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Archives for Global Health

Reach, Cure, Prevent to End TB

Multidrug-resistant TB education exercise on treatment support in Nigeria. / FHI 360

Multidrug-resistant TB education exercise on treatment support in Nigeria. / FHI 360

Tuberculosis, or TB, is a curable disease, and for the first time in history, we have the opportunity to defeat this age-old killer. We have effective diagnostic tools and medicines for most forms of TB, and several new and improved medicines are likely to be rolled out in the next few years.

In May 2014, the U.S. Government and global community joined together around the vision of a world free of TB. We pledged to reduce TB deaths by 95 percent and new TB infections by 90 percent by 2035.

This is an ambitious goal, but it is achievable.

Change Through U.S. Leadership & Partnerships

The U.S. Government is a leader in the global TB care effort, having invested almost $3 billion to combat TB between 2009–14, and USAID leads this U.S. Government effort.

At USAID, we are focusing our investments on strengthening national TB strategies and programs in 26 countries with high rates of TB, multidrug-resistant TB and HIV-associated TB.

X-ray technicians in Cambodia are trained to identify characteristics that define TB. / Seak Kunrath

X-ray technicians in Cambodia are trained to identify characteristics that define TB. / Seak Kunrath

In order to achieve our goal of eliminating TB as a global health threat by 2035, we will work with partners to reach every person with TB, cure those in need of treatment, and prevent new TB infections, as laid out in the U.S. Government’s 2015-2019 Global TB Strategy [pdf].

Here’s how:

Expanding our Reach

Of the estimated 9 million people who develop TB each year, 3 million never seek or receive formal diagnosis or treatment. These individuals suffer – and often die – needlessly, compounding this tragedy by transmitting TB to others.

In order to end the TB epidemic, we must do more to reach these “missing” 3 million. USAID is working with partner governments to increase TB case-finding by improving diagnostic networks and improving screening for those who are at risk of getting TB.

As part of this effort, we are supporting the global scale-up and use of new diagnostic tools such as GeneXpert, a revolutionary tool that provides faster and more accurate diagnoses and is particularly effective at diagnosing TB among children, people living with HIV, and people suffering from multidrug-resistant TB (MDR-TB).

Curing and Preventing TB

USAID supports national programs to diagnose and treat TB in the countries hardest hit by TB, MDR-TB and HIV-associated TB. In 2013, we helped support TB treatment for 2.7 million people.

We are continuing to tackle the growing threat posed by drug-resistant TB. MDR-TB has been detected in almost every country in the world and poses a serious threat to both the global community and American citizens. Left unchecked, the spread of drug-resistant TB will reverse the great progress made thus far. USAID is working with partners to scale-up MDR-TB treatment programs and to make medicines more available and affordable.

We are also expanding our efforts to detect, cure, and prevent HIV-associated TB—an urgent priority as TB kills one out of every four people living with HIV/AIDS. Early initiation of antiretroviral therapy and isoniazid preventive therapy can greatly reduce the risk of TB among people living with HIV/AIDS. Through the President’s Emergency Plan for AIDS Relief (PEPFAR), the U.S. Government is working to improve TB case detection for those with HIV/AIDS and increase coverage of these therapies.

Currently, the most effective way to prevent the spread of TB is by providing life-saving treatment to those who fall ill. TB patients who are cured through appropriate treatment will no longer transmit the disease to those around them. Accordingly, we are focusing on TB treatment as a primary method of preventing new infections. We are also working to improve infection control measures in health care settings and communities to further reduce the spread of TB.

Looking to the Future with Optimism

From 2000-13, more than 37 million people were cured of TB. We’ve reduced TB deaths by almost half since 1990, and the world has achieved the Millennium Development Goal target of reversing the spread of the disease.

We stand with our partners, united in our efforts to save lives and develop healthier societies in vulnerable countries. We have the ability to rid the world of TB. And – with continued global action, investment and innovation – we will do so.

I hope that on this World TB Day, you will join us in the pledge to reach every person with TB, cure those in need of treatment, and prevent new TB infections.

ABOUT THE AUTHOR

Ariel Pablos-Mendez is Assistant Administrator for Global Health and Child and Maternal Survival Coordinator at USAID. Follow him @ampablos

USAID Takes to the High Seas to Bring Reinforcements to Guinea’s Ebola Fight

In the war against Ebola, health care workers on the front lines need more than personal protective equipment and training to keep safe. / Morgana Wingard, USAID
In the war against Ebola, health care workers on the front lines need more than personal protective equipment and training to keep safe. / Morgana Wingard, USAID

In the war against Ebola, health care workers on the front lines need personal protective equipment — overalls, gloves, goggles and boots; training on infection prevention and control; and plenty of something called HTH.

HTH stands for high test hypochlorite. It’s chlorine in concentrated granular form and so potent that, according to the U.S. Centers for Disease Control and Prevention, only a few tablespoons in a 5-gallon bucket is sufficient to kill the Ebola virus and disinfect contaminated surfaces. The substance is often used to sanitize pools.

