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Archives for Health

All in Good Faith: Partnering with Malawian Ministries for Maternal Health

In USAID’s—and the world’s—goal of ending preventable child and maternal deaths, the faith sector is a powerful partner.

Close to 90 percent of the world’s people adhere to some religious belief, and in rural areas in many of the developing countries in which we work, health care is provided by religious organizations. Faith-based organizations like the Christian Health Association of Malawi (CHAM) reach deep into the community, and bring a unique set of skills, experience and contributions to the development arena.

They play a pivotal role in improving the quality, accessibility and respectfulness of maternal and child health services—and in promoting the demand for these services. Many faith-inspired groups are enthusiastic supporters and invaluable allies in our efforts to save the lives of mothers and children.

Memory Mponda (right), Priscilla Ziyaye and Pacharo Kumwenda, USAID-supported students training to become nurse-midwives, stand outside the Kangaroo Mother Care ward at the Chonde Health Center. / Grace Soko, Christian Health Association of Malawi

Memory Mponda (right), Priscilla Ziyaye and Pacharo Kumwenda, USAID-supported students training to become nurse-midwives, stand outside the Kangaroo Mother Care ward at the Chonde Health Center. / Grace Soko, Christian Health Association of Malawi

Take the Ndirande Health Center in the city of Blantyre, Malawi, where 15 students from St. Joseph’s College of Nursing and Midwifery work alongside clinical staff to check the vital signs and collect the histories of women who have come to give birth. They assist during the deliveries, and administer necessary care when emergency situations arise.

Recent visitors to the hospital have been pleased that their waiting time has been reduced, as the students, organized into teams, quickly and efficiently check people in and get them the care that they need. As the only public health facility in a district of more than 300,000 people, there is never a dull moment at Ndirande.

On the other side of Blantyre, at the Chilomoni Health Center, 19 of their classmates perform similar duties. Both facilities see upwards of 300 deliveries a month; at Ndirande, that number sometimes approaches 450. On average, 10 or more women come to each facility to give birth each and every day.

For the nursing students at St. Joseph’s, the challenges and experiences that they face at the health facilities are an invaluable learning tool. And for the clinical staff, the extra hands on deck provide much-needed assistance throughout the busy days. At Chilomoni, the hospital’s staff is more than doubled by the addition of the students.

St. Joseph’s is one of 12 constituent training colleges funded in part by USAID and operated by CHAM. Established in 1966, CHAM is an ecumenical organization overseen by the Episcopal Conference of Malawi and the Malawi Council of Churches, and provides administrative and technical support to the health care services of member units across the country.

With 175 member health facilities, CHAM reaches more than 4 million Malawians with health services—37 percent of all care provided in Malawi, and second only to the Ministry of Health. Through training programs like those at St. Joseph’s, students are able to become nurse midwife technicians, medical clinicians, laboratory technicians and psychiatric nurses.

This training helps students bring knowledge and experience to Malawian communities—and is an important step towards ending preventable newborn, child and maternal deaths.

Chimwemwe (“Joy” in the local Chichewa language), a community health worker in Malawi, meets with an HIV-positive pregnant woman at her home in Lilongwe through the USAID-funded Tingathe program, which works closely with the Ministry of Health. / Chris Cox, Baylor College of Medicine Children’s Foundation.

Chimwemwe (“Joy” in the local Chichewa language), a community health worker in Malawi, meets with an HIV-positive pregnant woman at her home in Lilongwe through the USAID-funded Tingathe program, which works closely with the Ministry of Health. / Chris Cox, Baylor College of Medicine Children’s Foundation.

In the 2014 Acting on the Call report, USAID laid out a framework for using proven, high-impact interventions and data-driven investments to improve health outcomes in 24 priority countries for maternal and child health, saving the lives of 15 million children and 600,000 thousand mothers through 2020.

In Malawi, a scale-up of key interventions could save more than 25,000 newborns and 5,000 mothers—lives that we know how to save, but that will likely be lost if we do not act.

Already, our efforts are yielding results and translating into lives saved. The 2015 report shows that Malawi is on track or has exceeded the year’s target for improving key interventions, such as the percentage of live births occurring in a health facility or being overseen by a skilled birth attendant, or the percentage of households with at least two insecticide-treated bed nets. But more rapid progress is needed in pregnant women receiving antenatal care and in women and children having access to clean water.

Our collaboration in Malawi with CHAM is one of many ways we are leveraging strategic partnerships, promoting country ownership and building the capacity of local communities. The holiday season reminds us how vital these partnerships are—now, and all throughout the year.

As the students at St. Joseph’s graduate next year, we will be there applauding them for their hard work, wishing them future success, and welcoming in the next class of students to begin their training.

ABOUT THE AUTHOR

Katie Taylor is the deputy Child and Maternal Survival Coordinator and a deputy assistant administrator for the Bureau for Global Health at USAID.

‘We Are Grateful’: How One Liberian School Has Battled Ebola

Children at the Lango Lippaye Elementary, Junior and Senior High School in Kakata, Liberia. / Courtney Babcock, USAID

Children at the Lango Lippaye Elementary, Junior and Senior High School in Kakata, Liberia. / Courtney Babcock, USAID

Last month I, along with a multidisciplinary team from USAID and colleagues from the Centers for Disease Control and Prevention and the National Institutes of Health, traveled to Guinea, Sierra Leone and Liberia.

Our objectives were to observe Ebola recovery efforts in each country, assess the progress of USAID’s transition from response to recovery activities on the ground, and get a better understanding of the impact of the disease on the survivors. We met with government officials, international NGOs, civil society organizations, other donors, and a host of ordinary citizens from each country, and visited many project sites.

One of the highlights of our time in Liberia was the visit to Lango Lippaye Elementary, Junior and Senior High School in Kakata, Margibi County, a 50-year-old school with nearly 2,200 students.

In July 2014, as the magnitude of the Ebola outbreak was gaining international attention, Liberian President Ellen Johnson Sirleaf, in an unprecedented move, closed the nation’s 4,500 schools in an effort to stop the spread of the disease. More than 1 million children were forced to stay home for over six months as the country battled the deadliest Ebola outbreak in history.

Over one year later, and after 4,200 deaths, Liberia has made significant strides in defeating the disease and is focused on recovering the development gains achieved prior to the outbreak.

