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Facing Death, Six Days a Week

Morgana Wingard This is the third blog in our Daily Dispatches series in which we’ve teamed up with photojournalist Morgana Wingard, who is on the ground with USAID staff in Liberia documenting the fight on Ebola. Her photo series and blogs from the team will offer unique angles into the many facets of the Ebola story – from life inside a treatment center, to profiles of the health care workers battling Ebola from the front lines, to the many ways the epidemic is impacting the health, economy and future of the nation.

What do you say to a mother who just lost her child? To a neighbor who just lost her best friend? How do you comfort them before you carry away the body of their loved one in a black bag in the back of a dark green pick-up truck? Varbah Dolley faces these scenarios six days a week. Varbah is tough – like most Liberian women who have lived through two civil wars. She is now fighting another a war, against an enemy she can’t see.

Varbah is a member of a Liberian Red Cross burial team. Funding from USAID and support from the U.S.-based NGO Global Communities is providing burial-team support activities in all 15 counties of Liberia, as well as engaging with communities to share information on proper hygiene practices and preventing transmission through workshops, community meetings, and radio campaigns.

From the moment they start showing symptoms, someone who has contracted the Ebola virus is highly contagious. The virus is spread through direct contact with bodily fluids including vomit, diarrhea, blood, and saliva. After the person dies, the body is even more contagious.

In Liberia, rituals to prepare bodies for burial are contributing to the rapid spread of the virus. The dead body is typically washed and dressed by multiple people before being carried to a grave — a ripe situation for the virus to spread. Graves are also important landmarks for Liberians. Decoration Day, a government holiday, is dedicated to visiting and decorating family graves. It’s where they can speak with their ancestors and commune with them. As the burial team prepared to take one body, I heard a woman wail: “I will have nothing to decorate on Decoration Day.”

To stop the spread of Ebola, burial teams have been mobilized across Liberia to provide safe disposal of contagious bodies, which often includes cremation. With the epidemic on the rise, every dead body is now considered an Ebola body. Varbah’s team leaves central Monrovia every morning to respond to reports of deaths. These calls often lead them to communities deep in rural Liberia. Last week, we drove for more than two hours over rough dirt terrain to reach Arthington – which also happens to be the birthplace of former warlord Charles Taylor.

On Sept. 26, 2014, Varbah, a member of  Liberia Red Cross and Global Communities burial team, listens to the mother of  Phelica Anthony, 6, explain the events leading up to her daughter’s recent death. Although  Phelica was taken to several hospitals, the cause of her death was not determined, and now her father is exhibiting symptoms of Ebola.

On September 26, 2014, Varbah, a member of the Liberian Red Cross and Global Communities burial team, listens to the mother of  Phelica Anthony, 6, explain the events leading up to her daughter’s recent death. Although Phelica was taken to several hospitals, the cause of her death was not determined, and now her father is exhibiting symptoms of Ebola.


Monrovia, Liberia - September 26, 2014: Burial team members take notes for their end-of-day report as  Phelica’s mother describes the events leading up to her 6-year-old daughter's death.

Burial team members take notes for their end-of-day report as Phelica’s mother describes the events leading up to her 6-year-old daughter’s death.


Varbah climbs out of the mud-splattered jeep and calmly walks over to a crowd with her notebook and pen. She jots down as much information as possible about each patient and their family for the report she submits every evening. “I know what you people are going through. But take courage,” she counsels the family of 6-year-old Phelica as they describe the events leading up to her untimely death. Phelica became inexplicably sick while playing outside. Her mother carried her to multiple hospitals for treatment. After spending a couple days at one hospital where they ran several lab tests, the doctor said she would not survive and Phelica died on the way home. Her father, who had cared for her, later began exhibiting symptoms of Ebola. A health team transported him to an Ebola treatment unit the day before we arrived.

Like many in West Africa, when it comes to the current public health crisis, Phelica’s family is suspicious.“You don’t know what killed the person because they are hiding the truth from us,” Varbah tells me later in the car.

Melvin Payoh, the assistant team leader of the burial team,suits up like an astronaut in the middle of the hot, rural village as onlookers gather and stare. A few minutes after disappearing past the first row of earth-walled homes, the team returns carrying a black bag. Everything about this Ebola outbreak feels unreal until men in white spacesuits walk through a town with a body-filled bag. A mother wails, “My baby, O. My baby, O.” Then it is painfully real. Numbers have names. Tears flow. Relatives fall on the ground. Hands flail. Melvin and his team lay  Phelica’s little body in the back of a dark green pick-up truck.

I think Varbah and Melvin have the hardest job fighting this Ebola outbreak. They face death six days a week in order to save more lives. When I asked Varbah why she applied for the position she replied, “I do this for my country.”

"The body is over there," says Arthington's town chief pointing past the mother of Phelica, a 6-year-old girl that had recently died on Sept. 26, 2014.

“The body is over there,” says Arthington’s town chief pointing past the mother of Phelica, a 6-year-old girl that had recently died on September 26, 2014.


Melvin, a member of a burial team, suits up to remove the body of 6-year-old Phelica Anthony as onlookers from Arthington town film with a cell phone.

Melvin, a member of a burial team, suits up to remove the body of 6-year-old Phelica Anthony as onlookers from Arthington town film with a cell phone.


