Archives for Global Health

Q&A: How Changing Behaviors is Helping Stop Ebola’s Spread in West Africa

Posted by Clara Wagner on Wednesday, June 10th 2015

In a new Q&A series, we are profiling the experts who have worked tirelessly to stop the spread of the deadly Ebola virus in West Africa and are helping societies rebuild and strengthen health systems in the aftermath of the outbreak.

Kama Garrison is a senior public health advisor for USAID’s Neglected Tropical Disease Program. For the Ebola response effort, she has been working on social mobilization with other agencies and partners.

What is social and behavior change communication (SBCC) and what role has it played in the Ebola response?

SBCC is the use of communication strategies — mass media, community-level activities, face-to-face communication and technologies — to influence behaviors that affect people’s health.

Within the context of Ebola, SBCC is critical to ending the epidemic. Ebola is an easily preventable disease; changing a few key behaviors can stop the virus from spreading further. And while health facilities and health care workers are absolutely essential in responding to an Ebola outbreak, the behaviors of individuals, families and communities are key to stopping it entirely.

Kama Garrison holds up the silhouette of a hand, echoing the wall of handprints from Ebola survivors at the Bong County Treatment Unit in Liberia. / Ellie Van Houtte, USAID

But SBCC isn’t just about telling people about Ebola, warning them to stop touching those who are sick or discouraging them from using traditional burial practices. It’s about carefully understanding a community’s cultural, religious and social beliefs so we can deliver meaningful, relevant and respectful messages and interventions.

Early on in the Ebola crisis, some fear-based messages made people feel powerless, hopeless and unable to act. Effective SBCC must be founded in the target population’s belief in their own ability to succeed; we seek to develop interventions that instill hope. Now, successful SBCC interventions have been developed to engage and better educate communities about Ebola.

Why is it critical to employ social and behavior change communication in a response like this?

Human behavior plays an important role in the spread of infectious diseases such as Ebola. Therefore, understanding the influence of behavior on the spread of disease can be the key to stopping disease transmission. Even if a new medical technology such as a vaccine is developed, people still have to trust that vaccine and choose to receive it – so addressing behavior is at the core of disease prevention and outbreak response.

But the motivations behind why people do what they do are complicated. People are complicated — our behaviors reflect our personal experiences, education, cultural/religious beliefs, community etc. SBCC seeks to understand these motivations. By using methods from psychology, anthropology, marketing and behavioral economics, we collect information and data about target populations to design suitable interventions that address the specific needs, beliefs and practices of the target populations.

Ebola survivors in Liberia leave their handprints on a wall of the Bong County Ebola Treatment Unit – the facility that saved their lives. / Adam Parr, USAID

What previous experiences with social and behavior change communication informed our Ebola response? How do you think those lessons that Ebola taught us will be relevant to future crisis responses?

In the past, I worked on SBCC and risk management for crises like the Avian Influenza and the 2009 H1N1/Swine Flu pandemic.

I’ve seen that large-scale outbreaks aren’t inevitable — that by working on preventative behaviors we can minimize the emergence of diseases and by strengthening response capacity, we can quickly contain them if they do emerge. But it isn’t easy. Food preferences, economics, and cultural and religious practices all contribute to the risks associated with emerging diseases. Those are difficult behaviors to address.

If prioritized, though, we can draw from proven solutions and make the necessary investments to prevent diseases such as Ebola from turning into regional or global epidemics.

What’s the next steps with these efforts?

The three affected countries aren’t out of the woods yet; there will be a continued focus on Ebola to end the epidemic in the region. Even after the end of this Ebola crisis, there will be a great need to rebuild trust in the health system so that children are immunized, women get appropriate maternal care, malaria is addressed, etc. SBCC is key to that trust building.

The Ebola outbreak has caused much pain and suffering. However, in the midst of the crisis many heroic stories have emerged. What has touched you the most?