The schools reopened in February as part of the recovery efforts. USAID and our partners at UNICEF worked with the Government of Liberia to ensure that children were able to safely return to school by providing more than 7,000 infection prevention and control kits to schools throughout the country, and training teachers and administrators on how to prevent infection.

The safety kits included buckets, soap, chlorine and cleaning items to help schools reduce the risk of Ebola transmission. USAID also partnered with UNICEF to provide schools with 700,000 learning kits that included chalk, pencils, books, erasers and folders. In addition, we trained teachers and PTA members on how to provide psychosocial support to the students and their families.

The students, teachers and administrators of Lango Lippaye Elementary, Junior and Senior High School welcomed us warmly during our visit. As we alighted from our vehicles, many beaming, cheering students greeted us; virtually all of them showed off their USAID-funded learning kits, holding up blue school bags with the familiar handclasp logo.

Children at the Lango Lippaye Elementary, Junior and Senior High School in Kakata, Liberia. / Courtney Babcock, USAID

Children at the Lango Lippaye Elementary, Junior and Senior High School in Kakata, Liberia. / Courtney Babcock, USAID

At the official welcoming ceremony, a student choir filed in singing joyously and full of energy about being grateful for the United States and its citizens for helping Liberia overcome Ebola. What an uplifting moment!

Reflecting on what life was like during the height of the crisis, one high school student told us, “It was very difficult during that period. We did not leave our home. I felt alone. People were afraid to go out.”

Another student added, “I tried to keep up with my courses while the school was closed but it was difficult. I missed my friends.”

The students said they were excited that they were now able to attend school and could pursue their career dreams once again. For some this meant aspiring to be doctors so they could contribute to addressing public health emergencies like Ebola. Being back in school also gave them renewed hope about the future.

Children at the Lango Lippaye Elementary, Junior and Senior High School in Kakata, Liberia. / Courtney Babcock, USAID

Children at the Lango Lippaye Elementary, Junior and Senior High School in Kakata, Liberia. / Courtney Babcock, USAID

Rosetta Fardolo, the student representative, asserted that USAID is “helping this school develop into a stronger, safer, and more productive environment to teach the next generation of Liberian leaders. We look forward to a long partnership with you as we work to rebuild our school and community post-Ebola.”

Students at the Lango Lippaye Elementary, Junior and Senior High School in Kakata, Liberia sing to welcome the visitors. / Courtney Babcock, USAID

Students at the Lango Lippaye Elementary, Junior and Senior High School in Kakata, Liberia sing to welcome the visitors. / Courtney Babcock, USAID

Principal Robert Zaza expressed deep appreciation for the United States, telling us, “We are grateful and blessed even though we lost teachers and parents. Your donations helped our students come back to school and teachers to teach. You gave us those things that make us to be alive today, so we say, thank you.”

He noted that the school had established peer educators and a social club in an effort to fight stigma and discrimination against survivors of Ebola. Addressing survivor care and support are high priorities for USAID and we are developing new approaches to focus on this issue.

We know that there is more to do. Life is still scary and difficult for many Liberians—including schoolchildren and their families. As we support future education programs, we must remain dedicated to easing their concerns about Ebola and reintegrating students who have not yet returned to school. We cannot afford to fail these students now. Their futures depend on it.

ABOUT THE AUTHOR

Denise Rollins is the senior coordinator of the Africa Ebola Unit at USAID.

Unprecedented Coordination Helped Turn the Tide of an Unprecedented Outbreak

The response to the Ebola outbreak required coordination among a wide, varied array of groups -- and ultimately helped bring the disease under control. / Morgana Wingard/USAID

The response to the Ebola outbreak required coordination among a wide, varied array of groups — and ultimately helped bring the disease under control. / Morgana Wingard/USAID

The international response to the Ebola outbreak was truly unprecedented, combining humanitarian and public health interventions in ways and at a scale that had never been done before. Ultimately, controlling the outbreak required the combined efforts of not only disease experts and national governments, but ordinary citizens, political and religious leaders, community workers, NGOs, U.N. agencies and even militaries.

Writing in the latest edition of Emerging Infectious Diseases , officials from the Liberian Ministry of Health, the U.S. Centers for Disease Control and Prevention (CDC), and the World Health Organization credit the control of the Ebola outbreak in Liberia to six factors: government leadership and sense of urgency, coordinated international assistance, sound technical work, flexibility guided by epidemiologic data, transparency and effective communication, and efforts by communities themselves.

At a glance, it is easy to see how all of these factors  are interconnected; the ability to act with urgency, guided by technical experts, and the full participation of communities guided by strong coordination. But, the authors are quick to point out that no single factor explains how the disease was brought under control in Liberia. There is still much to learn about the virus. But here is one thing we do know: the effectiveness of the response depended not on limiting action to what was known at the time, but taking action in spite of the unknown.

The United States played a critical role in the response, ultimately sending more than 3,000 people to West Africa and supporting more than 10,000 civilian responders in Liberia, Sierra Leone and Guinea. / Carol Han/USAID

The United States played a critical role in the response, ultimately sending more than 3,000 people to West Africa and supporting more than 10,000 civilian responders in Liberia, Sierra Leone and Guinea. / Carol Han/USAID

The United States was actively involved in fighting  Ebola from the beginning, sending more than 3,000 people—including aid professionals, public-health specialists, soldiers and logisticians—to Liberia, Sierra Leone and Guinea at the height of the response to support more than 10,000 civilian responders.

The CDC sent teams in March 2014, shortly after the outbreak began. To assist overwhelmed health agencies and local resources, USAID deployed a Disaster Assistance Response Team (DART)—a highly-skilled humanitarian crises response group that August.

Soon after, the U.S. military arrived, bringing speed and scale to the immense logistical effort of training health workers and operating laboratories. The U.S. Public Health Service contributed medical expertise, deploying hundreds of staff to the region to fight the deadly disease.

Author Justin Pendarvis first traveled to the region in July 2014 and helped stand up USAID's Disaster Assistance Response Team to coordinate the response. / Morgana Wingard/USAID

Author Justin Pendarvis first traveled to the region in July 2014 and helped stand up USAID’s Disaster Assistance Response Team to coordinate the response. / Morgana Wingard/USAID

I first arrived in Guinea in early July 2014, visiting each of the affected countries to observe and gauge the growing outbreak, understand the coordination at play for the response and identify key challenges. I helped stand up our DART , with staff deployed in each the three affected countries and eventually to Mali, Nigeria, Senegal and Ghana.

