During this week, we attended a forum on preventing youth violence and crime. Many organizations attended to hear about the results of a survey that was conducted on various municipalities to measure people’s perception of crime in their communities. Most of the findings showed prevalence of domestic violence, homicides, gender violence, dysfunctional families, etc - all of which are linked to lack of education and lack of community and family cohesion.
It’s been only a few days since we set foot on the beautiful islands of the Dominican Republic. I could not believe it finally happened; it was so surreal. Our preceptor, Mrs. Teresa Narvaez (who is the country director for Project HOPE and the clinics), picked us up from the airport and took us to eat some “sancocho”, which is a delicately seasoned stew with spices, meat, potatoes, lemon, and avocado.
This post was original published at One.org.

I was shocked to learn that the largest previous Ebola outbreak occurred in 1976 in Zaire: 318 confirmed cases and 280 deaths, but the current outbreak in West Africa has exceeded 4,200 cases with 2,200 deaths and growing. According to WHO estimates, 10,000 more lives will be lost before the virus is contained.

September 17, 2014


By Bill Frist

I was shocked to learn that the largest previous Ebola outbreak occurred in 1976 in Zaire: 318 confirmed cases and 280 deaths, but the current outbreak in West Africa has exceeded 4,200 cases with 2,200 deaths and growing. According to WHO estimates, 10,000 more lives will be lost before the virus is contained.

This is terrifying, I know. I remember feeling the same urgency over a decade ago. I was working with Bono on the ground in Africa, traveling across the U.S. on a listening tour, and I ultimately went to the White House to inform then-President George W. Bush that the U.S. desperately needed to address HIV/AIDS.

That appeal worked. President Bush boldly announced the unprecedented President’s Emergency Plan for AIDS Relief (PEPFAR) during the State of the Union Address in 2003—a time when only 50,000 people in Africa had access to anti-retroviral therapy.

Today 12.8 million people have access to these drugs, and PEPFAR has provided HIV testing and counseling to 57 million people. In 2011 alone, PEPFAR provided services to prevent mother-to-child transmission of HIV resulting in over 240,000 babies born free of HIV.

This is what the U.S. is capable of.

Today, Ebola is ravaging West Africa thanks to a confluence of circumstances. But the important message is, that we can address these circumstances, and we are not in this predicament for lack of a vaccine or anti-viral drug. The real issue are the significant cultural barriers to containing the outbreak, and lack of medical infrastructure in West Africa.

For example, people are avoiding treatment because of a widespread local doubt that Ebola even exists. There is fear that medical workers—foreign and local—are spreading the virus. Families do not want their loved ones to die in isolation, so they choose to keep them home.

Additionally, when an individual succumbs to the virus, burial practices of washing and kissing the body and then reusing the burial mat further spreads the disease because the recently deceased Ebola victim is actively shedding the virus from her skin.

For these reasons, changing culture by working within the culture will be imperative to our success. With HIV/AIDS, PEPFAR collaborated with traditional medical practitioners to deliver education and training, while also building an infrastructure that was sustainable. With HIV there were cultural practices like using leeches for bleeding that increased transmission of HIV outside safe sex practices or reusing needles. We had to address those practices in a culturally sensitive way.

We are also faced with a tragic lack of resources. The medical supplies and personnel needed to offer the routine intensive care necessary to support someone through a hemorrhagic fever like Ebola simply do not exist in West Africa.

President Obama has just announced an escalation of military involvement in Liberia only. He has committed 1,700 beds, to training of 500 health care workers and sending 400,000 home treatment kits. This will all be deployed by the Department of Defense via “command and control,” meaning they will deliver and direct the use of the resources to treat the sick.

While this is a major commitment, it is only for Liberia, but I suspect once we have boots on the ground, we will escalate even further.

As a former member of the Senate Foreign Relations committee, I have spent a lot of time dealing with the tension between our responsibility to protect and the sovereignty of foreign nations. There are myriad issues at play.

Specifically, military involvement in humanitarian efforts must always be approached carefully. I truly believe that global health is a vital diplomatic instrument to strengthen confidence in America’s intent and ability to bring long-term improvements to citizen’s lives in other nations. The fight for global health can be the calling card of our nation’s character in the eyes of the world.

