staffed with U.S. Government assistance is now receiving patients. / Justin Pendarvis, USAID/OFDA


The facility was built by Save the Children with USAID providing construction materials, gravel, cots for patients, generators to power the ETU, and other support.  The red fencing separates public areas from Ebola “hot zones.” Photo courtesy: Justin Pendarvis, USAID/OFDA The facility was built by Save the Children with USAID providing construction materials, gravel, cots for patients, generators to power the ETU, and other support. The red fencing separates public areas from Ebola “hot zones.” / Justin Pendarvis, USAID/OFDA


USAID is funding International Medical Corps (IMC) to operate the ETU in Kakata. Here, USAID Disaster Assistance Response Team (DART) Deputy Justin Pendarvis (left) gets a tour from IMC Emergency Response Team Director Sean Casey (right). / Alisha McMichael, USAID/OFDA USAID is funding International Medical Corps (IMC) to operate the ETU in Kakata. Here, USAID Disaster Assistance Response Team (DART) Deputy Justin Pendarvis (left) gets a tour from IMC Emergency Response Team Director Sean Casey (right). / Alisha McMichael, USAID/OFDA


More than 160 people—mostly Liberian national staff—work at the ETU. For the past two weeks, IMC’s medical team received rigorous training on Ebola patient care, safety protocols, and ETU management. Photo courtesy: Alisha McMichael, USAID/OFDA More than 160 people—mostly Liberian national staff—work at the ETU. For the past two weeks, IMC’s medical team received rigorous training on Ebola patient care, safety protocols, and ETU management. / Alisha McMichael, USAID/OFDA


The 88-bed ETU, which opened on November 22, has received a number of patients. Some were discharged after testing negative for Ebola. Photo courtesy: Alisha McMichael, USAID/OFD The 88-bed ETU, which opened on November 22, has received a number of patients. Some were discharged after testing negative for Ebola. / Alisha McMichael, USAID/OFD


NO DETAIL OVERLOOKED: Inside the clinical care areas are electrical outlets where patients can play music or charge their cell phones to keep in touch with their loved ones. USAID provided generators to power the ETU. / IMC NO DETAIL OVERLOOKED: Inside the clinical care areas are electrical outlets where patients can play music or charge their cell phones to keep in touch with their loved ones. USAID provided generators to power the ETU. / IMC

ABOUT THE AUTHOR

The Ebola Disaster Assistance Response Team (DART) is overseeing the U.S. Ebola response efforts in West Africa. The DART includes staff from across the U.S. Government, including USAID’s Office of U.S. Foreign Disaster Assistance (OFDA), the U.S. Centers for Disease Control and Prevention (CDC), and the Departments of Defense and Health and Human Services.

Related Links:

Key Populations Essential to Realize AIDS-Free Generation

Sex worker working on the Phnom Penh riverside. /  Ian Taylor

Sex worker working on the Phnom Penh riverside. / Ian Taylor

As we commemorate World AIDS Day this year, let’s take a moment to remember how far we’ve come, and where we must go. There are currently 35 million people living with HIV worldwide, and 13.6 million of those people are receiving antiretroviral therapy. New HIV infections continue to decline each year, with 2.1 million in 2013, which was 38 percent lower than in 2001. However, over 4,000 people continue to die from AIDS each and every day.

In accordance with the immense toll that HIV and AIDS have taken on the world, the U.S. Government established the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003 as the single largest commitment by any nation to combat a single disease. Since then, working closely with many partners, PEPFAR has supported lifesaving antiretroviral therapy for more than 6.7 million men, women and children. As a key implementing agency of PEPFAR, USAID has made significant contributions to this remarkable progress. But, together, we have more work to do to finish the job.

UNAIDS has identified the 90-90-90 targets by 2020. These milestones aim to have 90 percent of people living with HIV know their status, 90 percent of people who know their status receive treatment, and 90 percent of people on HIV treatment having a suppressed viral load so their immune system remains strong and they are no longer infectious. In order to achieve these goals and have a lasting response to this epidemic, we must examine what is required to sustain HIV treatment for decades to come.