Varbah helps Melvin put on his personal protective equipment and ensures there are no gaps from the outside world to his skin before he goes in to pick-up the body of 6-year-old Phelica .

Varbah helps Melvin put on his personal protective equipment and ensures there are no gaps from the outside world to his skin before he goes in to pick-up the Phelica’s body.


The mother of Phelica Anthony, 6, says goodbye to her daughter as a burial team takes her body away. USAID is supporting the safe burial teams and Agency partners are working with communities to share information on proper hygiene practices and preventing transmission through workshops, community meetings, and radio campaigns.

The mother of Phelica Anthony, 6, says goodbye to her daughter as a burial team takes her body away. USAID is supporting the safe burial teams and Agency partners are working with communities to share information on proper hygiene practices and preventing transmission through workshops, community meetings, and radio campaigns.


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Melvin, a member of the Liberian Red Cross and Global Communities burial team removes the body of Phelica Anthony from her family home in Arthington.


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Phelica’s mother sings, “My baby O. My baby O” as the burial team removes her body.

Family, friends, and neighbors grieve as the body of Phelica is removed from their family home.

Family, friends, and neighbors grieve as the Phelica’s body is removed from their family home.


Family, friends, and neighbors grieve as the body of Phelica is removed from their family home.

Melvin lays the body of 6-year-old Phelica in the back of a pickup truck. They are under a mandate by the Government of Liberia to take all bodies they collect in Montserrado County to the crematorium.


(All photos by Morgana Wingard)

ABOUT THE AUTHOR

Morgana Wingard is a photojournalist documenting the many facets of the Ebola crisis in Liberia. All this week she will be guest posting from USAID’s instagram

A Grand Challenge to Help Health Care Workers Fight Ebola

Health care workers put on Personal protective equipment (PPE) before going into the hot zone at Island Clinic in Monrovia, Liberia on Sept 22 2014. / Morgana Wingard, USAID

Health care workers put on personal protective equipment (PPE) before going into the hot zone at Island Clinic in Monrovia, Liberia on Sept. 22 2014. / Morgana Wingard, USAID

Today, West Africa faces the largest Ebola epidemic in history. Markets are empty. Schools are closed. Friends greet each other from a distance. As President Obama said yesterday at the United Nations:

“Ebola is a horrific disease. It’s wiping out entire families. It has turned simple acts of love and comfort and kindness — like holding a sick friend’s hand, or embracing a dying child — into potentially fatal acts. If ever there were a public health emergency deserving an urgent, strong and coordinated international response, this is it.”

From Guinea to Liberia to Sierra Leone, the alarm has been sounded, and United States is mobilizing a global response. We know how to stop this epidemic, but it will take ingenuity, speed, and cooperation. That is why President Obama announced a new Grand Challenge for Development to generate pioneering solutions that help health care workers provide better care in the midst of the epidemic.

“I’m pleased to announce a new effort to help health workers respond to diseases like Ebola. As many of you know firsthand, the protective gear that health workers wear can get incredibly hot, especially in humid environments. So today, we’re issuing a challenge to the inventors and entrepreneurs and businesses of the world to design better protective solutions for our health workers… And our goal is to get them to the field in a matter of months, to help the people working in West Africa right now.  We can do this.”

Every day, courageous men and women are performing critical tasks that save lives and prevent the spread of the virus. Personal protective equipment (PPE)—the suits, masks and gloves the health care worker wears—is their primary protection, but it is also the greatest source of stress. In these hot and uncomfortable suits, health workers must administer to the patients and remove contaminated materials.

Health workers in personal protective equipment (PPE) wait to enter the hot zone at Island Clinic in Monrovia, Liberia on Sept 22. 2014. PPE is their primary protection, but it is also the greatest source of stress. / Morgana Wingard, USAID

Health workers in personal protective equipment (PPE) wait to enter the hot zone at Island Clinic in Monrovia, Liberia on Sept 22. 2014. PPE is their primary protection, but it is also the greatest source of stress. / Morgana Wingard, USAID

Announced at the Global Health Security Summit in Washington, D.C., this Grand Challenge for Development will unite the global community in the quest for ingenious ideas that deliver practical and cost-effective innovations in a matter of months, not years.

We need new ideas to help ensure that treatment sites, communal transport units, and burial sites do not become infection sources. We need new solutions that strengthen the safety and increase the comfort of the suits, from improving fabric design to measuring a health worker’s temperature and heart rate.

We need new ways to simplify clinical processes, including point-of-care diagnostics. And we need new tools that continue to create a safer clinical environment, including improving infection control and waste disposal. Taken together, these innovations will enable health workers to provide better care for those who are suffering.

Together with our international partners, we will translate the expertise and ingenuity of scientists, innovators, engineers, and students from across the globe into real solutions. With your bold thinking and engagement, we can give health workers the tools they need to win this fight.

To get involved, please visit: http://www.usaid.gov/grandchallenges/ebola

 

ABOUT THE AUTHOR

Dr. Rajiv Shah is USAID Administrator. He tweets from @rajshah

Five Promising Innovations in Contraception

You may know that there are countless forms of contraception available to choose from: pills, IUDs, injections, implants, and more.

What you may not know is that USAID has supported the development of essentially every modern contraceptive available today, both in the U.S. and abroad.

World Contraception Day on September 26th draws attention to the important health and economic benefits contraception brings families, communities, and nations. Studies show that pregnancies that occur too early or late in life or too close together can result in devastating consequences for both the mother and child.