Ebola has created thousands of orphans — they are the ultimate tragedy of this crisis. In that tragedy, heroes emerge every day, from families that take in extended relatives to single individuals who adopt orphaned children. Those are the stories that touch me.

ABOUT THE AUTHOR

Clara Wagner was an intern for USAID’s Bureau of Legislative and Public Affairs working on content and public engagement.

Fighting Ebola with Information

Posted by Eric King on Thursday, May 28th 2015

Youth-turned-social mobilizers in Liberia learn how to use social media tools on their cell phones to stay connected while spreading awareness about Ebola prevention in communities. / Eric King, USAID

A room full of young people with heads buried in their phones is not an unfamiliar sight. In fact, this was the scene in rural Margibi County, Liberia, during a training of youth-turned-social mobilizers in late February.

The audience members weren’t distracted, though — they were following the trainer’s instructions. To foster culturally adaptive community engagement in the fight against Ebola, USAID-funded training events like these are teaching social mobilizers how to use social media tools like WhatsApp and SMS-based U-report to stay connected while they’re out in the communities, educating people about how to protect themselves from the disease.

“This is enhancing coordination, it’s cost effective, and the young people find it exciting to work with,” said Jzohn Alexander Nyahn, Jr., executive director of nongovernmental organization (NGO) CHESS Liberia.

Outsmarting the deadly Ebola virus requires that communities and response organizations work together. A key component of the USAID-led U.S. Ebola response strategy in Liberia — where they have now reached zero cases — has been arming community members and responders with the information they need to prevent Ebola transmission.

For example, at-risk communities need to know the facts about Ebola and how to prevent its spread. Rapid response teams need to know where to find suspected cases as soon as they show symptoms. Health ministries need to know which public health facilities are not yet equipped to isolate and treat infected individuals.

But these types of data originate in thousands of different places with thousands of different people, and we must get the right information into the hands of thousands more who can take action. Fast moving collective action on such a massive scale is a serious challenge.

By weaving well-placed feedback loops into human response networks, USAID, the U.S. Centers for Disease Control and Prevention (CDC), the governments of the affected countries, and private and NGO partners have coordinated efforts to prevent, detect and treat the disease. And, in many cases, mobile phones provide the key link to connect those who have life-saving information with those who need it.

The growing ubiquity of mobile phones in the developing world is unlocking tremendous opportunities to amplify humanitarian response efforts. Liberia, for example, which is one of the world’s poorest countries, has seen an explosion in its mobile market in recent years; phone ownership rates skyrocketed from 4 percent to 60 percent in just the last decade.

In the Ebola response, information and communication technologies like mobile phones empower local and international humanitarian responders to save lives by tightening the feedback loops between those who need help and those who can offer it.

Here are a few examples of how:

This Ebola outbreak has mobilized one of the largest public health crisis responses in history. Although it is the hard work and sacrifices of frontline responders and the people of West Africa, and not technology, that will ultimately defeat the disease, transformative technologies like mobile phones empower us to act together to get to zero cases.

ABOUT THE AUTHOR

Eric King is an Innovation Specialist with the U.S. Global Development Lab’s Digital Development Team, who joined the USG DART in Liberia for several weeks. Follow him @eric_m_king.

Growing Children, Trees and Science: The Work Towards an AIDS Vaccine

Posted by Margaret McCluskey on Monday, May 18th 2015

HIV’s outer-envelope proteins penetrate and infect host T-cells; this illustration shows areas where antibodies can bind to and block the virus. / Evan Oto, Science Source

Sixteen years ago, on HIV Vaccine Awareness Day, a group of mothers, their children and a few researchers gathered to plant a new maple tree on the median of Monument Street.

