Adonis Diaries

Posts Tagged ‘West Africa

Cuba sent early on more Health workers to Ebola afflicted West Africa than the USA did

What Guatemala, Pakistan, Indonesia, Haiti share?

These 4 different nations suffered calamities in the past decade: they were all struck by natural disasters which overwhelmed their under-staffed and under-funded public health systems.

Into the rubble, flooding, and chaos of these distinct cultures and contexts, Cuba dispatched a specialized disaster and epidemic control team to support local health providers.

It was a story of unprecedented medical solidarity by a developing country which few media outlets picked up – until now.

Conner Gorry in Havana posted in the Guardian Professional, Thursday 23 October 2014

Raul Castro and Venezuelan President Nicolas Maduro at the summit on Ebola in Havana
What can the governments of Guinea, Sierra Leone and Liberia learn from Raul Castro’s health policies? Photograph: Xinhua/Landov/Barcroft Media

The Henry Reeve Brigade, as it’s known, was established in 2005 by more than 1,500 Cuban health professionals trained in disaster medicine and infectious disease containment; built on 40 years of medical aid experience, the volunteer team was outfitted with essential medicines and equipment and prepared to deploy to US regions ravaged by Hurricane Katrina (the offer was rejected by the Bush administration). Today, Cuba’s Henry Reeve Brigade is the largest medical team on the ground in west Africa battling Ebola.

The small island nation has pledged 461 doctors and nurses to provide care in Sierra Leone, Guinea and Liberia, the largest single-country offer of healthcare workers to date.

While United Nations Secretary-General Ban Ki-moon decried the pallid aid commitment from around the globe calling for “a 20-fold resource mobilisation and at least a 20-fold surge in assistance” Cuba already had 165 of these specially-trained healthcare workers on the ground in Sierra Leone.

Each of these volunteers, chosen from a pool of 15,000 candidates who stepped forward to serve in west Africa, has extensive disaster response experience.

Preparation for this mission required additional, rigorous training at Havana’s Pedro Kourí Institute of Tropical Medicine with biosecurity experts from the United States and the Pan American Health Organisation.

This rapid mobilisation of sorely-needed health professionals begs the question: how can a poor developing country spare qualified, experienced doctors and nurses?

By pursuing a robust medical education strategy, coupled with a preventive, community-based approach, Cuba, a country of just 11.2 million inhabitants, has achieved a health picture on par with the world’s most developed nations.

This didn’t happen overnight. Rather, Cuba’s admirable health report card results from decades of honing a strategy designed specifically for a resource-scarce setting.

By locating primary care doctors in neighbourhoods and emphasising disease prevention, the health system – which is universal and free at the primary, secondary and tertiary levels – makes care accessible and keeps people as healthy as possible, as long as possible, saving resources for more expensive treatments and interventions in the process.

But prevention and health promotion by community-based healthcare workers are only part of the story. Cuba’s policies and practices, both at home and abroad (currently more than 50,000 Cuban health professionals are serving in 66 countries) are built on several principles proven effective in resource-scarce settings.

First, coordinating health policies at the local, regional, and national levels is essential; this is particularly important where infectious diseases are concerned since uniform protocols are integral to containment.

Next, health initiatives must be cross-sectoral and based on integrated messages and actions. A fragmented, uncoordinated response by and among different agencies can prove dangerous and even deadly.

This was tragically illustrated by the death of Thomas Eric Duncan in Dallas and the US Centers for Disease Control allowing a nurse who has Ebola to travel on a commercial flight.

Finally, infectious disease outbreaks must be addressed quickly – easier said than done in poor settings, where public health systems are already strained or collapsing already.

The Ebola outbreak snaps the need for Cuba’s approach into sharp relief: only a coordinated response, provided by well-trained and – equipped primary healthcare professionals will contain this – and future – epidemics.

Indeed, policymakers such as World Health Organisation’s Margaret Chan and US secretary of state John Kerry have lauded the Cuban response, underscoring the importance of collaboration as the only solution to this global health crisis.

Forging this solution, however, requires harnessing the political will across borders and agencies to marshal resources and know-how. Havana took up the challenge by hosting a special Summit on Ebola with its regional partners and global health authorities on 20 October.

Noticeably absent were US health representatives; if we’re to construct a comprehensive, integrated, and effective global response, all resources and experiences must be coordinated and brought to bear, regardless of political differences. Anything less and Ebola wins.