The downside is that HTH is volatile and can cause explosions. So instead of transporting the chlorine by plane—as was done with other Ebola response commodities—USAID arranged for a cargo ship to safely move more than 53 metric tons of HTH to Guinea and another 38 tons to Sierra Leone. Combined, that equals the weight of almost 70 compact cars.

The cargo ship arrived at Port of Conakry on Feb. 24, and the more than 9,700 drums of HTH were transferred by truck to a warehouse managed by the Central Pharmacy of Guinea to be distributed to health care facilities across the country.

From obtaining the the chlorine to ensuring its safe delivery to Guinea and Sierra Leone, USAID’s Ebola Disaster Assistance Response Team (DART) played a crucial role in making sure this operation went off without a hitch.

In late February, USAID’s Office of U.S. Foreign Disaster Assistance sent 53 tons of chlorine to Guinea by ocean freight rather than airlifting the supplies by plane due to safety protocols. / Allen Carney, USAID/OFDA

In late February, USAID’s Office of U.S. Foreign Disaster Assistance sent 53 tons of chlorine to Guinea by ocean freight rather than airlifting the supplies by plane due to safety protocols. / Allen Carney, USAID/OFDA


High test hypochlorite (HTH) is a concentrated form of chlorine; only a few tablespoons in 5 gallons of water are enough to kill the Ebola virus. But HTH is also volatile and can cause explosions. / Allen Carney, USAID/OFDA

High test hypochlorite (HTH) is a concentrated form of chlorine; only a few tablespoons in 5 gallons of water are enough to kill the Ebola virus. But HTH is also volatile and can cause explosions. / Allen Carney, USAID/OFDA


Ebola Disaster Assistance Response Team (DART) member Emily Betz Close lifts a 55-pound drum of highly concentrated chlorine. / Allen Carney, USAID/OFDA

Ebola Disaster Assistance Response Team (DART) member Emily Betz Close lifts a 55-pound drum of highly concentrated chlorine. / Allen Carney, USAID/OFDA


In total, more than 9,700 drums of high test hypochlorite (HTH) were safely stored for further distribution to medical facilities across Guinea. / Allen Carney, USAID/OFDA.

In total, more than 9,700 drums of high test hypochlorite (HTH) were safely stored for further distribution to medical facilities across Guinea. / Allen Carney, USAID/OFDA.


Despite the back-breaking work, these warehouse workers manage to stay positive. USAID is happy to be working in partnership with Guinea in the fight against Ebola. / Allen Carney, USAID/OFDA

Despite the back-breaking work, these warehouse workers manage to stay positive. USAID is happy to be working in partnership with Guinea in the fight against Ebola. / Allen Carney, USAID/OFDA


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.

How Progress Works: A Disappointing Microbicides Trial and Why We’re Not Discouraged

The FACTS 001 trial made use of applicators to dispense 1 percent tenofovir gel before and after sex. / Andrew Loxley Photography

The FACTS 001 trial made use of applicators to dispense 1 percent tenofovir gel before and after sex. / Andrew Loxley Photography

Science is messy. Data don’t always show us what we hope they will. But science is reality, and that’s why we must be unflinching in our pursuit of getting honest feedback on what works.  Today, we got that honest feedback, and it was disappointing: What once appeared to be a major breakthrough in HIV prevention was not confirmed. Results released from a large USAID-supported trial indicate that an antiretroviral-based vaginal gel may not be effective in reducing the risk of HIV infection in women when used before and after sex.

With women increasingly vulnerable to HIV infection, we must work towards finding a prevention method to protect them.  / USAID, Tash McCarroll

With women increasingly vulnerable to HIV infection, we must work towards finding a prevention method to protect them.
/ USAID, Tash McCarroll

The FACTS 001 trial—named after the Follow-on African Consortium for Tenofovir Studies (FACTS)—was designed to test the safety and effectiveness of a vaginal microbicide that contains 1 percent tenofovir gel. The study aimed to replicate the groundbreaking results of a 2010 trial called CAPRISA 004, which found a 39 percent reduced risk of HIV infection. Unfortunately, the FACTS 001 study did not replicate those results on a larger scale. Although the answer wasn’t what we’d hoped, in the process of asking we have learned and grown, and we’ll  redouble our efforts to take the next steps forward.

In sharing this news, I am struck by a simple observation made by the editor in chief of “Science News,” Eva Emerson: “This is how science is supposed to work.” Her remark referred to a recent discovery in physics that upon further investigation could not be confirmed. Emerson’s conclusion was matter of fact. Scientists are in the business of asking questions, whether it is the existence of gravitational waves or the ability of a gel to protect vulnerable women.

The process of “asking” also re-emphasized the reason why we pursue new technologies for HIV prevention. The young South African women who participated in the study live in communities with some of the highest incidence rates of HIV infection in the world. Their lives are complex and the decisions they face daily are staggering. Everything we do, whether it be investigating new methods of HIV prevention or conducting thorough evaluations, is in the effort of bringing relief to these women and achieving an AIDS-free generation.

