ebola evd&hs&dev day1v3 · postconflictseng& • guinea,&2010&massacre&...
TRANSCRIPT
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Precursors for vulnerability
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Root Causes Dynamic Pressures Unsafe CondiRons Disasters Hazards Limited access to: Lack of: Fragile physical environment:
Risk
Earthquake Resources Ins:tu:ons Dangerous loca:ons Wind storm Structures Training & skills Unprotected structures Flooding Power Investment Fragile local economy:
=
Volcano Ideologies: Markets Livelihoods at risk Landslide Poli:cal systems Press freedom Low income Drought Economic systems Civil society Vulnerable society: Hazard
Virus
Macro-‐forces: Groups at risk Heat wave Popula:on growth LiTle capacity to cope +
Pests
Urbaniza:on Public acRons: Arms expenditure Lack of preparedness Vulnerability
Debt repayment Endemic disease Deforesta:on Soil degrada:on Root Causes Dynamic Pressures Unsafe CondiRons Disasters Hazards
Source: Blaikie et al. (1994) Structure of vulnerability and disasters.
Pressure and release Model
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PAR model: Root Causes
Limited access to: Resources Structures Power Ideologies: Poli:cal systems Economic systems
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Post conflict se<ng
• Guinea, 2010 massacre • Liberia, 10-‐15 out of a 2 decade long civil war
– Democra:c governance
• Sierra Leone, VP ousted from office • Ivorian civil War • Distrust of power and government
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PAR model: Dynamic Pressures Lack of:
Ins:tu:ons Training & skills Investment Markets Press freedom Civil society Macro-‐forces: Popula:on growth Urbaniza:on Arms expenditure Debt repayment Deforesta:on Soil degrada:on
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Transport and commerce • Post conflict in Sierra Leone and Liberia
• Infrastructure s:ll poor but slowly improving • Increased ability to safely travel within and between countries
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Transport and commerce • Liberia’s gains slower
84 percent live on less than $1.25 per day – GDP per capita has grown on average by nearly 8 percent per year since 2006
– 66,000 miles of roads; less than 7 percent paved • Two main road arteries • Monrovia to fron:er Cote d’Ivoire • Monrovia to fronRer with Guinea
• Foster V, Pushak N.( 2010) Liberia’s Infrastructure: A Con:nental Perspec:ve The Interna:onal Bank for
Reconstruc:on and Development / The World Bank
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Transport and commerce • As of May 2014:
• Sierra Leone: Masiaka-‐Bo Highway completed • rehabilita:on of 600km of feeder roads in Port Loko, Kambia, Pujehun and Kenema Districts
• Allafrica (2014) Liberia: S/Leone & Liberia -‐ Next Door Neighbors Baole Road Woes • hTp://allafrica.com/stories/201405150311.html
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Environmental factors
• longitudinal sampling of bats • epidemiology of EBOV in West Africa " possible public health threats should be inves:gated and addressed Hayman DTS et al (2012) Emerging Infec:ous Diseases Vol. 18, No. 7, July 20 2012
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Environmental factors
• Ebola Virus An:bodies in Fruit Bats, Ghana
• Zaire an:bodies in a lone migratory fruit bat
• tested 88 non-‐migratory fruit bats in 2007
• EBOV an:bodies in 32 of 88 fruit bats • • Hayman DTS et al (2012) Emerging Infec:ous Diseases Vol. 18, No. 7, July 20 2012
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Environment
immune func:on natural reservoir of ebola
viral replica:on compe::on for scarce resources
Decreased fruit supply
Increase in Ebola outbreaks in primates in during the dry season – November to April
infec:on
exposure
Illness or death
Hayman DTS et al (2012) Emerging Infec:ous Diseases Vol. 18, No. 7, July 20 2012 Leroy EM, Kumulungui B, Pourrut X, Rouquet P, Hassanin A, Yaba P, et al. Fruit bats as reservoirs of Ebola virus. Nature. 2005;438:575-‐6. [PMID: 16319873]
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Environmental factors
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PAR model: Unsafe CondiRons
Fragile physical environment: Dangerous loca:ons Unprotected structures Fragile local economy: Livelihoods at risk Low income Vulnerable society: Groups at risk LiTle capacity to cope Public acRons: Lack of preparedness Endemic disease
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Health system
Country Popula:on (millions) MD
Nurses/midwives
MMR Deaths Per
100,000 Live births
Under 5 m Deaths Per 1000
Live births
Per capita
for health $USD
2010 (2000)
Liberia 4.2 51 978 770 108 $8($3)
Sierra Leone 5.9 116 991 890 174 $10($6)
Guinea 11. 0 940 401 610 130 $ 10 ($4)
Nigeria 168.8 60,000 225,000 630 143 $21($6)
AFRICA HEALTH, HUMAN & SOCIAL DEVELOPMENT INFORMATION SERVICE (AFRI-‐DEV.INFO)2014.
