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At the Heart of Ebola — Health Systems That Need Strengthening

A man at Texas Health Presbyterian Hospital in Dallas tested positive for Ebola September 30th, the first case of the disease to be diagnosed in the United States. According to many experts, it was only a matter of time.

Health officials in the U.S. have been preparing since summer in case an individual traveler arrived here unknowingly infected. With stringent isolation protocols in place, infection-control steps to prevent the virus from spreading in health facilities, and efforts to trace people who have had close personal contact with the ill person, the director of the Centers for Disease Control and Prevention (CDC), Dr. Tom Frieden, was confident addressing media, saying “I have no doubt that we will contain this.”

But in West Africa, the Ebola epidemic is a sobering reminder of the lethal consequences of limited infectious disease surveillance and response capacities, and the vast development needs that persist in some of the region’s poorest countries despite rapid economic growth and investment.

At the heart of the Ebola epidemic sweeping across Africa, is a matter of health systems.

Health workers in personal protective equipment (PPE) wait to enter the hot zone at Island Clinic / Morgana Wingard

Health workers in personal protective equipment (PPE) wait to enter the hot zone at Island Clinic / Morgana Wingard

Much like cholera preys on weak water systems after a disaster, Ebola is preying on a weak public health system after years of conflict and upheaval in Liberia. And health system perfor­mance in many partner countries is challenged by critical health worker shortages, inadequate financing, poor or disjointed information systems, lack of essential information on public health threats, and inexperienced leadership.

Countries that already have limited ability to provide health care for their citizens can ill-afford to lose health care workers to sickness and death, close health facilities, or redirect resources for other development priorities to battle this epidemic.

As Ebola spreads, citizens are impacted not just by the virus itself, but also by the loss of other critically needed services. As hospitals and clinics become overwhelmed by the epidemic, they are unable to provide necessary maternal and child care and life-saving treatment for malaria, tuberculosis and other diseases.

Dr. Ariel Pablos-Mendez, USAID’s Assistant Administrator for Global Health, said, “The state of the health workforce and health systems has hampered the ability of these countries to respond to the Ebola epidemic – but these countries are hardly alone in having inadequate training, support and numbers of health workers.”

Zaira Alonso, a finance and administration director for USAID’s Rebuilding Basic Health Services project in Liberia implemented by John Snow International, paints a bleak picture. “The entire Liberian landscape has changed dramatically in just a matter of weeks. Many government ministries are practically empty, as non-essential staff were placed on 30 days compulsory leave. Roads are empty, as many Liberians are staying at home to remain safe, and a large part of the expatriate community has left the country. Most people are just simply scared.”

The U.S. Government, including USAID and Centers for Disease Control and Prevention, the World Health Organization, and others are using a broad disaster management approach to contain the epidemic. Since the spring of 2014, the United States has been providing health equipment and emergency supplies, training and supporting health care workers on infection control and case management, supporting public outreach campaigns and helping build the capacity of local health care and emergency response systems.

As part of the overall U.S. Government response effort, the United States recently provided support to the African Union’s urgent deployment of trained and equipped medical workers to West Africa to help combat the Ebola epidemic. This support is helping transport doctors, nurses and other essential personnel to manage and run Ebola treatment units that isolate and treat those affected by the disease, helping minimize the spread of Ebola. It will also provide urgent emergency supplies and health equipment to help these medical workers respond.

A health care worker checks on patients admitted to the Ebola Treatment Unit in Island Clinic. / Morgana Wingard

A health care worker checks on patients admitted to the Ebola Treatment Unit in Island Clinic. / Morgana Wingard


And President Obama earlier this month announced a major surge in U.S. assistance in West Africa to help recruit, organize and train new health care workers and build treatment clinics.

Adding qualified and trained health workers will make a big difference. Guinea, Liberia and Sierra Leone are among 83 countries worldwide that the WHO last year reported to have below the minimum ratio of doctors, nurses and midwives (22.8 per 10,000 people) needed to provide basic health services to a population. WHO and the Global Health Workforce Alliance estimate at least 7.2 million doctors, nurses and midwives are currently needed globally – a gap that could creep to nearly 13 million by 2035 if we keep with the status quo.

Dr. Larry Barat, senior advisor with the U.S. President’s Malaria Initiative said one distinguishing factor of countries in Africa that have controlled malaria from those who still struggle to do so is the functionality of their health systems and their skilled human capacity. “Countries like Rwanda, Senegal, Ethiopia and Zambia have successfully reduced malaria burden, in part, because their health systems are able to deliver essential commodities to all parts of their countries, and people can access health services, with trained personnel.”

Haja Wurie, of COMHAS and the ReBUILD Consortium in Sierra Leone, where she has been working on health systems research, painted a vivid picture of a health system already weakened by years of war. Ebola first hit isolated, remote communities with limited access to health services. Their reliance on traditional healers and informal providers of health care may have exacerbated the spread of the illness. “Health staff face a very uncertain future as they bravely respond to Ebola,” she said. “They have inadequate supplies of the commodities they need to protect themselves. Many have watched their colleagues succumb to the illness die. They need urgent support and solidarity from the international community to motivate and incentivise them to face the tough times ahead.”

