Infectious Diseases

  1. Ebola in Kailahun

    May 26, 2016 by Virginia Nowakowski

    On August 8, 2014, the World Health Organization declared a Public Health Emergency of International Concern. Reports of the rapidly spreading Ebola virus in western Africa convinced WHO’s Emergency Committee to alert the international community of impending danger. However, according to Krista Johnson, an assistant professor at Howard University Graduate School, Ebola’s warning signs were clear long before 2014.

    “We certainly didn’t prepare the population to respond to this, but the United States government was doing research on this and had samples,” Johnson said. “It was not as though Ebola was off of the radar. In fact, they were looking to implement programs and have strategies that would combat disease–specifically Ebola and other diseases like that.”

    Health professionals originally discovered the Ebola virus in Sudan and the Democratic Republic of the Congo in 1976. They considered it a tropical ailment, similar to the Lassa fever discovered in Nigeria in 1969. WHO estimates that more than 1500 people lost their lives to Ebola between the 1970s and 2012. It was not until the 2014 outbreak that Ebola gained international attention.

    Johnson specifically researched the outbreak of Ebola in the Kailahun district of Sierra Leone. With her colleagues, she noted the effects of both the virus and the community and international responses to its dangers.

    “When Ebola struck in 2014, Sierra Leone was a country that had recently recovered from an 11-year civil war [and] gone through political transition from a one-party state to the reintroduction of multiparty democracy,” Johnson said. “The healthcare system was very weak and ill-equipped to handle a disease of this nature given its rapid spread throughout the country.”

    It is difficult to pinpoint the first case of Ebola in the district, but given its close proximity to both Liberia and Guinea, other key hotspots of Ebola, Johnson stated that Ebola probably arrived in Sierra Leona at about the same time as it appeared in the other countries. Yet, the government was slow to respond.

    “Although its believed that Sierra Leone had Ebola cases as early as March of 2014, the government of Sierra Leone only declared a national health emergency at the end of May,” Johnson said. “Its initial plans only focused on quick fixes and not addressing the root causes of the epidemic.”

    With a healthcare system left in shambles from a civil war that ended in 2002, the country was faced with a lack of basic supplies to fight the disease. Citizens ignored health measures adopted by the government and avoided treatment centers, believing them to be dangerous.

    Despite the adverse situation facing the country, President Koroma remained adamant that Sierra Leone would not “export Ebola” to the international community. The illness became an issue of security, as Koroma called on the military and international organizations for help. He also set up NERC, the National Ebola Response Centre, to fight the illness.

    “NERC had United Nations and WHO representatives on its highest level,” Johnson said. “It was largely being run out of the international agencies headquarters, so the response was largely ceded to the international community.”

    In contrast, response to Ebola in the Kailahun district was local and swift. Doctors Without Borders helped create volunteer task forces throughout the region to alert officials to new cases and deaths. Leaders in the region quarantined certain villages and temporarily banned traditional social gatherings to stop the spread of the virus.

    As a result of these measures, the region became one of the first to successfully beat Ebola. Sierra Leone as a whole was not as lucky. According to data from WHO, nearly 4000 people in the country died from Ebola as of March 2016.

    Johnson suggested that the high number of deaths from the outbreak could have been prevented if the government had considered more of the strategies used by the Kailahun district.

    “The community response really highlights the importance of democratic participation and respect for human rights,” Johnson said. “It’s a long process in terms of gaining people’s trust and getting people on board in terms of what an effective strategy is going to be, but that’s what is required for people to be informed and to understand.”

  2. Vaccination Crisis: 80% of children under 2 without vaccinations in Guatemala

    May 16, 2016 by Odette Zero

    More than a year ago, I was sitting with my grandparents on the morning of the New Year eating a champurrada and reading the Guatemalan newspaper Prensa Libre. We had celebrated the previous night at a nice restaurant in the colonial city of Antigua where we watched the sky light up with fireworks at midnight. I was reading the newspaper with the intention of practicing my reading comprehension skills in Spanish, as I had not taken a formal class in years, when I stumbled upon an emergency that has largely been ignored in the Western press.

