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Temperature Check: Border Screening of Travelers Key to Stopping Ebola from Spreading

Posted by  on Friday, September 14th 2018     
A person wearing a protection suit

A health worker dons personal protective equipment. / Alma Golden, USAID

With confirmation of the Democratic Republic of Congo’s 10th outbreak of the Ebola virus in North Kivu and Ituri provinces, health officials have focused on border screening as a method to identify travelers who could pose a danger to local communities.

Recently, I traveled to the border between the DRC and Uganda with U.S. Centers for Disease Control and Prevention (CDC) Director Dr. Robert Redfield and U.S. Ambassador to Uganda Deborah Malac to see border health screening and surveillance efforts at two key checkpoints.

The border between Uganda and DRC is porous. Several times a week, small-scale traders, mostly women, ferry goods and food across the border by bicycle, cart or on their heads. In addition to traders, local farmers, merchants, business people and refugees move through the area.

At Busunga, a border crossing in western Uganda, the shallow Lamia River acts as a physical barrier between the two countries. People wade across the river by foot, while others do laundry, wash their motorbikes and take baths in the river that flows from the nearby Rwenzori Mountain Range. On market days there, Wednesdays in Uganda, almost 500 people are screened for Ebola.

A woman in a red medical vest greets USAID officials

USAID Senior Deputy Assistant Administrator for Global Health Alma Golden receives information about Ebola at a border crossing between the Democratic Republic of Congo and Uganda. / Courtesy Photo

There are another 16 informal crossing points nearby. At the busiest border crossing point, Mpwonde to the south, more than 12,500 travelers pass through each day. And on Tuesdays and Fridays, which are market days at Mpwonde, there can be a fivefold increase in travelers and shoppers.

Early identification, confirmation and isolation of possible Ebola cases is critical for stopping the outbreak as early as possible. Ugandan Red Cross Society volunteers are screening travelers at all border crossings. Volunteers have been trained on the signs and symptoms of Ebola and are equipped with tools for screening.

Health screening procedures include hand washing with chlorinated water and soap, and a temperature check of travelers using a thermoscan thermometer that can detect a fever in seconds. Those who are screened are given simple, illustrated brochures that provide information about the symptoms of Ebola and how to prevent the spread of the virus.

People with Ebola can have symptoms similar to those with malaria and other endemic infectious diseases, including typhoid and Rift Valley fever. Ebola spreads from an infected sick person to others when there is direct contact with bodily fluids.

Travelers suspected to have Ebola symptoms are referred to Bwera hospital for further assessment; ambulances are available to transport individuals with symptoms to an isolation unit until tests are completed. Health workers have been given protective gloves, gowns, masks and other equipment provided by WHO to reduce the chances of contact with the Ebola virus.

Border screening is just one important element of the complex response to this crisis.

In Uganda’s neighbor, the Democratic Republic of the Congo, the U.S. Government, through USAID, is supporting core interventions to control the spread of Ebola, including: disease surveillance, contact-tracing, triage and isolation, and case management in Ebola treatment units; the prevention and control of infection; diagnostic laboratory support; community engagement; risk communication; interventions in water, sanitation and hygiene; and safe and dignified burial activities.

In DRC, through trusted messengers, community leaders and radio, communities are quickly learning how to protect themselves by learning the basics of the disease, how it is transmitted and what they can do to prevent it, care for and transport the sick, and to safely bury the dead. A targeted vaccination campaign is underway and is initially following a ring vaccination protocol: vaccines are being given to frontline health-care workers and response teams, contacts of confirmed cases, and contacts of those contacts.

The U.S. Government is also providing expertise and supplies. CDC and USAID have deployed over a dozen technical experts to the region in support the response. And USAID supported the World Health Organization (WHO) to send 20,000 personal protection equipment kits (including full body coveralls, heavy duty gloves, and goggles) and 50,000 universal care kits (surgical masks, face shields and gloves, and disinfection materials) to support response efforts in the DRC provinces affected by Ebola.

