Tag: Ebola

1000 Deaths and Rising: The Complexity of DR Congo’s Ebola Outbreak

by pragmaticsolidarity, posted in APHA IH Section, Conflict and Health, Infectious Disease

The Ebola epidemic in the Democratic Republic of Congo (DRC) has officially taken the lives of over 1000 individuals, according to the country’s Ministry of Health. These statistics, which were released at the end of last week, have been accumulating since the outbreak’s onslaught in August 2018. This occurrence is considered the second deadliest in the history of this Filoviridae Virus in the world and the deadliest in the DRC. This specific incidence afflicting humanity is often referred to as the Kivu outbreak due to the initial emergence in this northeastern DRC province; however, the identified virulent strain is the Zaire Ebola Virus which happens to carry the highest rate of mortality of all strains.

The following is an up-to-date timeline of the current Ebola outbreak’s transition to an epidemic:

  • August 1st, 2018: The DRC’s Ministry of Health declares an Ebola outbreak in Mangina, North Kivu
  • August 7th, 2018: Laboratory findings confirm this outbreak is caused by Zaire Ebola
  • October 17th, 2018: World Health Organization (WHO) convenes a meeting about the Kivu outbreak. WHO declares this situation does not constitute the classification of a “Public Health Emergency of International Concern”
  • October 20th, 2018: An armed attack occurs in Beni, Kivu at a health care facility leaving 12 people dead
  • November 9th, 2018: The number of cases in DRC reaches 319 which marks the largest outbreak in the country’s history
  • November 29th, 2018: The Kivu epidemic becomes the second largest recorded outbreak of the Ebola virus in the history of the disease on this planet.
  • December 27th, 2018: There is an announcement of postponement of elections in Benin & Butembo which are two largest cities in Kivu.
  • February 24th, 2019: An MSF health care facility is partially burned down and MSF suspends activities in North Kivu by unknown militants
  • February 27th, 2019: A second MSF health care facility is attacked also by unknown militants and the NGO is forced to evacuate staff and suspend all operations in the province of Kivu
  • March 20th, 2019: The outbreak reaches the 1,000 confirmed cases mark of the Ebola Virus
  • April 12th, 2019: WHO holds an additional meeting but finds the Kivu outbreak still doesn’t qualify as a “Public Health Emergency of International Concern”
  • May 3rd, 2019: The number of deaths secondary to the Ebola virus reaches 1000

Although each explicit manifestation of this deadly communicable disease carries with it seemingly insurmountable barriers in the form of human resources, supply logistics, social tendencies, and global support, the Kivu is particularly devastating due to political uncertainty, lack of trust in the health care system, and civil unrest.

Despite the increase in novel innovations for treating Ebola and even a promising vaccine that can prevent the virus virology, the Kivu outbreak continues to surge ahead and torture the human species in large part to a break down of trust in the medical system. The surge has lead to identifying 126 confirmed cases over a seven day stretch at the end of April 2019 in addition to the aforementioned data confirming this outbreak to be the second largest in the history of Ebola. Despite this, the mistrust has amassed in a disbelief that the outbreak even exists. A study conducted by the Lancet in March 2019 revealed that 32% of the respondents believed that the outbreak did not exist in the DRC, it only served as a way serve the elite’s financial interests. Another 36% stated that the Ebola outbreak was fabricated to further destabilize the surrounding areas. With these sentiments, the responders marked that fewer than two-thirds would actually want to receive the vaccine for Ebola. These perceptions of fellow humans provides an additional barrier to overcome for health care professionals in addition to treating a high mortality rate disease in resource limited settings.

While the mistrust in the healthcare system provides a tremendous intrinsic challenge for the DRC, the civil conflict that has targeted Ebola treatment centers delivers a physical and emotional component of the devastatingly uniqueness of this outbreak. With over 100 armed groups thought to be estimated within Kivu province, this has led to widespread violence causing this area to be difficult to maintain access. Due to the high rate of armed groups and the political unrest, there has been 119 incidents of Ebola treatment centers and/or health workers that have been attacked since the start of this outbreak. A few shocking examples include the murder of Dr. Richard Mouzoko who was a Cameroonian WHO physician and the two torched MSF facilities in the northern part of Kivu that were mentioned in the timeline.