India World AIDS Day 2008 / AFP/Narinder Nanu/Getty Images

India World AIDS Day 2008 / AFP/Narinder Nanu/Getty Images

The vision for the next phase of PEPFAR is partnering to deliver an AIDS-free generation with sustainable results.However, a sustainable response to this epidemic requires intensified action to address major ongoing challenges such as health care financing, health systems and new technologies for treatment and prevention. And there is a special need for increased attention to the human rights of key affected populations. These include sex workers, men who have sex with men, transgender persons and persons who inject drugs.

The high vulnerability of key populations to HIV is disturbing. Compared to the general population, sex workers are 14 times more likely to be infected with HIV; men who have sex with men are 19 times more likely to be infected; and the limited data we have on transgender women suggest that they are 49 times more likely to be infected with HIV. Equally unsettling are the global estimates that the number of people living with HIV who inject drugs range from over 1 million to slightly less than 4 million people.

Barriers to essential services prohibit these figures from coming down. Stigma and discrimination, violence, criminalization, bad or ineffective policies, and opposition to civil society engagement present real challenges. One of the most egregious barriers is the lack of acknowledgement by governments and other leaders that key populations even exist and/or are underserved. As I have observed over the years, the most insidious form of oppression is to ignore a people.

Fortunately, that pessimistic view is tempered by the knowledge that these barriers can be overcome. We know from experience that effective programs can reach key populations with high quality, effective services, and that key populations infected with HIV can be linked to the care and treatment services that they desperately need. On Thursday, Dec. 4, we will highlight the importance of key populations in the HIV epidemic at the D.C. launch of USAID’s PEPFAR-funded LINKAGES project.

The U.S. Government’s official theme for World AIDS 2014 is Focus, Partner, Achieve: An AIDS-free Generation. This theme captures the core elements of what is needed to reach this goal, which is outlined in the PEPFAR Blueprint. We must deliver the right thing, in the right place and at the right time. This means focusing on the highest impact interventions, bringing them to scale in key geographic areas and among the most vulnerable populations, including men who have sex with men, sex workers, injecting drug users, and transgender persons.

On this World AIDS Day, nearly 35 years into the epidemic, I am extremely proud of our collective progress. But, while an AIDS-free generation is within our reach, we must not stop until it becomes our reality.

ABOUT THE AUTHOR

David Stanton is the Director of USAID’s Office of HIV/AIDS

Building Ebola Treatment Units to Foster Hope, Healing in Liberia

Liberian Vice President Joseph Boakai, middle, gets a tour of the U.S.-built Tubmanburg Ebola treatment unit from USAID partner International Organization for Migration, which will be running the facility / Carol Han, USAID/OFDA

Liberian Vice President Joseph Boakai, middle, gets a tour of the U.S.-built Tubmanburg Ebola treatment unit from USAID partner International Organization for Migration, which will be running the facility / Carol Han, USAID/OFDA

In the Bomi Hills northwest of Monrovia, in an area that used to be the region’s iron and diamond mining center, it’s hard to miss the new “precious resource” that has become critical to Liberia’s fight against Ebola.

Four stark white tents gleam in the sun, the most prominent part of the new Ebola treatment unit (ETU) in Tubmanburg, which is the first ETU to be built and staffed by the United States in Liberia.

Liberian Army Capt. Glee Dilliard Dada led a team of Liberian soldiers who worked closely with the U.S. military to build the facility. Despite the rain, heat and construction setbacks, the Ebola treatment unit was built in 35 days / Carol Han, USAID/OFDA

Liberian Army Capt. Glee Dilliard Dada led a team of Liberian soldiers who worked closely with the U.S. military to build the facility. Despite the rain, heat and construction setbacks, the Ebola treatment unit was built in 35 days / Carol Han, USAID/OFDA

Construction on the 2-acre site was overseen by the U.S. Defense Department in close partnership with the Armed Forces of Liberia. More than 60 people had to overcome the rain, heat, poor roads and supply shortages to build the site in 35 days, completing the ETU earlier this month.

“Especially in this time of national crisis, it has been rewarding to be out here and assisting,” said Armed Forces of Liberia Capt. Glee Dilliard Dada, who supervised the Liberian military construction crew. “I am very overwhelmed with a lot of pride. In a month’s time we did all of this.”

