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What it’s REALLY like fighting Ebola in Liberia

Categories: Ebola, global health security, infectious disease

 

This blog was originally posted on the ONE.org on September 11, 2014.

 

A Médecins Sans Frontières/Doctors Without Borders (MSF) staff member ties the face mask of Dr. Jordan Tappero, CDC, before Dr. Tappero enters the Ebola treatment unit (ETU), ELWA 3. MSF operates the ELWA 3 ETU, which opened on August 17.

A Médecins Sans Frontières/Doctors Without Borders (MSF) staff member ties the face mask of Dr. Jordan Tappero, CDC, before Dr. Tappero enters the Ebola treatment unit (ETU), ELWA 3. MSF operates the ELWA 3 ETU, which opened on August 17.

Jordan W. Tappero, MD, MPH

Jordan W. Tappero, MD, MPH

During my time in Liberia, I have tried not to provide much detail to my family about the day-to-day work we are doing.

I don’t want to cause alarm or propagate fear; conditions in Monrovia can at times be deeply troubling.

I have spent the past month working to help control the Ebola outbreak in Liberia as part of the United States Government’s Disaster Assistance Response Team, or DART.

Our work here has been nonstop and it doesn’t appear that the end of the epidemic will be anytime soon. There are days when there is palpable tension in the air, especially when a new community experiences Ebola virus transmission for the first time, or experiences a second or third wave of disease.

I have seen what needs to be done to stop Ebola from spreading – find patients quickly, isolate and treat them, identify their contacts and safely bury those that die. But the scale of this Ebola outbreak is unprecedented.

The systems currently in place to identify, refer, isolate and treat Ebola cases are overwhelmed. Knowledge of how the disease is spread varies from community to community, and unsafe burial practices continue to take place far and wide.

In addition, the international response has not been enough. This is in part due to fear that is fostered by ongoing transmission of infection among health care workers with inadequate supplies of personal protective equipment, soap and clean water, and incomplete understanding of required infection control practices, or both.

As part of the DART, our goals are to help partners find people with the virus in the community, get them into Ebola treatment centers and improve infection control practices to prevent the spread of the virus to health care workers and burial teams.

I have worked with many Liberians, our CDC team, and partners in the field who are at the front of the response, and I’m amazed by their dedication in this challenging environment.

As just one example, Dr. Mohammed Sankoh, Director of the Ministry of Health and Social Welfare’s Redemption Hospital in Monrovia is now managing a primary care facility that is being overrun by suspected Ebola patients.

He has lost many of his staff (doctors, nurses, a physician assistant and a midwife) to Ebola. His remaining staff are fearful of coming to work, and his community is increasingly afraid of coming to the hospital, with many preferring to die at home.

In his own words “When we had our civil war, we knew who we were fighting, but with Ebola, the enemy is invisible, and it is taking us in increasing numbers.”

We simply need more people to step up to help supply, train and equip Liberian nationals to take on the epidemic.

The work is challenging, yet highly rewarding. The United States’ effort in Liberia is but one cog in a larger wheel of the response that is striving to save lives. However, I am certain that the epidemic would be even worse without our presence.

I am grateful to be able to contribute to the fight against this scourge.  And the Liberian people are thankful that the U.S. has not abandoned them.

We need others to join in the fight against Ebola. But let’s not stop there.

To prevent such public health events, all countries need to have the capability to prevent the spread of infectious disease threats quickly, detect them accurately, and respond to them effectively.

It is heartbreaking to see countries like Guinea, Sierra Leone and Liberia trying to tackle this epidemic with inadequate public health infrastructure and trained public health and medical workforce that could have averted it with modest investment.

It is a global health security imperative to contain Ebola in West Africa and to prevent its spread across the continent and beyond.

Indonesia Takes a Leadership Position in the Global Health Security Agenda

Categories: global health security

Maluku mom and kid with mosquito bed net (Photo courtesy of Edi Purnomo, UNICEF)

Photo courtesy of Edi Purnomo, UNICEF

Dr. William Hawley, Country Director for CDC-Indonesia

Dr. William Hawley, Country Director for CDC-Indonesia

As the world’s fourth most populated country, Indonesia plays an important strategic role in protecting the global community from infectious disease threats. As one of the early countries to take a leadership role in the Global Health Security (GHS) Agenda, the Government of Indonesia will welcome senior health and agricultural leaders from 36 countries and 12 international organizations for the next commitment meeting August 20-21. The meeting, “Building Global Commitment to Multisectoral Approaches to Manage Emerging Zoonotic Diseases in Support of the Global Health Security Agenda within the Framework of Public Health”, demonstrates the progress and growing momentum of the GHS Agenda.