The group was composed of women and children, all of whom were at risk for HIV by virtue of where and how they lived; some came from areas of East Baltimore with HIV rates worse than in parts of sub-Saharan Africa.

lab technician works in the Kenya AIDS Vaccine Initiative (KAVI) laboratory / Sokomoto Photography

A lab technician works in the Kenya AIDS Vaccine Initiative laboratory / Sokomoto Photography

I stood with them, as well as fellow Johns Hopkins Center for Immunization Research staff and a White House representative, for an official dedication of the little sapling. In all of our hearts was the hope that by the time the little tree and these precious children were grown, we might have a vaccine to prevent HIV infection and AIDS.

Former President Bill Clinton harbored the same hope, when in 1997, in a commencement speech at Morgan State University, he declared that we should have an AIDS vaccine in 10 years’ time.

Clinton’s hopeful statement began the annual recognition of May 18 as World AIDS Vaccine Day, when we mark the progress made in the global search for an AIDS vaccine.

Now, the children and maple tree are grown, and we still don’t have an AIDS vaccine – not yet. But we will. Because along with the tree and children, the other thing that has grown considerably is the body of amazing science that tells us how a vaccine might work.

Many of these potentially pivotal discoveries are, in part, thanks to USAID’s support and the Agency’s belief in the critical importance of an HIV vaccine as potentially the singular most important tool to end AIDS.

We will stay the course — here are just a few of the reasons why:

We know that an HIV vaccine is possible. Between 1999 and 2009, a trial with Thai volunteers proved that an experimental HIV vaccine was modestly effective. This proof-of-concept trial has encouraged droves of world-class scientists to work together on improving the 31 percent protection rate seen in that historic trial, known as RV 144. Significant improvements to the vaccine regimen have been made, and trials to test these enhancements are now underway in South Africa.
We’re learning key lessons about how HIV behaves and how it can be stopped. New insights about how the virus invades the body’s infection-fighting T-cells are helping scientists design promising AIDS vaccine candidates that can produce antibodies to block the invasion that leads to chronic HIV infection.
While these and other remarkable discoveries are happening, USAID stays ever-focused on strengthening clinical trials in developing countries, building on our longstanding partnerships in Africa, actively increasing local scientific leadership, improving the sustainability of advanced research, and helping to expand and prepare the next generation of investigators.

No matter what, we’ll keep at it — and like that 16-year-old maple tree, we’ll keep growing until we have reached an AIDS vaccine that is safe, effective and accessible to those who need it most.

ABOUT THE AUTHOR

Margaret McCluskey is a Senior Technical Advisor in USAID’s Office of HIV/AIDS working on HIV vaccines. Follow her @m3indc.

Vaccinating Each Child to Build a Village

Posted by Gunjan Taneja and Anjali Vaishnav on Monday, April 27th 2015

Community members in a village in eastern India learn about the “My Village My Home” tool at a vaccination session. / MCHIP

This post is part of the #ProtectingKids blog series. Read the whole series here.

In Chandradeepa, a remote village in eastern India, Esther Das works as an auxiliary nurse midwife tending to the primary health care needs of the community. For almost a decade, she has been playing a key role in making sure pregnant women and children in her village receive routine, life-saving vaccinations.

To keep track of which child has received which vaccine, she has been using a tool called “My Village My Home.” The tool is easy to construct – Esther draws the frame of a house on a piece of paper. After conducting a headcount, she draws a “plank” at the foundation of the house for each child in the village, with the oldest children at base of the house. When a dose of vaccine is administered to a child, Esther shades in their plank to make a solid brick.

“By using the tool, I am able to count all the [children] in my community with their immunization status on a single chart,” she said.

Just as more bricks make the foundation of a real home strong, more vaccinated children make Esther’s village healthier. By using the illustration of a house, Esther is able to easily identify unvaccinated children. To ensure the health of the village, every child needs to receive all recommended vaccinations, the same way every brick in the foundation of the house needs to be in place.

The diligence of community workers around the world like Esther in keeping track of childhood immunizations is critical to helping people live long and healthy lives. This week is World Immunization Week, and according to the World Health Organization progress toward global vaccination targets for 2015 is far off track. One in five children worldwide are not being vaccinated for preventable diseases.

