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How the World Health Organization is Responding to the Ebola Outbreak in Guinea

The World Health Organization this morning confirmed a “rapidly evolving” outbreak of Ebola in Guinea. This is the first ebola outbreak in western Africa and the worst outbreak in Africa since 2007.

There is no treatment for Ebola, which is a viral disease that jumps from animals to humans often after a person eats tainted meat. It is exceedingly deadly, killing about 80% of infected people. Once in a human host it can spread easily through human-to-human interaction. So far this outbreak has claimed 59 lives out of 80 reported cases.

So far the only confirmed cases are located in remote south eastern Guinea. Two suspected cases in the capitol city of Conakry have tested negative. Another suspected case of a man who traveled to Canada from nearby Liberia has also tested negative. Two samples from six suspected cases in Liberia are currently being tested.

When an acute emergency like this occurs in a country that lacks the capacity to deal with an outbreak like this on its own, the World Health Organization springs into action and manages a global response. The WHO typically plays a coordinating role, with local officials and supporting institutions US Centers for Disease Control and NGOs like MSF taking the lead on the ground. The WHO has facilitated the move of an Institute Pasteur laboratory from nearby Dakaar to Conakry and is supporting an MSF lab in the affected province of Guinea.

The WHO also has in-house expertise in responding to Ebola outbreaks in Africa. It is dispatching a team to Guinea that includes not just medical doctors and epidemiologists, but an anthropologist as well. This multi-disciplinary approach to stemming the outbreak is key. In past outbreaks transmission has often occurred when friends and family members bury their dead. Part of this anthropologist’s job will include finding the balance between a culturally appropriate yet medically hygienic burial practice.

This outbreak is far from over. The  samples in Liberia may test positive, adding a further layer of complexity to crisis response. Still, this is one of those moments where humanity should be thankful we have something like the World Health Organization. Ebola knows no boundaries. As the scare in Canada shows, even an outbreak in remote corner of West Africa can spread across the globe.

 Credit: The CDC responds to an outbreak in Uganda in 2011. Credit: CDC 

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Top of the Morning: #Kony2014

#Kony2014. The USA is more than doubling its troop commitment to help find the reclusive leader of the Lord’s Resistance Army, sending 150 troops and at least four CV-22 aircraft to Uganda. This is the first time the US has sent military planes to find Kony and his fighters.  Will they find him?  Maybe. These US troops are part of a 5,000 strong regional military force that has been trying to find Kony and his gang for the past three years. The search is focused on border regions of Central African Republic, South Sudan and the Democratic Republic of Congo where dense jungle and remote terrain make this task exceedingly difficult. Does it Matter? The UN says that over 325,000 people are displaced across the region because of the ongoing LRA threat. However, the LRA has been significantly diminished in recent years. Top commanders have defected, been apprehended or killed. The LRA is most definitely on the run.  How will we know this works? When those displaced people feel free to return home.  Take a deeper dive:  “Is the LRA Only Sleeping?” Thibaud Lesueur from the International Crisis Group  →

 About that Ebola outbreak…Tests on suspected cases of deadly Ebola virus in Guinea’s capital Conakry are negative, meaning the virus hasn’t reached the city yet. So that’s good! (BBC

The UN accused Syria’s government and rebels of hindering aid access, suggesting both sides could be violating UN Security Council demands that emergency relief reach civilians. (Reuters

Gunmen have attacked and burned a camp for displaced people in Sudan’s Darfur region, adding to an upsurge of suspected militia violence which has wreaked havoc. (AFP

Stat of the Day: Roughly 1 million children, double the previous estimate, fall ill with tuberculosis every year. (AFP

Bangladesh began compiling details Monday about the victims of the 2013 Rana Plaza factory collapse as part of a compensation deal. (AP

H/t DAWNS Digest

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We Are Winning the Fight Against TB

It’s World Tuberculosis Day today.

First some cold hard facts about the disease from the World Health Organization:

– 8.6 million people fell ill in 2012 and 1.3 million people died from TB. This makes it the second biggest killer from an infectious disease after AIDS. TB is everywhere–even in the United States. But it disproportionally affects people in the developing world, which carries over 95% of the global burden.