The High Stakes in Fighting Ebola: Leave One Burning Ember and the Epidemic Could Re-Ignite

Categories: Ebola, global disease detection, global health security, health systems strengthening, infectious disease

 

This blog was originally posted on the Huffington Post on August 7, 2014.

 

A banner encouraging people suffering from Ebola to go immediately to a health center for treatment is seen on a sidewalk in the city of Freetown, Sierra Leone, Thursday, Aug. 7, 2014. While the Ebola virus outbreak has now reached four countries, Liberia and Sierra Leone account for more than 60 percent of the deaths, according to the World Health Organization. The outbreak that emerged in March has claimed at least 932 lives. (AP Photo/Michael Duff)

(AP Photo/Michael Duff)

CDC and our partners are currently fighting the biggest and most complex outbreak of Ebola virus disease ever recorded.

CDC Director Dr. Tom Frieden

CDC Director Dr. Tom Frieden

There are hundreds of cases in West Africa and now a new cluster of cases in Nigeria is very concerning. The spread of Ebola shows what happens if we don’t have meticulous infection control, contact tracing, and proper isolation of those with symptoms of the disease.

There are two things that are very important to understand about how Ebola spreads.

The evidence suggests that Ebola only spreads from sick people—not from people who have been exposed to the disease but haven’t yet become sick from it. The illness has an average 8-10 day incubation period, although in rare instances the incubation period may be as short as two days or as long as 21 days, which is why we recommend monitoring for 21 days after any potential exposure.

Global Health Security in Africa: Collaborations Between CDC and African Partners

Categories: global health security

2012 investigation of Ebola virus in Uganda

2012 investigation of Ebola virus in Uganda

Thomas Kenyon, MD MPH, Director of CDC Center for Global Health

Thomas Kenyon, MD MPH, Director of CDC Center for Global Health

The ambition and scope of the Global Health Security Agenda are clear. Its reach can be discerned from the very first word: global. The Agenda’s overarching goal is just as expansive—making the world safer and more secure by preventing epidemics and outbreaks, detecting them more rapidly, and responding effectively to lessen the health, economic, and societal consequences from disease threats.

Less obvious, but no less true, is that African ownership will be central and fundamental in shaping the way the Global Health Security Agenda evolves worldwide, the way it is enacted and refined, and to a large extent, how it succeeds.

CDC and African nations have been close and successful partners for many decades in the battle to protect and improve public health. In many ways, the concepts, practices, and tools that are central to the Global Health Security Agenda are drawn from experiences honed with our partners in Africa over many years.

World Cup serving as real-world test for new disease detection technology

Categories: global disease detection, global health security, health systems strengthening, infectious disease

 

World Cup soccer ball

 

With the World Cup underway in all its frenzied glory, you can be forgiven for missing another major effort currently underway in Brazil that represents the first large scale, real-life, real-world test of important new technology.

And no, it’s not the goal-line technology that’s being used for the first time at soccer’s biggest competition.

This technology uses computer tablets, sophisticated software designed by CDC and public health experts from Brazil’s Ministry of Health (MOH) trained in the Field Epidemiological Training Program (FETP) to provide the most complete, detailed and timely information about disease threats and other public health concerns.

Communication Matters in Global Health Deployments

Categories: global health security, infectious disease

During the simulation exercise, ECN trainees deployed to the site of a mock disaster in Avully, Switzerland.

During the simulation exercise, ECN trainees deployed to the site of a mock disaster in Avully, Switzerland.

Communication matters.

Gaya Gamhewage, MD, Coordinator, WHO Communication Capacity Building Team; Founder, WHO Emergency Communication Network

Gaya Gamhewage, MD, Coordinator, WHO Communication Capacity Building Team; Founder, WHO Emergency Communication Network

That’s not a new idea. Many of us have learned this the hard way. This concept is being applied in a new, more comprehensive way for a key purpose—to help the World Health Organization (WHO) communicate more effectively, with more clarity and purpose during humanitarian and public health emergencies.

The idea is to better integrate communications specialists from WHO, CDC, ministries of health and a wide array of other humanitarian and global health organizations into a cohesive, specially trained team that can be dispatched on short notice when public health or humanitarian emergencies occur.

The logic is based on the idea that communications is part and parcel of emergency health response. Communicating in a crisis not only provides the public and policy maker clear and critical information, it also can help the technical side of the response. It connects those affected with those willing to help and can make sure that resources are aligned to the most important needs.

Public Health Informatics in Action in Malawi: Making life easier for healthcare workers and patients while improving quality through an innovative national Electronic Medical Record System

Categories: child health, global health security, HIV/AIDS, women's/maternal health

Instituting an Electronic Medical Record System reduces the need to manage and store growing volumes of patient charts, a major challenge in resource-limited settings.