The Congolese and Ugandans have demonstrated a strong capacity to manage outbreaks. However, never before has Ebola struck in an area quite like this one. The region suffers from chronic insecurity due to local militia groups, and is under a long-term humanitarian crisis, which limits international and national responders from fully deploying disease control measures.

USAID has a long history of engagement in the health sector in the DRC, having worked to improve maternal and child health, immunizations, HIV diagnosis and treatment, and the prevention and management of malaria and tuberculosis.

Map of ebola cases in Democratic Republic of Congo

Map shows the Ebola outbreak in the Democratic Republic of the Congo as of Sept. 5, 2018. Latest figures from the World Health Organization indicate deaths have risen to 92, and confirmed or probable cases are now at 137.

The clinics, health workers, laboratories and health systems supported through USAID funding in both Uganda and the DRC provide the backbone of the response to the current outbreak. The DRC national laboratory, with supports from USAID and other donors, rapidly sequenced the virus, and provided critical laboratory capacity in the field to diagnose the disease at the site of the outbreak. The Ministry of Health is providing essential leadership, coordinating the response in the provinces and nationally.

My visit to the DRC and Uganda was enlightening. I am impressed by the dedication, determination and skill of our partners in the ministries of health and the countless epidemiologists, clinicians, logisticians, social mobilizers, vaccinators and volunteers working to stop the outbreak.

ABOUT THE AUTHOR

Alma Golden is Senior Deputy Assistant Administrator for Global Health at USAID.

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Ebola Aftermath: Restoring Trust in Hospitals in Guinea

Posted by  on Monday, June 26th 2017     
Fatimata Binta Diallo, an anesthesiologist, inside the office of Dr. Bakayoko Sekou, director of Dubreka Hospital. / Mariama Keita, USAID

Fatimata Binta Diallo, an anesthesiologist, inside the office of Dr. Bakayoko Sekou, director of Dubreka Hospital. / Mariama Keita, USAID

In 2014, Guinea was declared ground zero for the Ebola outbreak, and before it was brought under control in January 2016, there were more than 3,300 confirmed Ebola cases in the country.

During the peak of the rapid spread of the disease, people were afraid to go to the hospital because of low levels of trust in government and poor delivery of health services in general. People were less willing to accept Ebola as real, nor did they embrace social messaging aimed at reinforcing behavior change to save lives.

In the aftermath of the 2014-2016 epidemic and in the face of its reemergence in the Democratic Republic of Congo, USAID is working with partners, communities and policymakers to help Guinea recover and stay resilient. Through a combination of hospital renovations, medical equipment donations and community engagement, we are rebuilding the people’s trust in the healthcare system so they will resume using hospitals and clinics.

Karoline Nyoka, a program officer with Health Communication Capacity Collaborative, greets and interviews patient Salematou Sylla. / Mariama Keita, USAID

Karoline Nyoka, a program officer with Health Communication Capacity Collaborative, greets and interviews patient Salematou Sylla. / Mariama Keita, USAID

Recently, I traveled to the francophone West African country and made my way to Dubreka, a small town of 8,000 people just north of the capital, Conakry. There, I met with Dr. Bakayoko Sekou, director of Dubreka hospital, and we talked about how the Ebola crisis had affected his community.

Prior to the emergence of Ebola, on average there were up to 95 births per month at the hospital. But during the outbreak, the rate dropped to the single digits due to fear of sickness and death associated with hospitals during the outbreak.

Dr. Bakayoko Sekou, director of Dubreka Hospital, takes a group photo with his staff. / Mariama Keita, USAID

Dr. Bakayoko Sekou, director of Dubreka Hospital, takes a group photo with his staff. / Mariama Keita, USAID

However, Dr. Sekou proudly reported that the community is once again using Dubreka hospital to meet their health care needs — he attributed the current rate of 100 births per month to a higher quality of services that the staff now offers.