Coordinating efforts among various U.S. Government agencies—as well as host governments, NGOs, other responding governments, local communities and the United Nations—was a heavy lift. Even as support rapidly scaled up, there was still no playbook on how to respond .

USAID coordinated with many partners that were doing jobs that they had never done before. For example, we worked with Global Communitie s (known best for its emergency shelter work) to support safe burials across all of Liberia, and UNICEF to develop tools for community-led social mobilization. We worked with the International Medical Corps and the International Organization for Migration on running Ebola treatment units.

Through Mercy Corps, we partnered with more than 70 local organizations to reach 2 million Liberians with life-saving information to protect themselves and their communities from infection. Through the International Rescue Committee and Action Contre la Faim, we ensured that the Liberian Ministry of Health had the necessary support to link together investigation teams, ambulances and burial teams, treatment facilities and community-led actions—linkages that were critical to stopping the explosive outbreak in densely populated urban Monrovia.

Because of our work in Liberia and other affected countries, local health systems are increasingly poised to maintain control and prevent future large-scale outbreaks themselves. / Morgana Wingard/USAID

Because of our work in Liberia and other affected countries, local health systems are increasingly poised to maintain control and prevent future large-scale outbreaks themselves. / Morgana Wingard/USAID

All in all, USAID worked with dozens of partners, the majority of whom remain in the region, committed to working alongside their national counterparts to safeguard against new outbreaks and restore routine health and social services. And throughout the response, the DART worked closely with national and international agencies to ensure that all the resources brought to bear by the United States were aligned with a common strategic plan, minimizing the burdens on national counterparts so they could be more responsive to their own leadership and ultimately to those affected.

Safe burial teams were a critical component to controlling the outbreak in Liberia. / Morgana Wingard/USAID

Safe burial teams were a critical component to controlling the outbreak in Liberia. / Morgana Wingard/USAID

Our work has made a difference. While there have been a handful of cases reported in the region, national systems and local health actors are now increasingly poised and ready to take the immediate steps necessary to maintain control and prevent future large-scale outbreaks. And new treatments and vaccines are being tested that may dramatically reduce mortality and prevent new infections.

With so few cases in the region now, it can be easy to forget that a much larger humanitarian catastrophe was averted. By some estimates, hundreds of thousands of lives have been saved. And despite the fact there were no days off on the DART, I am proud of the assistance we supported and grateful for the opportunity to have served alongside so many brave men and women on the epidemiological frontlines of an extraordinary response.

ABOUT THE AUTHOR

Justin Pendarvis is a public health advisor with USAID’s Office of U.S. Foreign Disaster Assistance.

From the Household Hearth to Global Health: Creating a Healthier Planet Starts with a Cookstove

Each year, in the days leading up to holiday gatherings across the United States, stoves and ovens put in a lot of hours.

Many are used to cook turkeys; some roast more than one. Stovetops steam green beans, simmer gravies, and cook cranberries down to a sauce.

Now, imagine a different scene. Instead of a kitchen filled with the aromas of a holiday meal, imagine a kitchen filled with black smoke that stings the eyes and itches the back of the throat. An open fire of kindling and cow dung burns in the center of the room, and clouds of smoke billow steadily forth to hang thick, heavy and hazy in the air.

For nearly 3 billion people around the world, this is not a sign that the casserole has caught fire in the oven. Rather, it’s a daily part of life.

More than 40 percent of the world’s population relies on solid fuels such as wood, coal, dung, charcoal and crop residues for everyday cooking. And in the clouds of thick smoke that such fuels produce, threats to environmental and human health converge.

Cleaner Technologies for Safer Homes

In Uganda, biomass fuel sources are used for nearly all household cooking needs. Open biomass fires release harmful particles into the air, and household air pollution is estimated to cause 20,000 premature deaths in Uganda each year.

A community organizer in Uganda demonstrates the use of the TLUD stove to a local group. / Kendra Williams, URC

A community organizer in Uganda demonstrates the use of the TLUD stove to a local group. / Kendra Williams, URC

To address this, USAID’s Translating Research into Action (TRAction) Project is researching the drivers and barriers for the household adoption and sustained use of cleaner cooking technologies.

A Top-Lit UpDraft (TLUD) stove was selected for the TRAction behavior change initiative in Uganda. The new stove burns wood more efficiently, emitting less ash and particulate residue than open fires. Local artisans produce and repair the stoves and leaders encourage adoption of the stove, promoting community ownership of the intervention.

A Global Concern

USAID is a founding member of the Global Alliance for Clean Cookstoves. The Alliance and its partners hope to disseminate 100 million cookstoves by 2020.

An investment in clean cookstoves is an investment in human health. Exposure to household air pollution accounts for 4.3 million deaths worldwide each year. Exposure to household air pollution is the leading risk factor for pneumonia, the second-leading cause of child mortality.

The linkages to the environment are also well-established. Solid fuel dependency for household fires contributes to climate change through the emission of gases and particles such as carbon dioxide, methane, and black and brown carbon. Unsustainable wood harvesting can lead to deforestation, reducing the uptake of carbon by plant matter and exacerbating soil erosion, waterway pollution, and altered vector-borne disease patterns.

Teresia Oloitai of Tanzania installs a chimney stove in her home to reduce the intake of smoke and carbon dioxide during household cooking. / Morgana Wingard, USAID

Teresia Oloitai of Tanzania installs a chimney stove in her home to reduce the intake of smoke and carbon dioxide during household cooking. / Morgana Wingard, USAID

Clean cookstoves are also an investment in women’s empowerment, as the burden of collecting biomass fuel often falls on women and girls — at the expense of other productive opportunities. New cookstoves also improve the health of women and children, who spend much of their time at home near the hearth.

Improving the health of communities through the expansion of sustainable fuel sources is one of the many ways in which climate change considerations both affect and are affected by efforts to improve global health. And as our understanding of the full impacts of climate change on the planet come to light, the connections to global health continue to grow.

The Talks in Paris: Envisioning a Healthy World

Recently, the WHO concluded that climate change is the greatest threat to global health in the 21st century. Its effects on human health are myriad. Air pollution accounts for 7 million deaths each year, and outbreaks of infectious diseases are expected to increase as weather patterns shift. Natural disasters and political instability — both linked to climate change — disrupt primary health services, and displaced populations are put at a heightened risk of illness and infection due to poor nutrition and a lack of vaccinations, medications, clean water and sanitation.