The Ebola treatment unit (ETU) in Tubmanburg is the first ETU to be built and staffed by the United States in Liberia / Carol Han, USAID/OFDA

The Ebola treatment unit (ETU) in Tubmanburg is the first ETU to be built and staffed by the United States in Liberia / Carol Han, USAID/OFDA

USAID Disaster Assistance Response Team leader Bill Berger called the ETU an extraordinary effort, saying, “It took strong partnership to build this ETU. It will also take strong partnership to provide care to patients.”

USAID partner the International Organization of Migration, or IOM, has stepped forward to manage the ETU under the leadership of the Liberian Ministry of Health and Social Welfare. For the past two weeks, IOM’s medical team—made up of local and international health care workers—received rigorous training on Ebola patient care, safety protocols and ETU management.

Within the 2-acre site is a changing area where local and international staff with the International Organization for Migration will be donning googles and other protective equipment to care for patients. / Carol Han, USAID/OFDA

Within the 2-acre site is a changing area where local and international staff with the International Organization for Migration will be donning goggles and other protective equipment to care for patients. / Carol Han, USAID/OFDA

More than 120 members of IOM’s team are now prepared to care for patients. Tejanie Golafaley, a local resident and Ebola survivor, is especially eager to speak to patients at the ETU about his experience beating the disease.

“When I got Ebola, people didn’t want to come around me. I was stigmatized by Ebola,” Golafaley said. “The best thing I can do is talk to [patients] …. I’m going to tell them I’m a survivor. I want to give them hope.”

Tejanie Golafaley, an Ebola survivor, saw it as his personal mission to work at the USAID-supported Ebola treatment unit in Tubmanburg. “I want to explain my story to patients [so that] they can start to take courage.” / Carol Han, USAID/OFDA

Tejanie Golafaley, an Ebola survivor, saw it as his personal mission to work at the USAID-supported Ebola treatment unit in Tubmanburg. “I want to explain my story to patients [so that] they can start to take courage.” / Carol Han, USAID/OFDA

ABOUT THE AUTHOR

Carol Han is the Press Officer for USAID’s Ebola Disaster Assistance Response Team [DART], which is overseeing the U.S. Ebola response efforts in West Africa. The DART includes staff from across the government, including USAID’s Office of U.S. Foreign Disaster Assistance, the U.S. Centers for Disease Control and Prevention, and the Departments of Defense and Health and Human Services.

The Power of Toilets, Simple Medicines, and Strong Policies to Stop Diarrhea

Children outside of the health center in Kampong Thom province in Cambodia, where oral re-hydration therapy is provided to children who have diarrhea. PATH/Heng Chivoan

Children outside of the health center in Kampong Thom province in Cambodia, where oral re-hydration therapy is provided to children who have diarrhea. / PATH/Heng Chivoan

More than 2.5 billion people still do not have access to a toilet. As we #CelebratetheToilet on this World Toilet Day, we should remember that universal access to toilets is one of the many necessary steps to ending preventable death.

Day in and day out, I’m reminded of the power of innovation to save the lives of women and children. Often,we forget how successful low-cost innovations and solutions—and the policies that support them—have been in advancing health progress. Like the toilet.

It might seem like an odd thing to celebrate, but the invention of the toilet has been a critical contribution to modern-day public health. Access to toilets, safe water, vaccines and simple interventions like oral rehydration solution (ORS) and zinc have the power to stop deadly diarrhea and save lives. But like all health innovations and interventions, toilets need more champions and complementary policies to reach their full lifesaving potential.

 Children and their families attend community health education sessions in Kampong Cham Province. Diarrheal disease is a leading infectious killer of children under 5 years old. PATH/Heng Chivoan

Children and their families attend community health education sessions in Kampong Cham Province. Diarrheal disease is a leading infectious killer of children under 5 years old. / PATH/Heng Chivoan

Around the globe, local leaders and advocates are playing a critical role in bringing innovations, interventions and policy together to accelerate health gains within their countries. It was heartening to see India’s new prime minister, Narendra Modi, embracing innovative thinking and advocacy to solve the health problems caused by open defecation. As a result, he has the country talking about toilets. Diarrheal disease is devastating in India—as well as other parts of Asia and Africa—where it is one of the leading causes of death among children under the age of 5.