    In August 2015, almost 400,000 children under the age of one did not receive vaccination against measles, a disease that was eradicated from Guatemala 20 years ago. There are 328 health posts in the country, however 26 of those are closed, and the rest of them are understaffed and under-resourced at epidemic proportions. I heard about this first-hand from the Guatemalan women who I interviewed for my research project on diabetes this past summer, as they described stories of arriving at the health post at 3 AM and waiting in line to receive medicine that would run out by the time it was their turn. The health post catered to the growing population of diabetics, but only on one day of each month.

    Shortly after that article was published, Prensa Libre published another article describing how 602,357 vaccinations were lost in the transition between the Ministry of Health and the health posts due to robbery, improper refrigeration and lack of coordination in 2014. This resulted in a loss of almost a million dollars, but more than anything, it created a growing risk for thousands of infants now vulnerable to dying of preventable diseases in the near future. The incoming Director of the Ministry of Health, Luis Monterroso, said that 45% of children in Guatemala were not vaccinated in 2014. Data shows that the most rural and impoverished regions of Guatemala did not receive any vaccinations for the entire year.

    Prensa Libre

    Prensa Libre

    Fast forward to April 2016. It is now one year after the former President of Guatemala, Otto Perez Molina, was impeached and arrested for insurmountable charges of stealing money from the health system, several months after the national hospital ran out of food for their patients, the same month in which six newborns died at the National Hospital of Sololá due to lack of medical attention, and the same month when the recently elected president, Jimmy Morales, failed his promise to fix the health system crisis within 100 days of being in office. In Guatemala today, 800,000 planned vaccinations were not completed in 2014 and 2015. According to the Alliance for Nutrition (Alianza por la Nutricion), 81.5% of children under two years old do not have the recommended vaccinations. On top of everything, the Guatemalan government owes millions of dollars to the Pan-American Health Organization – a sum that rivals what is needed to immunize the thousands of children lacking vaccinations in Guatemala today.

    While local actors are combating this national emergency, I could not find any information about this crisis in an English-speaking source. In fact, this emergency has only received attention from Prensa Libre, the Guatemalan newspaper that I happened to read on a dining room table in Guatemala two years ago. Both UNICEF and WHO had data on vaccination coverage for Guatemala. The percentage of coverage was in the 90’s for most of the immunizations on UNICEF’s profile of Guatemala. Looking closer, I noticed that the data on the home page was from 2013, and more recent data showed vaccinations had fallen by 10% across the board. Going back to the Guatemalan newspapers and a report published by the Ministry of Health, Hepatitis B and Pneumococcal vaccine were administered to 21.86%, and 59.87% of children in 2014, respectively. Statistics from the WHO matched these results. Rotavirus vaccine, which prevents vomiting and severe diarrhea in infants, had percentages of immunization coverage varying from 81% in 2013 (UNICEF) to 54.27% in 2014 (Prensa Libre and WHO). The international standard for all vaccinations is 95% – so no matter, Guatemala is very much below the standard, and with each passing year this problem becomes more dangerous.

    A family walking outside Antigua, Guatemala

    This past summer, I saw two cases of Hepatitis B – one in a private pediatric clinic in Guatemala City, and the other in an NGO-funded health clinic open once a week in rural San Martin Jilotepeque. They were both boys no older than five with scared brown eyes and thin limbs. The boy from the urban private clinic had just returned from Disney World and was accompanied by his two parents, both dressed in American brands, while the boy from the rural public clinic was accompanied by his mother, dressed in a Mayan huipil with his younger baby sister strapped to her back. Looking back, I found it a strange coincidence that I had seen two Hepatitis B cases in boys of nearly the same age but from vastly different worlds. And yet, how much of a coincidence was it in a country where only 22% of children were vaccinated against Hepatitis B in 2014? Hepatitis B has a higher likelihood of resolving itself in children above the age of 5, but for younger children and infants there is a 50/50 chance of chronic life-long infection of the liver. For a family living in poverty, this is devastatingly costly condition in a young child. Thus, like most health problems in the world, the vaccination crisis in Guatemala falls most heavily on the most vulnerable in society – children, and the poor.

