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Battling Ebola: How Tours into Guinea’s Hot Zone are Helping in the Fight

Harlan Hale has deployed to Guinea twice to serve on USAID’s Ebola Disaster Assistance Response Team. / Carol Han, USAID/OFDA.

Harlan Hale has deployed to Guinea twice to serve on USAID’s Ebola Disaster Assistance Response Team. / Carol Han, USAID/OFDA.

In Guinea, misinformation about Ebola abounds. Here, the disease has killed more than 2,300 people, and the streets are rife with rumors—of how Ebola is a hoax or a conspiracy to harvest organs. Some Guineans who have seen the ravages of Ebola firsthand believe that the very people coming to help them are actually spreading the disease.

After deploying two times to this West African country as a member of USAID’s Ebola Disaster Response Assistance Team, it became clear to me that community resistance is one of the biggest obstacles to stopping Ebola.

But one NGO is taking a novel approach to dispel these rumors. In the town of Forécariah—a two hour’s drive southeast of Guinea’s capital Conakry—the French Red Cross is running an Ebola treatment center in this hard-hit prefecture with the support of USAID’s Office of U.S. Foreign Disaster Assistance. While a team of health care workers is fighting for the lives of the sick, another group is fighting fears by inviting the community inside.

Tours into the Unknown

Anne-Flore Hivet heads the social mobilization team for the USAID-funded French Red Cross Ebola program in Forécariah. She is also the brainchild behind the idea of offering tours of the treatment facility so the public can actually see what the Red Cross is doing to care for patients.

Rumors keep people from going to Ebola treatment centers because some believe they do harm to the patients they’re supposed to heal. / Rachel Wood, CDC

Rumors keep people from going to Ebola treatment centers because some believe they do harm to the patients they’re supposed to heal. / Rachel Wood, CDC

“We conduct the tours like a museum visit,” Anne-Flore told me. “We stop at every important part of the facility and explain what happens at triage, for example. We demonstrate [how people put on] personal protective equipment. We show them the patient visiting area, the laundry area, and the incinerator where waste is burned.”

The tours have opened the eyes of both the people taking the tours and the French Red Cross staff giving them. Anne-Flore has a whole page of rumors her team has heard from the visitors, among them: that people are burned in the incinerators; hygienists are not disinfecting homes but spraying the Ebola virus; and that health care workers are taking the blood of sick people and storing them in the facility’s water tanks.

Anne-Flore Hivet leads social mobilization efforts for French Red Cross in Forécariah, Guinea and acts as a chief tour guide inside its Ebola treatment facility. / Carol Han, USAID/OFDA

Anne-Flore Hivet leads social mobilization efforts for French Red Cross in Forécariah, Guinea and acts as a chief tour guide inside its Ebola treatment facility. / Carol Han, USAID/OFDA

“They think we behead the sick, take their blood, and harvest their organs,” Anne-Flore explained.  “Fears run very deep in the culture.”

The tours have been slowly breaking down the walls of misinformation about the disease.

“To witness what is going on is powerful,” said Laurent Larose, who heads the French Red Cross project in Forécariah. “[The tours] changed the perceptions about the center…. They see that we work to help people.”

Growing Popularity

The French Red Cross has given tours to everyone from school groups to traditional healers who hold great power in the community, Since January 15, 2015, more than 800 people have visited the center–some have come more than once.

USAID is partnering with French Red Cross and Guinea Red Cross teams to treat Ebola patients and raise awareness about the disease. / Carol Han, USAID/OFDA

USAID is partnering with French Red Cross and Guinea Red Cross teams to treat Ebola patients and raise awareness about the disease. / Carol Han, USAID/OFDA

Yet with new Ebola cases emerging, everyone agrees that community engagement must be stepped up to stem the tide of the disease. Winning the trust of communities helps county health teams trace contacts and isolate the disease. In addition, it encourages the sick to seek treatment more quickly, reducing the risk of transmission to others.