When each of these effects of climate change on human health, both direct and indirect, are taken into account, the number of people affected reaches into the billions.

Through a variety of efforts, USAID and others have contributed to the significant global progress over the past half century in reducing mortality rates and improving health and quality of life. There is undoubtedly much work left to be done — yet neglecting the issue of climate change could undermine the past 50 years of progress in global health.

The conversations at this week and next’s COP21 conference in Paris must take into account the full implications of our changing climate — not only for the health of our planet, but for the health of our fellow human beings. And as world leaders gather round the conference tables in Paris, our team will continue to help families gather round cleaner, safer cookstoves. Global health depends on both.

ABOUT THE AUTHOR

Benjamin Rost works on communications within the Global Health Bureau.

A Time of Unparalleled Need

A young boy smiles as he walks out of his local bakery, arms full of freshly baked bread. Families such as this boy’s family rely on local bakeries to get their daily bread.

A young boy smiles as he walks out of his local bakery, arms full of freshly baked bread. Families such as this boy’s family rely on local bakeries to get their daily bread.

It’s hard to believe that what began as a simple cry for opportunity and human rights has become the biggest humanitarian crisis of our time.

Five years ago, at the height of the Arab Spring, the Syrian people took to the streets to peacefully protest for fundamental freedoms from an increasingly authoritarian leader. The response from the Syrian regime was unequivocal force and brutality that has left half of all Syrians dead or displaced, and spawned a breeding ground for extremists like the so-called Islamic State or Daesh.

If you want to know how this crisis feels, talk to some of the more than 17 million Syrians directly impacted by the violence—their homes bombed, their schools destroyed, their relatives and friends killed. That’s like upending the lives of everyone living in the New York City, Los Angeles, Chicago and Houston. And lives have certainly been shattered.

Ayyush is 80 years old. She recently lost her son in the conflict in Syria. She now only wishes for more years ahead to raise her grandchildren. Ayyush and her family live in the Islahiye refugee camp in Turkey where they receive monthly food assistance through an e-food card program.

Ayyush is 80 years old. She recently lost her son in the conflict in Syria. She now only wishes for more years ahead to raise her grandchildren. Ayyush and her family live in the Islahiye refugee camp in Turkey where they receive monthly food assistance through an e-food card program.

Today, 4 million Syrian refugees are living in neighboring countries—Jordan, Lebanon, Turkey, Iraq, Egypt—in donated apartments, relatives’ spare rooms and tents. Another 6.5 million are displaced internally, trapped in a living hell that includes daily indiscriminate barrel bombing by the Assad regime on the one hand and Daesh’s murderous reign of terror on the other.

Behind the figures are children and the parents who would do anything and risk everything to keep them safe. For families inside Syria, the choice is agonizing: Stay and risk your child being killed on the way to school, or risk their safety on a treacherous journey across borders.

What are these Syrians facing every day?

Hunger for one. Since this crisis began nearly five years ago, USAID has provided $1.55 billion in food assistance, more than all other donors combined. Since 2013, we have given bakeries still operating inside the country 122,000 metric tons of flour and yeast, which comes out to more than 300 million daily bread rations. USAID has also helped distribute food vouchers—essentially preloaded debit cards—so refugees can shop for the familiar foods they yearn for and, at the same time, boost the local economies of Syria’s neighbors.

These two Syrian sisters now live as refugees in Mafraq, Jordan. / Peter Bussian for USAID

These two Syrian sisters now live as refugees in Mafraq, Jordan. / Peter Bussian for USAID

Nearly 2 million children in Syria and another 700,000 Syrian refugees are out of school because of the conflict. As Secretary of State John Kerry said recently: “The burden of the conflict falls most heavily on the smallest shoulders.” Without that daily stability in their lives, children are at risk of being exploited as laborers and young girls in particular may face the pressures of early marriage.

Our teams on the ground are helping refurbish and modernize public school buildings in Lebanon and Jordan so they can accommodate the extra load of new learners. Some of the schools have doubled or tripled shifts to ensure everyone gets a chance to learn and thrive.

USAID is also providing health care to people in need across 14 governorates in Syria—2.4 million this year alone—as well as clean water to 1.3 million.

We are also supporting women to be change agents for peace inside Syria, and assisting moderate civilian actors inside Syria to keep schools open, repair public services and literally keep the lights on for communities under siege.

We are proud to say that we reach 5 million people every month in spite of the often dangerous conditions to make those connections happen.

Our assistance inside Syria and the region is not only keeping people alive, but keeping their aspirations alive, too. A future Middle East needs peace and opportunity, not spirals of retribution.

“Our dreams are very simple,” said Mohamad, a former bus driver in Syria who is now a refugee living in a cramped apartment in Jordan with what is left of his family. He lost three sons in the conflict.

Bags of wheat flour inside a storage room at a Syrian bakery wait to be turned into bread. Bakeries such as this one are vital to providing food to Syrians in need.

Bags of wheat flour inside a storage room at a Syrian bakery wait to be turned into bread. Bakeries such as this one are vital to providing food to Syrians in need.

What he wants now is what any person would want: “To have a decent living so that we can be self-sufficient and not put out a hand to beg. We want people to look at us as humans because we are just like them.”

Though the United States has been generous—$4.5 billion in humanitarian assistance over nearly five years in addition to other aid—our funding that supports the heroic organizations working with Syrians on the ground throughout the region is simply not enough. Additional support is sorely needed.

The United Nations’ appeals for humanitarian aid to address the crisis in Syria are still only 48 percent funded for this year. This is a shortfall of over $4.4 billion in life-saving services.

We must support those suffering inside Syria as well as those fleeing across the border.

As President Barack Obama reminded the world at the G20 Summit in Turkey, Syrian refugees are leaving their country to escape violence and terrorism. “Slamming the door in their faces would be a betrayal of our values,” he said. “Our nations can welcome refugees who are desperately seeking safety and ensure our own security. We can and must do both.”

This conflict has spiraled out of control for too long. And while we are undertaking herculean efforts to help the Syrian people and Syria’s neighbors, we cannot alleviate this crisis without more help. If we do not continue to work with our partners to address the Syrian crisis and its impacts now, the problem will only get worse.

That is why we are asking you to stand in solidarity with USAID, our partners and, most critically, the people of Syria. Visit Humanity Acts to learn more about the humanitarian crisis that directly impacts the majority of Syrian people and how you can join us in supporting them.