On my way to meet Dr. Sekou, I noticed the symbolic large Gold Star (Etoile d’Or) signage prominently displayed near the entrance of the health facility, signifying that the Dubreka hospital had passed a months-long accreditation process.

The smile of 26-year old Salematou Sylla brings tears of joy to the health team at Dubreka Hospital who saved her life. / Mariama Keita, USAID

The smile of 26-year old Salematou Sylla brings tears of joy to the health team at Dubreka Hospital who saved her life. / Mariama Keita, USAID

The Gold Star accreditation system is part of a campaign by USAID partner Health Communication Capacity Collaborative, Jhpiego and the Guinea’s Ministry of Health to rebuild people’s trust in the healthcare system and improve the quality of services offered at hospitals.

The brand and the quality associated with it was widely promoted through a mass-media campaign on radio, TV, on billboards, and at community events. Dr. Sekou

cited the Gold Star accreditation as one of his greatest achievements.

He also attributed the accreditation to USAID support in renovating the pediatrics and maternity section of Dubreka hospital, which included adding ramps, repairing the roof, installing ceiling fans and air conditioners in delivery rooms and operating rooms, and fixing the building’s plumbing.

Basic supplies and amenities like protective gloves and air conditioning are rare in hospitals in the developing world. Fatimata Binta Diallo, an anesthesiologist who visited Dr. Sekou’s office during our meeting, told us she vividly remembered a patient who was completely surprised by doctors’ use of protective gloves. Another patient being prepared for surgery had shouted to her, “Madame Diallo, wait, don’t put me to sleep yet. I feel like I am in paradise with this cool air.”

The services that the hospital provides are life-saving, but they only work if people trust that the hospitals are safe to use. Dr. Sekou told me the story of 26-year old Salematou Sylla, who came to the hospital in need of an emergency C-section. Although she lost her unborn child and underwent three major surgeries, she survived.

“Salematou entered into the hospital unable to pay for her medical fees and was in need of emergency caesarean section due to a shattered womb,” Dr. Sekou told me. “Many times, healthcare workers pull resources together from their own pocket to support the financial health care needs of patients like Salematou.”

Dr. Sekou then offered to introduce her to me. We walked into what appeared to be an outpatient section, where I saw a young, thin and fragile-looking woman sitting in a chair. Our presence brought a smile to her face. I had to fight back tears as I watched Dr. Sekou embrace Salematou as he would his own biological daughter.

Her survival is a huge success, as maternal and neonatal mortality rates in Guinea are some of the highest in the West African region. At USAID, we remain committed to re-establishing trust and restoring confidence in the health care system to prevent another global health humanitarian crisis.

As Ebola recovery interventions come to an end in the region, USAID has renovated 16 health facilities, and we expect to renovate another 20 by the end of this year. This translates into more success stories like Salematou’s as the citizens of Guinea get access to quality health care.

About the Author

Mariama Keita is a Communication and Partnership Advisor in USAID’s Africa Bureau, Office of Sustainable Development working on Ebola Recovery programs in West Africa. Follow her @mariamakeita

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Ebola’s Second Punch: Hunger

Posted by  on Tuesday, June 28th 2016     
Fudia Lansana is back at work on her farm in Sierra Leone after the Ebola outbreak kept her home without food for her family. / Michael Stulman, CRS

Fudia Lansana is back at work on her farm in Sierra Leone after the Ebola outbreak kept her home without food for her family. / Michael Stulman, CRS

Fudia Lansana once felt that nothing could be as terrifying as becoming one of more than 14,000 people infected with Ebola in Sierra Leone. But as her household of nine went from eating three meals a day to two, and then from two to one, Fudia realized she was facing something just as scary: hunger.

Under normal circumstances, Fudia would walk a few miles from her village to work on her farm with friends and family, but these were far from normal times. The government—in an effort to stop the spread of Ebola—restricted movement and prohibited public gatherings.