Conner Gorry is senior editor of Medicc Review. Follow @ConnerGo on Twitter.

 

Mother Julia recollects: “How I fell in love and selected my husband…”

After WWII ended and travel lines were opened, Julie’ dad asked for her and her two younger sisters Maria and Montaha to join the family in the town of Segou, West Africa. Segou is in current Rep. of Mali and was a French colony till 1962.

Apparently, Julia’s father had lined up two prospects for marrying Julia without her knowledge.

The trip from Beirut to Marseilles took an entire month, and mother was so sea sick that she couldn’t swallow anything. The Captain alluded that Julia will not make it to destination.

A month later, Julia and her sisters left on a rickety plane from Agadir (Morocco?) and barely made to Dakar (Senegal)  and to Segou by train and cars.

About a month before Julia left Beirut, Georges had advanced her to Segou.  Georges’s ship landed first in Cyprus, then to Alexandria before resuming the travel to Marseilles. Georges boarded a “bananier” or a cargo ship for banana to Dakar and then by cargo train to Segou.

Julia’s mother opened a shop for selling almost everything that could be sold and Maria and Therese took over the running. Julia barely set foot in the shop.

There were deep enmities and animosity between the Georges and Julia’s  families: Julie’s father Tanios considered the other family to be plainly a lazy lot and nothing good will ever come from them.

Tanios was not far off the target in his assessment from facts and evidences. Actually, my dad worked hard in the next 20 years and then reverted to his genes. Same case with me.

Julie’s dad disagreed with any marriage arrangement with Georges, although he knew that “I loved him and will refuse any alternative arrangement”.

Julie said “Father brought me an eligible handsome and tall guy, but I faked to be busy and never met him”.

She resumed: “I asked Georges to rent a room in the hotel in front of our shop in order to distance himself from his family. The next day, Georges packed a suitcase and moved in a room”.

Georges crisscrossed West Africa for a suitable location to settle with his future bride but could find nothing but a shack in Bouake, kind of 100 km from Segou and leading to Haute Volta (current Burkina Faso) you you had to use a barge to cross the river since no bridge was available at the time.

Julia convinced her dad to meet once with Georges and he changed his opinion: “Seemed a nice and intelligent guy”

Georges’s family refused to attend the wedding despite several attempts by many people. And Julie’s father had to pay for all the expenses of the wedding ceremonies.

Note: Mother was 8 months in her pregnancy when two problems happened simultaneously. Father had to undergo surgery of the appendix, which turned out not to be the case, and all the saved cash was stolen in the shop at night.

I came to life in dire conditions. I was born upside down, feet first, and I was blue and barely breathing. I would not eat or take the tits and the physicians took me for a goner. Mother would lie to the doctors saying that I managed to suck some milk. I’m sure they never believed mother’s assertions but they had to deal patiently with such cases of insane mothers under grave situations.

 Ebola outbreak in West Africa harvest over 1,000 lives: Epidemiologist Perspective

The current case in point is Ebola viral disease that is spreading wildly in Liberia, Sierra Leon, Guinea, Nigeria and a few cases in Saudi Arabia

There has been much ranting and raving about closing our borders to people with Ebola infection (as if that were possible), even some misinformed speculation that the virus has been intentionally released.

Much Ado About a Fist Bump Study

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Ebola: A Nurse Epidemiologist Puts the Outbreak in Perspective

August 6, 2014 (Selected as one of best posts for the day)

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

We have a knack for taking any newly reported issue of legitimate concern entirely out of context, foregoing all common sense as we transform it into a danger of galactic proportions.

To me as a nurse epidemiologist, though, the central questions in this tragic outbreak are the same for Ebola as for any other disease:

  • How is the organism transmitted?
  • What is the risk of protected or unprotected exposure to the infected person?

Ebola is a blood-borne pathogen.

It’s spread in the same way as HIV, hepatitis B, or hepatitis C: when blood or other body fluids contaminate another person’s non-intact skin or mucous membranes.

None of these diseases is spread by casual contact.

And unlike HIV or hep B or C, Ebola is not a chronic condition; transmission occurs during acute infection, after the fever begins and the disease progresses. It is virtually impossible to contract the virus by walking past an infected person in the airport, or sharing a bus ride, or shopping in the same grocery store. (When you have high fever you don’t travel)

Preventing transmission.