The French Red Cross and Guinea Red Cross are among the many groups traveling from village to village to raise awareness about Ebola. They’re also explaining the importance of safe and dignified burials and helping survivors return home by breaking down stigmas. Some teams have been attacked for their work, but people tell me that attitudes are changing.

Members of the Guinea Red Cross say they’re thankful for USAID’s support to do outreach to communities and perform safe burials. / Carol Han, USAID/OFDA

Members of the Guinea Red Cross say they’re thankful for USAID’s support to do outreach to communities and perform safe burials. / Carol Han, USAID/OFDA

“It’s getting better now,” said Swaray Karamokobo, who leads the Guinea Red Cross safe burial team. “More people understand and they believe. They are no longer hiding cases. They are calling in and bringing out the sick.”

ABOUT THE AUTHORS

Harlan Hale is a regional advisor with USAID’s Office of U.S. Foreign Disaster Assistance and has served on the Ebola Disaster Assistance Response Team.

Ending the ‘Neglect’ in Neglected Tropical Diseases

Ghanaian school children stand in line waiting for their turn to get drugs that will protect them from several neglected tropical diseases, such as blinding onchocerciasis, during a mass drug administration supported by USAID. / FHI360

Ghanaian school children stand in line waiting for their turn to get drugs that will protect them from several neglected tropical diseases, such as blinding onchocerciasis, during a mass drug administration supported by USAID. / FHI360

“If you refuse to take the drug, you invite disease into the community. These drugs fight the  disease and stop blindness.” That’s what Madam Mary Becheyiri tells people in Asubende, Ghana, the village where she lives and works as a community drug distributor for the country’s Neglected Tropical Diseases Program.

The disease that Mary is referring to is onchocerciasis, also known as oncho or river blindness. Spread from person to person through contact with parasite-carrying flies, oncho causes people to lose their sight if left untreated. Yet, when a drug called ivermectin is periodically given to everyone in the community, people can be kept safe from the disease.

A national monitoring team meets during a field visit to a mass drug administration in Ghana. / FHI360

A national monitoring team meets during a field visit to a mass drug administration in Ghana. / FHI360

USAID’s Reach: More than One Billion Treatments

For almost a decade, USAID has supported the delivery of preventive drug treatments for neglected tropical diseases–also known as NTDs–to millions of people, working with programs such as the one in Ghana and others around the globe. These neglected diseases affect one-sixth of the world’s population–primarily the poor and those living in rural areas with no access to safe water, sanitation, and essential medicine.

USAID’s support allows 25 countries to implement programs through which multiple diseases can be simultaneously treated on a national scale, using drugs donated by pharmaceutical companies such as Johnson & Johnson, Pfizer, Merck and GlaxoSmithKline. The Agency’s neglected tropical diseases program is the largest public-private partnership in USAID’s 50-year history, having secured $8.8 billion in drug donations to date. We estimate that for every tax dollar spent by USAID, more than $26 in drugs is donated in-country.

Now that our neglected tropical diseases program has matured, we have recently expanded it to include two new components: support for programs addressing existing disabilities caused by these diseases–which lead to long-term suffering and trap individuals in poverty–and support for research to discover new drugs and accelerate progress toward disease elimination.

Volunteer community drug distributors stand proudly in front of a local health center in Sierra Leone. / Chad MacArthur

Volunteer community drug distributors stand proudly in front of a local health center in Sierra Leone. / Chad MacArthur

From Prevention to Elimination

USAID focuses on prevention of the seven most common neglected tropical diseases—river blindness, lymphatic filariasis (elephantiasis), schistosomiasis (snail fever), soil-transmitted helminthiasis (round worm, whipworm, and hookworm), and trachoma, and is working toward targets to control or eliminate them.

In the case of river blindness, the Agency aims to eradicate the disease in the Americas by 2016. We are close to achieving this goal. We helped Colombia in 2013 become the first country to obtain verification of oncho elimination from the World Health Organization, and now the only remaining area in Latin America where oncho is being transmitted is a hard-to-reach border area between Brazil and Venezuela.