Increasing access to modern contraception across the globe could avert an estimated 7 million child deaths and 450,000 maternal deaths by 2020.

We also know that family planning is crucial to ending extreme poverty by opening the opportunity for countries to reap the benefits of the demographic dividend, a phenomenon that can add as much as two percent to annual GDP growth for decades.

For this reason, USAID has worked for nearly half a century to expand access to voluntary family planning information and services across the globe.

As we work to meet the needs of the 222 million women who want to avoid pregnancy but aren’t using modern contraception, it is vital for us to invest in new methods that expand women’s options. Studies show that some women don’t use currently available contraceptives because of concerns over potential side-effects, preference for non-hormonal methods, and a lack of options for women who have infrequent sex. Furthermore, we must expand availability of long-acting reversible contraceptives and permanent methods for women who choose to delay or limit childbearing.  Here are five promising new innovations in contraception:

SILCs Diaphragm. / Credit: PATH/Mike Wang

SILCs Diaphragm. / Credit: PATH/Mike Wang

1)  SILCs Diaphragm: The SILCS diaphragm, marketed as the Caya® contoured diaphragm, is a new type of diaphragm that is easy to use, non-hormonal, does not need to be fitted by a clinician, and is reusable for up to three years. In addition to being a contraceptive, this diaphragm has the potential to be a true multipurpose prevention product, serving as a delivery platform for gels that help protect against HIV and other STIs. After numerous studies clinically proving safety, acceptability, and comfort, Caya® recently received FDA regulatory approval for marketing within the United States. USAID and partners are currently working in Malawi and Zambia to make this new contraceptive available to women.

Sayana Press. / Credit: PATH/Patrick McKern

Sayana Press. / Credit: PATH/Patrick McKern

2) Sayana Press: Sayana Press is an injectable contraceptive packaged in a pre-filled single-use syringe. Its unique delivery system makes it more portable and easier to use, allowing injections to be delivered by health care workers to women at home or in other convenient settings. This new delivery system has the potential to drastically expand the availability of injectable contraceptives in the hardest-to-reach areas. Through a public-private partnership, USAID, DFID, the Bill and Melinda Gates Foundation, Pfizer, and Path are supporting the introduction of Sayana Press in Senegal, Uganda, Burkina Faso, Niger and Bangladesh.

Woman's Condom. / PATH

Woman’s Condom. / PATH

3) Woman’s Condom: The Woman’s Condomis designed to be easy to insert, use and remove, making it unique compared to other female condoms. Condoms offer contraception and protection against HIV in one inexpensive, simple-to-use package. As awareness about the multipurpose protection benefits of the female condom grows, global demand is increasing.

NES/EE vaginal ring. / Julie Sitney

NES/EE vaginal ring. / Julie Sitney

4) One-Year Contraceptive Vaginal Ring and Progesterone Vaginal Ring:  The NES+EE Contraceptive Vaginal Ring is the first medium-term hormonal method completely under the woman’s control that lasts for one year. This discreet method meets the needs of women who may encounter partner opposition and who don’t want a family planning method that requires a daily routine. The three-month Progerone Vaginal Ring for breastfeeding women is an effective, user-controlled method that can be used safely by breastfeeding women to aid in spacing pregnancies. It does not affect a woman’s ability to produce breast milk and does not require insertion by a healthcare provider.

CycleTel. / Institute for Reproductive Health, Georgetown University

CycleTel. / Institute for Reproductive Health, Georgetown University

5) Digital Fertility-Awareness Based Methods of Family Planning iCycleBeads™ Smartphone Apps, CycleTel™ and CycleBeads® Online are mobile and digital services that enable women to use the Standard Days Method (SDM) directly on a phone or internet-enabled device. This effective, natural family planning method helps women track their cycle and know on which days there is a high likelihood of getting pregnant.

ABOUT THE AUTHOR

Ellen Starbird is the Director of USAID’s Office of Population and Reproductive Health.

René Van Slate: “I’ve pretty much done everything that terrifies me… except for Ebola”

Morgana Wingard This is the first blog in our Profiles in Courage series in which photojournalist Morgana Wingard compiles snapshots and sound bites from our USAID and Disaster Assistance Response Team staff on the front lines of the Ebola response. Here she talks to a veteran in humanitarian disaster assistance, René Van Slate, who serves as a liaison between the military on the ground and the U.S. civilian team.
René Van Slate

René Van Slate
USAID Humanitarian Assistance Advisor to the U.S. Military

A veteran in humanitarian disaster assistance, René Van Slate is afraid of nothing… nothing except Ebola. She was on the ground after the flooding in Thailand in 2011, typhoon Bopha in the Philippines in 2012, the Republic of Marshall Islands drought in 2013, and typhoon Haiyan in the Philippines last year. Now, on her fifth disaster response team René explains her trepidation, “Ebola is microscopic, it’s covered in mystery and it’s incredibly deadly.” But, René is here with USAID facing her greatest fear on the front lines of the Ebola response in Liberia.

René touched down with the first crew from USAID’s Disaster Assistance Response Team (DART) at the beginning of August. Since then, she has liaised between the military on the ground and the U.S. civilian team, advising and coordinating logistics to best utilize military assets and personnel. Specifically, she is working on Operation Liberty with the Armed Forces of Liberia (AFL) supported by U.S. forces to build Ebola treatment units across Liberia.

