Ebola Tag

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Strengthening Sierra Leone Health Systems: Applying Lessons from the 2014 Ebola Outbreak to Future Emergencies

This guest post was written by Laurentiu Stan (laurentiu_stan@jsi.com), MD,MPH, MBA, Chief of Party, Advancing Partners and Communities (APC) Project, Sierra Leone, JSI Research & Training Institute, Inc. John Snow, Inc., a member of Global Health Council (GHC), and the nonprofit JSI Research & Training Institute, Inc., are public health management consulting and research organizations dedicated to improving the health of individuals and communities in the US and around the globe.

Zainab Jalloh, holding her one-year-old daughter Khadijatu, at the Gbanti Community Health Post (CHP) on April 3, 2017 in Bombali District, Sierra Leone.

I’ve lived in Sierra Leone for almost two years, working to help this country’s long-battered health system recover from the Ebola outbreak that took the lives of more than 200 health professionals. Now the country has been affected by an epic landslide. Despite these tremendous setbacks, health systems and health indicators are improving.

Even before the Ebola Virus Disease (EVD) outbreak, Sierra Leone had the world’s highest maternal mortality ratio: 1630 of 100,000 live births (UNICEF, 2010). By 2015, the ratio had dropped to 1360, but Sierra Leone still held the top spot in this dismal measurement. Ebola compounded the problem because about 1 in every 4 women stopped coming to clinics for prenatal care and delivery. In fact, although almost 4,000 Sierra Leoneans died due to the EVD outbreak (between May 2014 and January 2016), during that same period more than 4,500 women died in childbirth.

The Ministry of Health and Sanitation (MOHS) focused its post-Ebola health recovery priorities on strengthening the health system’s capacity to safely detect and prevent diseases and respond to future epidemics in cooperation with its neighbors. It also recognized the need to contribute to global health security to improve health and economic opportunities.

A health facility water pump before APC revitalization. Photo courtesy/ JSI Research & Training Institute, Inc.

Between September 2015 and August 2017, under the umbrella of the USAID-funded and JSI-managed Advancing Partners & Communities (APC) project, I have helped implement a number of programs that are contributing to MOHS recovery objectives by improving primary care service delivery in the communities hardest hit by Ebola. APC has revitalized 305 primary care facilities, ensuring access to basic health services—with a focus on improving quality of maternal health services—for almost 2 million Sierra Leoneans, including the 3,400 registered Ebola-survivors.

A health facility water pump after APC revitalization. Photo courtesy/ JSI Research & Training Institute, Inc.

APC’s community health facility upgrades dramatically improved water and sanitation standards, installed solar power systems, provided basic equipment, and trained more than 900 health professionals and 1,500 community health workers (CHWs) on reproductive, maternal, newborn, and child health and as—importantly, given how Ebola was spread—infection prevention and control practices. Today, more than 2 million Sierra Leoneans in five districts have access to revitalized primary care and community health services in these primary care units and their catchment villages.
We know that another epidemic or emergency could come at any time, and while the Sierra Leone health system is going through significant transformations as part of the five-year recovery plan, it is better equipped now to address it.

The tragic August 14 landslide was just such an emergency—and the new systems that the U.S. government has invested in are working. The emergency coordination and resource mobilization mechanisms put in place with CDC support reacted well and fast. Mental health nurses who were trained to support Ebola survivors are providing psychosocial support to the several-thousand people who lost homes and relatives: more than 1,000 people died in the landslide. The CHWs recently trained by APC have undergone a 15-day social mobilization exercise to identify and convey messages on the prevention of cholera and other waterborne diseases to at-risk populations. With USAID and DfID support, JSI is assisting the MOHS relief efforts with emergency delivery of essential pharmaceutical and medical consumables to one area hospital and six primary care units.

This most recent tragedy has demonstrated that the country’s service delivery system has improved. One year after the outbreak ended, the MOHS data showed about a 10% positive change in uptake of facility deliveries and outpatient services in the four districts where 70% of Ebola survivors live. Now that health facilities have been revitalized, and health care workers are providing higher-quality services, we are seeing more and more Sierra Leoneans returning to their local health facilities.