USAID is supporting efforts to solve this problem. In 2011, the Maternal and Child Health Integrated Program — the predecessor to USAID’s flagship Maternal and Child Survival Program — introduced the “My Village My Home” tool in 28 public health care centers in Jamtara and Deoghar districts in Jharkhand state in eastern India to capture and track the immunization status of all children in those villages up to their second birthday.

Esther Das, an auxiliary nurse midwife, reviews the “My Village My Home” tool with community members in a village in eastern India. / MCHIP

The Anganwadi center, or health care center, in every village posts a copy of the hand-drawn house tool prominently in public. As an easy to understand illustration, the tool allows parents to track their children’s immunization progress compared with other children in the community.

During the study, the “My Village My Home” tool significantly increased the number of children who received vaccines — only 1.9 percent of eligible children in the participating villages did not receive the necessary vaccinations.

The program’s successful outcome combined with advocacy by the Maternal and Child Health Integrated Program encouraged the government of Jharkhand to implement the tool across all vaccination sites in the state.

Successful efforts like the “My Village My Home” tool are helping USAID work toward our mission of ending extreme poverty.

ABOUT THE AUTHORS

Gunjan Taneja and Anjali Vaishnav are consultants for USAID’s flagship Maternal and Child Health Integrated Program in India.

Shrinking the Malaria Map

Posted by Retired Rear Adm. Tim Ziemer on Friday, April 24th 2015

The President’s Malaria Initiative (PMI) Africa Indoor Residual Spraying Project protects millions of people in Africa from malaria by spraying insecticide on walls and ceilings to kill mosquitoes that transmit the disease. With PMI’s support, more than 18 million in Africa people have been protected through indoor residual spraying. / Jessica Scranton

Malaria has plagued mankind for millennia. In the 5th century B.C, Herodotus described fisherman wrapping themselves in their fishing nets to protect themselves against biting gnats. Several centuries later, a malaria epidemic may have contributed to the fall of the Roman empire. And in Elizabethan England, the disease was so prevalent that Shakespeare featured it in nine of his plays.

Ten years ago, President Bush decided that malaria had caused enough suffering. At the time, malaria was killing more than 1 million people each year, mostly young children and pregnant women, and was responsible for up to 45 percent of all hospital admissions. The President’s Malaria Initiative (PMI) aimed to lower those numbers.

Although beginning in 2007 with three focus countries, today, PMI works in 19 countries in sub-Saharan Africa, Latin America and the Greater Mekong. President Obama expanded the initiative, and bipartisan Congressional leadership has sustained our work.

Together with partner countries, we are bringing effective tools to the people who need them most, including use of insecticide-treated mosquito nets, indoor spraying, accurate diagnosis, prompt treatment of cases, and preventive treatment of women during pregnancy.

Last year, the President’s Malaria Initiative (PMI) provided more than 31 million long-lasting bed nets. Use of insecticide-treated nets among children under 5 has increased from a median of 18 percent to 46 percent since PMI’s launch. / PSI Kenya

Last year, PMI used home spraying to help protect more than 18 million people, and provided more than 31 million long-lasting bednets, 80 million antimalarial treatments, and more than 59 million rapid diagnostic tests.

In 2014 alone, 85,000 health workers were trained to administer malaria diagnosis and treatment; almost all trainings also prepared participants to effectively address the other main causes of childhood illness. With every health worker trained, local local health systems were strengthened.

Thanks to these efforts and others, an estimated 4 million malaria-related deaths have been averted worldwide in the last decade. Of these, 95 percent are estimated to be children under age 5 in Africa. Less malaria means fewer newborn, infant and maternal deaths; fewer days missed at school and work; more productive communities; and stronger economies.

We are getting much closer to a world without malaria.