One of the greatest challenges on the ground is that almost no one had ever dealt with an Ebola outbreak other than Médecins Sans Frontières (MSF) and those were much smaller and rural. “The whole humanitarian community is learning Ebola,” René says. “Though [building] an Ebola treatment unit is simple, like rocket science, it must be done perfectly every time.”

In an operation as large and complex as the current Ebola response, it takes a team of people working day in and day out processing requests to arrange for all the logistics to get materials transported, imported and delivered to where they are needed.

The best part of her job is days like today, when requests are fulfilled, referring to Thursday’s  arrival of 9,000 community protection kits—a joint effort of UNICEF, the Paul G. Allen Family Foundation and USAID—as part of the response to help Liberians fight Ebola. Each kit includes biohazard bags, soap, personal protective equipment, and gloves. They will be distributed to Ebola Community Centers across Liberia in partnership with UNICEF.
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(all photos by Morgana Wingard)

ABOUT THE AUTHOR

Morgana Wingard is a photojournalist documenting the many facets of the Ebola crisis in Liberia. All this week she will be guest posting from USAID’s instagram

Powering The Ebola Response: Monrovia’s Island Clinic

Morgana Wingard This is the first blog in our Daily Dispatches series in which we’ve teamed up with photojournalist Morgana Wingard, who is on the ground with USAID staff in Liberia documenting the fight on Ebola. Her photo series and blogs from the team will offer unique angles into the many facets of the Ebola story – from life inside a treatment center, to profiles of the health care workers battling Ebola from the front lines, to the many ways the epidemic is impacting the health, economy and future of the nation.

MONROVIA, Liberia—One of the saddest things about the Ebola outbreak in Liberia is the inability for many patients to get treatment. In Dolo Town recently, I watched a father carry his ailing son in a wheelbarrow to the clinic for treatment, but they did not have the capacity to help. He had been calling the government hotline for four days to no avail. A team of NGO workers proceeded to call the hotline again and a personal ambulance, but they also couldn’t get any help. All the treatment centers were full. In the end, the clinic sent him and his son home along with two other patients. Different versions of the same story have repeated across Monrovia for weeks. Liberians, trying to do the right thing, called the hotline and drove their loved ones to the hospital only to be denied entrance.

A father is devastated in Dolo Town after he was unable to get his son into an Ebola Treatment Unit (ETU) . It’s unclear whether he has Ebola as he can’t get to a facility for testing -- an all too common problem. The U.S. Government is helping build and staff several new facilities in Liberia. / Morgana Wingard

A father is devastated in Dolo Town after he was unable to get his son into an Ebola Treatment Unit (ETU) . It’s unclear whether he has Ebola as he can’t get to a facility for testing — an all too common problem. The U.S. Government is helping build and staff several new facilities in Liberia. / Morgana Wingard

After hearing too many of these stories as I have documented the unfolding Ebola crisis over past weeks, the opening of another Ebola treatment unit (ETU) was a huge relief. With the help of USAID, the Liberian Government and the WHO opened the 100-bed facility on Sunday, September 21. To power the treatment center, USAID provided two generators, amongst other supplies. These generators are vital to the functioning of the clinic by providing power for lights, pumps for water, and washing machines to clean scrubs worn by health care workers under their personal protective equipment (PPEs).

Miata, a nurse we met, said all the health care workers ran from nearby Redemption Hospital, the largest government-run hospital in Liberia, at first. A doctor and several nurses on staff became infected with Ebola and died as the outbreak was beginning in Liberia. But when a team of Ugandan health care workers arrived in Liberia who had fought previous Ebola outbreaks in their own country, they called them together for a training workshop.

“That workshop inspired me to come back. If we don’t help the patients, who will?” Now, she is not afraid because she can cover herself with personal protective equipment before she enters the “hot zone” to provide food for patients fighting the Ebola virus. This new Island Clinic facility is helping. But many more beds and qualified health care workers are needed to meet the needs of growing numbers of patients.

Qualified health care workers’ interested in volunteering can go to http://www.usaid.gov/ebola/volunteers for information.

Here are some shots I took on our trip to Island Clinic on Monday.

The entrance for health care workers going into Island Clinic

The entrance for health care workers going into Island Clinic, a new Ebola Treatment Unit that opened in Monrovia, Liberia on Sept. 21, 2014 and within one day, reached capacity. The building was a Doctors without Borders hospital during Liberia’s Civil War. It was neglected for several years until the government, with help from the World Health Organization, transformed it into a 100-bed clinic in response to the surge of patients needing care due to the Ebola crisis that is hitting Liberia especially hard. Many people are calling the battle against the Ebola epidemic a “biological war” and now these same facilities that were used during the country’s long Civil War are finding a new use as Liberia struggles to contain the crisis. USAID has provided two generators to the facility which are providing power for lights, pumps for water, and washing machines to clean scrubs worn by health care workers under their personal protective equipment.


A family waits at the entrance to the Island Clinic in Monrovia, Liberia

A family waits at the entrance to Island Clinic in Monrovia, Liberia, which was opened by the World Health Organization and the Liberian Ministry of Health in response to the surge of patients needing an Ebola Treatment Unit. Here, a health worker in protective gear tells the family to wait on the side as they open the doors for an ambulance to exit the facility. Before the facility opened on September 21, ambulances and patients arrived at the gates waiting to be admitted. Just a day after opening, the clinic is already at capacity. USAID has provided two generators and other supplies to equip the facility with life-saving care.