The Kivu Ebola outbreak has been unanimously christened one of the most complex humanitarian crises that faces this fragile planet today – the global health community is attempting to treat a disease with a 50% mortality rate, with inadequate but effective evidence-based treatment options in a resource-limited setting, all while in a treacherous war zone. Although these are insurmountable odds, health care professionals across Africa and other parts of the world are addressing the needs of their patients and communities to defeat this ailment. These physicians, nurses, pharmacists, and so many others are generating trust in the health care system at a grass-roots level in the DRC to combat the negative perceptions and the actual outbreak. This example, that the global health community can learn from, highlights the role each person dedicated to global health needs to undertake before an outbreak batters a part of this fragile planet. The vitality of trust can start to be built through having individual/group conversations truly listen to health beliefs, coming in with an open mind to acknowledge local health treatments to complement evidence-based treatment, providing patient centered care that encompasses their culture and values, supporting capacity-building initiatives that allow humanity to act accordingly, investing both time and resources in local public health care infrastructure, and expressing empathy ubiquitously socially and professionally.

Being part of the global health community, it is imperative that this outbreak is adequately supported by humanity. As fellow humans striving towards a healthier society, health care professionals and public health experts must accompany those tormented by the social factors associated with Ebola and the actual virus through global awareness of the situation, an un-stigmatized compassion for those who contract the disease, and a pragmatic solidarity to address this humanitarian crisis.  

Ebola: The Ripple Effects (infographic)

by ihsection, posted in Infectious Disease

For better or worse, Ebola is becoming old news. Aside from the initial case in Dallas that was transmitted to two nurses, there have been no more cases here in the U.S., and panicked predictions of a massive outbreak causing mayhem and catastrophe never materialized (much like public health experts said they would not – funny how that works).

The outbreak in West Africa is ongoing and continues to be a tragedy on a massive scale that is losing public interest. We previously posted an article by Mary Anne Mercer on lost opportunities and the weaknesses in the healthcare systems that the outbreak has laid bare. Now, the MPH@GW blog has kindly provided an infographic on the outbreak and its collateral damage.

Ebola-Public-Health-Crisis-IG

Making Social Justice the Ultimate Goal

by nsoleye, posted in APHA IH Section

In the global health field, we generally understand that investing in health is critical for a nation to prosper. But would you consider a lack of investment in health to be a social injustice?

The United Nations’ Under Secretary-General Michel Sidibe thinks so. In this short interview with CCTV News, he talks about how the Ebola outbreaks in Guinea, Liberia, and Sierra Leone have exposed global health failures and explains why health is an investment, not an expenditure.

Prior to watching his interview I’d never really labeled a weak health system as a social injustice in my mind. But health is a right and a shortage of health workers, the inability to provide basic health services, and lack of infrastructure – all of which have become very apparent in the Ebola outbreak – are in fact social injustices. So I think this is a very apt way to label the current situation as it puts a broader lens on the issues and ties everything into the bigger picture of the role of health in society.

His interview made me think of universal health coverage (UHC) because the definition of UHC requires social justice. It addresses the issues of access, equity, and capacity. I wonder if there will be an increased focus on moving towards UHC for the three Ebola-affected countries as part of their rebuilding efforts.

What do you think will be the biggest social justice issues coming out of the Ebola outbreaks? And how do you think we can best address them?

Remembering My Aunt, Dr. Ameyo Adadevoh, Who Stopped Ebola in Nigeria

by nsoleye, posted in APHA IH Section

This blog post originally appeared on the Management Sciences for Health (MSH) blog and was authored by Video Editor Niniola Soleye. This reposting does not convey an endorsement of MSH from the IH Section.

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L to R: MSH staffer Niniola Soleye and her aunt, Dr. Ameyo Adadevoh 

My aunt, Dr. Ameyo Adadevoh, identified and contained the first case of Ebola in Nigeria.  She paid with her life because the health system was not ready to deal with Ebola.  The system has since caught up, and is today a model for other countries.  But the loss of such a gifted doctor and family anchor is incalculable.

Ebola arrived in Nigeria at a time when doctors at all federal government hospitals were on a labor strike (my aunt worked in a private hospital).  After ongoing negotiations with the government failed to meet their demands, the doctors – desperate to see significant changes in the health system and seeking improved salaries, positions, and titles – reached their breaking point.  So they went on an indefinite strike.