–The global fight against TB is an ongoing success story. The Millennium Development Goal of reversing the spread of TB is on track to be achieved by 2015. In all, death rates have declined by 44% since 1990.

–Progress against TB is largely due to the WHO and Stop TB Partnership, which have helped establish and implement guidelines for diagnosing and treating TB. By following these guidelines, China was able to reduce its TB prevalence by more than half since the 1990s.

The theme this year is to “Reach the 3 Million.” This is reference to the three million people around the world who suffer from TB every year, but are missed by health systems for a variety of reasons. Treating TB is relatively inexpensive and relatively easy from a medial standpoint–it usually requires taking medicines daily for a few months.  The medicine is not that expensive, but reaching vulnerable populations with the WHO treatment guidelines can be difficult.

“Reaching the 3 million” requires scaling up existing efforts and programs, as well as finding new technologies to diagnose and treat TB. This is expensive, but well worth the investment. If first line TB is not treated, or treated improperly, resistant forms of TB can develop. Those are much more expensive to treat–and far deadlier. Supporting health systems infrastructure that can stop first line TB is among the most cost effective and useful global health interventions in the world today.

Image Credit: Richard Venturi/WHO


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CAR: What’s Religion Got to Do With It?

How important is religion to the crisis in the Central African Republic?

Recent reports on ongoing violence have drawn attention to the fact that Muslims, by the hundreds of thousands, are being attacked and forced to flee by Christian/animist “anti-balaka” militias. In March of last year, a loose rebel coalition called Séléka overthrew the government of François Bozizé, installing the country’s first Muslim president, Michel Djotodia. In September, Djotodia disbanded Séléka, but according to the Guardian  “Many of the rebels refused to disarm and leave the militias as ordered but veered further out of control, killing, looting and burning villages.” Djotodia was no longer in control of them. The anti-balaka (balaka means machete in Sango) militias are reportedly a response to the crimes of the former Séléka. They are perhaps even more decentralized than Séléka; a French officer described elements of the anti-balaka as “civilians armed with machetes.”

The role of religious identity in this conflict is paramount, but it would be a mistake to assume that this makes it a religious conflict. In CAR, religion is tied to a number of historical and political factors and intersects with ethnic identity. This has led to some interesting constructions, such as the call by Amnesty International to “stop ethnic cleansing” of Muslims in CAR.

So if it’s not about religion, what is it about, and why are people targeting each other based on their religious identity?

The answers lie in CAR’s history; Muslim traders arrived in the early 19th century, but by the latter half of that century this amicable relationship was transformed by the Arab slave trade. Louisa Lombard, an anthropologist who as been studying the country for over a decade, writing for the blog Africa is a Country, tied religious and political identities in CAR together this way:

It’s not that religion is unimportant, but rather that religion maps onto a host of other historical divisions in the country, chief among them “foreignness.” Among people in the capital, Bangui, there is a widespread anxiety that their country is being invaded and plundered by foreigners. They have a fair amount of historical support for this fear: whether in the case of the trans-Saharan trades’ nineteenth-century raiders or the case of the French-backed concessionary companies of the early twentieth, or of incompetent contemporary ministers’ corporate contracting, people with roots in far-off places have been the ones to obtain greatest monetary benefit from the CAR’s resources. The fear of foreign plunderers — and especially “Chadian,” “Muslim” plunderers — festered and grew during former President Jean-Francois Bozize’s decade (2003-2013) in power, because of the support he received from Chadian President Idriss Deby, who sent a contingent of Muslim soldiers to assure Bozize’s security. The impunity “Chadians” in Bangui enjoyed as a result was the source of much tension. The fact that the Seleka alliance that toppled Bozize in March was also predominantly Muslim piled more injustices and abuses onto these longer-standing tensions.

Because of this history, Muslims have historically been the target of state harassment in CAR. Ultimately, however, like most other conflicts in the world, this one is about political power and the access to resources it provides. After decades of French exploitation and the despotic rule of the colonial state, a coup against the French-backed independence government, and a French-backed coup against that government, CAR’s people have struggled to replace the old colonial machine with a more democratic system. History also shows why the African Union force in CAR, made up in part of Chadian soldiers, is seen as not neutral or untrustworthy by many; especially when Chadian peacekeepers are thought to have backed the Séléka rebellion and are accused of having killed three Christian civilians in February.