The FACTS 001 study was launched in October 2011 at nine clinical trial sites in South Africa and included 2,059 female participants aged 18-30. By the end of the trial in September 2014, about 4 percent of both the placebo group and the treatment group receiving the gel became infected with HIV.

In spite of this setback, USAID has already developed a robust pipeline of new products, many of which are jointly supported by the National Institutes of Health, the Bill & Melinda Gates Foundation and others. These include innovative methods such as vaginal rings, long-acting injectable antiretroviral drugs, and products that combine contraceptives and HIV prevention technologies. For each hurdle we encounter, USAID is determined to jump two steps forward—our commitment to helping women protect themselves from HIV has never been stronger.

To the women who participated in this trial: Thank you. You are why the trial was done, and you are why we will persevere.

The FACTS 001 trial was led by Wits Reproductive Health and HIV Institute, sponsored by CONRAD, and funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID, the Bill & Melinda Gates Foundation, and the Government of South Africa, with support from Gilead Sciences.

ABOUT THE AUTHOR

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

Guinean Doctor Survives Ebola, Pays ​I​t Forward

Participants in an infection prevention and control training in Guinea learn key skills. / Jhpiego

Participants in an infection prevention and control training in Guinea learn key skills. / Jhpiego

Conakry, Guinea—Dr. Thierno Souleymane Diallo is a formidable ally in Guinea’s race to prevent and contain the spread of the deadly Ebola virus. As a survivor of the disease, he is championing with colleagues the Infection Prevention and Control (IPC) skills that can save lives.

Last August, Dr. Thierno contracted Ebola during his rotation in the maternity ward at the Ignace Deen National Hospital. The 35-year-old father of three was infected while treating a pregnant patient who showed no Ebola-related symptoms, but who later tested positive for the disease. The doctor candidly admits that he could have avoided infection if he had known “to take every precaution.”

However, because the hospital failed to follow recommended IPC practices while caring for the patient, Dr. Thiero and five team members had to be isolated after contact. “I was the only one of the team to develop the disease,” he said.

Thierno spent 21 days in an Ebola treatment center run by Doctors Without Borders, suffering from bloody diarrhea, nausea, body aches and constant 104-degree fevers. “Sometimes I prayed to God to let me sleep, to forget my state…and when I woke up,I felt like my entire body was full of lead,” he said.

When he received a visit from his wife during this period, he was so disoriented that he at first didn’t recognize her. From the designated visitors’ area of the center, Dr. Thierno and his wife had to call out to each other from a distance of about three meters—over a wire fence and across an empty lane. Dr. Thierno remembers little or nothing of this visit.

After his release, Dr. Thierno spent another two and a half months at home recovering from severe joint pain. Upon returning to work he participated in an update and refresher training for health workers during which he learned the importance of following proper IPC practices, especially during the Ebola outbreak.

The five-day training was organized by the USAID’s flagship Maternal and Child Survival Program (MCSP) in conjunction with the Ministry of Health in Guinea. The training used lectures along with simulated practical sessions and health facility site visits to allow for hands-on demonstrations of proper IPC.

Dr. Thierno is now among 27 providers with updated skills who are managing a large-scale training—under the guidance of the USAID team—for 2,200 Guinean health care workers in IPC practices adapted for Ebola-impacted countries. They are also providing follow-up supportive supervision to these workers every two weeks as part of Ministry of Health efforts to keep front-line health workers safe and prepared to serve Guineans who may become ill.

“This training has closed the door on ignorance related to infection prevention and opened a door on behavior change,” he said.

Rachel Waxman contributed to this article.

ABOUT THE AUTHORS

Jacqueline Aribot and Alisha Horowitz are the Senior Monitoring and Evaluation Advisor and Associate Editor for USAID’s flagship Maternal and Child Survival Program, implemented by Jhpiego 

Anatomy of a Logistics Operation: How USAID is Equipping Ebola Fighters on the Frontlines

Transporting vital supplies and critical commodities quickly to the epicenter of an international disaster is what USAID’s Office of U.S. Foreign Disaster Assistance does every day. However, the Ebola response has proved especially challenging for USAID’s disaster experts.

A USAID-chartered plane lands in Monrovia, Liberia, transporting critically-needed medical supplies to the frontlines of the Ebola response. Photo courtesy: Carol Han, USAID/OFDA

A USAID-chartered plane lands in Monrovia, Liberia, transporting critically-needed medical supplies to the frontlines of the Ebola response. Photo courtesy: Carol Han, USAID/OFDA

“Most disasters we respond to are either natural disasters—such as an earthquake, where the acute needs peak and then go down very quickly—or it’s a war,” explained Kelly Bradley, a logistician with USAID’s Ebola Disaster Assistance Response Team (DART). “Ebola is essentially a brand-new type of response because outside of a few groups, no one has dealt with it on a large scale before.”