Women in Casamance, Senegal with mosquito net coupons. The President’s Malaria Initiative has procured 155 million long-lasting bed nets and helped to distribute over 73 million more procured by other donors. / Diana Mrazikova

April 25th, Malaria Day, calls attention to the disease and mobilizes action to combat it. Today, we recommit to bringing tools and effective solutions to people in need; the global community must continue to invest in research and development to improve these tools, from vaccines and new drugs to more sensitive diagnostics and surveillance systems.

With partner countries, we plan to help reduce malaria mortality by one-third from 2015 levels in PMI-supported countries by 2020.

Malaria disproportionately affects the poor and traps families in a vicious cycle of disease and poverty. For hundreds of millions of people, every day is malaria day. And for more than 1,000 people, mostly children, because of malaria today will be their last.We have the knowledge and ability to prevent and treat malaria, and we will not stop until we defeat malaria.

ABOUT THE AUTHOR

Retired Rear Adm. Tim Ziemer is the U.S. Global Malaria Coordinator.

Rebuilding Liberia As Ebola Cases Decline

Posted by Clara Wagner on Monday, April 20th 2015

Ebola survivors leave their handprints on a wall of the Bong County Ebola Treatment Unit – the facility that saved their lives. / Adam Parr, USAID

In Liberia, life will never be the same. The lost lives will never be forgotten. Much work remains in not just defeating the Ebola virus but making sure it does not return. As the number of Ebola cases gets close to zero, new stories, signs of hope and efforts to rebuild are emerging. Citizens are regrouping, government services are emerging from a standstill and eyes are looking to the future.

USAID is focused on getting to and staying at zero, as well as helping the families impacted by Ebola. USAID programs will get food to communities, help children safely return to school, improve communications systems, get people back to work and re-establish and strengthen health services.

With the help of USAID, Liberia is rebuilding:

FAMILIES

Orphaned by the Ebola crisis, a young girl carries freshly harvested crops to the home of Harriet B. Quenisseeir. Harriet and her husband have welcomed 35 youth–most orphaned by Ebola–into their home. USAID is using food distributions to help ensure that all 35 are fed, happy and healthy. / Adam Parr, USAID

USAID’s mission is to support the many families and individuals who have taken risks and opened their hearts and homes to respond to the Ebola outbreak; our work extends past disease control to providing vulnerable families with food to eat, getting children back in school, and helping reinvigorate markets and economies decimated by the Ebola crisis

In this way, we’re supporting new relationships in families. But we’re also supporting the relationship between people and their government. That means improving public services and communication systems to build confidence between a nation and its citizens.

HEALTH CARE

At the Star of the Sea clinic in West Point, Liberia, a young child waits for an immunization shot. The clinic, run by Catholic Relief Services with support from USAID, has now returned to providing critical health care services including triage, delivering newborn babies, and continuing vital childhood immunizations. / Neil Brandvold, USAID

When Ebola struck, the already weak health care systems in West Africa took a major hit. Most normal services were put on the backburner and the region’s health security infrastructure was put to the test. Ebola taught us that an epidemic knows no boundaries. All nations need health care systems that can respond quickly and effectively to prevent the spread of Ebola and other viruses across their borders.

Now, USAID is helping affected countries restore health services and rebuild their health systems. On April 18, at the Global Citizen 2015 Earth Day Concert in Washington, D.C., USAID Associate Administrator Mark Feierstein announced the Agency’s next step: a $126 million commitment to Liberia, Sierra Leone and Guinea to re-establish and strengthen their health systems.

By supporting a return to normal health procedures, including immunizations, triage and newborn deliveries, we want to ensure Liberians have access to the care they need. At the same time, by better preparing health care workers, clinics and state infrastructures to identify dangerous animal pathogens before they become serious threats, we hope to create a safer, healthier future — not just for West Africans but for Americans and the entire global community.

