Category: APHA IH Section

Not a typical deployment, part 6

by Disease Detective, posted in APHA IH Section
Homecoming

After I came home, I began to process and tell the story of what had happened to me. My husband was sick with an upper respiratory infection, so I went to the pharmacy and the grocery store to get cough medicine and Gatorade. What should have been a quick run for supplies in a setting I had been in hundreds of times before triggered a panic attack. Initially confused and alarmed, I quickly learned that grocery stores are one of the most common triggers for anxiety and panic attacks. I spoke to my father and another close friend, both combat veterans, who were able to relate to my experience.

It took me several days to collect the mental strength to unpack my suitcases. I separated clean from dirty clothes, put away my shoes, and carefully hung up all the silk scarves I had taken with me to cover my neck from mosquitoes. I showed my husband the black feather I had kept from my visit to the church near the hotel, and he played Blackbird by the Beatles for me. I still have that feather on a bookshelf of mementos in my front hallway.

I also began to realize the scale of what had happened to my USAID colleagues who had been evacuated with me as Elon Musk and DOGE worked with Pete Marocco to feed the agency “into the woodchipper.” As difficult as it was to make myself sit down and write, I summoned the willpower to describe my airport companion’s story in a letter to my Congressional representative. I wrote the following letter on February 2.
I want to start off by saying how deeply I appreciate what the Congressman is doing today to try to help USAID. While I was studying for my PhD…I worked as a TA and had a student who now works at USAID as a foreign service officer. As you might imagine, she is beside herself with grief and rage. We are both sick over this whole situation. I hope that the Congressman and his allies in the Senate are able to put a stop to this in the short term. However, I wanted to share an account of something I recently experienced alongside a USAID contractor, which demonstrates that this rushed dismantling at the agency literally put American lives at risk overseas.

You may be aware of the fact that the U.S. embassy in the Democratic Republic of the Congo evacuated all non-emergency personnel under Chief of Mission (COM) authority in Kinshasa last week. I was there on TDY with CDC to assist with the agency’s country mpox response, so I was evacuated with everyone else. As a CDC employee, the process, though somewhat harrowing, was pretty straightforward. State Department personnel were incredibly professional and kept us all safe and informed. However, I met a USAID contractor for whom the process was not nearly as smooth.

She arrived on Sunday (26 January), the departure was ordered on Tuesday (28 January), and then she was furloughed by her employer in response to the freeze on foreign aid. At that point, things started to go off the rails for her and another colleague with her: because she was furloughed, she was told that (1) she was not allowed to use her government-furnished equipment (which is where the State Department instructions for evacuation were coming) and (2) they were not sure whether she was still under COM authority and thus eligible to be evacuated with USG personnel and their dependents. Her employer tried to tell her to get to the Kinshasa airport to take a commercial flight out after the RSO had specifically said that the airport (and the road to it) was not safe, AND after multiple news reports that commercial airlines were canceling service to Kinshasa. She did manage to get on the charter flight that got us all back to DC, but only after she reached out to her own Congressman.

I am reaching out to pass on this story in the hope that the Congressman can use it to raise awareness among fellow members of the consequences of this “move fast and break shit” mentality that the federal government is being subjected to by (unelected) Elon Musk. I have no doubt that USAID could have benefited from reform. However, government moves slowly for a reason. If this woman had not had the courage that she did, she and her colleague very well could have been left stranded in the middle of a country in upheaval, with no way out and no one to help them. It is America’s responsibility to take care of personnel who are working on behalf of the American people overseas. This attack on USAID put these American women at risk. There are very serious consequences to what Elon Musk is doing. If he is not stopped, I fear CDC may be next.
This is the first time I have read that message since writing it. I had no idea how right I would be about CDC.

This is the final installment of a multi-part series on a Section member’s deployment to, and evacuation from, the Democratic Republic of the Congo while on an emergency response assignment with the CDC. All views expressed here are the author’s own personal perspective and do not reflect the position of their employer or the U.S. government.