Inside the cargo hold, thousands of sets of protective equipment (PPE) to protect Ebola health care workers. As of January 2015, the U.S. has transported more than 400 metric tons of medical and disaster supplies to West Africa. / Carol Han, USAID/OFDA

Inside the cargo hold, thousands of sets of protective equipment (PPE) to protect Ebola health care workers. As of January 2015, the U.S. has transported more than 400 metric tons of medical and disaster supplies to West Africa. / Carol Han, USAID/OFDA

One major obstacle: Affected West African countries did not have robust infrastructure in place to receive and distribute all the goods pouring into their airports. As a result, the United States found itself in the unique position of moving an unprecedented amount of medical supplies to a region while simultaneously working to build a logistics supply chain almost from scratch—all to ensure that health care workers are able to get what they need to save lives.

USAID Ebola Disaster Assistance Response Team (DART) logisticians Kelly Bradley and Rogers Warren receive medical supplies at Roberts International Airport in Monrovia, Liberia. In addition to airlifting critical commodities, they had to help build a supply chain to ensure that the medical supplies got to areas of need. / Carol Han, USAID/OFDA

USAID Ebola Disaster Assistance Response Team (DART) logisticians Kelly Bradley and Rogers Warren receive medical supplies at Roberts International Airport in Monrovia, Liberia. In addition to airlifting critical commodities, they had to help build a supply chain to ensure that the medical supplies got to areas of need. / Carol Han, USAID/OFDA

“We were getting requests left, right and center,” said Bradley. “People didn’t know what they were asking for. We didn’t know what was coming in a lot of the time. Even the experts who do medical responses didn’t fully understand the scope of the need.”

Inside a warehouse in Monrovia, the U.S. military and USAID put together “starter kits” of medical and cleaning supplies to sustain U.S.-supported Ebola clinics for the first critical days of operation. / Carol Han, USAID/OFDA

Inside a warehouse in Monrovia, the U.S. military and USAID put together “starter kits” of medical and cleaning supplies to sustain U.S.-supported Ebola clinics for the first critical days of operation. / Carol Han, USAID/OFDA

Much of the need centered on delivering enough personal protective equipment (PPE) – including gloves, goggles, coveralls, masks and boots—to health care workers. Enter the U.S. military, which has been working closely with USAID to airlift more than 1.4 million sets of PPE to Monrovia, the country’s capital.

However, once the supplies were flown in, there was no dedicated system in place to transport them to the Ebola treatment units (ETUs) being constructed and staffed by the United States.

USAID funded the UN World Food Program (WFP) to build a system of warehouses in five strategic locations throughout Liberia. Photo courtesy: Carol Han, USAID/OFDA

USAID funded the UN World Food Program (WFP) to build a system of warehouses in five strategic locations throughout Liberia. Photo courtesy: Carol Han, USAID/OFDA

That’s when USAID partnered closely with the UN World Food Program (WFP) and supported its work to build a system of warehouses throughout the country and develop a supply chain of medical equipment to ensure ETUs received ample resources to open its doors and stay operational.

With this supply chain in place, PPE and other medical supplies could now be transported by truck to logistics bases located in five strategic Liberian cities, close to U.S.-supported ETUs.

In addition to supplying Ebola Treatment Units with medical equipment, USAID has been providing communities with household kits containing bleach, masks, soap and gloves so that families taking care of sick loved ones could be better protected against Ebola. / Carol Han, USAID/OFDA

In addition to supplying Ebola Treatment Units with medical equipment, USAID has been providing communities with household kits containing bleach, masks, soap and gloves so that families taking care of sick loved ones could be better protected against Ebola. / Carol Han, USAID/OFDA

Mira Baddour, a logistician with WFP in Liberia, admits that getting all the main players on the same page was initially very challenging.

Coordination in action: U.S. Army logistician Terri Mcfadden (center) consults with USAID logistician Kelly Bradley (right) at a WFP warehouse in Harper, Liberia, on best ways to transport supplies to U.S.-supported Ebola clinics. / Carol Han, USAID/OFDA

Coordination in action: U.S. Army logistician Terri Mcfadden (center) consults with USAID logistician Kelly Bradley (right) at a WFP warehouse in Harper, Liberia, on best ways to transport supplies to U.S.-supported Ebola clinics. / Carol Han, USAID/OFDA

“For us, for WFP, we usually deal with delivering food,” Baddour explained. “Now, we were dealing with unfamiliar concepts like ETUs and working with different partners. But [being here] is really a great experience for me… and everyone is now working very well with each other.”

“It’s a totally different crisis,” said WFP logistician Mira Baddour at one of the warehouses in Liberia that her agency is running. “It has been challenging, but at the same time it is a really great experience for me.” / Carol Han, USAID/OFDA

“It’s a totally different crisis,” said WFP logistician Mira Baddour at one of the warehouses in Liberia that her agency is running. “It has been challenging, but at the same time it is a really great experience for me.” / Carol Han, USAID/OFDA

USAID’s Kelly Bradley, who is a veteran of several disasters, agrees that the experience has been personally rewarding.