There is still much to be done, of course. But Sierra Leone is on its way to a health system that meets the needs of its people—and, given the toll that Ebola took, is ready to confront the next infectious disease—be it Ebola or some other virus—with stronger, better prepared health services. And that helps us all.

Spillover: Zika, Ebola & Beyond – Film Screening and Discussion

Organized by Smithsonian’s National Museum of Natural History 

Spillover: Zika, Ebola & Beyond

Film Screening and Discussion

November 15, 2016
6:30 – 8:30 pm 
The Smithsonian’s National Museum of Natural History
Baird Auditorium



Over the last half century, a number of diseases have spilled over from animals to humans with increasing frequency. What’s behind the rise in spillover diseases? What can we do to stop them?

PBS documentary Spillover — Zika, Ebola & Beyond, produced by HHMI Tangled Bank Studios, is a harrowing documentary that follows scientists into the world’s hot zones in a search for answers. And it does so while providing much needed scientific context for the most recent Ebola and Zika outbreaks. The film extends to the new frontiers of disease detection, prevention, and containment, and travels the world with virus hunters who are tracking old enemies while vigilantly looking out for new foes.

A discussion after the screening will focus on Zika and how scientists have tracked the disease globally and locally, how the disease affects people and what we need to know to help manage and prevent an outbreak in DC and beyond. 

Featured Speakers

Vanessa van der Linden, M.D., Neuropediatrician, Association for Assistance of Disabled Children, AACD, Recife, Brazil; Barão de Lucena Hospital, HBL, Recife, Brazil, the first to recognize the severity and extent of the Zika outbreak on newborn children in Brazil.

Anthony Fauci, M.D., Immunologist, Director, National Institute of Allergy and Infectious Diseases.

Yvonne-Marie Linton, Ph.D., Research Entomologist, Walter Reed Biosystematics Unit.

LaQuandra S. Nesbitt, M.D., M.P.H., Director, DC Department of Health.

The Ebola Crisis and Innovative WASH Solutions

The Ebola Crisis and Innovative WASH Solutions

September 28, 2016
10:00 am



Water, sanitation, and hygiene (WASH) has played a critical role in the fight against Ebola and has promoted ongoing community health in Sierra Leone, Liberia, and Guinea. Now, almost a year later, we must ask ourselves “What’s next?” How can we ensure that lessons learned are incorporated into how the WASH sector promotes sustained behavior change? Can the response to the Ebola crisis frame how the world responds to infectious diseases?

Join The Global Public-Private Partnership for Handwashing to discuss these questions and more. Experts from the CDC, Global Communities, UNICEF (to be confirmed), and more will share key takeaways on the impact of infection prevention and control, CLTS approaches, and WASH interventions in schools.

Global Preparedness for Pandemics Symposium: Lessons from Ebola

Global Preparedness for Pandemics Symposium: Lessons from Ebola

Wednesday, October 28, 2015
9:00 am-4:00 pm
MaRS Auditorium, 101 College St.

On Wednesday, October 28, The Gairdner Foundation will be holding “Global Preparedness for Pandemics: Lessons from Ebola,” a symposium in honour of the 2015 Canada Gairdner Global Health Awardee Dr. Peter Piot.

With leaders from the lab, the treatment pipeline and direct from the field of treatment, we will be discussing what we have learned about addressing the modern pandemic phenomenon.

We welcome you to join us, and to distribute the attached program and poster to your organization and those who may be interested.

This is a free event which will also be available by webcast.

Register with sarah@gairdner.org

From West Africa to South Korea, No Pause between Outbreaks

This blog was cross-posted from IntraHealth International and written by Allison Annette Foster and Aanjalie Collure

As nurses prepare to gather in Seoul, South Korea, later this week for the annual International Council of Nursing’s 2015 Conference, the country is experiencing an alarming outbreak of the Middle East Respiratory Syndrome or MERS Coronavirus.

Just last Thursday, South Korea announced the closure of a second hospital following the confirmation of four new cases of MERS. The country’s most recent case count stands at 153, with 19 deaths, as of June 16. This deadly virus has a survival rate of only 64%, and more than 5,500 people have already been quarantined. As of last Friday, 2,900 South Korean schools and kindergartens were closed around the country. Decisions to temporarily close the Mediheal Hospital in western Seoul and Changwon SK Hospital in Changwon resulted from new information that MERS patients were found to have had contact with hundreds of people at the two hospitals prior to diagnosis.