India is not the only country making progress in the fight against deadly diarrhea. Another example is in the Mekong Delta, where my organization, PATH, has helped policymakers in Vietnam and Cambodia evaluate and refocus their policy efforts to stop diarrheal disease—a leading killer of children in their region as well.

About 10 years ago, when new formulations of ORS and zinc, the two cornerstone interventions for severe diarrhea, were recommended for widespread use by the World Health Organization (WHO) and UNICEF, it became clear that the diarrheal disease policies needed to be updated in both Vietnam and Cambodia. Unfortunately, making these updates was not a government priority at the time. Local health workers, NGO advocates and scientists knew more needed to be done to prioritize diarrheal disease so that lifesaving medicines could reach the children dying in their local communities.

Latrine in Cambodia. 2.5 billion people-- 1 in 3 worldwide-- lack access to a toilet, and open defecation is a major culprit behind the tragic number of diarrhea –related deaths. PATH/Anne Aumell

Latrine in Cambodia. One in three people worldwide–or 2.5 billion–lack access to a toilet, and open defecation is a major culprit behind the tragic number of diarrhea–related deaths. PATH/Anne Aumell

Using our unique advocacy model, PATH worked with these local champions to help them assemble a compelling case to present to the ministries of health in each country, which included a package of strong evidence based on the WHO’s global policy recommendations, more effective treatments, the high burden of disease, and support among communities and potential partners. This informed the governments’ policies and compelled action to increase access to ORS and zinc, better equipping health workers to deal with the scope of the diarrheal disease problem in both countries.

As the global health community, including USAID, works to end preventable maternal and child deaths in a generation, country leadership and collaboration for stronger advocacy is key. At PATH, we are always gratified to help local communities and technical experts take action to achieve policy improvements that will save lives.

Students learn healthy hygiene habits and help maintain school toilets in the GIZ Regional Fit for School Programme in Cambodia. Photo credit: Ivan Sarenas

Students learn healthy hygiene habits and help maintain school toilets in the GIZ Regional Fit for School Programme in Cambodia. / Ivan Sarenas

I am confident that we can continue to expand toilet use, improve water and sanitation, and advance diarrheal disease policies around the world if we equip and empower more local leaders and experts to be champions of health innovations, interventions and policies. Together, we can bring the basic essentials of our everyday lives to the rest of the world.

ABOUT THE AUTHOR

Steve Davis is President and CEO of PATH, an international NGO working to drive transformative innovation to save lives.

Recapturing Growth in Ebola-Stricken West Africa

With funding and support from USAID, construction crews work quickly to build a new Ebola treatment unit in Monrovia, Liberia, in front of the former Ministry of Defense building, Oct. 1, 2014

With funding and support from USAID, construction crews work quickly to build a new Ebola treatment unit in Monrovia, Liberia, in front of the former Ministry of Defense building, Oct. 1, 2014 / Morgana Wingard

Unlike a civil war or natural disaster, an epidemic does not destroy property. But it sharply increases the cost of doing business, with powerful effects on employment and investment.

This is happening in Guinea, Liberia and Sierra Leone where the secondary impacts of the Ebola crisis have been seen in terms of shuttered businesses and closed schools. But just as economies can stall during an epidemic, we also know what expedites their recovery—a robust business climate that encourages private sector investment.

New Ebola cases continue to be recorded in Guinea, Liberia and Sierra Leone, but as health workers have begun to contain the epidemic, we are already turning our attention, in partnership with host governments, to the task of restoring business activity in these countries. Liberia and Sierra Leone had been growing strongly before the crisis, driven largely by foreign direct investment in the mining sector; Guinea’s growth was weaker but had been expected to increase in 2014. All three economies have contracted sharply in the latter half of 2014, with full-year gross domestic products now expected to be at or below 2013 levels.

A first look at a 25-bed critical care hospital—staffed by U.S. medical professionals—in Harbel, Liberia, that will treat all Ebola health care workers in the country, Oct. 15, 2014

A first look at a 25-bed critical care hospital—staffed by U.S. medical professionals—in Harbel, Liberia, that will treat all Ebola health care workers in the country, Oct. 15, 2014 / Morgana Wingard

Public and private investment plans have been scaled back, suggesting that slow growth will linger through 2015 even if the epidemic is contained early in the year. This is actually not driven primarily by the loss of labor to sickness and health care, but rather by what economic epidemiologists call “social distancing”—when people avoid interacting with each other in order to avoid a perceived risk of viral transmission.