Not a typical deployment, part 5

by Disease Detective, posted in APHA IH Section, Emergency Preparedness and Response

Exodus

I woke up early on Wednesday morning, ate breakfast, and then brought my suitcases down to the lobby to check out. I was surprised to see a large group of Americans there for the same reason. Besides my fellow deployers, there was a group of a dozen or so with a distinctly ex-military look: large muscles, shaved heads, camouflage duffel bags. One guy had a ball cap with the Marine insignia that read SEMPER FI. I approached them, smiled, and said good morning. Are you all with CDC? No, they answered, we work at the embassy. When I asked what they did there, one man answered curtly that they were IT contractors. I suppressed a laugh.

I checked out of the hotel and got my statement, and then checked my full-sized suitcase with the concierge. I sent the luggage tag and photos of the bag to the CDC country team.

1349: We will continue evacuations tomorrow. Departing personnel should be ready for pick-up beginning at 4:00 am on Thursday morning. We are going to move very quickly, so please be ready to go when your residence is called on the radio. Remain beside your radio and your phone.

We all groaned and lined up to check back into the hotel. I joked in French with the hotel concierge, trying to take the edge off what was undoubtedly a stressful situation. We had another accountability drill. Disease Detective, Safe, Hilton.

I went back up to my room and set my laptop up on the desk again to continue monitoring emails. I was forwarded an email chain between senior agency leadership, who were clarifying whom we were allowed to communicate with for outbreak response overseas, amid the flurry of executive orders. “WHO remains a red light…One related question that has come up is how we view PAHO. For now, we consider them as tantamount to WHO, so the restriction on engagement applies as to [sic] PAHO, as well.” Not a single one of the senior leaders on that email chain still works at CDC today.

I started awake on Thursday morning at my 0330 alarm clock. I rolled out of bed, changed into my selected travel clothes, stuffed my pajamas into my go-bag, and made my way down to the lobby.

0415: Evacuation will start at approximately 04:30hrs (04:30am) today. All personal [sic] should be sheltering-in-place until the motorcade arrives to pick up their residence. SAFEAlerts and radio broadcasts on E&E R will announce collection zone and residence pickups. All supervisors who have TDY employees staying at any of these locations are responsible for forwarding SAFEAlerts and sharing radio broadcast messages. Personnel will be transported to the DCMR for consolidation and then to the embassy boats for evacuation to Brazzaville.

0423: No movements are permitted. Requests for exceptions must be approved by RSO. LE staff designated as essential staff performing critical duties are permitted essential movements. There will be no airport movements until further notice.

We all checked out of the hotel again. The CDC country director waited with us in the lobby, making sure that everyone was accounted for. I sent text updates to friends and called my husband to check in, listening to him explain the conspiracy theories being traded about the plane crash that had happened the day before at Washington Reagan National Airport. Like me, he was not sleeping.

We milled around the lobby as we waited for pickup. Our hotel, along with one other, was the final collection zone. We were the last ones.

0525: Collection Zone 4 HOTELS – Be Ready. Monitor Channel E&E R for further motorcade arrival updates. For TDY Personnel, sponsoring sections are responsible for ensuring they are kept updated on all SAFE alerts and applicable radio announcements. IF YOU ARE IN CZ1, CZ2, or CZ3 AND HAVE NOT YET BEEN PICKED UP: Contact Post One.

We received an email to take our suitcases back from the concierge and bring them with us. Then, at 0545: “The motorcade is there – please go to the ground floor.”