FOOD SECURITY

Fabio Lavelanet, CEO of Fabrar Rice Liberia, stands in front of a small portion of the tons of rice processed at his facility. The company plays an important part in the USAID Food and Enterprise Development (FED) Program, an initiative to reduce hunger and promote food security for Liberians. / Adam Parr, USAID

When most people think about Ebola, they usually don’t think about food. USAID does. Through the Food for Peace program, food distributions have been made available to those in need. Also, by stimulating local food production, market functions and household livelihoods, vulnerable groups are gaining access to food security.

As families regroup and rebuild, we want to make sure that having food on the table isn’t a concern, hence ensuring that people can follow their quarantines, support their loved ones and focus on the future.

SCHOOLS

While schools were closed due to Ebola, Aminata, 16, and her siblings refused to put learning on hold. With the help of her mother, Aminata led classes for the family and several neighborhood children. Now, schools have safely reopened and the kids are happy to be back. / Neil Brandvold, USAID

Crises like Ebola aren’t just health sector threats. In fact, when the outbreak made attending school dangerous, classrooms were closed for months — putting children’s education on hold.

However, USAID partnered with the Liberian Government to develop protocols in case of future suspected cases, integrate Ebola social behavior changes into the curriculum, and equip schools with supplies such as chlorine washes and disinfectant kits. As of February, classes are back in session.

Alivin Davi almost died from Ebola. Now he helps trace contacts of possible Ebola cases and gives psychosocial support to patients undergoing treatment. It is the strength and courage of people like him that will move Liberia forward. / Neil Brandvold, USAID

Ebola has left much tragedy in its wake. But the call to action that the crisis provoked is well on its way to becoming a triumph. The Ebola response has marked an unprecedented global effort to save lives; the combined and coordinated efforts of the U.S. Government, partner countries, NGOs and the private sector have made this recovery possible while illustrating global coordination at its best.

We are proud to have led the response along with our many partners, and will continue our work until all of Liberia and other West African countries are 100 percent Ebola free.

ABOUT THE AUTHOR

Clara Wagner is an intern for USAID’s Bureau of Legislative and Public Affairs working on content and public engagement.

From Vaccinations to Vitamins: Ensuring West Africans Get Critical Care Amid Ebola Crisis

Posted by Nic Corbett on Saturday, April 18th 2015

Since the Ebola epidemic began in West Africa, the U.S. Government has contributed some $1.4 billion in funding to stop the disease in its tracks. This decisive action led to the major international response we see today and helped lower the number of new Ebola cases.

But our help extends beyond simply getting treatment to people who have fallen ill with Ebola, preventing the virus from spreading, and educating communities about the disease. We are also delivering food to devastated families, making sure children–some of whom lost relatives to Ebola–can get back to school, and ensuring markets are up and running so their parents can make money again.

USAID Associate Administrator Mark Feierstein made an important announcement about the United State’s ongoing commitment to getting to zero new Ebola cases today during the star-studded Global Citizen 2015 Earth Day Concert on the National Mall in Washington, D.C.

Speaking before hundreds of thousands of concertgoers, Feierstein announced the Agency will provide $126 million to Liberia, Sierra Leone and Guinea to re-establish and strengthen their health systems, which have been weakened by this protracted public health crisis. Thanks to the American people, that money will go to both restoring critical health services that shut down during the Ebola outbreak and rebuilding those health systems so a crisis of this magnitude never happens again.

“That means more moms, dads and their children will get the critical care they need–from vaccinations to vitamins,” Feierstein said. “Our goal is not only to get to zero, but to stay at zero.”

We will also ensure that citizens have access to water and sanitation services, prenatal and maternal health care and nutrition, and programs to prevent and treat malaria and other infectious diseases.

Thanks to USAID clinics like the Star of the Sea in Monrovia, babies like this one are being born safely once again. / Neil Brandvold, USAID

USAID has been hard at work getting hospitals and clinics in the region into better shape.

In Liberia, the already-weak health system was unprepared to handle a crisis of this proportion. When the Ebola outbreak was at its peak, many routine health services became unavailable. Most hospitals were forced to close their doors to anyone but Ebola patients.