“Think about the sheer volume of personal protective equipment that [has been] coming in,” said Bradley. “My unit is directly responsible for making sure that it gets to our partners… the Ebola health care workers on the frontlines. It’s a really big responsibility and a really rewarding thing to be a part of it all.”

Meet the team of experts with USAID, the U.S. military, and the UN World Food Program that have been working around the clock to transport, track and deliver critical medical supplies for the Ebola response. / Carol Han, USAID/OFDA

Meet the team of experts with USAID, the U.S. military, and the UN World Food Program that have been working around the clock to transport, track and deliver critical medical supplies for the Ebola response. / Carol Han, USAID/OFDA

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.

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Training the Next Generation of Ebola Fighters

To learn how to safely treat Ebola patients while staying alive, doctors and nurses must learn how to navigate an Ebola “maze” run by the U.S. military in Liberia. / Carol Han, USAID

To learn how to safely treat Ebola patients while staying alive, doctors and nurses must learn how to navigate an Ebola “maze” run by the U.S. military in Liberia. / Carol Han, USAID

Walk into the gymnasium of the Liberian National Police Training Academy and you’ll come across a maze so bizarre—and as it turns out so high-stakes—that  successfully navigating it could mean the difference between life and death.

Welcome to the nerve center of the U.S. health care worker training program. It’s a replica of an Ebola treatment unit (ETU), where doctors, nurses, hygienists, and others learn how to safely care for Ebola patients while staying alive.


The U.S.-run Ebola health care worker training takes place at the Liberian National Police Academy, where the gymnasium has been transformed into a mock Ebola treatment unit.  / Carol Han, USAID

The U.S.-run Ebola health care worker training takes place at the Liberian National Police Academy, where the gymnasium has been transformed into a mock Ebola treatment unit. / Carol Han, USAID

“Everything is about safety—the safety of the staff and the safety of the patients,” said U.S. Army Colonel Laura Favand, who helps oversee the Ebola health care worker training program.

During the week-long class, students first spend three days in the classroom where U.S. military doctors, nurses and medics teach them every aspect of Ebola care, from diagnosis and patient recordkeeping to proper disinfection techniques and safe handling of the dead.

Cross-contamination is the biggest threat in an ETU, which is why there’s an entire class dedicated to proper hand-washing techniques. Another critical lesson: how to take off protective suits, goggles, and gloves without inadvertently contracting the disease.

According to Colonel Favand, this is one of the most vulnerable times for Ebola health care workers.


Taking off protective suits—like what’s being done here at a USAID-supported ETU in Sierra Leone—is a vulnerable time for health care workers. That’s why so much time is spent teaching health care workers how to prevent cross-contamination.  / Carol Han, USAID

Taking off protective suits—like what’s being done here at a USAID-supported ETU in Sierra Leone—is a vulnerable time for health care workers. That’s why so much time is spent teaching health care workers how to prevent cross-contamination. / Carol Han, USAID

“You’ll see someone getting ready to take their gloves off and their hands are shaking,” said Favand. “They know how important this is.”

Classroom time is followed by two days spent in the “mock ETU” where students are taught how to navigate in a clinical setting and practically apply all that they have learned. Actual Ebola survivors play the role of patients, offering invaluable insight into what actually happens in an ETU. According to participants, the survivors also help teach them how to communicate with patients.


Actual Ebola survivors play the role of patients at U.S. Ebola health care worker trainings, providing invaluable insight. Here, a student assesses a child patient and Ebola survivor during a training session in Greenville, Liberia under the watchful eyes of the instructor. / Col. Laura Favand, U.S. Army

Actual Ebola survivors play the role of patients at U.S. Ebola health care worker trainings, providing invaluable insight. Here, a student assesses a child patient and Ebola survivor during a training session in Greenville, Liberia under the watchful eyes of the instructor. / Col. Laura Favand, U.S. Army

“We learn some different terms in Liberian English that allows us to have a more accurate perception of the patient,” said Ephraim Palmero, medical director for the International Organization of Migration, an organization being supported by USAID to run three U.S.-built ETUs in Liberia.

“For example, instead of saying ‘how are you,’ Liberians ask, ‘how’s the body,’” Palmero explained.


On the Road: The U.S. military has deployed mobile training teams throughout Liberia to offer the same course to those who can’t travel to the main training site in the Monrovia metro area. / Carol Han, USAID

On the Road: The U.S. military has deployed mobile training teams throughout Liberia to offer the same course to those who can’t travel to the main training site in the Monrovia metro area. / Carol Han, USAID

Besides running the training at the Liberian police academy, the U.S. military deploys four mobile training teams throughout Liberia to offer the same course to health care workers who are unable to make it to Monrovia.  Liberian health officials — in charge of training the next generation of Ebola health care workers — also take the class.

“I love doing this mission,” said U.S. Army Captain Alex Ailer. “I like that people here are being helped and that we are also helping local people help themselves.”