They took us in vans to the DCMR (Deputy Chief of Mission Residence), a walled compound with a spacious house and a manicured yard. I walked into the house and was immediately overwhelmed by the chatter of hundreds of people. A table in the foyer had been set with beautiful china coffee cups, but there was no coffee. Children were darting from room to room. Parents were trying to comfort screaming babies and toddlers. The DCM called for attention, and the room went quiet as she told us all that it was not safe for the children to play outside. “There is a construction site on the next block, and yesterday there were men climbing up to look over the compound walls. We do not want them to know that we have 300 people sheltering here. Please do not let your children go outside.” She went on to explain that embassy staff were working to get authorization for us to leave from the DRC government, and for those of us who needed them (including me) to get visas to enter the Republic of the Congo (ROC), so we could be evacuated to Brazzaville.

I wandered around the mansion in a sleep-deprived haze. The coffee was replenished, so I poured some into one of the lovely gold-rimmed demitasses and looked for a quiet corner. After hiding in the kitchen for a bit and washing the dishes in the sink, I found a spot looking out of a door by the laundry machines. The sound of the rain brought some comfort.

After a few hours, we received notice that we had clearance to leave. The DCM was handing out trash bags for people to wear as makeshift raincoats for when they were ferried across the river. I scrambled to find my suitcase and pulled my hardshell out. We were handed our passports as we climbed into the vans to take us to the riverbank. We drove to the “beach” as it was called and loaded onto covered ferries, 20 at a time. Even after looking out over the river from the hotel, I did not realize how large, or how fast, the Congo river was until I was on it. Huge chunks of dirt and grass swirled by us as we powered across the rapids. I should be nervous, I realized, but I’m not. I was too tired.

We arrived on the opposite riverbank and sat down in a holding area. While our passports were checked, a diplomat from the ROC embassy welcomed us. “Things are a lot quieter over here,” he joked. He explained that we would go to a hotel “to relax for a few hours.” That evening we would be taken to the Brazzaville airport, which had been closed to everyone but us, for our charter flight back to DC. I went to the Pefaco Hotel Maya Maya, which was quaint if a bit outdated. I took a shower and stumbled down to the restaurant for a 4 p.m. lunch. I went back upstairs and tried to sleep. At around 7 p.m. the front desk called to let me know that the motorcade was leaving. I ran down the stairs and out to the van. I was the last one.

The Brazzaville airport is a blur in my memory. I stood in line with families with children, including one with a hamster, and a young woman who had just been fired from her contractor position at USAID. We joked about trauma-bonding and fanned ourselves to try to stay cool, as there was no air conditioning. I went through the exit screening and made my way to the airport gate. I sat in a daze as we waited to board the flight, struggling to stay awake so I would not be left behind. I would not realize until later that the bright lights and noise of the grocery store would trigger that memory, and a panic attack to go with it. Finally, the jet bridge opened and we filed onto the plane. I sat down in the aisle seat of a row in front of the lavatory and prayed that no one would sit next to me. I dozed in my seat as we waited for the flight manifest to be approved at Dulles.

Finally, at 2 a.m., the plane took off. Once we reached cruising altitude, I laid down across the seats in my row and pulled a blanket over my head. For the rest of the 18-hour trip, I drifted in and out of sleep. There was a newborn who spent most of the flight screaming, his father trying to comfort him while pacing up and down the aisles. If I ate, I don’t remember it. We stopped in Dakar to refuel.

We crossed the Atlantic and touched down at Dulles. As the plane braked on the runway, the passengers around me burst into applause. I began to laugh, and then to cry, pressing my airplane blanket into my face to muffle the sound as I sobbed. It was over, I told myself. I had no idea that it was only the beginning.

This is the fifth installment of a multi-part series on a Section member’s deployment to, and evacuation from, the Democratic Republic of the Congo while on an emergency response assignment with the CDC. All views expressed here are the author’s own personal perspective and do not reflect the position of their employer or the U.S. government.

Cardiovascular Disease and COVID-19

by ihsection, posted in APHA IH Section

This is the second part of a IH Blog series on Cardiovascular Disease.