Health care workers put on personal protective equipment before going into the hot zone at the Island Clinic in Monrovia

Health care workers put on personal protective equipment before going into the hot zone at Island Clinic, in Monrovia, Liberia on Sept. 22, 2014. The 100-bed clinic opened on Sept. 21, and within one day it is already at capacity after approximately 100 Ebola patients were moved from the nearby Redemption Hospital and ambulances brought other Ebola-stricken patients from the community. There are still more patients on the way. The facility was set up by the World Health Organization and Liberia’s Ministry of Health in response to the surge of patients needing an Ebola Treatment Unit. USAID has provided two generators and other supplies the facility.


Hygienists at the ebola treatment unit at Island Clinic in Monrovia wash health workers' scrubs

Hygienists at the ebola treatment unit at Island Clinic in Monrovia wash health workers’ scrubs, a vital part of the operation at the new clinic, which opened September 21, 2014. Health workers at the clinic must follow extensive protocol to protect themselves. All scrubs worn under their personal protective equipment and shoes must be washed thoroughly in chlorine water and then with soap. While we were at Island clinic, one of the health workers told me why she was working here: “If we don’t help the patients, who will?” She said she is not afraid because she can cover herself with personal protective equipment before she enters the “hot zone” to provide food for patients fighting the Ebola virus.


A patient lies in a bed at the newly opened Island Clinic in Monrovia

A patient lies in a bed at the newly opened Island Clinic in Monrovia, Liberia on Sept. 22, 2014. The patient is getting an intravenous treatment – a crucial part of treatment for Ebola because the virus quickly dehydrates those it infects. However, using IV is also considered risky for health workers if they do not take proper precautions and not all treatment centers are using them. At the Island Clinic, a concrete wall and glass window offers those outside the clinica sobering view into the patient area. While I am standing less than a foot from this man, the perception is that I’m peering into a restricted and isolated world.

(All photos by Morgana Wingard)


ABOUT THE AUTHOR

Morgana Wingard is a photojournalist documenting the many facets of the Ebola crisis in Liberia. All this week she will be guest posting from USAID’s instagram

An Unprecedented Response to the Ebola Crisis

The Ebola crisis has quickly overwhelmed West Africa’s health system: new Ebola victims fill medical facilities faster than new ones can be established

The Ebola crisis has quickly overwhelmed West Africa’s health system: new Ebola victims fill medical facilities faster than new ones can be established. / Morgana Wingard

Today the world is facing the largest and most-protracted Ebola epidemic in history. Yesterday, at the Centers for Disease Control and Prevention, President Obama declared the Ebola epidemic in West Africa a top national security priority and announced a clear, comprehensive, and global strategy to stop the outbreak.

“Faced with this outbreak, the world is looking to us, the United States, and it’s a responsibility that we embrace. We’re prepared to take leadership on this to provide the kinds of capabilities that only America has, and to mobilize the world in ways that only America can do.  That’s what we’re doing as we speak.”

The United States has been combating the Ebola epidemic since the first cases were reported in March, and we have expanded our efforts and increased personnel in the region as the crisis has unfolded. More than 120 specialists from across the U.S. Government are on the ground in West Africa to prevent, detect, and stop the spread of this disease. USAID deployed a Disaster Assistance Response Team—or DART—to the region to oversee and coordinate the U.S. response, providing logistics, planning, program, and operational support to the affected countries; drawing forth critical assets and resources from several U.S. departments and agencies.

This crisis continues to escalate exponentially and requires an intensified speed and scale of response to address a rising rate of infection. It has quickly overwhelmed West Africa’s health system: new Ebola victims fill medical facilities faster than new ones can be established. Heroic doctors, nurses, and health workers are stretched to their personal and professional limits.

Against this landscape of overwhelming despair, there is hope. As the President declared in Atlanta:

“The world knows how to fight this disease. It’s not a mystery. We know the science.  We know how to prevent it from spreading. We know how to care for those who contract it.  We know that if we take the proper steps, we can save lives. But we have to act fast.“

That’s why yesterday afternoon President Obama announced a significant expansion of our response.

In an Ebola crisis, chlorine is used to disinfect areas that people infected with the virus may have come in contact with.

In an Ebola outbreak, chlorine is used to disinfect areas that people infected with the virus may have come in contact with. / Morgana Wingard

Through a whole-of-government approach, we’re mounting an aggressive U.S. effort to fight this epidemic and have devised a clear strategy with four key pillars to stop this epic crisis:

  • Controlling the epidemic;
  • Mitigating second-order impacts, including blunting the economic, social, and political tolls;
  • Coordinating the U.S. and broader global response; and
  • Fortifying global health security infrastructure in the region and beyond.

Our goal is to enable the most effective international response possible, using our government-wide capabilities to fight the epidemic on a regional basis. Our current efforts have focused on controlling the spread of the disease—bringing in labs for specimen testing; supporting the construction and management of Ebola treatment units; airlifting critical relief supplies; strengthening emergency response systems of the affected governments; supporting burial teams who are safely managing human remains to prevent transmission; and spearheading mass public awareness campaigns with communities to describe how to prevent, detect, and treat Ebola.