The benefits to workers, firms and farms to restoring normal economic activity can provide a powerful counterbalance to the effects of social distancing, suggesting that capacity utilization, employment and income will rebound as the epidemic is contained.  But tomorrow’s economy depends on today’s investment. The pace of economic recovery will therefore depend crucially on how private-sector firms view the evolving business environment.

Containing the outbreak will do much to restore that environment, but firms across the size spectrum—including potential new entrants—will be wary of their exposure to health-related losses even as the overall health system is strengthened. Reforms that enhance the quality of regulation and reduce the costs of doing business are therefore crucial components of the recovery effort.

Pick-up trucks-turned-ambulances drive hours through dirt roads in Bong County, Liberia, to collect patients, Oct. 9, 2014

Pick-up trucks-turned-ambulances drive hours through dirt roads in Bong County, Liberia, to collect patients, Oct. 9, 2014 / Morgana Wingard

The World Bank’s newly released business-climate survey of 189 economies—Doing Business 2015:Going Beyond Efficiency—highlighted sub-Saharan Africa as home to five of the 10 top reformers, four of which are in West Africa. “Doing business” reforms are changes in the procedure, time or cost of conducting business in a country, such as reducing the time it takes to get a construction permit or the number of approvals required to open a business. USAID has supported the Doing Business project since its inception in 2004.

Several of the highlighted business reforms from this year’s top reformers in West Africa (Benin, Cote d’Ivoire, Senegal and Togo) were the result of coordinated harmonization efforts led by the Council of Ministers of the Organization for Harmonization of Business Law in Africa. These efforts encouraged  business-friendly innovations throughout the region such as one-stop shops for registering a business, easier land registry and transfer processes, and improved credit information systems—including in the countries most affected by the outbreak.

Liberia and Sierra Leone took the impressive step of establishing public credit registries in the past year, making it easier to get credit in these countries. The resolve demonstrated by member governments in setting a regional reform agenda and implementing meaningful changes for business also bodes well for increased regional trade, which USAID supports through its regional Trade Hubs in West, East and Southern Africa.

USAID has been working with many of the reformers highlighted in this year’s report and will continue to partner with governments in the region as they tackle both the immediate challenges and the secondary effects of Ebola. Better regulatory environments, supported by governments taking the right steps to attract both domestic and foreign investment, will help these countries recover and prosper in the future.

ABOUT THE AUTHOR

Stephen O’Connell is the Chief Economist for USAID

You Can’t Save Lives if you Don’t Fight Pneumonia

MCHIP immunization work in India.

MCHIP immunization work in India / JSI

For many problems in global health, we struggle to know the solutions.

Pneumonia is not one of them.

Since passing the 500 day countdown in August, the global public health community has talked a lot about what it will take to meet the ambitious Millennium Development Goals (MDGs). And one thing is clear: achieving MDG 4 – to reduce child mortality by two-thirds by 2015 – will not be realized without better addressing pneumonia, the leading killer in children under 5.

The good news is that pneumonia is preventable—and that safe, effective and affordable tools are helping to avoid and treat the disease.

Nepali village health worker counting the respirations of a sick infant

Nepali village health worker counting the respirations of a sick infant / JSI/Nepal Family Health Initiative

Pneumonia can be prevented by feeding children micronutrient rich foods, ensuring proper hygiene, including frequent hand-washing, and improving indoor air quality through well-ventilated cooking areas.

Most of all, the disease can be prevented by ensuring all children are vaccinated on schedule and treated promptly and appropriately if signs of pneumonia appear.

Devoted to combating the causes of under-5 morbidity and mortality, USAID’s flagship Maternal and Child Survival Program (MCSP) is celebrating this World Pneumonia Day by working to ensure that every infant in the developing world is fully immunized.