    In a crumbling health system in crisis, 80% of children under the age of two cannot afford to be without all the necessary vaccinations. Amid debate on national sovereignty and governmental requirements from international bodies, what is to be done about this national emergency, and by whom? While some parents in the US benefit from the luxury of “herd immunity” and do not vaccinate their children, Guatemalan parents have neither the choice to vaccinate their children nor are able to prevent their children from dying of preventable causes. What can be done against the systematic invisibility of long-term global health emergencies in Western media? Without proper attention to this public health emergency, nothing will be done in the near future.

  3. Issues of Contraception and Abortion in the Zika Outbreak

    February 17, 2016 by Allison Park

    Director General Margaret Chan of the World Health Organization (WHO) officially declared the Zika virus a global health emergency Monday, February 1. Given the intense backlash from their delayed response to the Ebola crisis, it comes as no surprise that the international agency would take little time in declaring the Zika outbreak an international emergency.

    CDC_map_of_Zika_virus_distribution_in_January_2016Though the disease has been seen in Africa, Southeast Asia, and the Pacific Islands for years, it was only introduced to the Americas within the last year. The first cases were seen in Brazil last May, and it has since spread rapidly to 20 Latin American countries. The lack of immunity in Latin American populations has fostered rapid transmission, while experts anticipate heavy rain from El Niño weather patterns to further catalyze the spread of this mosquito-borne illness.

    Little attention has been paid to the virus in the past, as the symptoms, only experienced by a fifth of those infected, are relatively mild and rarely fatal. The main concern lies in the perceived link between prenatal infection and microcephaly, a condition that causes infants to be born with abnormally small heads and brain damage. The Director General stated that, “The experts agreed that a causal relationship between Zika infection during pregnancy and microcephaly is strongly suspected, though not yet scientifically proven. All agreed on the urgent need to coordinate international efforts to investigate and understand this relationship better.”

    Brazil, Colombia, El Salvador and Ecuador have all responded to the crisis by asking the women of their countries to avoid getting pregnant. Beyond broad issues of population management and economic development for these countries, such requests carry serious threats to the health of these women.

    Latin American women are faced with limited access to viable resources to manage their pregnancies, and must frequently resort to life-threatening options to do so. It is estimated that over half (56%) of all pregnancies in the region are unintended—a direct symptom of the 23 million women who lack access to contraception and wide spread gender based violence.
    Screen Shot 2016-02-16 at 10.02.36 PMFurthermore, Latin American countries have some of the most prohibitive abortion laws in the world. El Salvador is one of only six countries worldwide with a complete ban on abortions. Of the four countries currently advising against pregnancies, only Columbia allows for abortion in the case of fetal impairment (check out this interactive to learn more about abortion laws worldwide). But the fact of the matter is that, rather than stopping abortion services, these laws only push women towards unsafe abortions. Unsafe abortions represent 95 percent of the 4.4 million abortions performed in Latin America and the Caribbean each year. Women continue to seek out these risky procedures, despite that fact that roughly a quarter result in hospitalization. Worldwide, abortion remains among the top five causes of maternal mortality.

    With Latin American governments pushing women towards these life-threatening operations, it remains unclear whether the WHO’s announcement will mediate or exacerbate the situation. On one hand, it seems probable that their emergency designation will incite public panic and further encourage the use of unsafe abortion services. However, on the other hand, this classification will serve to stimulate funding and action from the international community, position the organization as a global coordinator, and allow for more standardized surveillance of the virus’ spread. Additionally, the Emergency Committee has not supported the calls to avoid pregnancy, instead stating that “attention should be given to ensuring women of childbearing age and particularly pregnant women have the necessary information and materials to reduce risk of exposure.”