Now that the number of new cases is dwindling, USAID-supported clinics like the Star of the Sea are restoring vital health services. They are triaging patients and delivering newborn babies, ensuring that fewer pregnant women will die from preventable causes.

A little girl prepares to get her final round of adolescent shots at the Star of the Sea clinic in Monrovia, Liberia. / Adam Parr, USAID

Although the Liberian Health Ministry recommends that all children under the age of 1 get several vaccinations, many hospitals and clinics were too overwhelmed during the Ebola crisis to continue to provide immunization services. That has since changed thanks to USAID’s support of clinics like Star of the Sea, operated by Catholic Relief Services. Now, Liberia’s next generation can grow up well protected from preventable diseases.

Mothers and their children wait to be seen for primary health care services at the USAID-supported Star of the Sea Clinic in Monrovia, Liberia. / Neil Brandvold, USAID

Beth Gaddis, an American working as a health advisor at the USAID mission in Liberia, has helped provide pre- and post-natal care as well as routine vaccinations at the Star of the Sea clinic.

Working on the Ebola response since March of last year, Beth can tell stories from the “early days.” She’s brought thousands of infrared thermometers in her personal suitcase for temperature checks, and she watched USAID and the Liberian Ministry of Health collaborate when the first Ebola case crossed over from Liberia to Guinea.

Beth Gaddis, a health advisor for the USAID mission in Liberia, is providing routine health services at the Star of the Sea clinic in Monrovia, Liberia. / Neil Brandvold, USAID

USAID has also been supporting the training of thousands of health workers in infection prevention and control — which includes instruction on proper use of personal protective equipment, such as suits, gloves and masks. Institutionalizing these procedures will ensure health care workers tasked with treating people infected with viruses like Ebola won’t fall ill themselves.

In partnership with the West African governments, USAID is committed to restoring and strengthening their health care systems so that any future outbreaks of Ebola can quickly be extinguished.

This map shows the latest statistics regarding the Ebola response in West Africa as of April 14. (Click for PDF)

ABOUT THE AUTHOR

Nic Corbett is the deputy blog editor of Impact. Follow her @nickycorbett.

Road to Redemption: How One Liberian Hospital is Recovering from Ebola

Posted by Carol Han on Friday, April 17th 2015

Redemption Hospital, one of Liberia’s largest health care facilities, became ground zero for the country’s Ebola epidemic. / Carol Han, USAID/OFDA

On March 19, a 44-year-old woman walked into the emergency room of Monrovia’s Redemption Hospital displaying Ebola-like symptoms. Hospital staff quickly isolated the patient and safely transported her to an Ebola treatment center. She would later test positive, becoming the first confirmed Ebola patient in Liberia after almost three weeks without a single case.

The news dashed hopes that the country would soon be declared Ebola-free. But it also represented a small victory for Redemption Hospital—one of the county’s largest government-run facilities—which had once been considered ground zero for Liberia’s Ebola epidemic. The system works.

Redemption’s Dr. Jude Senkungu lost several friends and colleagues to the Ebola outbreak. “I think the first thing I felt was shock. Shock because you didn’t expect it to happen.” / Carol Han, USAID/OFDA.

Ebola Trauma Ward

Ebola devastated an already struggling health system in Liberia. Before the outbreak, the country had approximately 100 doctors in the entire country and only about one health care worker for every 3,400 people. When Ebola hit, they bore the brunt of the impact, dying faster than the patients they were trying to save, according to the World Health Organization. Ebola killed more than 180 health care workers in Liberia, including eight at Redemption Hospital. Pediatrician Dr. Jude Senkungu knew all of them and even shared an apartment with one of the doctors who died.

“The first thing I felt was shock…. The second thing was fear and despair,” said Senkungu. “The situation felt hopeless… and [I] could hardly sleep because of the fear that I could also be a case. That’s when you really kneel down and pray.”