Patrick Sawyer – the index case – left quarantine in Liberia and collapsed at the airport in Lagos, Nigeria.  He was trying to travel to a meeting of the Economic Community of West African States (ECOWAS) in Calabar, Nigeria.

When he arrived at my aunt’s hospital, another doctor diagnosed him with malaria.  My aunt first encountered him during her ward round the following day and once she saw him she suspected Ebola even though she had never seen an Ebola patient before.  She questioned him and he denied being near anyone suffering from the virus but she immediately contacted the Lagos State and Federal Ministries of Health and got him tested.  While waiting for the test results to come back, the pressure on my aunt began.  Liberian government officials (and the patient himself) insisted that she discharge him so he could attend the ECOWAS conference.  She held her ground and resisted his release.  They even threatened to sue her for a violation of human rights (holding him against his will) but she remained steadfast for the greater public good.  Though she didn’t have the proper protective gear or protocols, she created an isolation area in her hospital to continue his treatment and protect her staff.  The patient couldn’t be moved because there was no isolation facility available in Nigeria at the time —the infectious diseases hospital in Lagos wasn’t functional.

The test results came back.  Patrick Sawyer’s Ebola diagnosis was confirmed, and he died in her hospital.

My aunt became ill ten days later and was taken to a makeshift isolation ward that had been set up for all the Ebola cases in the infectious diseases hospital.  The conditions of the facility were so poor that she and other patients were eventually moved to a former tuberculosis ward that had been donated by the USG.

Between the doctors’ strike and the lack of preparedness, the Ebola outbreak in Nigeria could have been a thousand times worse.  My aunt’s actions helped prevent a major spread of the virus across the country.  Because she raised the necessary red flags quickly and refused to discharge the patient, all Ebola cases in Nigeria can be traced to a single path of transmission originating with the index case. That’s no small feat in a country of more than 170 million people.

The events leading to my aunt’s death were a clear result of the larger health system troubles in Nigeria.  That said, today, Nigeria is Ebola-free.  In fact, other countries – including the US – are now looking to Nigeria to share best practices for the response and containment of Ebola.  This demonstrates that the health system eventually did catch up to Ebola, but the response was too late for my aunt and several others who were on the front lines.  If the index patient had ended up in another hospital under the care of another doctor, the delayed response from the health system may have been much more costly.

There are so many lessons to learn from the current Ebola outbreak in West Africa.  For me, the most obvious one is the importance of health system strengthening as a means to not only improve overall quality and access for all, but also to give countries the ability to properly respond to unexpected health challenges like Ebola.  If any of the affected countries had stronger health systems before this outbreak, the number of fatalities would have been significantly reduced.  We must learn from this outbreak and focus on health system strengthening as a crucial part of the rebuilding process.

One of the biggest challenges in the Ebola current outbreak is a shortage of health workers.  The high fatality rates in this Ebola outbreak reflect that.  Health workers at all levels of a health system need to be properly supported, incentivized, and protected.  They shouldn’t have to go on strike in order to improve their health systems so they can provide higher quality care.  My aunt and the more than 200 other health workers in West Africa who also lost their lives in the battle against Ebola shouldn’t die in vain.

I’m so proud that MSH is developing a solid short-term and long-term response to the Ebola outbreak in West Africa.  As part of my role at MSH, I’m supporting the Ebola response team and I see that as my way of continuing my aunt’s legacy through my job and helping to prevent other families from experiencing what my family has gone through in the last two months.

For me, the inability of the Nigerian health system to adequately prepare and quickly respond to the Ebola outbreak was an agonizing, first-hand example of the need for MSH and it reinforced the importance of the work we do.  My aunt’s death is still very painful but it comforts me to know that I am part of an organization that’s truly committed to saving lives (in everyday practice, not just in theory) and is dedicated enough to step into a crisis situation and mobilize the expertise and resources that are so desperately needed.

IH News Global Health Weekly News Round-Up

by Vaani, posted in News
  • May 31 was observed as World anti-tobacco day by the World Health Organization.
  • The Fitness Industry Council Canada has announced June 1 as National Health and Fitness Day.

Politics and Policies:

  • The Republic of Congo has passed a law that prohibits the purchase, consumption and possession of tobacco for minors, pregnant women and mentally ill. The advising and any kind of promotion of tobacco are also prohibited in the country. Smoking is prohibited in public places.
  • According to the World Health Organization On June 10th Ethiopia is launching an emergency mass-vaccination campaign against yellow fever.
  • According to the Ghana’s Minister of Health, the country is committed to ban all forms of tobacco advertisements and promotions.
  • Smoking in presence of children equaled to physical violence in Latvia.
  • Russia’s smoking ban came into effect on Saturday. It involves no smoking in public places and curbing cigarette advertising and sales.