To complement these efforts, the President also announced the launch of the USAID-led Community Care Campaign, which will aim to provide every family and every community the critical information and basic items that can help protect them from this deadly virus.  Information will stress the importance of sick families members seeking help at a clinic or Ebola treatment unit and how to exercise basic infection control that can be life-saving, such as washing hands or not washing their dead relatives. Items like soap and chlorine can reduce transmission. Women are especially important to reach given their traditional role in washing the bodies of dead relatives — a prime transmission route of the virus. To reach people with low literacy, the campaign will train health volunteers and community leaders on how best to verbally provide messages to their neighbors.

Partnering with the affected countries, the U.N. Children’s Fund (UNICEF), the Paul G. Allen Family Foundation, and organizations on the ground, USAID will initially target 400,000 of the highest risk households in Liberia with this vital training and important tools.

The campaign is also rooted in a sobering reality. Half of all people who get sick don’t seek treatment at hospitals or Ebola treatment units. Many are frightened by rumors and deterred from traveling to hospitals where their friends and neighbors are taken and never return. A complex array of traditional beliefs and practices mean many of those who should seek help choose to stay in their homes – often putting those family members who care for them at risk.

The Ebola crisis is wreaking havoc on West Africa’s health care system. USAID is focused on supporting the construction and management of Ebola treatment units; airlifting critical relief and medical supplies; training health care workers; strengthening emergency response systems of the affected governments; and supporting public messaging with communities on how to prevent, detect and treat Ebola.

The Ebola epidemic is wreaking havoc on West Africa’s health care system. USAID is focused on supporting the construction and management of Ebola treatment units; airlifting critical relief and medical supplies; training health care workers; strengthening emergency response systems of the affected governments; and supporting public messaging with communities on how to prevent, detect and treat Ebola. / Morgana Wingard

This week, working alongside the Paul G. Allen Family Foundation, we will airlift 50,000 USAID-funded home health care kits to be delivered to some of the most isolated and vulnerable communities in Liberia. We will simultaneously work with every part of society to educate people on how to prevent and detect Ebola through mass public awareness campaigns supported by radio, text, television and community announcements. As we scale up our response, the only way the virus will be controlled is if we make concerted efforts to reach every community, and every home in the affected areas.

We know tough months lie ahead. It will require a coordinated effort by the entire global community to help stem this terrible public health crisis. But every outbreak of Ebola in the last 40 years has been stopped, and this one will be, as well.

ABOUT THE AUTHOR

Nancy Lindborg is the USAID Assistant Administrator for the Bureau for Democracy, Conflict and Humanitarian Assistance

5 Things You Didn’t Know About Female Condoms

Langton Ziromba promotes female condoms in the casual and friendly space of his barbershop. / UNFPA

Langton Ziromba promotes female condoms in the casual and friendly space of his barbershop. / UNFPA

Since the first female condom hit global markets in 1992, the female condom has become more effective, more comfortable, and more accessible. Today, a variety of female condom products are sold worldwide, including the FC2, the Cupid, and the Women’s Condom. With more options for keeping yourself and your partner protected from HIV and STIs, there’s a lot to celebrate this Global Female Condom Day.

FC2 Female Condom Packaging

New packaging released for FC2. / The Female Health Company.

While the female condom has come a long way in user acceptability, user rates are still below targets needed to achieve an AIDS-free generation and prevent HIV and STI transmission among people of all genders. As awareness about the multipurpose protection benefits of the female condom grows, global demand is increasing.

In honor of Global Female Condom Day, read and share these five facts about female condoms, and help ensure that we continue celebrating successes in advancing sexual and reproductive health for all.

1. Best Multi-purpose Protection: According to research, the FC2 can be 97 percent effective in reducing risk of sexual transmission of HIV. The female condom is also approximately 80 percent effective in preventing  pregnancy. As a multi-pronged protection method, the female condom can transform women’s sexual and reproductive health lives and provide them with a means of taking control over their health, especially in circumstances where their choices are limited.

2. Global Appeal: The United States Government through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is one of the largest procurers of female condoms worldwide. In 2003, PEPFAR supplied roughly 1.1 million female condoms worldwide. By 2009, global shipments had increased to almost 15 million per year. In 2012, a record 32 million female condoms were distributed in total by the international donor community. Today, the female condom is available in over 100 countries.

3. Becoming More Popular: In the past, many have been reluctant to use the FC2, or other female condom styles, claiming they feel unnatural. Subsequent designs made of latex can offer a natural feel for male partners.

4. Easy To Use: Female condoms can be inserted up to 8 hours prior to sex, giving people even more control over their bodies. For detailed instructions on proper usage, see here.

5. They Keep Getting Better!: In 2013, the Gates Foundation launched a $1 million award to create the next generation of more user-friendly condoms. Among the 11 proposed designs, is a new female condom infused with air that would be faster and easier to insert. Other innovations include the 100 percent silicone Origami female that is made of a single accordion-like piece that can be washed and reused. Several of these promising designs are set to reach the market in 2015.

ABOUT THE AUTHOR

Clancy Broxton is the Senior Social Marketing & Commodities Advisor for USAID’s Office of HIV/AIDS and Rahel Beigel is a Global Health Fellows Program intern working with Clancy on condoms.