Instituting an Electronic Medical Record System reduces the need to manage and store growing volumes of patient charts, a major challenge in resource-limited settings.

Denise Giles, M.P.H., Health Scientist, CDC-Malawi

Denise Giles, M.P.H., Health Scientist, CDC-Malawi

Keeping track of even one patient undergoing treatment for HIV/AIDS can be complicated enough.

Doing it for over 472,865 patients when you’re a low income country coping with high demand and a sputtering economy magnifies the complexity.

Which is why Malawi’s story – and its solution – is attracting attention and praise. It’s a story of how Electronic Medical Record System (EMRS) technology is being used and the foresight needed to bring it to reality.

You don’t have to look far to see the positive results.

FETP Work in South Sudan Benefits the Whole World

Categories: global health security, health systems strengthening

I’ve been with the Field Epidemiology Training Program (FETP) for 2.5 years now, where I am currently the resident advisor (RA) in South Sudan. My epidemiology training has provided me with the opportunity to gain a wide variety of experiences; prior to joining FETP, I served as an epidemiologist with Médecins Sans Frontières-Switzerland (MSF-CH), working in the refugee camp in Dadaab, Kenya, and have also worked in Dawei (Tavoy), Burma . I am glad to be able to pass on my knowledge about epidemiology to future leaders in the field. As an RA I assist with basic FETP implementation for county and state surveillance officers as well as immunization managers and supervisors. I also advise on outbreak response for priority diseases as well as assist with cascade training for the health facility staff who provide immunization services.

Helsinki, Finland – The Next Step in Accelerating Global Health Security

Categories: global health security

The Global Health Security Agenda Commitment Development meeting is being hosted by Finland, May 5-6, 2014 at Finlandia Hall in Helsinki.

The Global Health Security Agenda Commitment Development meeting is being hosted by Finland, May 5-6, 2014 at Finlandia Hall in Helsinki.

When senior leaders from more than 30 countries and 4 international organizations converge on Helsinki on May 5th for two days of intensive discussion, the over-arching topic will be one that is closely associated with Finland’s capital city – security.

CAPT (USPHS) Eric Kasowski, DVM, MD, MPH – Chief, CDC Global Health Security Branch

CAPT (USPHS) Eric Kasowski, DVM, MD, MPH – Chief, CDC Global Health Security Branch

But this time, unlike 1975 when Helsinki hosted the Conference on Security and Cooperation in Europe, or 1990 when President George Bush met President Mikhail Gorbachev met in the same city for a path-breaking U.S. – Soviet summit, the leaders arriving in Helsinki will be working on a new aspect of security, one that will better protect the world from infectious disease threats.

The Helsinki meeting is the next major step in a historic partnership unveiled Feb. 13 in Washington, D.C., called the Global Health Security (GHS) Agenda. This effort is aimed at improving our ability worldwide to prevent, detect and respond to infectious disease outbreaks at a time when diseases of all types can travel greater distances in less time than ever before and potentially threaten a larger number of people no matter where they live.

DPDx: 15 Years of Strengthening Laboratory Capacity for Parasitic Disease Diagnosis

Categories: global health security, parasitic diseases

 

CDC’s DPDx helps labs around the world identify parasites like Taenia saginata. (Photo courtesy of David Snyder/CDC Foundation)

CDC’s DPDx helps labs around the world identify parasites like Taenia saginata. (Photo courtesy of David Snyder/CDC Foundation)

The inquiries and images come from almost every state in the United States, and often with a sense of urgency. Still others arrive from Argentina and Germany, Italy, Japan, China, New Zealand, India—and dozens more countries around the globe. Each time the question for CDC’s parasite identification laboratory, known as DPDx, is the same: What is it?

Alexandre J. da Silva, PhD, CDC DPDx

Alexandre J. da Silva, PhD, CDC DPDx

The diagnostic parasitology experts on CDC’s Division of Parasitic Diseases and Malaria’s DPDx team provide answers.

DPDx is the effective merger of technology, laboratory science, and CDC’s unparalleled expertise in parasite identification and the diseases they cause.

DPDx is a unique online educational resource that includes visual depictions of parasite lifecycles, a reference library of free images of parasites, and guidance on proper laboratory techniques for diagnostic parasitology. But it is much more than a Web site.

The primary role of DPDx is reference diagnosis, wherein CDC laboratory scientists confirm diagnoses or discover that the diagnosis is something altogether different from what was originally thought. In both cases, but especially in the latter cases, DPDx impacts treatment. For example, Babesia microti is one of the parasites that cause the tick-borne disease babesiosis; it can be misidentified as Plasmodium falciparum, which causes malaria. The two diseases require different treatments and on many occasions, the DPDx team has corrected a misdiagnosis, ensuring that the patient is appropriately treated.

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