I also agree that our military comprises brilliant and compassionate minds and state of the art resources. But use of the military instead of an NGO or an organization like USAID comes at a price. There is always a tension between giving aid and the deeply instilled training to maintain order especially in a humanitarian situation when the rules of engagement prevent the military from firing unless fired upon.

We can win hearts and minds with military help, but we must do it in the right way – by building a sustainable infrastructure and empowering West Africans to continue the work. The commitment to build facilities and train local personnel is a good start.

Without containment, this epidemic will become a pandemic. The World community including the U.S. needs to help. However, help needs to be culturally sensitive and build lasting solutions. We cannot fish for them, we must teach them to fish.

Bill Frist, M.D is a nationally acclaimed heart and lung transplant surgeon and former U. S. Senate Majority Leader. Dr. Frist represented Tennessee in the U.S. Senate for 12 years where he served on both the Health and Finance committees responsible for writing health legislation. Dr. Frist was the former Co-Chair of ONE Vote ’08 and his leadership was instrumental in the passage of PEPFAR.

Read my earlier Ebola primer and a look at what we know about how the virus behaves.

As the Ebola situation in West Africa progresses, we are dealing with increasingly complex medical and cultural challenges. I addressed some of the cultural issues in a Morning Consult column last month, and highlighted the importance of identifying infected patients:

The only solution is prevention, which relies on containment and isolation. The sick must be rapidly identified and contained. Their contacts must be followed for 21 days so they can be rapidly isolated, should they develop symptoms. Their care must be delivered in a hazmat suit. If the patient dies, and [50%] do, the body must be properly disposed of because a recently deceased Ebola victim is actively shedding the virus from his skin.
Click here to watch our Mother & Child Project video.

The Mother and Child Project:
Helping Families in the Developing World
Keynote Speaker: Former US Senate Majority Leader Bill Frist, MD
Host: Senior Pastor Mike Glenn

Ebola's Hard Lessons

Sep 08 2014

As September opened, a striking consensus had emerged among global health leaders that the Ebola outbreak in Liberia, Sierra Leone, and Guinea has transmuted into a colossus that continues to gather force: It is "spiraling out of control" (Dr. Thomas Frieden, Director of the U.S. Centers for Disease Control and Prevention, CDC); “We understand the outbreak is moving beyond our grasp” (Dr. David Nabarro, Senior UN System Coordinator for Ebola Disease ); Ebola is “a global threat” that “ will get worse before it gets better, and it requires a well-coordinated big surge of outbreak response” (World Health Organization Director General Dr. Margaret Chan); “Six months into the worst epidemic in history, the world is losing the battle to contain it. Leaders are failing to come to grips with the transnational threat” (Dr. Joanne Liu, Doctors Without Borders (MSF) International President).
Last November, at an event associated with the International Conference on Family Planning in Addis Ababa, Ethiopia, I was struck by a public comment from a representative of the U.S. Agency for International Development (USAID): “With almost 90% of people globally professing a faith, it doesn’t make sense to do family planning without the faith community.”


Melany Ethridge, (972) 267-1111, [email protected]

NASHVILLE, TENNESSEE, Aug. 25, 2014 – Former Senate Majority Leader Bill Frist, M.D., founder of Hope Through Healing Hands, and Brentwood Baptist Church Senior Pastor Mike Glenn will host a free, public conference on “The Mother & Child Project: Simple Steps to Saving Lives in the Developing World,” at Brentwood Baptist Church on Wednesday, Sept. 24.

Running 8:30 a.m. to 2:30 p.m., the event is free and open to the public. Breakfast and lunch will be provided. This faith-based conference will host a diverse panel of experts who will discuss how healthy timing and spacing of pregnancies can dramatically improve the health of women and children in the developing world.

Representatives from the Bill & Melinda Gates Foundation and other local and national speakers will come together to share their perspectives on global efforts to increase access to health services that save lives. They will lead a robust Q&A session encouraging further discussion, closing with practical ways attendees can get involved to save lives and see families thrive in the developing world.