An Opportunity of 300,000 Lifetimes

“Healing is a matter of time, but it is sometimes also a matter of opportunity.” The Greek physician Hippocrates wrote this in about 400 BC. Of course, when Hippocrates practiced medicine, opportunities to heal were scarce as he and his peers understood relatively little about anatomy and physiology, much less biomolecular science. In Hippocrates’ era, some percentage of young children were expected to succumb to illness. Over the last 2,000 years, however, developments in medical science have allowed for the previously unthinkable. The collective brilliance and hard work of scientists and healers have ensured that many of the maladies that afflicted Hippocrates’ patients took a one-way trip to the history books.  Children, for the most part, can be expected to reach adulthood.

Alas, some exceptions stubbornly remain.

There is no clearer example than pediatric HIV. A single generation has seen the rise of a devastating epidemic and, though there have been breakthroughs in the fight against the virus, 3.2 million children currently live with the virus and an estimated 700 children are infected daily. The recent, sudden viral rebound in the “Mississippi baby,” the first child believed to be functionally cured, was the latest punch to the gut in the long, drawn out brawl to protect children from the virus. In low-resourced regions, children living with HIV are often among the last to be tested and treated. Initiating children on treatment early, which allowed the Mississippi baby to remain virally suppressed for years, is exceptionally rare.

A baby receives life-saving drugs. / Anna Zeminski, AFP / Getty Images

A baby receives life-saving drugs. / Anna Zeminski, AFP / Getty Images

Now for some good news. Earlier this month, as part of the U.S.-Africa Leaders Summit, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR),in partnership with the Children’s Investment Fund Foundation (CIFF), launched Accelerating Children’s HIV/AIDS Treatment (ACT). ACT is an ambitious $200 million initiative to double the total number of children receiving life-saving antiretroviral therapy (ART) across 10 priority African countries over the next two years. This investment will enable 300,000 more children living with HIV to receive life-saving ART.

At the onset of the HIV epidemic in the early 1980′s, an HIV diagnosis was equivalent to a death sentence. Failing to treat a child remains just that, as half die by 2 years of age. Up to three people die of AIDS every minute and an estimated 190,000 children died of AIDS in 2013 alone.

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An HIV-positive mother holds her child after visiting an HIV clinic. For children who are born HIV-positive, life-saving antiretroviral therapy is critical to protecting their health. / AFP

Hippocrates was right: Healing is indeed both a matter of time and opportunity. Time does not heal HIV, however, and deaths continue to mount, a disproportionate number of them among children.

So, now is the time to act. Thanks to PEPFAR and CIFF, we have an unprecedented opportunity to do just that.

ABOUT THE AUTHOR

Dr. Benjamin Ryan Phelps is a Medical Officer who focuses on Preventing Mother-to-Child Transmission of HIV (PMTCT) and Pediatric AIDS. Follow him at @BRPhelpsMD.
Joella Adams is a Global Health Fellows Program intern working with PMTCT programs.

On the Frontlines of the Ebola Response: an Inside Look at a Program to Help the Grieving

The West African Ebola outbreak is the worst outbreak in history, affecting four countries. The U.N. World Health Organization declared it an international health emergency

The West African Ebola outbreak is the worst outbreak in history, affecting four countries. The U.N. World Health Organization declared it an international health emergency / Christina Goldsmith, CDC

In Liberia, a country gripped by Ebola, the outbreak has not only taken its toll on health care workers but also on the professionals who comfort the grieving.

“The outbreak of Ebola was very shocking and overwhelming to our country,” said Jestina Hoff, a counselor with the Liberian Red Cross. “It brought a lot fear.”

As a counselor with the Liberian Red cross, Jestina Hoff must find ways to comfort Ebola victims or their families without getting close to them

As a counselor with the Liberian Red cross, Jestina Hoff must find ways to comfort Ebola victims or their families without getting close to them. / Carol Han, USAID/OFDA

The outbreak has also hampered Hoff’s ability to do her job. “As a counselor, I talk to parents who lost a child or to someone who has gotten sick with the virus,” said Hoff. “They are feeling so discouraged, and I have to help them accept the situation and comfort them, but without touching them.”

Francesca Crabu, a clinical psychologist with the International Committee of the Red Cross, explained that having close contact with those who are grieving is key to providing psychosocial support. But in Liberia and other parts of Western Africa, preventative measures require people to stay at arm’s length from each other.

“Here in Liberia, it is very painful that you cannot shake hands. If somebody is dying I cannot hug you,” said Crabu.

To make matters worse, once Ebola claims a life, the body is taken immediately, before families have time to mourn their loss, according to Eliza Yee-lai Cheung, a clinical psychologist with the Hong Kong Red Cross.

Eliza Yee-lai Cheung (right) a clinical psychologist with the International Federation of the Red Cross, listens as counselors in Monrovia share stories about helping families cope with Ebola

Eliza Yee-lai Cheung (right) a clinical psychologist with the International Federation of the Red Cross, listens as counselors in Monrovia share stories about helping families cope with Ebola. / Carol Han, USAID/OFDA

“They cannot hold a memorial service or burial according to their culture,” said Cheung. “That’s why it’s very hard for them.”