Several other countries are also getting close to applying for certification of elimination of one or more neglected tropical diseases. The future holds much hope.

“Last Mile” Toward Control of Neglected Tropical Diseases

As countries get to the so-called “last mile” of disease elimination, surveillance will be critical to make sure no pockets of disease remain. USAID will continue to focus on activities associated with mass drug administration for disease prevention, including disease mapping and surveillance, drug distribution and training of health workers.

However, countries have a role to play. They need to invest domestic resources in ongoing surveillance and control of neglected tropical diseases. This is especially true for managing public health threats like snail fever and intestinal worms, which cannot be wiped out without strengthened water and sanitation infrastructure.

With the training provided with USAID support, committed community drug distributors like Mary Becheyiri are diligently educating and treating residents in even the most remote communities. As these dedicated people, drug companies and governments combine their efforts, hopes are high that soon diseases such as river blindness will be gone for good.

ABOUT THE AUTHORS

Rabab Pettitt is a Senior Communications Advisor at USAID’s Bureau for Global Health.
Katherine Sanchez is a Knowledge Manager for USAID’s END in Africa Project, managed by FHI360, which works toward NTD control and elimination in Burkina Faso, Ghana, Niger, Sierra Leone and Togo.

Working to Beat Ebola Along the Border

Border crossings like this one at Bo Waterside in Liberia were closed for six months due to the Ebola outbreak. / Carol Han, USAID/OFDA

Border crossings like this one at Bo Waterside in Liberia were closed for six months due to the Ebola outbreak. / Carol Han, USAID/OFDA

Liberia’s main border crossings officially opened February 22, bringing to an end six months of prohibited international foot and vehicle traffic put in place by the Ebola crisis. But the actual opening of the borders did not happen as one would have expected.

At Bo Waterside—a small town on the Liberia side of the Mano River which divides Liberia and Sierra Leone—people didn’t see or hear trucks and taxis sputtering legally across the border for the first time since August. Instead, sounds of hammering rang through the air.

Migrant workers, farmers, and fruit sellers like this little boy use the borders every day to make a living. When the borders closed, business suffered. / Carol Han, USAID/OFDA

Migrant workers, farmers and fruit sellers like this boy use the borders every day to make a living. When the borders closed, businesses suffered. / Carol Han, USAID/OFDA

It turned out that Sierra Leone had yet to declare its side of the border open. While immigration officials waited for the official word, an NGO called Global Communities—with support from USAID’s Office of U.S. Foreign Disaster Assistance—was hard at work building Ebola screening and triage stations to ensure travelers from both sides of the border would be effectively monitored for Ebola symptoms. Local officials approved of the new measures.

“We expect an influx of people,” said Charles Brooks, a security commander at Bo Waterside. “It’s safer [this] way. We need to take preventative health measures and have a more secure border.”

The USAID-supported NGO Global Communities is beefing up Ebola preparedness at the border by building screening and triage stations. / Carol Han, USAID/OFDA

USAID supported Global Communities to beef up Ebola preparedness at the border by building screening and triage stations. / Carol Han, USAID/OFDA

Because merchants, farmers and migrant workers routinely cross borders to make their living, the prevention of cross-border Ebola transmission has become a priority for affected governments and communities, as well as for response organizations.

At the Bo Waterside border crossing, Global Communities is beefing up preparedness at border checkpoints with hand washing stations, a temperature screening booth, and holding rooms for suspected cases. The screening and triage stations also have a disinfection team on hand and an ambulance on call to transport potential Ebola patients. The triage and screening stations are being run by another USAID partner, the International Organization for Migration (IOM).

MEET THE TEAM: USAID also partnered with IOM to run the screening and triage stations along the Liberia-Sierra Leone border. / Carol Han, USAID/OFDA

MEET THE TEAM: USAID also partnered with IOM to run the screening and triage stations along the Liberia-Sierra Leone border. / Carol Han, USAID/OFDA

“Once we get to zero cases in Liberia, Sierra Leone or Guinea, borders will be the key to maintaining zero in the region,” said Doug Mercado, leader of USAID’s Ebola Disaster Assistance Response Team. “That’s why the work we are doing here is so critical.”