In addition to Sen. Frist and Pastor Mike Glenn, conference speakers include:

  • Dr. Gary Darmstadt and Tom Walsh, the Bill & Melinda Gates Foundation
  • James Nardella, Lwala Community Alliance
  • Dr. David Vanderpool, LiveBeyond
  • Lisa Bos, World Vision
  • Rick Carter and Terry Laura, Compassion International
  • Lucas Koach, Food for the Hungry
  • Jenny Eaton Dyer, PhD, Hope Through Healing Hands
  • John Thomas, Living Hope

While the event is free and open to the public, registration is requested by Sept. 18, and more information is available at www.hopethroughhealinghands.org/registration-bbc or by emailing [email protected]

This event follows a recent conversation with community leaders at Belmont University, during which Sen. Frist and Melinda Gates shared their efforts on this issue. Melinda Gates has championed a global movement to provide 120 million women with the tools and services necessary to time and space their pregnancies by 2020, in an effort to improve the health of women and children.

Hope Through Healing Hands’ Faith-based Coalition for Healthy Mothers and Children Worldwide seeks to galvanize faith leaders across the U.S. on the issues of maternal, newborn and child health in developing countries. Particular emphases include the benefits of healthy timing and spacing of pregnancies, including the voluntary use of methods for preventing pregnancy not including abortion, that are harmonious with members’ unifying values and religious beliefs.

Several faith leaders already involved in this issue have lent their voices to the coalition, and will continue to do so at the upcoming conference. As Pastor Mike Glenn stated, “The Evangelical church is often accused of loving the child and not the mother; but in doing so, we lose God’s mosaic. We believe in ‘Imago Dei,’ the dignity of every human being.”

Information about members of who have joined the coalition to-date, as well as how others can help, is available at http://www.hopethroughhealinghands.org/faith-based-coalition. Endorsements for the coalition are available at http://www.hopethroughhealinghands.org/endorsements.

Hope Through Healing Hands is a Nashville-based 501(C) 3 nonprofit with a mission to promote improved quality of life for citizens and communities around the world using health as a currency for peace. Senator Bill Frist, M.D., is the founder and chair of the organization, and Jenny Eaton Dyer, Ph.D., is the CEO/Executive Director.


Note to editors: For more information, visit http://www.alarryross.com/newsroom/hope-through-healing-hands-2/.

Morning Consult | August 22, 2014

By Bill Frist

I remember a time in South Sudan when I was on a surgical mission trip. The shaman of a local tribe brought us a young man who was dying. The local healers had tried everything – medicines, rituals, prayers. But the one thing this man needed was forbidden in their culture. He had a deep abscess on his inner thigh in desperate need of draining. He was clearly in septic shock from bacteria in his blood from the wound as well. But in his culture, you could not puncture the body in anyway. It was considered desecration of the body.

However, he was dying. Because I was serving with a group of established medical aid officers, our methods—though foreign—were proven. The shaman and the young man were terrified, but they were also desperate.

I took my scalpel, wrapped my hand respectfully around the shaman’s hand, and together we incised the deep abscess.

The young man immediately felt better and the infection was cured with further surgery and antibiotics. He fully recovered and the shaman eventually thanked me. He was skeptical and fearful at first, but the patient lived, and the shaman was convinced to trust me.

In dealing with the largest Ebola outbreak in history we face many challenges: the rapidly fatal course of the illness and the advanced medical supportive care required for survival. We have seen that with the case of Dr. Kent Brantley, who was recently discharged from Emory University Hospital. While he did receive an experimental drug and a blood transfusion from an ebola survivor, there is no scientific way to determine if that had any impact on his course of illness. What we do know is he did well because he was contained quickly and had a known course of supportive care. The unfortunate fact is that we have no evidence that any amount of American medical resources or new experimental drugs will end the outbreak on its own.

The only solution is prevention, which relies on containment and isolation. The sick must be rapidly identified and contained. Their contacts must be followed for 21 days so they can be rapidly isolated, should they develop symptoms. Their care must be delivered in the a hazmat suit. If the patient dies, and 70% do, the body must be properly disposed of because a recently deceased Ebola victim is actively shedding the virus from his skin.