U.S. Air Force Senior Airman Alexander Muniz and U.S. Army Captain Anna Bible take a break while teaching an Ebola health care training course in Harper, Liberia. They are part of a mobile training team. / Carol Han, USAID

U.S. Air Force Senior Airman Alexander Muniz and U.S. Army Captain Anna Bible take a break while teaching an Ebola health care training course in Harper, Liberia. They are part of a mobile training team. / Carol Han, USAID

As of early January 2015, more than 1,500 Liberian and international health care workers have taken part in the training, including several USAID partners that are now running the U.S.-built ETUs.

“The training was incredible and great for me because it alleviated my fears,” said Micaela Theisen with the International Organization for Migration. “It [made] me feel good and ready to get to work.”

Her colleague Catherine Thomas agreed.

“The staff there, their medical knowledge was very comforting to us who were just starting out.” said Thomas. “They were just great.”


(from left to right) Health care workers Catherine Thomas, Micaela Theisen, and Rene Vega—all working at USAID-supported ETUs—have taken the U.S. Ebola health care worker training course. “The training was incredible and great for me because it alleviated my fears,” said Theisen.  / Carol Han, USAID

From left to right: Health care workers Catherine Thomas, Micaela Theisen, and Rene Vega—all working at USAID-supported ETUs—have taken the U.S. Ebola health care worker training course. “The training was incredible and great for me because it alleviated my fears,” said Theisen. / Carol Han, USAID

 


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 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.

ABOUT THE AUTHOR

Carol Han is a Press Officer for the Ebola Disaster Assistance Response Team (DART), which oversees 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 (OFDA), the U.S. Centers for Disease Control and Prevention (CDC), and the Departments of Defense and Health and Human Services.

Invest in Health Workers to End AIDS

A nurse in the perinatology unit at the Jaime Moto Regional Hospital in Barahona attends to a newborn after receiving training in preventing mother to child transmission of HIV. The training was conducted through CapacityPlus, a USAID-funded project to strengthen the health work force in the Dominican Republic. / Wendy Tactuk, courtesy of CapacityPlus and IntraHealth International

A nurse in the perinatology unit at the Jaime Moto Regional Hospital in Barahona attends to a newborn after receiving training in preventing mother to child transmission of HIV. The training was conducted through CapacityPlus, a USAID-funded project to strengthen the health work force in the Dominican Republic. / Wendy Tactuk, courtesy of CapacityPlus and IntraHealth International

The recent focus on Ebola in West Africa has reminded us of the need for strong and resilient health systems. Behind every quality health system is an army of available and accessible health workers. However, in facilities and communities across the globe, health worker vacancies and weak support systems hamper achievement of health goals and threaten overall preparedness for future infectious diseases.

In most countries with a high HIV burden, health work force shortages are commonplace and create significant barriers to combating the epidemic.

Much has been accomplished. USAID is incredibly proud of its significant contributions to PEPFAR’s (the U.S. President’s Emergency Plan for AIDS Relief) achievements in strengthening the health work force to deliver quality HIV services. On World AIDS Day, Secretary Kerry announced that PEPFAR has exceeded the target of 140,000 new health care workers, which was mandated by Congress in 2008.  This is a great milestone not only for PEPFAR, but also for the broader global health work force agenda.

A strong health work force composed of both facility- and community-based workers is essential for achieving an AIDS-free generation. Health workers are key to making sure that people living with HIV access the appropriate services at the right time, ensuring effective linkages across HIV services and clients’ continuum of care. Health workers also play a critical role in providing HIV services to vulnerable populations, including children, adolescents and other key populations.

USAID has an extensive history in training and educating health workers. For the last decade, the Agency has been at the forefront of advocating for a growing focus on the health work force in the global health agenda. USAID has also supported a breadth of innovative program models that have made immense contributions to the health worker target.

A physician and nurse examine a young patient at a clinic in Mbarara, Uganda, one of 11 main service centers and clinics managed by The AIDS Support Organization (TASO), a large local NGO receiving USAID funding to provide care and support for orphans and vulnerable children. / USAID/Tash McCarroll

A physician and nurse examine a young patient at a clinic in Mbarara, Uganda, one of 11 main service centers and clinics managed by The AIDS Support Organization (TASO), a large local NGO receiving USAID funding to provide care and support for orphans and vulnerable children. / USAID, Tash McCarroll

For example, USAID and the Touch Foundation created a PEPFAR-supported public-private partnership in Tanzania to expand training of health workers and strengthen management capacities of the Catholic University of Health and Allied Sciences and Bugando Medical Center. Through this partnership, student enrollment has jumped from 277 students to over 1,800 across 14 different health worker cadres—a sixfold increase since 2004. Enrollment of medical students alone increased from 10 to 750 students over the last 10 years.

The program has also focused on strengthening deployment of graduates to underserved rural areas with the highest prevalence of infant and maternal mortality, HIV and malaria. With 96 percent of medical doctors trained in the program still employed in the Tanzanian health system, the program has become a model for achieving high graduate placement and retention rates.

However, there is still work to be done. Significant health work force shortages remain and systemic challenges continue to impact the support needed to enable and sustain health workers’ delivery of HIV services.