By Brianna Koenick MPH (c) MMS (c) and Dr. Heather F. McClintock PhD MSPH MSW

More than 670 million people have been infected with COVID-19 worldwide. The pandemic exacerbated health disparities between high-income countries (HICs) and low-income and middle-income countries (LMICs), and the global community is continuing to grapple with the immediate and long-term implications of COVID-19. Long COVID is loosely defined as having symptoms at least two months after the initial infection and lasting for at least four weeks. A longitudinal cohort study conducted in South Africa found 39% of participants showed significant symptoms 6 months after a COVID-19 infection. In the United States, approximately 1 in 7 people have suffered from long COVID according to survey data. Cardiovascular disease (CVD) is a leading cause of death in the U.S. and globally, and substantial evidence suggests that the COVID-19 increases risk for poor cardiovascular outcomes. Researchers suggest that biological, social/psychological, and systemic factors underlie the complex relationship between CVD and COVID-19. Biologically, chronic inflammation and other physiological changes may contribute to increased CVD risk. Impaired social, behavioral and psychological well-being related to contextual influences related to the pandemic exacerbate CVD risk. Further, systemic breakdowns and infrastructure challenges lead to poor access to high quality care and services.

  Several systematic literature reviews and meta-analyses have documented a relationship between long COVID-19 and CVD. One of these investigations reviewed 150 studies focused on 57 cardiac complications published between January 2020 to July 2023 that persisted for at least 1 month after a COVID-19 infection. Their meta-analysis included 137 studies that identified 17 complications. They found a high prevalence of many complications, particularly chest pain and abnormal heart rhythms (arrhythmias). The authors noted that there were many CVD complications identified that lasted for years post COVID-19. The World Heart Federation has conducted “the largest global effort to reflect geographic spread” of COVID-19 and CVD aiming to determine the short-and long-term clinical sequelae among COVID-19 hospitalized patients across 16 low-middle-,upper-middle and high-income countries. Findings were presented at the 2023 European Society of Cardiology Conference indicating high post-discharge mortality for persons with COVID-19 in LMICs. Future predictions for CVD in the U.S. from 2025 to 2060 indicate that stroke will increase 33.8%, heart failure will increase 33.4%, ischemic heart disease will increase 30.7%, and heart attack will increase 16.9%. These CVD rate increases are expected to have the biggest impact on Black and Hispanic communities in the U.S. Globally, predictions indicate there will be a 50.2% increase in cardiovascular mortality rates between 2025 and 2050 with an increased burden on LMICs. 

Many initiatives and interventions have been implemented to try to reduce the CVD burden in the context of COVID-19. For instance, the U.S. Centers for Disease Control and Prevention developed the Community Health Workers for COVID Response and Resilient Communities initiative (CCR) to “strengthen the public health workforce, slow the spread of COVID-19, and move toward health equity.” Regarding long COVID, the NIH RECOVER Initiative was launched in 2021 and included the largest, most diverse study group to learn more about long COVID in hopes to treat and prevent it moving forward. The World Heart Federation has information and resources related to COVID-19 and CVD including those with practical applications for practicing professionals. While many effective and impactful projects have been implemented, further research and initiatives are needed to understand and address the complex relationship between CVD and COVID-19. 

Brianna Koenick MPH (c) MMS (c) 

Brianna Koenick is a current student in Arcadia University’s Dual Master of Public Health/Master of Medical Science in Physician Assistant Program. As an MPH student, her capstone research explored the relationship between lifestyle factors and cognitive health outcomes related to dementia. She completed an internship at the Jewish Relief Agency, a hunger-relief organization working to inspire volunteerism across the greater Philadelphia region, where she assisted the client services team with community outreach and developed communication materials for both clients and volunteers. Her public health interests include preventative health, environmental health, and health equity. After graduating, she plans to continue practicing evidence-based public health and advocating for the communities she will serve as a Physician Assistant.