Programs:

  • The World Health Organization (WHO) in Gambia is launching polio campaign to vaccinate 400,000 children under five years.
  • The Ministry of Finance of Lesotho has signed two agreements totaling $17 million with the Global Fund to fight against HIV/AIDS, tuberculosis and malaria.
  • Professionals for Humanity International (PROFOH) have announced its third free medical screening in this year in Nigeria.
  • After the discovery of polio this week, United Nations emergency team rushes to vaccinate 424,000 people living in a refugee camp in Kenya.
  • Zimbabwe is going to conduct its first national tuberculosis prevalence survey with an objective to determine the national prevalence of bacteriologically-confirmed pulmonary TB among people aged 15 and over.
  • Rotary India extends its help to Pakistan in its polio vaccination drive.
  • The World Health Organization is calling on the countries to ban advertising about the tobacco products.

 Research:

  • Improvement of maternal health and reduction in child mortality in some countries was highlighted in a recently released report ‘Accountability for Maternal, newborn and Child Survival ‘.
  • According to the director of the National Institute of Combat of HIV (INLS), the prevalence of HIV in Angola has not changed since 1997.
  • According to the researchers patients who have developed oral cancer due to HPV can have sex with their spouses or long term partners.
  • According to a study done by the researchers at the Institute for Clinical Evaluative Sciences, rates of diabetes have jumped 15 fold within a decade for the Chinese Canadians.
  • A systemic review confirms that the licensed medicines for smoking cessation are successful in assisting people to quit smoking.
  • Scientists are using new optics-based single virus detecting methods for determining the exact viral load of a sample by counting individual virus sample.
  • New malaria vaccine developed by the team Japanese researchers has cut the infection rates by 72%.
  • A study conducted in over 13 hospitals in Indonesia, Singapore, Thailand and Vietnam shows that doubling Tamiflu vaccine dose does not help in severe flu.
  • Results of a study warn development of resistance to drug used in treatment of H7N9 virus.
  • A group of scientists discover how a single gene mutation helps brain cancer cells to survive and drive tumor growth.
  • According to the United Nations scientists, Fukushima No.1 nuclear plant has very low radiation doses and there is no increased risk of cancer on local residents.
  • According to the experts nearly one-sixth of young adults in Sri Lanka are overweight. Lack of nutrition education and food culture of the country are reasons for this problem.
  • A study states that particular combination of bacteria in the human digestive system can identify patients who have or are likely to develop Type 2 diabetes.
  • A study shows that the Coenzyme Q10 cuts the mortality rate by half in heart failure patients.
  • Report released by EU says that several new health risks are emerging from new chemicals, products and changing lifestyle patterns. It is important to address these issues all together.
  • According to a study fizzy drinks do harm to the teeth as drugs.
  • New vaccine for lung cancer has been developed by the scientists of Argentina and Cuba. It activates the body’s immune system to promote its destruction.

Diseases & Disasters:

  • Tornadoes hit Oklahoma again on 1st June. Death toll rises to 9.
  • A report issued by the Chinese Ministry of Land and Resources state that the ground water of China is poisoned. It did not address the severity and scope of this problem.
  • Death toll from bird flu has risen to 38 in China.
  • According to the reports of the United Nations, there is a suspected outbreak of Ebola fever in the north of the Democratic Republic of Congo.
  • According to the reports by Ghana Health Service, cholera outbreak hits greater Accra region.
  • The World Health Organization is concerned about the new strain of Coronavirus which has killed 55 of the confirmed cases.
  • A Starbucks in Hong Kong used water from the public restroom to brew coffee.
  • Pakistan is facing a severe measles epidemic. Since the start of 2013 about 239 deaths have been reported.
  • According to the Ministry of Health, Philippines, new cases of HIV infections recorded in the month of April were 388. It was 67 percent higher than those recorded in April 2012.
  • According to the reports Singapore is facing Dengue epidemic. More than 7,700 people are reported to be infected as of May 25.
  • Frozen berry and pomegranate mix has been reported to be linked to hepatitis A outbreak in five states in U.S.