The new PEPFAR Human Resources for Health (HRH) strategy  highlights the need to overcome these barriers. USAID continues to contribute to PEPFAR’s health work force investments by building upon and leveraging past contributions and advancements that span beyond training and include health worker deployment, retention and management.

The strategy’s five objectives outline a common roadmap for ensuring adequate supply and quality of the health work force to expand and sustain HIV and AIDS services:

  1. Assess HRH capacity needs to deliver HIV/AIDS services.
  2. Support adequate supply and appropriate skills mix of health workers to deliver HIV/AIDS services.
  3. Establish recruitment, deployment and retention strategies to ensure a consistent and sustainable supply of trained health workers.
  4. Establish sustainable financing for health workers, which ensures adequate local financing for health workers that provide HIV/AIDS services and sustained capacity for sites where PEPFAR salary support has been transitioned.
  5. Improve health worker performance for service quality.

We often, and rightly so, think about our impact from the perspective of the clients we serve. But it is also important to see through the lens of the health workers who have devoted their lives to serving others and have worked tirelessly in mediocre conditions. What is preventing them from doing their jobs effectively? What additional support do they need? That perspective may help us get one step closer to achieving an AIDS-free generation.

ABOUT THE AUTHOR

Diana Frymus is the Health Systems Strengthening Advisor in the Office of HIV/AIDS

Disruptive Innovations Bringing Nepal Closer to Ending Extreme Poverty

Nurses apply chlorhexidine to the umbilical cord of a newborn at Nepalganj Medical College & Teaching Hospital. USAID is helping Nepal bring the life-saving antiseptic gel to villages, communities and health centers across the country. / Thomas Cristofoletti for USAID

Nurses apply chlorhexidine to the umbilical cord of a newborn at Nepalganj Medical College & Teaching Hospital. USAID is helping Nepal bring the life-saving antiseptic gel to villages, communities and health centers across the country. / Thomas Cristofoletti for USAID

In the maternity ward of a USAID-supported hospital in Dhulikhel, a town on the eastern rim of the Kathmandu Valley in Nepal, I watched a nurse apply a disinfectant gel to the umbilical cord of a newborn baby. That tube of the antiseptic chlorhexidine — worth under 15 cents — has been shown in a randomized control trial, to reduce neonatal mortality by a remarkable 34 percent in Nepal.

All around the country, more than 50,000 female community health volunteers  are sharing this innovation and saving thousands of lives in the process.

Thanks to simultaneous advances in health, education, nutrition and access to energy, Nepal stands at the edge of its prosperity. On the path to overcoming the remnants of internal conflict and transitioning to democracy, the Nepalese have cut extreme poverty by 50 percentage points in the last two decades.

Gita, a female community health worker, visits a pregnant woman and her family to show them how to use the chlorhexidine antiseptic gel and how to apply it to the umbilical cords of newborns.   / Thomas Cristofoletti for USAID

Gita, a female community health worker, visits a pregnant woman and her family to show them how to use the chlorhexidine antiseptic gel and how to apply it to the umbilical cords of newborns. / Thomas Cristofoletti for USAID

Innovative programming like chlorhexidine application is growing more common in Nepal and around the world. USAID is also supporting creative community-based approaches to countering human trafficking, including a novel effort to criminalize organ sales that has won landmark court cases, setting new precedent in Nepalese law for holding traffickers accountable.

Suaahara, a comprehensive nutrition program  that translates to “good nutrition,” teaches skills for nutrient-rich backyard vegetable farming, raising poultry, improving sanitation and hygiene, and controlling pests through demonstration farms and new mothers’ discussion groups.

A focused effort to improve early-grade reading is supporting the Ministry of Education’s School Sector Reform Plan by strengthening curricula and training teachers, school committee members, parents and technical support staff in more than 27,000 Early Childhood Education Development centers across the country. Just a 10 percent increase in the share of students with basic literacy skills can boost a country’s economic growth by 0.3 percentage points, while laying the foundation for their later learning.

We need these kinds of disruptive innovations to help bend the curve toward increased child survival, better access to justice, lower malnutrition, greater literacy and skills, and, ultimately, the end of extreme poverty. Solutions like these will drive broader development progress and elevate our efforts to realize transformative change, and now, 2015, is the time to do it.

This year will be a pivotal year for international development. In Addis Ababa this summer, leaders will come together at the third Financing for Development conference to agree on a new compact for global partnership.

In the fall at the U.N. General Assembly in New York, heads of states will ratify a post-2015 development agenda, a universal, more comprehensive, more ambitious follow-on to the Millennium Development Goals, outlining a vision for the next 15 years of development progress. And in Paris next December, member states will adopt a new agreement to combat global warming at the 21st Conference of Parties to the U.N. Framework Convention on Climate Change.

Substantial challenges lie ahead for Nepal. Tensions from the recent conflict remain, simmering below the surface. The government has set a January 2015 deadline to approve a constitution – after a failed attempt in 2012 – to be followed by local elections, which haven’t been held in 16 years. And a quarter of Nepal’s population still lives on less than $1.25 a day.