We’re on social media using the hashtag #HumanityActs and we invite you to use it as well. Together we can help put an end to the biggest humanitarian emergency of our time. It starts here.

ABOUT THE AUTHOR

Tom Staal is the senior deputy assistant administrator in USAID’s Bureau for Democracy, Conflict and Humanitarian Assistance. Follow that office at @USAID_DCHA

Why Right Now is the Right Time to Act Faster to Stop Unnecessary HIV/AIDS Deaths

Emily with two employees of Project Concern International (PCI) and her youth group members, celebrating the youths' graduation from PCI's Entrepreneurial and Business Skills Training in Botswana. / Project Concern International

Emily with two employees of Project Concern International (PCI) and her youth group members, celebrating the youths’ graduation from PCI’s Entrepreneurial and Business Skills Training in Botswana. / Project Concern International

“Dineo! DINEO! Diiiiiny!”

I hear my Setswana name being called, but I can’t concentrate on that right now. I’m busy biting my tongue as I begin the familiar routine of mentally reminding myself to relax.

This is not a new experience for me as a Peace Corps volunteer in Botswana—closing my eyes and counting to 10 as I wait in line in a cramped grocery store while a cashier, in a comically unhurried manner, takes her sweet time ringing up customers’ items, moving at the speed of a sleepy-eyed cat that’s spent its day dozing in the sun. This seems to be the default speed in my village.

Thankfully, my lack of response did not deter my caller. I’m shaken out of my irritability by Masego, a shining star in the youth group that I manage. Before I can greet her, she’s excitedly speaking in a hushed tone:

“Dineo! I was calling! I want to tell you! Mpho got tested. She’s positive.”

Mpho is another member of my youth group. Masego should absolutely not be telling people, including me, Mpho’s* status. Before I can even speak on this, though, Masego nonchalantly adds:

“She says she won’t take the drugs when they ask.”

What? “Why?”

Masego shrugs. “Ga ke itse.” I don’t know. “She says she’ll take muthi.”

Muthi. Traditional medicine.

Well. That did not improve my mood.

Not only is that one of the last things an HIV/AIDS volunteer wants to hear, but it also scared me. Five weeks before, another youth that I had worked with, Pako, passed away. He was born with HIV and had been living with the virus until he was 21—the age he stopped his antiretroviral therapy because he didn’t want his new roommates to see and deduce that he was HIV positive.

Emily distributing condoms to youth group members after a lively condom demonstration in Botswana. / Thabo Lentswe

Emily distributing condoms to youth group members after a lively condom demonstration in Botswana. / Thabo Lentswe

This once healthy young man deteriorated before us, eventually dying, unnecessarily, all the while denying that he was HIV positive to his friends and denying that he had stopped taking his treatment to his family.

Twenty years ago, in Botswana and in many other parts of the world, an end like Pako’s was often inevitable for people diagnosed with HIV. That is no longer the case. More people than ever before are living with HIV. And by living, I mean living; they’re healthy—working, studying, caring for their children, playing soccer, hanging with friends, living.

How you ask? Antiretroviral therapy.

Now, more people than ever before have access to lifesaving medication. This monumental achievement is the direct result of the work of USAID, the President’s Emergency Plan for AIDS Relief (PEPFAR), international partners, partner countries and civil society.

But here’s the thing: In order for antiretroviral therapy to work, people have to actually start taking it. And once they start taking it, they must adhere to it. Completely.

Emily with four youth group members in Botswana. / Project Concern International

Emily with four youth group members in Botswana. / Project Concern International

This is why the Joint United Nations Programme for HIV/AIDS, as part of its 90-90-90 targets, is striving to get 90 percent of all people living with HIV on sustained antiretroviral therapy by 2020 in order to end the HIV epidemic by 2030. USAID and PEPFAR have established new targets to aggressively scale up treatment in order to reach this goal.

This goal cannot be accomplished, though, if people, like Mpho, do not start the treatment.

Right now.

This goal cannot be accomplished if people, like Pako, do not stay on the treatment.

Right now.

This goal cannot be accomplished if the international community, including beneficiaries, does not act urgently.

Right now.

We are closer than we have ever been to reaching an AIDS-free generation. This can’t be done, though, if international agencies, civil society, partner countries and beneficiaries move at the same languid pace as the cashier in that cramped, scorching grocery store in my village in Botswana.

In order to control the HIV epidemic, save lives and get people on sustained treatment, we need to move now, together, with a sense of urgency and purpose. This is the time to push. This is the time to work. The time to act is now.

*Names have been changed throughout to protect individuals’ identities.

ABOUT THE AUTHOR

Emily Reitenauer is a program assistant on the Gender Team for the Technical Leadership and Research Division in the Office of HIV/AIDS in USAID’s Global Health Bureau. She spent three years (2012-2015) serving as a Peace Corps volunteer performing HIV/AIDS work in Botswana.

Saving Mothers, Giving Life

The Chikomeni Rural Health Centre in eastern Zambia offers Basic Emergency Obstetrics and Newborn Care services to its clients. / Anne Jennings, Rabin Martin.

The Chikomeni Rural Health Centre in eastern Zambia offers Basic Emergency Obstetrics and Newborn Care services to its clients. / Anne Jennings, Rabin Martin.

For the staff at the Matanda Rural Health Center in northern Zambia, help during emergencies was hard to find. The nearest hospital is 60 kilometers away—40 of them over a rough gravel road. Lacking a cell tower, health center staff would walk or ride 27 kilometers in order to call for an ambulance. Until recently, nurse Esther Kabaye was the center’s only clinician; she treated women in the region when complications arose during pregnancy.

Through Saving Mothers, Giving Life, a public-private partnership launched in 2012, Kabaye began a mentorship program in which she met once a month with a district mentor, developing the necessary skills and knowledge for emergency obstetric and neonatal care.

These efforts were rewarded after only a few months, when Helen, a 35-year-old woman from a nearby village, was brought to the health center in labor. She successfully delivered a healthy baby, but afterwards began bleeding heavily. Kabaye identified the emergency as a postpartum hemorrhage, and promptly performed a bimanual compression of the uterus, saving Helen’s life.

“I am so happy that I am able to effectively handle emergencies and save lives that would have been lost,” Kabaye said. She now teaches other nurses, amplifying the lifesaving impact that she has had on her own community and others nearby.

