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

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

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

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

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

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.

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

USG Funding for the Ebola Response

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

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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.

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

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

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

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

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

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

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

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

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

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

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

Tours into the Unknown

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

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

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

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

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

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

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

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

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

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

Growing Popularity

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

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

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

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

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

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

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

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

ABOUT THE AUTHORS

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

Ending the ‘Neglect’ in Neglected Tropical Diseases

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

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

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

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

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

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

USAID’s Reach: More than One Billion Treatments

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

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

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

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

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

From Prevention to Elimination

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

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

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

“Last Mile” Toward Control of Neglected Tropical Diseases

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

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

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

ABOUT THE AUTHORS

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

Working to Beat Ebola Along the Border

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

ABOUT THE AUTHOR

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

Young Storytellers and the Power of Literacy

A Rwandan child reads with his teacher. / Jackie Lewis, EDC

A Rwandan child reads with his teacher. / Jackie Lewis, EDC

Editor’s Note: Parts of this blog post originally appeared as a longer feature story from Education Development Center (EDC).

The tale “Old Woman and a Hyena” tells the story of a Rwandan mother and her four sons who live in terror of a marauding hyena. Each day, while the sons are away hunting, the hyena comes to the family’s hut and steals their food. The boys are hungry but too scared to confront the creature. One day, the sons finally muster up the courage to fight the beast—and it is the youngest who finally kills it. He is then richly rewarded by his mother, for though he had been the most scared, he was the one to show the most bravery.

In a land with an oral history as rich and beautiful as the hills that roll across it, this tale is special—it was written by an 11-year-old boy named Francois Hakizimana.

Andika Rwanda, a national writing competition, was popular because it presented a nationwide opportunity to improve reading and writing in a way that was culturally relevant and important. / Jackie Lewis, EDC

Andika Rwanda, a national writing competition, was popular because it presented a nationwide opportunity to improve reading and writing in a way that was culturally relevant and important. / Jackie Lewis, EDC

Hakizimana was one of the winners of Andika Rwanda (Rwanda Writes), a national writing competition that captured the minds (and pens) of young and old storytellers alike. Three thousand entries of original children’s stories and poems poured in;12 winners were honored at an awards ceremony last fall. Their entries have been professionally illustrated and published in a book that will be distributed to every primary school in the country.

The competition was organized by Education Development Center’s USAID-funded Literacy, Language and Learning project in partnership with the Rwanda Educational Board and the Rwanda-based book distributor Drakkar Limited. Since 2011, the project has worked to improve literacy education in Rwanda through development of instructional materials, teacher training, policy development, and delivery of education materials directly to Rwandan communities.

According to Jackie Lewis at Education Development Center, Andika Rwanda was so popular because it presented a nationwide opportunity to improve reading and writing in a way that was culturally relevant and important.

“Rwanda prides itself on homegrown solutions,” she says. “Many schools have a shortage of storybooks, especially for younger children, and especially ones written by Rwandans in the local language of Kinyarwanda. The competition was meant to generate locally authored stories for primary school children, as well as contribute to a culture of reading and writing.”

Rwanda Literacy Week celebrated reading and writing across the country. / Jonathan Padway, USAID

Rwanda Literacy Week celebrated reading and writing across the country. / Jonathan Padway, USAID

A Global Effort

Rwanda is a success story and representative of the education work being done in dozens of other countries around the world. In addition to the Andika Rwanda competition, USAID supports many other innovative teaching and learning tools that target basic literacy and numeracy skills at the primary level. These efforts are focused on improving school quality now that Rwanda has increased access to education – in 2012, 96.5 percent of children were enrolled in primary school, and girls were enrolled at a slightly higher rate than boys.

Literacy isn’t just about kids, either–it’s about the economy, too. The Government of Rwanda has laid out ambitious plans to create a knowledge-based economy built on a skilled workforce that will allow Rwanda to compete both regionally and internationally. A literate population is the foundation of these efforts.

Improving literacy can also play a critical  role in addressing other issues faced by developing countries, including gender equality, economic growth, environmental sustainability, health and food security. Unfortunately, illiteracy is still widespread, with disadvantaged groups – including girls, minorities and people living with disabilities – suffering the most.

This is why, for decades, USAID has been a global leader in improving reading for developing countries. The Agency’s strong focus on reading is in itself an innovative practice. Driving and supporting a strong focus on reading puts us in the forefront of educational development.

On this Leaders for Literacy Day, we must remember the importance of policies that advocate for quality and equality in learning for all children and youth, so that stories like Hakizimana’s turn from extraordinary to commonplace.

ABOUT THE AUTHOR

Christie Vilsack is the Senior Advisor for International Education at USAID working to ensure ALL children have access to a quality education. Follow her @ChristieVilsack.

Filling the Void: Thinking About Limited Data in the Developing World

Ryan Zimmerman, third baseman for the Washington Nationals, on his way to homeplate to be mobbed by his ecstatic teammates after hitting a game-winning home run against the Atlanta Braves on opening night at the inaugural game played at Nationals Park in Washington, D.C. / Kevin Harber, CC

Ryan Zimmerman, third baseman for the Washington Nationals, on his way to homeplate to be mobbed by his ecstatic teammates after hitting a game-winning home run against the Atlanta Braves on opening night at the inaugural game played at Nationals Park in Washington, D.C. / Kevin Harber, CC

Watching baseball’s Opening Day this week reminded me of how the sport sparked my passion for numbers and statistics at an early age. One of my science fair projects way back when was on a (very limited) statistical analysis of whether or not expansion teams to Major League Baseball benefited pitchers more than batters.