The Ebola epidemic reminds us that our global efforts to build the capacity to prevent, detect, and rapidly respond to infectious disease threats like Ebola have never been more vital. If we use all of our might to ramp up the response to Ebola while also investing in strengthening critical health care systems (including the components that prevent, detect, and respond to infectious diseases), we can help bring the current epidemic under control and reduce the possibility of future outbreaks.

ABOUT THE AUTHOR

Chris Thomas is a Communications Advisor in the Bureau for Global Health providing strategic counsel to political and civilian leadership and technical staff on matters of public interest.

Standing with Liberia to Reverse Ebola’s ‘Spillover’ Effects

 With funding and support from USAID construction crews work quickly to build a new Ebola Treatment Unit in Monrovia in front of the former Ministry of Defence Building. / Morgana Wingard

With funding and support from USAID construction crews work quickly to build a new Ebola Treatment Unit in Monrovia in front of the former Ministry of Defence Building. / Morgana Wingard

The Ebola Virus Disease, and the pressing need for rapid containment over the next 3 to 9 months, presents the global community with a formidable challenge. More than 7,000 cases have already been confirmed in Guinea, Liberia and Sierra Leone (the three core countries of the epidemic), and more than 3,300 people have already died. The epidemic is strengthening, but so too is the international response.

Ebola threatens not only lives, but livelihoods. The main driver of economic impacts is not the loss of labor to sickness and death, or even the major diversion of resources into health care, but rather the much broader spillover effects from peoples’ fear of contagion.

Isolation of infected persons is critical to controlling transmission, and wider restrictions including land border closings and partial community quarantines can interrupt economic activity on a temporary basis. But in an atmosphere of uncertainty about personal and business risks, activity can decline across the entire economy. Self-protective aversion behavior shuts down businesses, disrupts transportation and agriculture, and sidelines employment-creating investment plans – all of which drives down peoples’ livelihoods by undermining a country’s production and trade.

Liberia, where the outbreak is worst, has been rebuilding its economy since emerging from a long civil war in 2003. While economic growth has been strong in recent years, the country remains one of the poorest in Africa, with a per capita income of only $440 dollars and nearly 60 percent of the population below the poverty line. Liberia remains both institutionally weak and aid dependent, so a swift international policy reaction to this epidemic is crucial.

Food prices have recently begun to rise sharply in urban areas in Liberia, reflecting slowdowns in container shipping and uncertainty about future supplies. Regional trade has been reduced by land border closings. Internal transport has slowed down, reflecting official and unofficial restrictions on movement and higher fuel costs. The expatriate economy – with its incomes and expertise – has thinned out.  Some urban enterprises are shedding workers as many government contracts are being cut back, or put on hold.

The World Bank’s latest estimate of economic losses for 2014, in the three core countries, is $359 million. Under a rapid containment scenario, losses in 2015 are projected to be roughly $100 million, with the bulk of these in Liberia where per-capita incomes are not expected to begin rising again until 2016. Left unchecked, however, this epidemic could grow exponentially and drive up both human and financial costs by as much as 8 to 10 fold.  So the international community needs to act quickly and decisively, along a number of fronts.

Simply put, an Ebola epidemic that is not effectively contained and mitigated could reverse years of development progress for the affected countries, with harsh negative impacts on some of the world’s most vulnerable communities. Failure to contain would also increase the risk of outbreaks in neighboring countries, driving economic losses into the tens of billions of dollars.

 Washing is a vital part of the operation of the Ebola Treatment Unit at Island Clinic in Monrovia. All scrubs worn under PPEs and shoes must be washed thoroughly in chlorine water and then with soap. / Morgana Wingard

Washing is a vital part of the operation of the Ebola Treatment Unit at Island Clinic in Monrovia. All scrubs worn under PPEs and shoes must be washed thoroughly in chlorine water and then with soap. / Morgana Wingard

This epidemic calls for concerted international response including health workers, new treatment facilities, and medical supplies to the health sectors of the core countries, food security assistance to stressed and especially isolated and quarantined areas, and preparedness training for health systems in neighboring countries.

The United States, along with our international partners, is stepping up to this challenge. With Liberian clinics overwhelmed with new patients, we are providing 2,000 new beds, 130,000 sets of personal protective equipment, and 50,000 hygiene kits, along with plans to rapidly construct new health clinics.  To prevent further infections within Liberia, the USG and its partners will also provide 400,000 protection kits to reduce transmission in community settings.

To help offset declining government revenues and skyrocketing health costs, we are providing base salary support for civil servants in Liberia’s Ministry of Health, and working closely with the World Food Program to provide emergency food supplies to 1.3 million people across the region, including Ebola patients and communities under quarantine.

We’re also working closely with President Ellen Johnson Sirleaf to intensify our response across a broad range of areas, including supporting the country’s health system so that the focus on Ebola does not come at the expense of providing care to pregnant mothers or newborn infants.

