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.

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.”

FOR INFORMATION CONTACT:

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.

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

This faith-based conference will host dynamic speakers talking about the critical global health issues of maternal and child health, with a special emphasis on the benefits of healthy timing and spacing of pregnancies as a life-saving mechanism in the developing world. Local and national speakers will come together to talk about their special work as service providers in countries around the world, caring for mothers and children worldwide. We will lead a robust Q&A session with all the speakers encouraging further discussion. And the conference will close with practical, simple steps for how YOU can save lies and help families thrive in the developing world.

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.

Originally published by the New York Times

Matt Cone writes about teaching students about global issues in the classroom, with a special nod toward Senator Bill Frist. Cone is a teacher at Carrboro High School in North Carolina.

Of the more than 8,000 class periods that I have taught, one stands out as my favorite — not only for what happened in the class but also for how it transformed my teaching. The class took place in the fall of 2004 and what strikes me about it now is how primitive it was by today’s technological standards. Indeed, the entire class consisted of the students sitting in a circle, staring at a speakerphone, and engaging in a dialogue about global health with a guest on the other end of the line. Fortunately for us, the guest was Dr. Paul Farmer, a path-breaking physician who co-founded the organization Partners in Health and who is the subject of a book the class had read, “Mountains Beyond Mountains.” For forty minutes, the students peppered Farmer with questions about Haiti, about how to best use one’s talents to address global health issues, and about how he had worked with Republicans and Democrats to ramp up global health funding.

As soon as we hung up, it was immediately apparent that the talk had lit a fire under the students: they not only wanted to track down the books and films that Farmer had referenced, but they also wanted to form a global health club. I returned home that night and told my wife, “I need to find a way to do this more often.” Over the past ten years, I have pursued having students study complex global issues in depth and then engage in discussions with a range of experts. The good news is that teaching about global issues through the use of technology and expert speakers is far easier than one might expect, it has great appeal for teenagers, and it frequently leads to learning that extends far beyond the classroom.

Thanks to the Internet, exposing students to global issues and to experts who work on them has never been easier. When I started my career, finding articles and videos on international issues was an arduous process that required hours of sleuthing and juggling VCR tapes; today it is possible with just a single computer to find and within minutes share information about even the most underreported international news stories. So, for example, if my class wanted to know more about the recent Ebola outbreak in West Africa, we could accomplish the following within a single period: find articles about it online, locate websites to track the disease’s spread, set up Google Alerts to keep us abreast of the latest news, and reach out to experts in public health, journalism, history and government who could help us to understand the issue in greater depth. Since staging a dialogue with Paul Farmer a decade ago, we have been fortunate to arrange dozens of meetings or Skype calls with a wide range of experts that includes Muhammad Yunus, Jim Yong Kim, Laura Bush, Colin Powell, Jeffrey Sachs, Noam Chomsky, Bill Frist, Dan Ariely, Paul Collier, Alan Mulally, Christy Turlington, Adam Hochschild, Peter Singer and many more.

Learning about global issues through the use of technology and expert speakers appeals to teenagers for two reasons. First, it’s not “busy work.” When students know that they are reading chapters from a macroeconomics text so that they can prepare for a wide-ranging dialogue with Jeffrey Sachs, they are eager to prepare as thoroughly as possible. Students appreciate that when they speak with an expert, they are able to ask critical questions and engage in an intellectual give-and-take with someone who (usually) treats their questions and opinions with respect. In fact, this goal of critically examining the issues and approaches that we are studying is one that is modeled by the experts with whom we speak. So, for example, my students spoke with Sachs and heard his ideas about why foreign aid can provide the big push that lifts nations out of poverty, and we also spoke with one of Sachs’ most vocal critics, Nina Munk, whose book “The Idealist” maintains that much of Sachs’ efforts have failed. Similarly, my students met with World Bank President Jim Yong Kim on the same ...

To read the rest of the article, click here.

As the CDC treats the nation’s first two Ebola cases there are a lot of questions and concerns about the disease in America—Could it become an epidemic here? How contagious is it? How is it caught?

Although my medical specialty is cardiothoracic surgery, I have spent a good deal of time working on global health issues in Africa and elsewhere, and I have been in close contact with the CDC over the past week. I thought it might be useful to highlight some of the features of Ebola that make it more—and less—dangerous.

As a viral disease, Ebola follows a fairly predictable timeline.

Published at ForeignPolicy.com on August 4, 2014

The news coverage of the Ebola outbreak in West Africa has left Americans reasonably unsure whether the threat is real or hype. In fact, it is both. The outbreak's startling spread and high mortality rate is indeed a real crisis, but it is unlikely to pose a serious threat to Americans at home. Stark differences in natural, cultural, and capacity factors between West Africa and the United States, and the way the virus is transmitted among humans make it extremely unlikely that the United States will face the kind of crisis that has swept through Guinea, Sierra Leone, and Liberia.

The low likelihood of a serious threat to us from Ebola, however, does not mean we should be unconcerned. Though the story is becoming part of a hype-and-fizzle news cycle that contributes to dangerous complacency and even cynicism about the very real threat of a global pandemic, such as from H5N1 influenza ("bird flu" or "avian flu") that could mutate and become readily transmissible among humans, it still carries important lessons.

Like bird flu, Ebola is an animal virus whose novelty among humans makes it highly pathogenic. But Ebola is spread only through direct contact with body fluids of an infected person, and a person directly exposed to Ebola is not contagious if he or she shows no symptoms, which makes travel possible and screening and response relatively straightforward, if admittedly challenging, for competent authorities.

By contrast, a traveler infected with a mutated bird flu could be asymptomatic yet contagious for days, giving no indication of the acute public-health threat they represent and rendering global point-of-entry-focused security measures dangerously ineffective. This scenario is the most common one discussed regarding a potential global pandemic -- it's not far-fetched and should be added to the growing list of things that keep a president up at night.

For its part, the Obama administration has responded to Ebola appropriately thus far, and has not treated the situation as a crisis it shouldn't waste. That said, a bit of "good crisis" thinking is perhaps in order to improve our ability to prepare for and respond to a future pandemic threat. Instead of allowing the "lessons learned" process around Ebola . . .

read the rest of this article at ForeignPolicy.com

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