While the use of sabermetrics is relatively new to the game (I’d highly recommend reading Moneyball if you haven’t already), statistics have been a part of baseball since the 19th century and are as much a part of the game as hot dogs and athletic cups.

The greats of baseball were defined by their stats, from their tally of home runs or stolen bases to the number of World Series they led their teams to. Listening to or watching baseball games, you’ll hear the commentator pull some of the most ridiculous statistics, which makes you think about how each part of the game is tracked in incredible detail — down to which team’s players sport the most facial hair.

Students participate in a local mapping project in Haiti in 2013. / Kendra Helmer, USAID

Students participate in a local mapping project in Haiti in 2013. / Kendra Helmer, USAID

With all the data that’s collected and pored over for baseball and other sports in the United States, you would think data would be as easily accessible across all areas. Unfortunately, that’s not the case, especially for our work in developing countries. When working with statistics about the developing world, you find a lot of holes due to a whole host of problems. And for the data we do have access to, much of it is outdated or unreliable, as mentioned in a report released by the Center for Global Development last summer:

“But nowhere in the world is the need for better data more urgent than in sub-Saharan Africa — the region with perhaps the most potential for progress under a new development agenda. Despite a decade of rapid economic growth in most countries, the accuracy of the most basic data indicators such as GDP, number of kids attending school, and vaccination rates remains low, and improvements have been sluggish.

This is a problem especially apparent as the United Nations cultivates the Sustainable Development Goals, the successor to the Millennium Development Goals. In order to determine progress toward the 17 goals, the United Nations needs to collect good data to track a wide range of indicators. In the search for good data, it must accept imperfection as is done with plenty of statistics and data in the developed world.

As USAID, other agencies and donors conduct evaluations and analyses to identify critical areas or assess projects effectiveness, the work can often be hindered by the lack of (usable) data.

George Washington University geography students help USAID and the World Bank map Kathmandu by tracing satellite imagery using online tools for the Open Cities project / Jessica McConnell Burt, GWU
George Washington University geography students help USAID and the World Bank map Kathmandu by tracing satellite imagery using online tools for the Open Cities project / Jessica McConnell Burt, GWU

To address the data void, USAID is finding new and innovative ways for collection and measurement. For instance, the USAID GeoCenter has been engaging with university students in the United States and host countries through mapathons to chart unmapped areas of the world, such as Nepal, Bangladesh and the Philippines. The mapping data, openly shared, provide USAID and partners with better baseline information for monitoring projects. When combined with household surveys, the data can improve analyses and understanding of specific areas of vulnerability within a country.

The development community is far from reaching the level and reliability of statistics collected on Major League Baseball, which has been allowing general managers, coaches and fantasy baseball fanatics to make more informed decisions to improve their teams for decades.

By concentrating efforts to alleviate some of the systematic problems that lead to a lack of data in the first place, the development community would not just be improving access to reliable data, but would be solving some of the underlying problems of developing countries in the first place.

With more abundant, reliable and geocoded data about the developing world, USAID and other organizations can make more informed decisions about how to better target poverty, helping us reach the goal of eradicating extreme poverty by 2030.

ABOUT THE AUTHOR

Aaron Chafetz is a Program Analyst in USAID’s Bureau for Economic Growth, Education and Environment. Follow him @achafetz.

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

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

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

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

Meet the Ebola Chrono news team! Their radio show gained more listeners and respect after they reported from inside a busy Ebola treatment center. / Internews

1. They are Breaking New Ground

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

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

According to Pierre Mignault, a veteran journalist now working with the team, Ebola Chrono is filling a gap he feels existed on the Guinean airwaves.

“What was missing here was solid, factual information about the response,” Mignault explained.

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

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

2. They are Venturing into Unchartered Territory

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

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

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

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

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

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

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

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

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

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

3. They are Making an Impact

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

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

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

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

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

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

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

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

ABOUT THE AUTHOR

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

Moving Beyond Ebola: Rebuilding Liberia’s Health Care System

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

ABOUT THE AUTHOR

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

FrontLines: Foreign Aid Impact in U.S. and Abroad

A worker at the Banko Gotiti Cooperative in the Southern Nations, Nationalities and People's Region of Ethiopia holds a handful of ripe red Yirgacheffe coffee berries. Credit: Marcelo Pereira / USAID Agribus Market Develop

Read the latest edition of USAID’s FrontLines to learn some of the ways entrepreneurs, corporations, universities, diaspora groups and others work hand-in-hand with USAID to help the Agency fulfill its mission in countries around the world—and how those efforts boomerang back to the United States. Some highlights:

  • More than 500 billion cups of coffee are consumed each year on this planet and Ethiopian growers are hard at work to get more of their brews in the hands of U.S. coffee drinkers
  • From farmers to disease detectives, USAID supports a wide swath of people in several Asian countries as they go about their critically important work of identifying viruses before they can become pandemics.
  • Playing matchmaker between Jamaican youth and successful Jamaicans in the U.S. is leading to a marriage of the ‘entrepreneurial’ minds.
  • She attended primary school in a refugee camp. Now this South Sudan native is earning a master’s degree in the U.S. so she can go back home for a mission close to her heart—boosting girls’ education.

If you want an email reminder in your inbox when the latest issue of FrontLines has been posted online, subscribe here.

ABOUT THE AUTHOR

Angela Rucker is a writer at USAID.
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