On August 7th we heard compelling testimony from Dr. Ken Isaacs, Vice President of International Programs and Government Relations at Samaritan’s Purse about the cultural barriers to containment. He testified before the House Committee on Foreign Affairs and related his recent experience.

Containing the Ebola outbreak requires not only the right medical tools, but a sensitive understanding of the culture in which it is flourishing.

Contributing to Ebola’s virulence are the cultural traditions around the veneration of the dead. Dr. Isaacs mentioned this in his testimony, and I later discussed this practice with the Center for Disease Control. They explained the local ritual further:

A deceased community member’s body is rinsed, wrapped in clean cloth and rolled in a mat of palm tree branches. A coffin is used if the family can afford it. The body is then buried in a community cemetery and the burial cloth may be kept as a memento of the deceased. During the process mourners will kiss and touch the body repeatedly.

These traditions are an important part of community and family mourning. But they can also be deadly to those in close contact with an infected body. Dr. Isaacs testified his staff had been threatened with violence when they attempted to collect bodies for sanitized burial.

Further testimony revealed that there has even been doubt about the virus’ existence among the local medical community. Dr. Isaacs told the story of a well-respected and educated Liberian physician who visited the facility in Monrovia and examined patients without protective gear, mocking the existence of the virus to his colleagues. He passed away in Nigeria a week later.

Certain groups have even assaulted containment centers with looting and violence. Why? The incident in West Point Liberia was driven by both fear of having a containment center in their community as well as a complete disbelief that the virus is real – total confusion begetting total chaos.

The United States has a role to play here, but we must move forward carefully.

Starting in 2003 with PEPFAR, the President’s Emergency Program for AIDS Relief, healthcare as a mechanism of diplomacy has become a more prominent part of our foreign policy. However, foreign policy is a dance, a negotiation of shared goals and identification of conflicts between nations. Even when the goal seems clear – to stop an Ebola outbreak for example – there is always an inherent tension between cultures, a worry about ulterior motives, a distrust of the unknown and sometimes a memory of the U.S.’s past use of health initiatives as cover for military operations.

But distrust and the cultural barriers can be overcome, as I saw with the young patient in South Sudan. While that was a single incident and this is an outbreak, the underlying principles are the same: We have to be physically present. We have to prove that our strange customs and beliefs can save lives. It’s an extension of what doctors have always tried to do with scared and vulnerable patients—be at the bedside, listen, and heal.

Ebola is more rapidly fatal than HIV, and has no specific treatment. But like HIV, it is a viral illness, spread through close contact that is often exacerbated by cultural beliefs and practices. PEPFAR was successful in reducing AIDs related mortality by 33% from 2005 to 2012 and it was the result of a coordinated and targeted effort to provide treatment as well as education. It required “boots on the ground” to integrate with the culture and build trust.

Today West Africa is facing a devastating illness in a culture of distrust and mis-education. The rest of the world is working in the face of budgetary constraints and fear of personal exposure. Add in the poor press about experimental drugs with access limited to Americans, and the fog of suspicion thickens. While USAID has already committed $14.55 million in emergency funding, this money has not bought the needed trained professionals and supplies to accomplish containment. A recent Kaiser Family Foundation report noted only $13 million of the $46 million needed in Liberia and Sierra Leone has been received.

This is a time for the United States—government, NGOs and all—to seize the mantle of global health as a vital diplomatic instrument to strengthen confidence in America’s intent and motives. Everything we do on the global stage sends a message. This is an opportunity for the U.S. to be a global leader, build trust, and show that we can break down cultural and communication barriers and align for a common goal. But to do this we need to go to West Africa with sensitivity as well as knowledge, and it needs to be a priority because it is the only way to stop the outbreak.

For some, this is a terrifying proposition, but so is the devastation of the population if Ebola is not adequately contained. We have the resources to safely fight the virus. We understand transmission and containment. But putting that knowledge to work in West Africa means putting trained and funded intervention where it’s needed most: at the bedside.

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