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Health Systems
• Risk is not confined to healthcare workers
• Pa:ents can be exposed to HIV and other bloodborne pathogen during procedures
• Pa:ents have no means to protect themselves from such exposure.
• Leow JJ. et al.(2012) Scarcity of healthcare worker protec:on in eight low-‐ and middle-‐income countries: surgery and the risk of HIV and other bloodborne pathogens. Tropical Medicine and Interna:onal Health volume 17 no 3 pp 397–401 March 2012
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Health system Protec:on of healthcare workers during surgery
Study of five protec:ons at each surveyed hospital. Review of WHO Tool for the Situa:onal Analysis of Access to Emergency and Essen:al Surgical Care: • eye protec:on, aprons, sterile gloves, sterilizers and suc:on pumps
• Leow JJ. et al.(2012) Scarcity of healthcare worker protec:on in eight low-‐ and middle-‐income countries: surgery and the risk of HIV and other bloodborne pathogens. Tropical Medicine and Interna:onal Health volume 17 no 3 pp 397–401 March 2012
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Health system
WHO Tool for the Situa:onal Analysis of Access to Emergency and Essen:al Surgical Care: Gambia, 2011; Ghana, 2010, Liberia; 2011; Sierra Leone, 2009 • Leow JJ. et al.(2012) Scarcity of healthcare worker protec:on in eight low-‐ and middle-‐income countries: surgery and the risk of HIV and
other bloodborne pathogens. Tropical Medicine and Interna:onal Health volume 17 no 3 pp 397–401 March 2012
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8:00-‐ 8:30 – BRAINSTORMING and Notes Session
• What was the state of the country or region prior to 2009?
• Consider the PaR Model • What would you recommend for the next 5 years to reduce vulnerability to future disasters
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Liberia November /December 2014
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References • Africa health, human & social development informa:on service (AFRI-‐DEV.INFO) 2014.
• Allafrica (2014) Liberia: S/Leone & Liberia -‐ Next Door Neighbors BaTle Road Woes • hTp://allafrica.com/stories/201405150311.html
• CDC(2014) Clinician informa:on in health care se<ngs hTp://www.cdc.gov/vhf/ebola/hcp/clinician-‐informa:on-‐us-‐healthcare-‐se<ngs.html
• Foster V, Pushak N.( 2010) Liberia’s Infrastructure: A Con:nental Perspec:ve .The World Bank
• Hayman DTS , et al (2012) Emerging Infec:ous Diseases Vol. 18, No. 7, July 20 2012 • Kuhn, J. H., Becker, S., Ebihara, H., Geisbert, T. W., Johnson, K. M., Kawaoka, Y., ... & Jahrling, P. B.
(2010). Proposal for a revised taxonomy of the family Filoviridae: classifica:on, names of taxa and viruses, and virus abbrevia:ons. Archives of virology, 155(12), 2083-‐2103.
• Leow JJ. et al.(2012) Scarcity of healthcare worker protec:on in eight low-‐ and middle-‐income
countries: surgery and the risk of HIV and other bloodborne pathogens. Tropical Medicine and Interna:onal Health volume 17 no 3 pp 397–401 March 2012
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References
• Leroy EM, Kumulungui B, Pourrut X, Rouquet P, Hassanin A, Yaba P, et al. Fruit bats as reservoirs of Ebola virus. Nature. 2005;438:575-‐6. [PMID: 16319873
• Mupapa, K., Massamba, M., Kibadi, K., Kuvula, K., Bwaka, A., Kipasa, M., ... & Muyembe-‐
Tamfum, J. J. (1999). Treatment of Ebola hemorrhagic fever with blood transfusions from convalescent pa:ents. Journal of Infec0ous Diseases, 179(Supplement 1), S18-‐S23.