    The United Nations High Commissioner for Human Rights has stepped in as well, asking Latin American governments to improve access to contraception and abortions. Though this request is both obvious and necessary, it has yet to be seen whether it is culturally feasible. The current lack of contraceptive use results not just from medication shortages but prominent religious aversion as well. As discussed during the recent cultural competency event, culturally appropriate interventions take bottom-up approaches and years of research and development. However, the current rate of transmission does not provide such a time frame.

     

     

  4. Mabie Fellowship Sends GlobeMed Team To Uganda

    October 30, 2015 by Drew Gerber

    This summer, the Northwestern GlobeMed GROW team traveled to Namugoga, Uganda and worked with the Adonai Medical Centre to learn more about the community’s perception of malaria and bed nets as part of the John & Martha Mabie Fellowship for Public Health, which helps fund student research. The GlobeMed team comprised Weinberg seniors Victoria Zapater-Charette and Carol Feng, Weinberg junior Marilyn Janisch, and SESP freshman Neil Thivalapill. Members of the team study a range of fields, including: biological sciences, philosophy, Spanish, human development and psychological services, anthropology, and cognitive science — and of course, global health.

    How did your experience on the ground vary from your expectations?

    GlobeMed1

    This year, the GlobeMed team worked to help the Adonai clinic address mosquito net use and treatment practices.

    Marilyn: As a person that had never been out of the country, I really didn’t have many expectations. I had no idea what to expect except, per the past GROW teams, how welcoming and friendly everyone at our partner, Adonai, was going to be. When I got to Namugoga, I was overwhelmed by the openhearted friends we would soon make. This experience was nothing like I was expecting. However, the first few weeks were more difficult than I would have been able to anticipate. I never knew what it felt like to be so out of my comfort zone, away from my culture and ripped from my usual lifestyle. As time went on, I learned to get past the unfamiliarity of a new place and just soak up the experience I was fortunate enough to have and take advantage of getting to know the wonderful people around me.

    What was your most challenging moment, and how did you cope?

    Marilyn: Throughout the stay, there were many different aspects that I had to adjust to. From shower accommodations to religious events, it was a lot to take in. However, coming from a very independent “self” culture to a very sharing and collaborative environment was one of the most difficult things to deal with. Having the need for alone time but the expectation to mingle and be social at nearly all hours of the day was very overwhelming and difficult to manage. I felt very misunderstood as being “quiet” or even “standoffish.” In order to express my true self while still being comfortable, I decided to be more present and active while I was outside and with the children, something that didn’t particularly come naturally to me. I gave myself a bit of a routine: a time to type the field notes of the day and a short time to even workout. This gave me a moment to myself and allowed me to reinstate the structure of my everyday life back at home.

    Tell us about your project. What inspired your work?

    Victoria: Each year, our ideas for the research projects begin with our partner. We are in contact throughout the year via Skype and email so when the team is decided, we discuss what we as students can do to best help the Namugoga community and the new clinic specifically. This year we studied the barriers to use of mosquito nets and the treatment seeking practices of community members to see how the Adonai clinic can best address these current issues.

    What was your most meaningful experience abroad, and what did it teach you?

    GlobeMed

    More than just collecting data, GlobeMed team members had the opportunity to hear community members’ stories.

    Victoria: With the nature of our qualitative and semi-structured research methods, we had the opportunity to hear community members’ stories without simply collecting survey data. We conducted most of the interviews inside or near community members’ homes and I was so grateful for how welcoming they were to students who they had never met. Both through the research and with our time living at the Adonai Centre, it was the process of learning personal stories, both about healthcare and not, that will stick with me for a very long time. This taught me to take advantage of every random encounter or free moment to chat because you never know whom you will meet and how their seemingly different experiences may relate to your own.

    Do you have any advice for students wishing to conduct research in an unfamiliar location?

    Victoria: The most important thing for me visiting a new community, even one I had heard so much about from my peers, was consistently keeping an open mind and open ears. No matter how well you prepare by speaking with other people or reading about the area, nothing will compare to the initial experience of arriving on the ground and absorbing everything you can. Our research questions and aims changed in just the first few interviews because there were challenges we hadn’t foreseen as well as simple solutions to what we as foreigners had perceived as problems. Finally, outside of whatever you are working on in the community, it is so important to participate in the social activities alongside community members. Some of our best memories are from the huge soccer tournament, long walks with Adonai workers, and meals shared with locals.