Certainly, there is no time to lose. The global community learned this the hard way recently in West Africa. It was only just over a month ago, on May 9, 2015, that the world took a sigh of relief as the World Health Organization officially declared Liberia Ebola-free. Guinea and Sierra Leone, while making progress, are still struggling to bring Ebola to an end.

“Ebola may be under control in Liberia and disappearing from headlines, but we are far from meeting the health needs of our populations—and even further from being prepared for the next pandemic.”

One year ago, we would have never imagined an Ebola epidemic of this scale raging through West Africa, threatening the health and well-being of bordering populations and destabilizing health security across the globe. Six months ago, we were having a hard time envisioning an end to this nightmare.

Although the initial response was slow, the global community gained momentum in supporting Liberia with the materials, medicines, and health workers desperately needed by the country’s weak national health system. During the scale up of this organized response, we lost many lives—precious lives—and the global community learned some hard lessons.

First and foremost, we realized that none of us are protected from such a sudden and unexpected outbreak whether in an American urban area such as Dallas, Texas–where one life was lost, two health workers quarantined, and an emergency room closed–or in Monterrado, a remote county in Liberia where 8,881 Ebola cases were confirmed and 3,826 lives lost. The countries suffering the most are those with weak health systems. Weak health systems are not exclusive to the West African countries hardest hit by Ebola. In many countries, over 70% of rural residents lack essential health coverage precisely because they lack the health workers they need to serve their communities.

Ebola may be under control in Liberia and disappearing from headlines, but we are far from meeting the health needs of our populations—and even further from being prepared for the next pandemic.  Even prior to Ebola, Liberia’s population suffered from a high incidence of preventable deaths. In 2010, the country had the eighth highest maternal mortality ratio globally, with 770 maternal deaths for every 100,000 live births. Malaria, diarrhea, and respiratory infections are the leading causes of death. Most of those deaths would be avoidable if skilled health workers were available with basic material and medicines.

We are all vulnerable, even those of us privileged to live in better-staffed and equipped health systems. Between 2002 and 2003, severe acute respiratory infection, or SARS, killed 44 people in Canada, 299 in Hong Kong, and 775 globally. In 2009, the H1N1 virus killed more than 18,000 people around the world. In 2012, the West Nile Virus—spread through mosquitos—killed 16 people in three Texas counties within three months.  Although the CDC does not yet release data on the exact number of influenza related deaths per year in the United States, as many as 49,000 people may have died during the 2006-2007 flu season alone from influenza.

“Nurses know all too well that global threats are felt locally.”

 In a recent interview, Bill Gates warned the world against complacency. Although we may be tempted to breathe a sigh of relief right now as Ebola appears to be on the wane, we must make some drastic changes to ensure our relief is not short-lived. “If anything kills over 10 million people in the next few decades, it is most likely to be a highly infectious virus, rather than a war. Not missiles, but microbes,” says Gates.

At IntraHealth International, we are working to help countries be battle-ready in the face of both current and future threats. We advocate for investing in health systems and the health workers that make them function because we understand the immeasurable return on such investments. Current initiatives including our mHero mobile phone communication platform, our iHRIS suite of health workforce information software, and our health worker crowdsourcing application are empowering  health workers with the information they need to respond rapidly to health emergencies as and when they emerge.

We hope that lessons learned from the tragic Ebola outbreak have become abundantly clear to the global community.

As nurses start to gather together in Seoul to deliberate the conference’s theme of “Global Citizen, Global Nursing” amidst a new global health security threat, nurses and other health workers around the world are risking their lives to do their jobs. Nurses know all too well that global threats are felt locally, as they work every day with frontline teams to support clients in life-or-death battles.

Mr. Gates, we hear your call. Winning the fight to strengthen global health security will require strong commitments of global and local actors. We must be ready and willing to take on tomorrow’s public health emergencies and prevent and treat today’s diseases. To do that, we must build resilient health systems and ensure that all of us have access to a health worker, ready and equipped for the battle.