Approximately 45 people wait to receive cash transfers during a Catholic Relief Services distribution in Konia village, Kanema district, in Sierra Leone. / Michael Stulman, CRS

Approximately 45 people wait to receive cash transfers during a Catholic Relief Services distribution in Konia village, Kanema district, in Sierra Leone. / Michael Stulman, CRS

“Farming is our source of survival, but things were locked down during the Ebola era,” says Fudia. “We couldn’t reach the farm, so having enough food was very difficult.”

Fudia survived for months on savings and borrowed money. But even now that the Ebola outbreak is over, she and other farmers still feel its effects. Their farms are overwhelmed by weeds after months of neglect. It will be a while before they can prepare the land, plant new crops and collect the harvest to replenish their depleted food stocks.

Immediate relief has come in the form of cash transfers distributed by Catholic Relief Services with support from USAID’s Office of Food for Peace. The monthly $30 distributions target nearly 24,000 people in Kenema district, which has one of the highest rates of extreme poverty and chronic malnutrition in Sierra Leone.

The cash distributions are a bridge to get farmers over the next 10 months. They help farmers make ends meet until markets and food production recover and income-earning opportunities increase.

Life Before Ebola

Before the Ebola outbreak, Sierra Leone was still feeling the effects of a brutal decade-long civil war that ended in 2002. More than 60 percent of the population lived on less than $1.25 a day, according to the United Nations Development Program, and life expectancy was 48.

“Life was difficult then too,” says Battu Koroma, the breadwinner for her household of eight. “Since I lost my husband during the war, things were hard. But then during the outbreak, I could not farm or visit my family. I would take loans from people. I would give away my clothes just for a cup of rice.”

Ebola’s Economic Impact

“If you didn’t have money saved, you couldn’t afford to buy food,” explains Fudia. “During the Ebola outbreak, I was surviving on plain rice.”

Children from over 4,000 vulnerable families could eat three healthy meals a day after their parents used cash transfers from Catholic Relief Services to invest in their farms and buy food. / Michael Stulman, CRS

Children from over 4,000 vulnerable families could eat three healthy meals a day after their parents used cash transfers from Catholic Relief Services to invest in their farms and buy food. / Michael Stulman, CRS

She buys the rice, fish and fruit at markets in her village. Fudia and others who received cash distributions were encouraged to buy locally produced food, which ensures the money supports local merchants and stays in the community. This helps local markets to recover from the shock of Ebola and helps community-based food producers and buyers to get back on their feet.

“Everyone is benefitting from this, including local businesses,” Fudia says. “When the money isn’t there in the community, businesses can’t sell, so they don’t make money.”

Cash distributions also mean people have the flexibility to purchase what’s most important for their family. For example, they are able to buy a variety of nutritious foods at the market or seeds to restart their farm.

‘Getting More Life’

Fudia chose to invest her first $30 installment in her farm.

“I have been able to hire people to help prepare my land for planting seeds and to increase the size,” she says. “This will change our lives.”

Fudia also likes the educational components of the food assistance program. “I’ve learned about nutrition and health care,” she says. “I can take care of my family, improve my farm and eat well.”

Like Catholic Relief Services’s work in more than 100 countries around the world, supporting families like Fudia’s is helping improve and advance human life.

“Food brings life,” she says. “And with this money, I’m getting more life.”

USAID, through its Food for Peace program, partners with seven NGOs, including Catholic Relief Services, across Liberia, Guinea and Sierra Leone to address acute food insecurity. The program uses a cash-based approach that restores household purchasing power, promotes the recovery of market function and trade, and supports agricultural production.

Since the onset of the Ebola crisis in 2014, Food for Peace has reached more than 1.3 million people with emergency food assistance. The program continues to help thousands of families like Fudia’s to meet their food needs, while simultaneously helping local food producers, markets and countries recover from the food security impacts of Ebola.