Global Communities is also working closely with traditional leaders and local health officials to track the movement of people using informal border crossings, especially in far-flung communities. In addition, the organization is trying to foster coordination and information sharing on multiple levels.

TEST RUN: Hygienist Mustapha Wiles with IOM tests out a disinfectant sprayer on Global Communities Contact Tracing Coordinator Abbiseh Pitte in preparation for the border opening. / Alice Urban, Global Communities

TEST RUN: Hygienist Mustapha Wiles with IOM tests out a disinfectant sprayer on Global Communities Contact Tracing Coordinator Abbiseh Pitte in preparation for the border opening. / Alice Urban, Global Communities

“We are not only partnering with Liberia’s immigration service to support official border crossing points, but we are also working at the community level to support surveillance and coordination where people cross informally,” said Global Communities Program Manager Michael Fogbawa.

A Liberian man waits with a shipment of water sacks on the Mano River Bridge. With the borders closed back in February, he was unable to take his truck across to Sierra Leone. / Alice Urban, Global Communities

A Liberian man waits with a shipment of water sacks on the Mano River Bridge. With the borders closed back in February, he was unable to take his truck across to Sierra Leone. / Alice Urban, Global Communities

When the borders finally opened at Bo Waterside, Musa Kamera was pleased to see activity once again in the tiny town. With a shop a few hundred yards from the Mano River Bridge, she sells popcorn balls, pasta, rice and other snacks. The sound of the cars and trucks now crossing the bridge means more income for her and her family.

“Business has been bad with the border closed,” she said. “I am happy the border [is] open.”

ABOUT THE AUTHOR

Alice Urban is a communications and reporting officer with Global Communities.

How Guinea’s Journalists are Fighting to Win the War Against Ebola

Before coming to USAID’s Office of U.S. Foreign Disaster Assistance, I worked as a TV news correspondent for more than 12 years. I covered everything from school shootings to presidential inaugurations and worked alongside some pretty incredible journalists.

But, while serving on the Ebola Disaster Assistance Response Team (DART) in Guinea, I met a group of local reporters who, with help from USAID, is taking dedication to news reporting to a whole new level. Here are three reasons why they are so amazing.

Meet the Ebola Chrono news team! Their radio show is breaking new ground as they were the first Guinean journalists to report from inside an Ebola treatment center. / Internews

Meet the Ebola Chrono news team! Their radio show is breaking new ground as they were the first Guinean journalists to report from inside an Ebola treatment center. / Internews

1. They are Breaking New Ground

Since January 2015, USAID has been partnering with a non-governmental organization called Internews to work with journalists in Guinea to produce a news magazine show called Ebola Chrono. Televisions are scarce, so radio is the best source of news here. Ebola Chrono is broadcast in French by 56 radio stations across the country.

In Guinea, where Ebola rumors abound and suspicions about the response are the talk of the street, the eight-member Ebola Chrono news team wants to set the record straight. The team’s mission aligns with one of USAID’s main priorities in the Ebola response: strengthening the communication of information about the outbreak.

According to Pierre Mignault, a veteran journalist now working with the team, Ebola Chrono is the first news program of its kind to hit the airwaves in Guinea.

“What was missing here was solid, factual information about the response,” Mignault explained. “We came in with a concept that didn’t exist before.”

Five days a week, the news team produces in-depth stories about the Ebola response, covering topics such as vaccine trials, community resistance and Ebola containment efforts along the border. Reporters routinely hit the road to pursue leads and get interviews from people affected by the disease. The goal of the show is to bridge the information gap and present Guineans with reliable stories in a way that speaks to them.

“I don’t see what I do as just a job,” News Director Afiwa Mata Ahouadjogbe told me. “Everyone is concerned about Ebola. If I can contribute to help people, to empower people to get rid of Ebola, then it’s my duty to do it.”