Health worker in Mali assessing the respiratory rate of a sick child

Health worker in Mali assessing the respiratory rate of a sick child / JSI

In 2013, MCSP’s predecessor program—the USAID-funded Maternal and Child Health Integrated Program—joined USAID and more than 100 partner organizations, along with national and global experts, to express support for WHO and UNICEF’s first-ever global action plan to simultaneously tackle the two leading killers of children—pneumonia and diarrhea. Implementation of this plan, linked with ownership by national governments and partners’ involvement, will make these goals a reality.

The Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPP-D) calls on all parties to coordinate their approach to fighting pneumonia and diarrhea, for which there are complementary interventions to provide protection, prevention and treatment.

Immunizing in Kenya

Immunizing in Kenya / MCHIP

On this day of reflection and action, let us commemorate the brief lives of the children lost to pneumonia—nearly 1 million every year worldwide—by vowing to support and focus on implementing the Global Action Plan and strengthening countries’ routine health systems in partnership with communities.

The fight against this deadly disease can be won. Children are not dying because effective interventions do not exist; they are dying because these interventions are not readily available for all. To dramatically reduce child mortality, we must achieve high and equitable coverage.

Through effective use of pneumococcal (PCV), Haemophilus influenzae type b (Hib), and rotavirus vaccines, vitamin A, zinc, oral rehydration solution, breastfeeding and other interventions, we can address MDG4.

Collectively around the world, we owe it to the future generation to give them the best start in life and protect them from preventable and treatable diseases like pneumonia.

ABOUT THE AUTHORS

Robert Steinglass is the Immunization Team Leader and Katrin DeCamp is the Senior Communications Specialist for USAID’s Maternal and Child Survival Program.

Bill Berger: “There is no book on responding to this Ebola crisis… we’re writing it now.”

Morgana Wingard This is the fifth blog in our Profiles in Courage series in which we’ve teamed up with photojournalist Morgana Wingard, who is on the ground with USAID staff in Liberia documenting the fight against Ebola. This series records the experiences of our Disaster Assistance Response Team staff on the front lines of the Ebola response – from the security officers, to public health experts, to information specialists – and offers their reflections on this historic health crisis.
General Darryl Williams, Bill Berger, and U.S. Ambasador to Liberia Deborah Malac.

General Darryl Williams, DART Team Leader Bill Berger, and U.S. Ambasador to Liberia Deborah Malac. / Natalie Hawwa, USAID

“There is no book on responding to this Ebola crisis… we’re writing it now,” says Bill Berger, Team Leader for the Ebola Disaster Assistance Response Team (DART) in West Africa.

A seasoned disaster expert, Bill has responded to more than 30 large-scale emergencies across the globe and led several DARTs for USAID’s Office of U.S. Foreign Disaster Assistance.

But how exactly are Bill and his team fighting this unprecedented Ebola epidemic?

“Day by day, pushing at a maximum speed on all fronts,” he says, and with every ounce of compassion and disaster knowledge they have.

As the DART Team Leader, Bill strategizes alongside the local governments and U.S. Ambassadors in the affected countries, the United Nations and NGO partners on the ground to mount the most effective aid effort possible. With Ebola, there are many complex technical pieces that need to come together to help save lives.

“We know the basic things that need to happen, such as building treatment centers, training health care workers, providing testing capabilities and coordination — but we also have a real opportunity here to transfer that capacity and boost national health care systems in West Africa.”

The DART is working across the region in Guinea, Liberia and Sierra Leone – each a unique country with its own dynamic for responding to Ebola. While there are challenges of navigating unknown territory for this unprecedented crisis, Bill draws strength from having the opportunity to help those affected by this tragedy. He’s also inspired by his team and the chance they have to contribute to such a critical and historic global issue together.

“Every DART is like living a full lifetime; you have many experiences and feelings in a short period, with so much confronting you daily,” he says. “Working with others during a crisis brings about wonderful and special bonds.”

Bill jokes that the DART will be giving each other the ‘Ebola bump’ — the new West African greeting of hitting elbows, adopted in lieu of a handshake due to the ‘no touch’ atmosphere — for years to come.

“Our DART is a very special group of dedicated people bringing in every piece needed for this Ebola response. It’s a great gift to lead this team.”

ABOUT THE AUTHOR

Morgana Wingard is a photojournalist documenting the many facets of the Ebola crisis in Liberia. Check out her guest posts from USAID’s instagram

Page 1 of 58:1 2 3 4 »Last »