ABOUT THE AUTHOR

Michael Stulman is the regional information officer for West and Central Africa at Catholic Relief Services (CRS).  Follow him @MichaelStulman

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More Community Health Workers Needed for a Healthier World

Posted by  on Thursday, February 25th 2016     

Editor’s note: This blog originally appeared as a longer article on the Wilton Park conference website.

We live in extraordinary times.

In 1960, more than 22 percent of all children in developing countries — one out of every five — died before the age of 5. Today, we are within reach of ending preventable child deaths

Across developing countries, when compared with 50 years ago, people are living longer, more people are educated, there are fewer wars, and there is an unprecedented drop in both the number and rates of people living in extreme poverty.

At the same time, Ebola and Zika are drastic reminders of our human frailty and the need for vigilance and responsiveness — in all countries, and at all levels of care, down to every community, every family. The survival and safety of the women and children of the world require us to find ways to link families and communities to the knowledge, behaviors and treatments that can help them survive, thrive and transform the world they live in.

Enter community health workers. For years, they have been vital in strengthening maternal and child health, preventing the spread of infectious diseases, and promoting sanitary behaviors. They will play a critical role in helping us achieve the Sustainable Development Goals.

Community health workers play an important role in USAID’s efforts to end preventable child and maternal deaths. / MCHIP/MCSP

Community health workers play an important role in USAID’s efforts to end preventable child and maternal deaths. / MCHIP/MCSP

Unlocking the potential of community health workers

Seeking to unlock the potential of community health workforces in post-Ebola Africa, 50 development practitioners, thinkers, experts and funders gathered two weeks ago in Wilton Park in England. Ministry and NGO practitioners presented models developed and being improved in several countries.

Three thoughts emerge:

  • Inspiring models of community health workforces already exist – which smart, experienced people are striving to make even better through policy improvements, strengthening supervision, leveraging technology and introducing long-term domestic financing.
  • There is not yet a simple, systematic way of sharing good practices across countries; we need to be able to compare solutions that could be replicated and scaled faster, smarter or more affordably.
  • We have not yet cracked the nut of financing. There is an urgent need for national governments and development partners to substantially increase investment in community health workers as part of integrated health care systems. We need financing solutions to be shared, adopted and adapted, as well as spur thinking on new ones.

A framework for community health

My colleagues and I shared the first version of a Community Health Framework with participants to jumpstart a “common language” on community health.

This first framework highlights some laudable models and tools; it’s simple to navigate and understand. It acts as an interactive learning tool to help practitioners and ministries better appreciate why we should care about community health, how to approach community health, and where to find successful examples.

The framework also offers a way of acting in a common ecosystem. In order to be successful, any country — whatever its circumstances — should follow a five-step process: identify target health outcomes, understand the existing system, analyze barriers, develop or strengthen programs and ensure oversight, monitoring and evaluation.

We urge our colleagues to consider leveraging this common language in their own work, so we can begin to find commonalities and ways to better scale and replicate.

In Senegal, community health workers provide essential services at local health posts and promote healthy activities within their communities. / Jane Silcock, USAID

In Senegal, community health workers provide essential services at local health posts and promote healthy activities within their communities. / Jane Silcock, USAID

It’s a time to be bold

This was the warning we heard at Wilton Park: “The acute crisis of Ebola may be over, but sustained crisis and emergency still exist.”

We cannot afford not to invest in community health workforce development. Strong political will and leadership, smart investment and coordinated planning are just a few of the critical components. The private sector has much to offer — both in terms of investment and bringing strong business models for sustainable solutions.

This is the time to be bold and to be practical. Two weeks ago, we set out broad principles to achieve strong community health workforce development. As we closed the conference, I felt inspired by the commitment and passion shared by those in the room

As one of our colleagues said, “It is not easy; it requires collaboration and determination, but we know what needs to be done — now let’s go and do it.”

ABOUT THE AUTHOR

Katie Taylor is USAID’s Child and Maternal Survival Coordinator and Deputy Assistant Administrator in the Bureau for Global Health.

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