BEFORE: After being closed to the public due to the Ebola epidemic, Redemption’s Emergency Department required major renovations before it reopened in mid-January. / Liz Hamann, IRC

Redemption took on some of the earliest Ebola patients and soon had to shut down other medical services to handle an increasing number of cases. Senkungu didn’t get sick, but twelve others at the hospital became infected. As people kept dying, including more of their own, nurses and other hospital staff soon became overwhelmed and alarmed. Eventually, they stopped coming to work altogether, and the entire facility was forced to close. The once-bustling hospital became like a ghost town.

“The community was suspicious of the hospital. They felt it was bringing Ebola into the community,” said Senkungu. “The staff was scared not knowing whether or not they had contracted the infection from their colleagues or from the patients they were attending to, and soon the hospital was deserted.”

AFTER: USAID supported IRC to renovate Redemption’s emergency and pediatric wards. “It not only looks different, it tells people this is a new place with a new way of doing things,” said Dr. Jude Senkungu. / Carol Han, USAID/OFDA

New Beginnings

Throughout the Ebola response, USAID recognized the importance of restoring basic health services so that Liberia could better prevent, detect and respond to future outbreaks. To make Liberia more resilient to Ebola and other infectious diseases, emergency measures used at Ebola treatment units had to be incorporated into daily hospital operating procedures.

To tackle this at Redemption, USAID’s Office of U.S. Foreign Disaster Assistance partnered with an NGO called International Rescue Committee (IRC) to renovate and reopen the hospital’s emergency and pediatric wards. IRC got to work training health care staff on infection prevention and control measures–teaching effective disinfection and hygiene techniques, safe disposal of infectious materials, and the proper use of personal protective equipment (PPE), such as gloves, masks and gowns.

USAID supported IRC in installing hand washing and disinfecting stations at every entrance of the hospital. / Carol Han, USAID/OFDA

IRC also revamped the hospital’s entire triage and inpatient areas, equipping every entrance with hand washing and disinfecting stations, as well as temperature checkpoints. Patient flow was rerouted so that people could be screened and sorted as quickly as possible.

“A hospital’s entrance is the key to good infection prevention and control,” explained IRC Project Manager Liz Hamann. “The whole point of proper triage is to immediately identify suspect [Ebola] cases and separate them from the rest of the patients.”

A look inside Redemption’s outpatient area where patients are now screened and sorted as quickly as possible to help reduce possible exposure to Ebola. / Carol Han, USAID/OFDA

This is what happened on March 19 when the woman displaying Ebola symptoms walked into Redemption’s emergency room. Hospital staff followed proper protocols and safely isolated her without disrupting the rest of the hospital’s operations. Triage nurse Kula Quiqui says health care workers feel more confident than before the improvements were made.

“I was nervous at first, but the system is improving,” said Quiqui. “Everything is getting better. People here feel more protected, and we now have PPE.”

Triage nurse Kula Quiqui say she feels more confident about coming to work, thanks to the improvements made by USAID and IRC at Redemption. / Carol Han, USAID/OFDA

The community is feeling more confident, too. Outpatient numbers have returned to pre-Ebola levels with the hospital seeing about 1,000 patients a week. Births and Cesarean sections are also up.

“They were scared because of Ebola, but at least they are coming back,” said Francis Saba, who manages the hospital’s medical supplies. “It’s important to build confidence here in the community. They now see patients leaving alive.”

As for Senkungu, he says that being part of Redemption’s restoration process has helped him heal.

“From where we are coming from to where we are now—even if we still have a long way to go—there is a very big difference,” Senkungu said. “I’m proud to be part of that.”

ABOUT THE AUTHOR

Carol Han is a Press Officer with the Ebola Disaster Assistance Response Team, which is leading the U.S. government’s Ebola response efforts in West Africa.

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

Posted by Harlan Hale on Thursday, April 16th 2015

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

“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

“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

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

“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

Posted by Rabab Pettitt and Katherine Sanchez on Wednesday, April 15th 2015

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

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

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.

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