Unlike for HIV or hep B or C infection, isolation precautions are implemented to prevent transmission of Ebola.

This is because bloody secretions, vomit, and diarrhea are typical symptoms as the disease progresses. Because of the resulting probability of exposure to the patient’s blood or bloody secretions/excretions, both contact and droplet precautions are used (i.e., gown, gloves, mask, and eye protection) in order to place a barrier between the infected person’s secretions and the caregivers.

Airborne transmission has not been documented—however, because of the potential for aero-solization of blood or bloody secretions/excretions, most experts recommend airborne isolation precautions as well (negative pressure room, N95 or greater respirators), if possible.

(Here’s a CDC table with recommendations regarding transmission precautions for Ebola in various clinical situations.)

Why the rapid spread in West Africa?

News reports of unchecked spread of the virus in West Africa have fueled global fears. However, a closer look at what’s happening makes it clear that two main groups of people have been at particular risk for Ebola infection:

  • close family members of those who are already infected
  • health care workers

There are risk factors unique to these groups in this region that have contributed to transmission.

It has been reported that many family members have continued to provide close personal care to their infected loved ones, without using any kind of protective gear. (Don’t attribute this to ignorance. If your two-year-old child were gravely ill, would you be likely to gown, glove, and mask? And even if you thought about doing so, do you have a large stash of these items at home?)

The repeated exposure of close family members to blood and body fluids inevitably leads in some cases to the contamination of mucous membranes or non-intact skin.

Postmortem care is traditionally done by families, and this also involves much intimate contact. Added to prolonged, unprotected exposure are health belief systems that can further increase risk.

Reportedly, family members in some of the outbreak regions deny the possibility of Ebola infection. They see their loved one’s illness as a curse, not a virus, and believe it can only be cured by a traditional healer.

For health care workers, risk is increased by the difficulties of maintaining full isolation precautions under these particular circumstances. Have you ever complained about suiting up for isolation because the gown, mask, and gloves make you too warm, even in an air-conditioned workplace? Imagine wearing all of this gear for a prolonged period of time in a high-temperature, high-humidity environment.

Western medical professionals who have worked under these conditions have noted how easy it is to unconsciously wipe their faces with their contaminated hands, as they try to keep the sweat streaming into their eyes from blurring their vision.

It’s not that personal protective equipment doesn’t work, but that difficult conditions and a high-pressure care situation can compromise the use of personal protective equipment (PPE), sometimes unnoticed.

Should we be worried in the U.S.?

In this age of global travel, it is inevitable that we will eventually see cases of Ebola in the U.S. Of course the prospect is sobering; though the virus is not spread casually, the mortality rate from Ebola infection is high. (As of August 1, there had been 1603 confirmed or suspected cases in this outbreak, with 887 deaths.)

However, given the infection-control resources and expertise of hospitals and health care providers, there is very little risk of the spread of Ebola in the U.S. The take-home points for health care workers are these:

  • This is a blood-borne pathogen. It is transmitted through contact of mucous membranes or non-intact skin with blood or body fluids.
  • Transmission is most likely to occur after fever develops and as the disease progresses.
  • If infection is suspected, ALWAYS inquire about the patient’s travel history. Ebola and other diseases don’t appear out of thin air. Look for a link to outbreak areas.
  • INSTITUTE ISOLATION PRECAUTIONS IMMEDIATELY. Policy in all health care organizations should specify that any clinical staff person can initiate isolation; if your policy limits isolation “orders” to physicians, change it.
  • Wear appropriate PPE.
  • Don and remove PPE as though someone’s life depends on it. Often, someone’s does. Unfortunately, we caregivers can be careless about suiting up because in most situations, we are not the people at risk.
  • But the patient down the hall to whom you’ve just carried MRSA (because of poor hand hygiene, messy glove technique, or a sloppily tied gown) can die from MRSA bacteremia or pneumonia.
  • With a disease like Ebola, or any emerging infectious disease that has not yet been fully defined (e.g., MERS), a “gatekeeper” should be stationed outside of the closed door of the patient’s room. The gatekeeper’s role: to ensure that only essential personnel enter the room, and to supervise the meticulous donning and doffing of protective gear.

For details on the pathogenesis, clinical presentation, epidemiology, and treatment of Ebola virus, see this still very relevant AJN article from several years back, free until the end of September.


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