    Did you encounter any cultural differences?

    Neil: There were definitely many cultural differences that the GROW team had to get used to. What was probably most evident was the calling out of our ethnicities in public or in conversation. While we may think it’s rude to identify someone solely based on their race, it was something that happened almost every day and something that became part of our daily routine that we just had to understand. A religious affiliation is part of everyday culture in the area of our partner. For me, it was hard to reconcile my own lack of religious conviction with their religious conviction. The conservative nature of the clothing was also sometimes hard to work around simply because I saw my friends forcing themselves to put on skirts and dresses in order to be culturally sensitive even though it might have been uncomfortable to wear.

    Has your summer experience impacted your future goals and interests at Northwestern or after?

    Carol: Leaving Uganda this summer, I gained a sense of clarity about my goals and interests — professionally and otherwise. Our time spent in the field working with our partner organization and the Namugoga village has reaffirmed my commitment to pursuing a future in which I can contribute positively to the health outcomes of underserved communities. Being able to see for myself the immense burden that health can have in the lives of others in this particular setting further motivated me to work towards changing that reality. Fortunately though, working with Adonai’s growing medical center showed me the possibility and potential to lift that burden — revitalizing my interest in medicine. Through our research interviews, I found that I really enjoyed talking to people about their experiences, problems and hopes. Connecting with people — and then having the technical knowledge to empower them to take ownership over their health — is what informs my desire to pursue a medical degree as soon as I can.

     

  5. Ebola and food security: local impacts of the outbreak

    October 22, 2014 by Arianna Yanes

    WFP response to EbolaEbola has been all over the news for the past few months. We’ve heard stories about American aid workers and journalists contracting the disease and being flown back to the U.S. for treatment. We’ve heard about the increasing numbers of deaths in West Africa. We’ve heard about the breach in infection control protocol at Texas Health Presbyterian Hospital in Dallas.

    What has been largely left out of the news is the effect of this Ebola outbreak on the lives of West Africans. Currently, food security is a major concern.

    The Ebola outbreak has profoundly affected food security in West Africa, causing prices to rise by an average of 24 percent.  The cost of food and accessibility pose barriers for individuals in Liberia, Sierra Leone, and Guinea, the countries in which the current outbreak is spreading.

    Fear and restrictions on movement have led to panic buying and food shortages. Additionally, labor shortages on farms have affected rice and maize production. Border crossing closures and reduction of trade has also profoundly impacted the food availability in these countries.

    Elisabeth Byrs, a WFP spokesperson, told Reuters that  “planting and harvesting [are] being disrupted.”

    The United Nations’ World Food Program (WFP) has approved plans for 65,000 tonnes of food to 1.3 million people; to patients, cases in isolation, and communities badly affected. Just this Saturday, food rations were delivered to 265,000 people in the Waterloo district outside of Freetown, the capital of Sierra Leone. The deliveries aim to prevent the spread of the virus, by stabilizing quarantined families and removing the necessity to leave their homes in search of food.

    The aim of the food deliveries is to “prevent this health crisis from becoming a food and nutrition crisis,” Gon Myers, the WFP Country Director in Sierra Leone told ABC News.

    Additionally, the World Food Program (WFP) is using mobile phones to carry out a food security survey in Liberia, Sierra Leone, and Guinea. The first round of the survey has reached 800 people in Sierra Leone.

    On Wednesday, October 15, international representatives gathered to the annual World Food Prize Award Ceremony. Though not initially scheduled as a topic, African leaders discussed the effects of Ebola on the food supplies in a press conference, with an available webcast online.

    “I think the impact on regional trade is going to be very, very serious,” said Dr. Kanayo Nwanze, President of the United Nations International Fund for Agricultural Development. “And so we believe that like in any other situation where you have a crisis, we should begin to plan for the aftermath of the crisis.”

     

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