Additionally, we’re working with the Government of Liberia and partners to mitigate the economic impacts of the crisis outside of the health system. This includes the crucial area of public messaging about the safe resumption of normal economic activities.

We’ve seen outstanding teamwork across our Agency, the U.S. Government, and our Disaster Assistance Response Team on the ground in Liberia, Guinea, and Sierra Leone—but we cannot win this fight alone.

We need qualified health care workers—nurses, doctors, and physician assistants—who could be a part of this historic response. We’re encouraging them to register at www.usaid.gov/ebola, and we’ll put them in touch with a network of organizations that are standing by to train volunteers. We’re also identifying care and evacuation procedures to support these professionals in their heroic humanitarian work.
With the same creativity and rigorous efficiency that we have applied to previous disasters, we can—and will—stop this epidemic. By working together with our partners from government, business, civil society, and the military, we can lay the groundwork for a brighter future in vulnerable communities grappling with Ebola’s devastation.

Stephen O’Connell

ABOUT THE AUTHOR

Stephen O’Connell is USAID’s Chief Economist. He guides the Agency on economics-based decision making and provides expert advice to Agency leadership and staff in the field of economic growth.

Andrew Hill: “There’s no standard blueprint for an Ebola treatment unit.”

Morgana Wingard This is the second blog in our Profiles in Courage series in which we’ve teamed up with photojournalist Morgana Wingard, who is on the ground with USAID staff in Liberia documenting the fight on Ebola. This series will record the experiences of our Disaster Assistance Response Team staff on the front lines of the Ebola response – from the security officers, to public health experts, to information specialists – and offer their reflections on this historic health crisis.
Andrew Hill

Andrew Hill
U.S. Army Civil Engineer

The buzzwords here in Monrovia are “unprecedented” and “exponential.” Everything about the Ebola epidemic in West Africa is unprecedented as it spreads exponentially.

U.S. Army civil engineer Andrew Hill is part of the USAID-led Disaster Assistance Response Team (DART) tasked with implementing an unprecedented response to the Ebola crisis.

An essential part of that response is constructing and staffing new treatment facilities that can isolate and care for the growing number of people infected with the virus.

On the ground in Liberia, one of the first tasks by Andrew and the U.S. military engineers was to conceptualize and design an ETU. Working hand-in-hand with members of the Armed Forces of Liberia (AFL), they consulted the experts with a gold standard ETU model: Médecins Sans Frontières (MSF) and the World Health Organization (WHO). Building off of their expertise, they tailored the designs to create Department of Defense and AFL-specific versions, which could be built and implemented with their resources.

The plans started with a hand-drawn sketch that Andrew created while driving in a car on his way to various sites. That sketch formed the basis for what would become a full concept and material list needed to begin ETU construction.

Photo of Andrew Hill sketching

Photo of Andrew Hill sketching

The U.S. Army Africa engineers, led by Lieutenant Colonel Scott Sendmeyer, pooled their collective professional engineering knowledge and tools in order to continue developing and finalizing the design, and to determine the remaining requirements needed for implementation.

The first site to use the design is scheduled to begin construction imminently — and this model will be replicated and constructed across Liberia by a team of 150 AFL engineers to help save lives and stop the spread of Ebola.

(All photos by Morgana Wingard)

ABOUT THE AUTHOR

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

Facing Death, Six Days a Week

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

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

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

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

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

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

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

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


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

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


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

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

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

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

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

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


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

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


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

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


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

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


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


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

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

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


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

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


(All photos by Morgana Wingard)

ABOUT THE AUTHOR

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

A Grand Challenge to Help Health Care Workers Fight Ebola

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

ABOUT THE AUTHOR

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

Five Promising Innovations in Contraception

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

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

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

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

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

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

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

SILCs Diaphragm. / Credit: PATH/Mike Wang

SILCs Diaphragm. / Credit: PATH/Mike Wang

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

Sayana Press. / Credit: PATH/Patrick McKern

Sayana Press. / Credit: PATH/Patrick McKern

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

Woman's Condom. / PATH

Woman’s Condom. / PATH

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

NES/EE vaginal ring. / Julie Sitney

NES/EE vaginal ring. / Julie Sitney

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

CycleTel. / Institute for Reproductive Health, Georgetown University

CycleTel. / Institute for Reproductive Health, Georgetown University

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

ABOUT THE AUTHOR

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

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

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

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

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

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

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

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

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

ABOUT THE AUTHOR

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

Powering The Ebola Response: Monrovia’s Island Clinic

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

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

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

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

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

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

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

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

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

The entrance for health care workers going into Island Clinic

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


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

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


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

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


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

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


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

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

(All photos by Morgana Wingard)


ABOUT THE AUTHOR

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

An Unprecedented Response to the Ebola Crisis

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

ABOUT THE AUTHOR

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

5 Things You Didn’t Know About Female Condoms

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

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

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

FC2 Female Condom Packaging

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

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

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

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

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

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

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

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

ABOUT THE AUTHOR

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

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