2. They are Venturing into Unchartered Territory

In Guinea—and in the rest of the world, for that matter—fear of Ebola runs rampant. Many Guineans believe the disease is part of a wider conspiracy to kill unsuspecting citizens and harvest their organs. Ebola Treatment Centers, or ETUs, are rumored to be the place where such alleged atrocities take place.

Enter Asmaou Diallo who is among that special breed of reporters who go the extra mile to get the story, even if it means possibly putting herself in harm’s way. When Asmaou and her team reported from inside Donka—one of Conakry’s busiest ETUs—people tuned in.

Reporter Asmaou Diallo goes the extra mile to get the story. After she filed in-depth reports from inside an Ebola treatment unit, other reporters followed her lead. / Carol Han, USAID/OFDA

Reporter Asmaou Diallo goes the extra mile to get the story. After she filed in-depth reports from inside an Ebola treatment unit, other reporters followed her lead. / Carol Han, USAID/OFDA

“That was revolutionary because nobody had ever been in the center. No one would go into a place like that,” said Diallo. “But we wanted people to have confidence in the system.”

Diallo and her team produced a three-day series that gave a step-by-step, first-hand account of everything that goes on inside an Ebola treatment center, from triage to treatment and beyond. The team also covered what happens to those who die, explained the process of safe and dignified burials, and interviewed Ebola survivors and family members of the sick.

Ebola Chrono reporter Asmaou Diallo interviews a health care worker from inside the Donka Ebola treatment center in Conakry. / Internews

Ebola Chrono reporter Asmaou Diallo interviews a health care worker from inside the Donka Ebola treatment center in Conakry. / Internews

But just as compelling as her reports was the fact that Diallo entered an Ebola clinic and came out alive. This not only raised eyebrows, it also raised the bar for reporting as other reporters soon followed her lead.

“A lot of things have changed,” Diallo explained to me. “We went to Donka, and we deconstructed the rumors around the centers. Other reporters are now doing the same thing. The impact is that more people know what is happening inside, and now more people go to the centers to get treated.”

3. They are Making an Impact

Many members of the Ebola Chrono news team were local radio reporters prior to being selected to take part in the USAID-funded program. But they tell me their mentor Mignault is helping them to become stronger journalists.

During the morning editorial meeting, reporter Mohamed Komah talks about the story he’s working on.  Pierre Mignault with Internews (left) says this is the best team he’s worked with. / Carol Han, USAID/OFDA

During the morning editorial meeting, reporter Mohamed Komah talks about the story he’s working on. Pierre Mignault with Internews (left) says this is the best team he’s worked with. / Carol Han, USAID/OFDA

“I learned ways to strengthen my reporting, like how to use interviews and ambient sound to make stories come alive,” said Diallo. “I also learned the importance of going out to gather content and verifying the information I receive.”

When I asked Mignault whether all this hard work is paying off, he told me there’s a growing appetite in Guinea for solid news reporting. Case in point: some radio stations are airing Ebola Chrono more than once a day. Others are broadcasting the program during primetime slots. And more listeners have been texting or calling in questions about the stories they hear.

Announcer Amadou Korkabah (right) and chief technician Kone Mamadou do a sound check inside a homemade studio built by Mamadou. / Carol Han, USAID/OFDA

Announcer Amadou Korkabah (right) and chief technician Kone Mamadou do a sound check inside a homemade studio built by Mamadou. / Carol Han, USAID/OFDA

“As far as I’m concerned, this is the best team I’ve worked with,” said Mignault. “They’re very strong, dedicated. They believe they have a rendezvous with history. They know they can make a difference.”

ABOUT THE AUTHOR

Carol Han is the Strategic Communications Team Leader with USAID’s Office of U.S. Foreign Disaster Assistance.