Stories like Kabaye’s are not uncommon within Saving Mothers, Giving Life districts. USAID is a founding member of the partnership, launched in 2012 by then Secretary of State Hillary Clinton as an innovative, integrated approach to health systems. Saving Mothers, Giving Life seeks to reduce maternal and newborn mortality by increasing the demand for services, facilitating access to lifesaving care, and strengthening health systems at the district level.

The initiative is supported by a range of partners, including the governments of Uganda, Zambia, the United States and Norway; Merck for Mothers; Every Mother Counts; Project C.U.R.E.; and the American College of Obstetricians and Gynecologists.

Target districts in Uganda (left) and Zambia. High levels of success during Phase 1 (June 2012-June 2013) led to the expansion of the program during Phase 2. Mid-Initiative results show even greater improvements in maternal mortality during Phase 2. / Saving Mothers, Giving Life

Target districts in Uganda (left) and Zambia. High levels of success during Phase 1 (June 2012-June 2013) led to the expansion of the program during Phase 2. Mid-Initiative results show even greater improvements in maternal mortality during Phase 2. / Saving Mothers, Giving Life

Initially implemented in four districts each in Uganda and Zambia, Saving Mothers, Giving Life emphasizes adequate and timely care for pregnant women and new mothers. The initiative focuses on three primary delays to lifesaving maternal care: the delay in seeking services, reaching services, and receiving high-quality care. The initiative generated astounding results: The target facilities in both Uganda and Zambia saw a 35 percent drop in maternal mortality in a single year.

Based on such astonishing success, the program was expanded in 2014 to an additional 12 districts in Zambia, and another 6 districts in Uganda. This week, I am excited to share the continued success of the initiative with our 2015 Mid-Initiative Report.

In Uganda, the institutional maternal mortality rate has fallen by 45 percent since the beginning of the initiative. This reflects a 30 percent increase in the rate of delivery in facilities that provide emergency obstetric and newborn care. Such inspiring results are not limited to health facilities, however: Across the target districts as a whole, maternal deaths have decreased by 41 percent—not just among women who delivered in a facility, but among the districts’ entire population

Women queue up for health services at the Chikomeni Rural Health Centre in eastern Zambia. / Anne Jennings, Rabin Martin.

Women queue up for health services at the Chikomeni Rural Health Centre in eastern Zambia. / Anne Jennings, Rabin Martin.

In Uganda’s Kabarole District, District Health Officer Dr. Richard Mugahi faced a challenge. “We had enough midwives and equipment, but mothers were not delivering in facilities,” he says. “They preferred delivering with the support of traditional birth attendants.”

With the support of Saving Mothers, Giving Life, the Kabarole District established a Demand Creation Committee to encourage women to take advantage of family planning services, prenatal care visits, and health facility deliveries. The Kabarole District has also used radio broadcasts to educate communities about the risks of giving birth at home and encourage them to give birth in a facility. The initiative is community-owned, sustainable in the long term, and—most importantly—effective.

The results from Zambia are equally as encouraging. Since the launch of Saving Mothers, Giving Life, institutional maternal mortality has fallen by 53 percent in the target districts. Nearly 90 percent of women are now giving birth in a facility, compared to 63 percent at the outset of the initiative. And the number of women who have received treatment to prevent the spread of HIV/AIDS to their infants has increased by 81 percent.

Mwasemphangwe Zonal Rural Health Centre in Zambia offers Basic Emergency Obstetrics and Newborn Care services to its clients. / Anne Jennings, Rabin Martin.

Mwasemphangwe Zonal Rural Health Centre in Zambia offers Basic Emergency Obstetrics and Newborn Care services to its clients. / Anne Jennings, Rabin Martin.

These results are heartening. They speak to the success of the approach employed through Saving Mothers, Giving Life that revolves around localized, evidence-based interventions. Efforts at the district level strengthen districts’ health systems as a whole, while community-level interventions generate demand for services among women and their families by changing social norms. The initiative is active in two dozen districts across Uganda and Zambia, with expansions underway in additional districts, as well as in Nigeria.

Yet perhaps even more encouraging is the potential that Saving Mothers, Giving Life has to extend far beyond the borders of Uganda, Zambia and Nigeria. The approach has proven to be successful, and is continuously fine-tuned and developed through extensive monitoring and feedback. The organizing principles employed by Saving Mothers, Giving Life can serve as an example to countries across the globe, who can adapt the model for use in their own communities.

The partnership has brought together the diverse strengths of a variety of organizations, contributing substantially to the mission to end preventable child and maternal deaths within a generation. Saving Mothers, Giving Life has amazed and inspired me over the past two and a half years that I have directed the Secretariat, and I am excited to see what we are able to accomplish in two and a half more.

ABOUT THE AUTHOR

Claudia Morrissey Conlon is USAID’s Senior Maternal and Newborn Health Advisor and the U.S. Government lead for Saving Mothers, Giving Life.

USAID Salutes Nobel Laureates Whose Discoveries Help Fight Malaria, River Blindness, Elephantiasis

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This year’s Nobel laureates in medicine developed therapies that revolutionized the treatment of some of the most devastating diseases caused by parasites.

On Monday, William Campbell and Satoshi Ōmura were cited for their discovery of the drug Avermectin, the derivatives of which have radically lowered the incidence of river blindness and elephantiasis. And Youyou Tu was rewarded for her research on malaria therapy. USAID relies on these medicines to protect millions of people at risk.

Parasitic worms afflict one-third of the world’s population, causing diseases like river blindness and elephantiasis. Before the development and widespread use of the avermectin-derivative ivermectin, river blindness left whole communities in Africa blind from the disease. Adults would be led around by children holding a stick. Agricultural productivity and development were at a standstill. Decades later, these communities are thriving agricultural centers, and children are in school instead of caring for the blind.

A child leads two individuals blinded by the parasite that causes river blindness through a village. / Bill VanderDecker

A child leads two individuals blinded by the parasite that causes river blindness through a village. / Bill VanderDecker

USAID’s neglected tropical diseases (NTD) program targets both river blindness and elephantiasis, as well as other diseases. Each year we distribute ivermectin, the drug used to treat river blindness, to more than 25 million people.

Since 2006, USAID has supported the delivery of more than 1 billion preventive drug treatments for NTDs – to almost a half a billion people. The neglected diseases team also manages the largest public-private partnership in USAID’s history, having secured more than $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.