Based on current projections, Nepal is likely to eradicate extreme poverty before 2030. If Nepal can navigate the pitfalls ahead, it is well-positioned to see long-term, sustainable growth by developing its immense hydropower potential, exploiting its unparalleled tourist draw, and producing goods and services for the growing middle class on its doorstep – the belt from eastern Pakistan through northern India to Bangladesh that constitutes the most densely populated area on earth.

A worker for Lomus Pharmaceutical packs tubes of a chlorhexidine antiseptic gel that is one of Nepal’s great innovations and success stories in global health. The gel, when applied to the cut umbilical cord stumps of newborns, instead of traditional substances like oil, curry powder or ash, can reduce the risk of infant death by up to a third.  / Thomas Cristofoletti for USAID

A worker for Lomus Pharmaceutical packs tubes of a chlorhexidine antiseptic gel that is one of Nepal’s great innovations and success stories in global health. The gel, when applied to the cut umbilical cord stumps of newborns, instead of traditional substances like oil, curry powder or ash, can reduce the risk of infant death by up to a third. / Thomas Cristofoletti for USAID

While the solution to a vexing challenge like neonatal mortality may seem as simple as applying a bit of antiseptic ointment at the right time, this breakthrough came only after a dedicated and concerted effort to hammer away at the problem. USAID worked in partnership with academic researchers, government service providers, community extension workers, private-sector drug manufacturers and others to rigorously pilot, test and scale the Chlorhexidine project.

One particular obstacle, for instance, was that in much of Nepal mothers traditionally rub substances like cooking oil, ash, or even cow dung, on their babies’ umbilical stumps. For widespread adoption to be viable, USAID and its partners had to develop a gel that could be applied similarly to traditional salves, and spend as much effort on behavior change and institutional strengthening as on the technology.

By focusing our efforts on disruptive innovations such as Nepal’s successful chlorhexidine project and using the U.S. Global Development Lab to design, test and scale similar interventions around the world, USAID will help bend the curve towards the end of extreme poverty.

ABOUT THE AUTHOR

Alex Thier is the Assistant to the Administrator in the Bureau for Policy, Planning and Learning. He tweets from @Thieristan

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Saving Korto and Josephine

This post originally appeared December 31, 2014 on the International Medical Corps website. It has been reposted here with permission.

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Photo courtesy of International Medical Corps

Bong County, Liberia – Korto was admitted to International Medical Corps’ Ebola Treatment Unit (ETU) in late November, while her four-month old daughter Josephine, who tested negative for Ebola, was cared for nearby. Although deeply saddened by being separated from her young baby, Korto maintained such positivity during her treatment. The whole medical team couldn’t help but believe she was going to make it and see her daughter again.

On December 3, a delegation from the U.S. government was visiting the ETU. This happened to be the same day Korto finally received her negative Ebola test, clearing her for discharge. Korto left the patient ward giggling, laughing, and soaking in the cheers from the delegation and ETU staff, and she was finally reunited with Josephine that day.

Korto noticed late that evening that Josephine had diarrhea, as well as a cough and fever. The next morning, Korto was back at the ETU, and our whole team sighed with the saddest disappointment. Seeing mother and baby back in the patient ward was difficult, but our doctors, nurses, and psychosocial support staff encouraged Korto to keep breastfeeding, which provides the best source of nutrition for an infant.

For more than two weeks, Josephine’s condition fluctuated. She would become very sick one day, then a bit stronger the next day, and then very feverish the next. Because Josephine was so small, the only way to give her the additional fluids she needed was through an intravenous drip placed in a vein on her head. There were several days when we held our breath, hoping to see Josephine alive as we began each shift. Eventually she gained strength. Her eyes were no longer puffy and tired but became bright and attentive. She held her little head, now shaved for the IV, higher and higher each day.

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Photo courtesy of International Medical Corps

Finally on December 22, our colleague from the U.S. Navy lab, brought in to expedite Ebola testing in the area, could not hide the excitement in his voice when he relayed the news to the team. Josephine had tested negative for Ebola. Many tears of joy flowed from all of our staff and about everyone else who heard the news. Korto, of course, started dancing and clapping, smiling big with her grin we all love. And for the first time in weeks, Josephine let a small smile peek through.

We have all seen so much devastation working on this outbreak in West Africa. In our ETU, we’ve lost several young patients, but bright moments like seeing Korto and Josephine together and well spur our team to continue the fight against Ebola alongside our partners and the people of Liberia.

To date, International Medical Corps’ Ebola Treatment Unit in Bong County, Liberia, has discharged 74 survivors, including Korto and Josephine. International Medical Corps is operating an additional ETU in Margibi County, Liberia, and has trained over 150 health care and other workers in Liberia to date, including senior management and experts from the Liberian Ministry of Public Works, Ministry of Health and Social Welfare, and the Ministry of Defense. In addition, International Medical Corps teams are also working to fight Ebola in Sierra Leone and Mali.

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.


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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


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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


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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


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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


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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


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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


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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


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“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.

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