Moving Beyond Ebola: Rebuilding Liberia’s Health Care System

A Liberian nurse prepares to go inside an Ebola patient ward to draw blood from confirmed patients for testing in Bong County last October. / Morgana Wingard, USAID

A Liberian nurse prepares to go inside an Ebola patient ward to draw blood from confirmed patients for testing in Bong County last October. / Morgana Wingard, USAID

In early March, global health leaders cheered as Liberia announced it had zero cases of Ebola. After weeks with no new cases, however, the Liberian government confirmed on March 20 that a patient had tested positive for the disease.

With the ongoing possibility of future Ebola cases, now is the time to build momentum toward a stronger Liberian health system that can stop the disease in its tracks before it turns into another large-scale outbreak. That’s where frontline Liberian health care workers Dorbor Dennis and Richard Mulbah come into the picture.

Over five days in February, Richard and Dorbor were trained to become experts in the critical skills in infection prevention and control (IPC) that all Ebola-fighting health care workers need to stay safe while preventing future epidemics. The curriculum included instruction on how to correctly use personal protective equipment (PPE), such as suits, masks and gloves.

USAID is teaming up with Jhpiego, a nonprofit organization affiliated with Johns Hopkins University, to teach critical infection prevention and control procedures to Liberian health care workers. / Kelly Dale, Jhpiego

USAID is teaming up with Jhpiego, a nonprofit organization affiliated with Johns Hopkins University, to teach critical infection prevention and control procedures to Liberian health care workers. / Kelly Dale, Jhpiego

They, along with 19 colleagues, will take what they learned in Monrovia back to eight counties in Liberia to conduct their own trainings for county and district health teams. In turn, those trained will work together to conduct refresher trainings at county facilities and provide guidance and mentorship—all to make sure lessons learned are being practiced on a day-to-day basis.

Marie, a training participant, learns how to put on personal protective equipment during a practice session. / Kelly Dale, Jhpiego

Marie, a training participant, learns how to put on personal protective equipment during a practice session. / Kelly Dale, Jhpiego

Think of it as a multiplier effect to make sure as many health care workers as possible get and maintain the skills needed to keep patients, and themselves, alive. The program aims to boost the IPC skills of more than 3,200 health care workers from hundreds of Liberian health care facilities.

Dorbor knows firsthand how such skills can save a life. He cared for a dozen fellow health care workers who had been infected with Ebola — and then he looked after their patients, too.

“I only had informal training in wearing and removing PPE, and no buddy to assist me, no one to disinfect me,”  Dorbor recalled. But he knew the importance of his work and the value of keeping himself safe.

“Today I ask myself, ‘why was I not infected?’” he said. “Because I carefully followed all of the IPC procedures I knew. I only wish these procedures were institutionalized in the health care delivery system of Liberia and her neighbors.”

Richard watched four nurses, including his own brother, die from Ebola. Then, the unthinkable happened—his wife became sick, too.

Health care worker Richard Mulbah gets his graduation certificate after completing the USAID-funded training. / Chandrakant Ruparelia, Jhpiego

Health care worker Richard Mulbah gets his graduation certificate after completing the USAID-funded training. / Chandrakant Ruparelia, Jhpiego

“Fortunately, my wife recovered,” Richard said. “But it is because of these experiences that I have taken an interest in advocating for proper IPC practices in health facilities in Liberia.”

The IPC training is part of a program funded by USAID’s Office of U.S. Foreign Disaster Assistance and led by Jhpiego—an international health nonprofit organization affiliated with Johns Hopkins University. Besides teaching correct use of PPE, the curriculum includes instruction on proper hand washing, disease screening, triage and isolation techniques and safe and dignified burial practices.

Trainees break into small groups to learn about proper infection prevention and control. / Kelly Dale, Jhpiego

Trainees break into small groups to learn about proper infection prevention and control. / Kelly Dale, Jhpiego

A health system is only as strong as its workers. Richard and Dorbor, alongside the county and district health teams supported by Jhpiego and USAID, represent substantial momentum toward a stronger and better-prepared health system in Liberia.

ABOUT THE AUTHOR

Kelly Dale is a Senior Program Coordinator with Jhpiego, a nonprofit organization associated with Johns Hopkins University that USAID is partnering with for the West Africa Ebola response.

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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