Inspired by a description in a 1,700-year-old Chinese text of the use of sweet wormwood to combat fever, it was Tu who discovered artemisinin. ​This medicine remains the most effective treatment for malaria today, saving millions of lives.

The parasite responsible for the most lethal human malaria started to resist the drug chloroquine in South America and Southeast Asia in the late 1950s and early 1960s. By the late 1960s, efforts to eradicate malaria had failed and the disease was on the rise.

At that time, Tu turned to traditional herbal medicine to find novel malaria therapies. In China, the qinghaosu plant was used in fever remedies for thousands of years. Tu examined 2,000 recipes for traditional Chinese remedies and discovered one derived from sweet wormwood (Artemisia annua) reduced malaria parasites in the blood.

USAID has been fighting malaria since the 1950s, helping develop the tools relied on today. For example, USAID funded trials showing that mosquito nets, treated with safe insecticide, were effective in significantly reducing child deaths and preventing malaria in pregnancy.

Habiba Suleiman, 29, a district malaria surveillance officer in Zanzibar, naps with her little girl Rahma under a mosquito net. She lives in Tanzania, where up to 80,000 people die from malaria each year. Hariba is working to change that. Read her story on USAID’s storytelling hub. / Morgana Wingard, USAID

Habiba Suleiman, 29, a district malaria surveillance officer in Zanzibar, naps with her little girl Rahma under a mosquito net. She lives in Tanzania, where up to 80,000 people die from malaria each year. Hariba is working to change that. Read her story on USAID’s storytelling hub. / Morgana Wingard, USAID

The U.S. President’s Malaria Initiative (PMI), launched in 2005, represents the U.S. Government’s bilateral commitment to massively scaling up proven malaria prevention and control efforts. Led by USAID, PMI has advanced game-changing innovations, like insecticide-treated mosquito nets and more effective drugs.

Through PMI, USAID funds operational research to improve uptake and scale of interventions, to preserve intervention effectiveness in the face of both drug and insecticide resistance, and to respond to changes in malaria epidemiology.

More than 6 million deaths have been averted, primarily among children under 5 in sub-Saharan Africa through the expansion of malaria control efforts by affected countries — with the support of PMI and other key partners.

This success would not have been achieved without access to high quality malaria treatments, diagnostics, and tools like bed nets and indoor spraying to kill or repel malaria carrying mosquitoes. Since the initiative began, PMI has purchased more than 318 million quality-assured artemisinin combination therapies, as well as more than 174 million rapid diagnostic tests to support appropriate malaria case management.

The financial and technical contributions of the U.S. Government are a major catalyst in the remarkable progress that has been achieved in many countries to reduce the devastating burden of parasitic worms and malaria. But the work is far from complete.

More than 1 billion people suffer from one or more NTDs. Almost all are poor who live in rural areas and urban slums of low-income countries. Nearly half a million people still die each year from malaria. When children fall ill, students miss school, and adults stop working and are unable to provide for their families.

We admire Campbell, Ōmura and Tu for their inspiration and celebrate their discoveries that helped mankind.

ABOUT THE AUTHOR

Chris Thomas is a communications advisor in the Bureau for Global Health.

Around the World in Videos: How USAID is Helping Curb Child and Maternal Deaths

Mom and baby are doing fine because mom was taught how to perform Kangaroo Mother Care to keep her premature newborn warm. / Molly Ronan, Embrace Global

Mom and baby are doing fine because mom was taught how to perform Kangaroo Mother Care to keep her premature newborn warm. / Molly Ronan, Embrace Global

In 1990, more than 12 million children under the age of 5 died every year because of preventable conditions and diseases. Today, we face a situation considerably less bleak.

But still, far too many children today are being robbed of the chance to lead full, healthy lives. They are being robbed by illnesses we can prevent and treat. And far too many mothers won’t get to hold their newborn in their arms. These women won’t have the chance to raise their families or contribute to their communities.

Over the past six years, the Obama administration has strategically focused our maternal and child health programs in the 24 countries that account for more than 70 percent of child and maternal deaths globally.

By providing expectant mothers with high-quality and respectful care during delivery, resuscitation for newborns, vaccinations, diarrhea treatment and education about the importance of breastfeeding and handwashing, it is estimated we have helped save the lives of nearly 2.5 million children and nearly 200,000 mothers since 2008.

Acting USAID Administrator Alfonso Lenhardt joins Indian Prime Minister Shri Narendra Modi and heads of delegations from around the world at the Call to Action Summit on Aug. 27 in New Delhi, India. / Clay Doherty, USAID

Acting USAID Administrator Alfonso Lenhardt joins Indian Prime Minister Shri Narendra Modi and heads of delegations from around the world at the Call to Action Summit on Aug. 27 in New Delhi, India. / Clay Doherty, USAID

This week in New Delhi, I join health ministers from those priority countries and experts from across the globe for The Call to Action Summit to take stock of progress, share best practices and forge alliances.

Here are snapshots of some of USAID’s efforts around the world.

India

Like all mothers, Satyawati wants the best for her children, including for her newborn son. In a world where motherhood is still a risky endeavour, her story reflects the Indian Government’s new approach to maternal and child survival. With help from her local health worker, Satyawati knows how to best care for her children. She has had them vaccinated, and she practices proper hygiene at home.

Millions more have benefited from India’s recent efforts to reduce maternal and child deaths. In fact, under-5 mortality has dropped from 126 per thousand live births in 1990 to 53 per thousand live births in 2013. The government is using a scorecard to track its progress, providing transparency and accountability.

Malawi

“It’s heartbreaking to not have the equipment you can use on a baby to survive,” said Indira Chikomoni, a nurse at Zomba Central Hospital in Malawi. But with USAID’s support, 27 hospitals throughout Malawi now have access to a device called the Pumani bCPAP, which helps newborn babies breathe until their lungs have fully developed. The device has tripled the survival rate for babies treated for respiratory distress syndrome.

Gloria Mtawila’s son Joshua, who was struggling to breathe at birth, stayed on the machine for a month until eventually he could breathe on his own, and now he is a healthy baby boy.

Ethiopia

Adanech Belay is a proud mother of three, one of millions of rural families that used to live beyond the reach of the health system in Ethiopia. With USAID’s help, the Ethiopian Government has trained more than 38,000 health workers and deployed them around the country. Now, Belay can give birth in a clinic. She knows about vaccines, hygiene and family planning. Health extension workers now form the backbone of Ethiopia’s health care system, empowering families like hers to take charge of their own health. And the efforts are working.