Dr. Heather F. McClintock PhD MSPH MSW

Dr. McClintock is an IH Section Member and Associate Professor in the Department of Public Health, College of Health Sciences at Arcadia University. She earned her Master of Science in Public Health from the Department of Global Health and Population at the Harvard School of Public Health. Dr. McClintock received her PhD in Epidemiology from the University of Pennsylvania with a focus on health behavior and promotion. Her research broadly focuses on the prevention, treatment, and management of chronic disease and disability globally. Recent research aims to understand and reduce the burden of intimate partner violence in Sub-Saharan Africa. Prior to completing her doctorate she served as a Program Officer at the United States Committee for Refugees and Immigrants and a Senior Project Manager in the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania. At the University of Pennsylvania she led several research initiatives that involved improving patient compliance and access to quality healthcare services including the Spectrum of Depression in Later Life Study and Integrating Management for Depression and Type 2 Diabetes Mellitus Study.

Webinar on Human Rights Approaches to Digital Health for Women, Children, and Youth

by ihsection, posted in APHA IH Section

Digital health is a vital tool for improving health outcomes and equity for women, children, and youth globally. The rapid adoption of technologies like AI and big data, accelerated by the pandemic, holds promise for closing health equity gaps. However, these advancements also pose risks such as privacy violations and discrimination. To ensure digital health technologies benefit women, children, and youth without causing harm, integrating human rights throughout their development and implementation is crucial. Join us in the first part of this series on digital health for women, children, and youth.

This session includes:

  • Presentations from experts on digital health and human rights
  • Mini panel with our distinguished professionals
  • An opportunity to ask experts your questions 

Attendees will learn:

  • Why human rights approaches are essential in digital health for women, children, and youth
  • How human rights approaches can be incorporated into digital health at all stages of its development, implementation, and evaluation

Speakers:

  • Susan Akanbong, Ghana National Association of Persons living with HIV (NAP+ Ghana)
  • Meg Davis, PhD, Centre for Interdisciplinary Methodologies, University of Warwick
  • Kene Esom, University of Warwick
  • Alberta Nadutey, Ghana National Association of Persons living with HIV (NAP+ Ghana)
  • Sarah Simms, Privacy International

To register, go to: https://bit.ly/GMCHNW1 

For a sharable flyer, go to: https://bit.ly/GMCHNW1F 

Please feel free to spread the word and forward this invite to your colleagues.

We look forward to bringing many more events like this after the annual meeting! For more information on GMCHN, our committee, and to keep in touch, please email me at info@gmchn.anonaddy.com.

To join GMCHN, visit APHA LEAD and login with your APHA membership ID and password. Go to the “Communities” tab and click on “All Communities.” Look for the Global Maternal and Child Health Network group and click on the “Join” button. GMCHN as an Intersectoral Work Group encourages and invites liaison representatives from a wide range of related APHA entities. Membership is open to all APHA members.

Newly Updated Mpox Fact Sheet

by ihsection, posted in APHA IH Section

Regional conflict has left hundreds of thousands of civilians displaced in the Democratic Republic of the Congo. Healthcare workers face overcrowding in refugee camps and a shortage of medical supplies in the midst of the second outbreak of mpox in three years. These conditions leave many of the most vulnerable people at risk of infection and serious illness. To date, over 500 people have died of the disease.  

The WHO has declared this outbreak a public health emergency of international concern after mpox patients were identified in several other countries. The Africa CDC is working with impacted countries and manufacturers to distribute vaccinations and diagnostic tools, but vaccine inequality and supply chain issues are major hurdles to treatment.  

In many circumstances, mpox is treatable, and most symptoms subside within 2 to 4 weeks. Misinformation and stigma around the disease complicate efforts to educate at-risk communities and treat the disease. Raising awareness about prevention and treatment options are essential to slowing the spread of the virus. 
 
“Hesperian just updated our two-page English-language resource for communities navigating the latest mpox outbreak.” The printable guide is designed to educate and assist individuals with the disease, along with their families and caregivers to understand the transmission, symptoms, prevention, and treatment of mpox.  

Share this resource widely throughout your network.