• Schoepp RJ, Rossi CA, Khan SH, Goba A, Fair JN. (2010) Undiagnosed Acute Viral Febrile Illnesses, Sierra Leone. Emerging Infec:ous Diseases • Vol. 20, No. 7, July 2014
• WHO Ebola fact sheet • hTp://www.who.int/csr/disease/ebola/en/
• WHO Marburg fact sheet • hTp://www.who.int/mediacentre/factsheets/fs_marburg/en/ •
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Ebola Response • MGH –Harvard Center for Global Health Seminar on Ebola • hop://www.mghcgh.org/resources/cgh-‐seminar-‐videos/
• CDC Ebola 2014 West Africa Outbreak Resources • hop://www.cdc.gov/vhf/ebola/resources/index.html?s_cid=cs_021
• CDC Generic EbolaResponse (ER) : Modeling impact in Excel • hop://stacks.cdc.gov/view/cdc/24900
• CDC Sept 23 2014:EsRmaRng the Future Number of Cases in the Ebola Epidemic • hop://www.cdc.gov/mmwr/preview/mmwrhtml/su63e0923a1.htm
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Ebola Response
• New England Journal of Medicine Sept 23 2014 : Ebola Virus Disease in West Africa ..Forward ProjecRons
• hop://www.nejm.org/doi/full/10.1056/NEJMoa1411100?query=featured_home
• WHO Ebola response roadmap • hop://www.who.int/csr/resources/publicaRons/ebola/response-‐roadmap/en/
• WHO BioRisk ReducRon • hop://www.who.int/csr/bioriskreducRon/en/
• WHO InfecRon prevenRon and control guidance for care of paRents in health-‐care serngs, with focus on Ebola
• hop://www.who.int/csr/resources/publicaRons/ebola/filovirus_infecRon_control/en/
• Global Health Delivery Online (GHDonline), Ebola response • hop://www.ghdonline.org/ebola/
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Mayinga N’seka (1954 – October 20, 1976) "7042 lores-‐Ebola-‐Zaire-‐CDC Photo" by Photo Credit: Content Providers(s): CDC/Dr. Lyle Conrad -‐ Centers for Disease Control and Preven:on Public Health Image Library (PHIL)
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• The prototype strain of Ebola, from which all variants and strains are compared, carries the name of the young Zairian nurse .
Zaire ebolavirus (Mayinga)
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Aranda S.(2014)” Tributes to nurses at the hospital who have died“ If They Survive in Ebola Ward, They Work On . The New York Times. August 24, 2014,page A1.
We honor and remember those who, like Mayinga, gave their lives in the course of their work
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Mohamed Fullah, Alice Kovoma, S. Humarr Khan, Alex Moigboi, Mbalu Fonnie,
Kenema Government Hospital, Kenema, Sierra Leone. Vogel G. 28 August 2014. Ebola's heavy toll on study authors hTp://news.sciencemag.org/health/2014/08/ebolas-‐heavy-‐toll-‐study-‐authors
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We honor those who place their lives at risk every day
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Pacnews January 2009 Port Moresby, Papua New Guinea • Nurses and other health workers at the Port Moresby General
Hospital in Papua New Guinea (PNG) are at grave risk of being infected with HIV, tuberculosis or other contagious diseases because they are handling pa:ents suffering from these illnesses without any protec:ve gear.
• Every :me they request… protec:ve gear like gloves or face masks, their supply division tells them the management has no money to buy these supplies.
• WriTen by Tangata Vainerere
…all over the world
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We honor those who work through suffering and loss, to become examplars of strength for the next genera:on of nurses.
Regis College Hai: Project :First cohort graduates with the first masters degree in nursing in Hai: granted by the University of Hai: and supported by the Hai:an Ministry of Health. hTp://www.regiscollege.edu/global/rchp-‐:meline.cfm
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“Some went, but we stayed,” said a nurse, Nancy Yoko. “We have kept
coming. We never leu.”
Nossiter A, Solomon BC. If They Survive in Ebola Ward, They Work On. New York Times. August 24, 2014, page A1.