In September 2013, Ethiopia announced it had achieved Millennium Development Goal 4—reducing child mortality by two-thirds by 2015—a full two years ahead of schedule. In 1990, Ethiopia’s under-5 mortality rate was one of the highest in the world at 204 for every 1,000 live births; by 2013, this rate had been slashed to 64 for every 1,000 live births.

Nepal

Until recently, three in 100 Nepali babies died before they were 1 month old, often from infections introduced into the body through the umbilical cord stump. In Nepal, where home delivery is common, a newborn’s umbilical cord has traditionally been cut with dirty household tools, and substances like oil, turmeric or even cow dung were rubbed on the stump to encourage “healing.”

All that is changing now with the support of USAID. With our partner JSI, we’ve helped develop a low-cost antiseptic gel we’re providing to pregnant women free of charge. A network of 50,000 female volunteer health workers are teaching communities how this little tube and new healthy practices can save their babies’ lives.


When a child dies, and when a mother dies giving birth, it is a tragedy for all of us. Because we miss out on everything they might have offered, and because it continues the cycle of extreme poverty that holds the entire world back. Together, we can break that cycle.

The goal of ending preventable child and maternal deaths is within our reach. We will continue Acting on the Call until every mother and child has the chance to lead a full, healthy life.

Q&A: The Legacy of West Africa’s Ebola Crisis

USAID’s Senior Ebola Coordinator Denise Rollins (right), Mission Director John Mark Winfield (second from right) and Bureau of Legislative and Public Affairs staffer Kate Alexander listen as a staff member of DuPort Road Clinic in Paynesville, Liberia speaks to them. / Jonta Williams, USAID

USAID’s Senior Ebola Coordinator Denise Rollins (right), Mission Director John Mark Winfield (second from right) and Bureau of Legislative and Public Affairs staffer Kate Alexander listen as a staff member of DuPort Road Clinic in Paynesville, Liberia speaks to them. / Jonta Williams, USAID

In this 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.

Denise Rollins, the senior coordinator of the Africa Ebola Unit, has worked at USAID for 28 years. She rejoined USAID in March after retiring last October because she felt a tremendous commitment to help those in need. She is USAID’s liaison coordinating with other U.S. Government agencies to help West African countries strengthen their ability to respond to future disasters.

What will the legacy of Ebola be in the countries affected by it?

Ebola has changed the lives of those affected by the virus and those who helped fight the disease. Ebola has left behind pain, sadness and death; we cannot keep our heads in the sand knowing what we now know about the disease.

However, as these countries get to and remain at zero, the international community will help build more enduring social and economic systems that will allow the countries to handle not only Ebola, but other infectious diseases, as well. We will once again see progress in health, agriculture, education and the overall economy. While Ebola leaves a legacy of caution and preparedness, it also gives us a future based on hope and resilience.

In July, USAID and other donor partners and governments gathered at the International Ebola Recovery Conference held at the UN. What are your thoughts on the conference?

The conference was a platform for representatives of Guinea, Liberia, Sierra Leone and the Mano River Union to outline their recovery strategies, and for the UN to foster a dialogue between the African countries and the donor community about recovery priorities and expectations.

Donors then pledged an unprecedented $3.4 billion in new funding, with the United States pledging $266 million, in addition to the $1.8 billion already provided for the response efforts. This brings the total pledged for response and recovery to more than $5.2 billion from the donor community.

This was a great step forward in a global call to action that will lead to the creation of more resilient societies in Africa.

What made the Ebola crisis different from past health crises?

The large number of people dying, the rapid spread of the virus, and an initial inability to treat patients made this crisis different. In terms of geography, Ebola reached bustling capitals and heavily populated cities, leading to a faster rate of transmission. Misunderstandings and lack of information about the disease also increased fear and panic, causing some victims to avoid reporting their illness. We have never seen a humanitarian public health crisis quite like this one.

What role has communications played in controlling Ebola?

Denise Rollins retired last October after working at USAID for 28 years, but when asked to return as senior coordinator for the Africa Ebola Unit, she said “yes” without hesitation. “I knew this was the right position for me,” she said. / Ellie Van Houtte, USAID

Denise Rollins retired last October after working at USAID for 28 years, but when asked to return as senior coordinator for the Africa Ebola Unit, she said “yes” without hesitation. “I knew this was the right position for me,” she said. / Ellie Van Houtte, USAID

Due to pre-existing issues with digital and communications infrastructure, it was hard to share information about the disease during the crisis. It was difficult to control the outbreak without accurate and timely information to detect Ebola, trace contacts of people who were infected, organize patients’ transport to treatment centers, and coordinate teams to conduct safe burials. Poor information hampered our ability to understand where the outbreak was occurring.

In Liberia, USAID sent a data logistician to serve on the Disaster Assistance Response Team to develop a better data sharing platform. He helped significantly reduce the time it took to get information from outlying areas to the capital. USAID is working with all three countries on improving data and communication technologies.

We are also strengthening public and private partnerships to bring low-cost Internet and mobile phone service to urban and lower-income, rural settings.

How are we helping to strengthen governance?

USAID is expanding the roles of community groups, NGOs and civil society to manage the effects of Ebola and more effectively work with the government to improve the quality of public services.

Our plan includes help with reopening schools, empowering civil society, and supporting open data policies and using technology for government services and information.

Interest in Ebola has been declining as the situation improves. Why are our response efforts still important?

The focus of the response continues to be ending the Ebola epidemic. While there is Ebola in West Africa, nothing prevents it from entering the United States, so this is a matter of national security.

In terms of the countries themselves, Ebola quickly damaged weak institutions, disrupted vulnerable communities and stymied health systems’ ability to address other infectious diseases or basic health care. We strive to rebuild and strengthen health systems there to enable societies to fend off future threats, while making sure those who’ve experienced setbacks can return to a path of prosperity.

These efforts are core to USAID’s mission to end extreme poverty and promote resilient, democratic societies.

Amid the Ebola crisis, many stories have emerged describing heroic aid efforts and acts of bravery. What stories touched you most?

Access to education and the preservation of arts and culture are important to me, so I was heartened to hear stories of children in Sierra Leone eagerly tuning in to an education radio program; of an American artist who stuck photos of smiling health workers on their protective suits so patients could see who was underneath the mask; of actors, taxi drivers, traditional leaders and musicians working together to raise awareness and stop Ebola.

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