To give psychosocial counselors the tools to help grieving communities, the USAID Ebola Disaster Assistance Response Team (DART) is partnering with IFRC in Monrovia, Liberia’s capital city. Among other things, the DART and the International Federation of Red Cross and Red Crescent Societies are working to raise public awareness of Ebola’s mode of transmission, teach disease prevention practices to communities, and train health workers and volunteers.

Training materials passed out to counselors will help them train others in the community

Training materials passed out to counselors will help them train others in the community / Dagny Olivares, CDC

In a classroom, 19 people—counselors with the Liberian Red Cross, staff with NGOs and social workers with the Liberian Ministry of Health & Social Welfare—are learning from Crabu and Cheung how to organize culturally appropriate activities to help families cope with their loss. They are also taught ways to keep themselves safe from the virus and how to provide support to each other. This group will then go on to train others in affected communities with the hopes that such efforts will help the country come to grips with Ebola.

“It’s overwhelming,” said Hoff. “But we have a goal. I have a goal. We have to serve our country. We need somebody to take a step to help others move forward. It’s scary, but there’s hope.”

How Gender Analyses Shaped the Future of Microbicides

Engaging women in conversations about microbicides will help facilitate an effective introduction of this HIV prevention tool when it becomes available / Lisa Marie Albert

Engaging women in conversations about microbicides will help facilitate an effective introduction of this HIV prevention tool when it becomes available. / Lisa Marie Albert

Women account for more than half of all people living with HIV worldwide. In sub-Saharan Africa, young women are twice as likely to have HIV as young men. It is clear that women are disproportionately affected by the virus. Women’s vulnerability to HIV stems not only from a higher biological risk than men, but also from violations of women’s human rights, gender inequalities and marginalization.

USAID, through PEPFAR, is committed to expanding the array of woman-controlled HIV prevention methods so that women and girls can better protect themselves from infection../ Lisa Marie Albert

USAID, through PEPFAR, is committed to expanding the array of woman-controlled HIV prevention methods so that women and girls can better protect themselves from infection. / Lisa Marie Albert

USAID, through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), is committed to expanding the array of woman-controlled HIV prevention methods so that women and girls can better protect themselves from infection. In 2010, the CAPRISA 004 trial, funded in part by PEPFAR through USAID, provided the first proof of concept that a vaginal microbicide made of tenofovir gel could protect women against HIV infection when used appropriately. Microbicides are substances applied vaginally or rectally to protect users against HIV infection. This scientific breakthrough presented the global health community with a potential new, female-initiated tool in the fight against HIV.

With these encouraging findings and continued clinical trials to test microbicides, we now need to look ahead toward their meaningful introduction and use. Through this process, we will recognize potential barriers to successful roll out, and identify ways to mitigate those barriers. Are women interested in using microbicides, and if so, how easy will it be for women to access them? To what extent do women want to communicate with their male partners about microbicides? How accepting are men to women’s choices about HIV prevention? To what degree are policies supportive of women’s microbicide use?

One of our implementing partners, FHI 360, foresaw these concerns and acted. Under the USAID-supported Preventive Technologies Agreement, FHI 360, with support from Sonke Gender Justice in South Africa,  conducted gender analyses in South Africa and Kenya, two countries where microbicide development work makes its future introduction likely. Gender analyses are systematic processes used to identify and understand gender differences. They examine how gender norms and inequalities affect relationships and power dynamics between men and women, as well as women’s access to resources, their rights, their opportunities, and their health practices and outcomes. In South Africa and Kenya, FHI 360 implemented this analysis to understand gender-related barriers to women’s microbicide use, identify solutions, and prepare for a gender transformative introduction

Of FHI 360’s findings, there are three key takeaways we would like to highlight:

1.  Promoting microbicides to all women, not just most at risk populations, will be important to avoid stigmatizing the product. People in both countries cautioned against promoting this HIV prevention method as a niche product for specific populations, fearing that targeted promotion of microbicides might stigmatize the method and lead to microbicide rejection by the populations who could benefit from it the most.

2.  Balancing women’s autonomy and male partner engagement in microbicide introduction is crucial. Women have the right to choose whether they inform their partners of their microbicide use, and health providers need to support women in making the decision that is appropriate for them. At the same time, educating men about microbicides may help increase acceptability and adherence and foster couples’ communication about sex and HIV protection. Microbicide introduction programs must take care to position women as the gatekeepers to their male partner’s involvement.

3.  Sex sells. Many believed that microbicide promotion should focus on sexual benefit and pleasure in order to increase its appeal. By highlighting these positive aspects of the gel, which were identified throughout earlier microbicide trials, people may be more likely to adopt this HIV prevention method.

In Sub-Saharan Africa, women’s access to sexual and reproductive health services is key to protecting their health and preventing HIV infection / Lisa Marie Albert

In Sub-Saharan Africa, women’s access to sexual and reproductive health services is key to protecting their health and preventing HIV infection. / Lisa Marie Albert

FHI 360’s gender analyses filled critical gaps in understanding that will enable public health practitioners to introduce this HIV-prevention method most successfully. As USAID and PEPFAR move closer to creating an AIDS-free generation, we recognize that gender analyses are a vital practice in order to better understand the communities with which we engage, strengthen the impact of our programs, and empower women and girls to protect their health and achieve their fullest potential.

ABOUT THE AUTHOR

Celia Karp is a public affairs intern in the Global Health Fellows Program II working in USAID’s Office of HIV/AIDS. Follow her @celkarp

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