When Séléka took power and Djotodia became interim president, he promised that he would step down and not run in post-transition elections, which were to be held no more than 18 months after he was elected by the National Transitional Council. In the meantime, shortly after Séléka took power, he declared that “The Central African Republic is a secular state… It is true that I am Muslim, but I must serve my country, all Central Africans.”

UN Secretary-General Ban Ki-moon recently met with religious leaders from CAR, who traveled to the UN and Washington DC in a show of inter-religious unity. The Secretary General publicly reiterated that the conflict is not a religious one, but that “religious and ethnic affiliations are being manipulated for political purposes.”

There are many reasons to be hopeful. In January, Djotodia stepped down when the National Transitional Council elected a new transitional president, the respected and popular mayor of Bangui (the capital city), Catherine Samba-Panza. She appealed for peace by saying ”I am the president of all Central Africans, without exception… I appeal to my anti-balaka and Seleka children to listen to me and together lay down your weapons.”

Religious leaders are highly influential and it is encouraging that at the highest levels, they are working together to encourage their compatriots to lay down their arms. Yet some have also stressed the importance of not mistaking the conflict for a religious one. The Alliance of Evangelical Churches and the Episcopal Conference in CAR released an updated version of its Bangui Declaration on February 14th, which said:

The confrontation between Seleka and anti-Balaka has started a cycle of reprisal in which the civilian population have fallen victim. We condemn this violence, whatever its origin. Moreover we do not accept the amalgam of labelling of anti-Balaka as “Christian” militia. Indeed the anti-Balaka are the expression of exasperation, with the ongoing atrocities, from a part of the population – mainly young men – that witnessed multiple abuses by Seleka rebels. However, we reiterate that all anti-Balaka are not Christians and that all Christians are not anti-Balaka. It is the same for ex-Seleka and Muslims. Incorrect terminology that labels anti-Balaka “Christian militias” must be corrected. This amalgam propagated by national and international media has given a religious connotation to a crisis that is in its core political and military.

Further international involvement, then, will have to pay attention to these political-military nuances and better coordinate the actions of the international community in terms of peacekeeping. The French sent in a unilateral force that was meant to be short-lived, but President Samba-Panza has already asked that they stay until elections early next year. The French population, and some opposition leaders, are less than enthusiastic about this idea. The broader climate is more conducive to an international force, as President Déby of Chad has called for a UN mission, Secretary-General Ban Ki-moon has recommended to the Security Council that the disparate forces currently deployed should come under a single UN command, and the European Union has approved the deployment of 1,000 troops. The EU force is set to deploy at the end of April, but it is off to a rocky start; so it remains to be seen whether a sufficiently resourced multilateral mission will be able to step in and prevent further violence while a political solution is worked out.

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image credit, United States Army Medical Research Institute of Infectius Disease via wikimedia commons

Top of the Morning: Ebola Outbreak in Guinea

Top stories from DAWNS Digest

An Ebola Outbreak: MSF and UNICEF are launching an emergency medical intervention following reports of Ebola in southern Guinea, where an outbreak of hemorrhagic fever has left at least 59 people dead. This is a highly contagious and deadly disease, and hard to contain once it spreads to populated areas. (CNN

More Protests Deaths in Venezuela: Two Venezuelans died from gunshot wounds during protests against socialist President Nicolas Maduro, witnesses and local media said on Saturday, pushing the death toll from almost two months of anti-government demonstrations to 33. (Reuters

Stat of the Day: For World Water Day! “768 million people lack access to improved water sources, 2.5 billion people have no improved sanitation and 1.3 billion people cannot access electricity, (Weather Underground

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Statistic of the Day: China Halves Tuberculosis Prevalence

The Lancet just published an important new study showing the prevalence of Tuberculosis in China has been reduced by half since 1990, from about 170 cases per 100,000 people to 59 cases per 100,000 in 2010.

This is hugely significant to the people of China and the world. It is also proof positive that a World Health Organization guideline for treating TB can be highly effective.

Treating TB generally requires a patient to take medicine once a day for several months.  In the 1990s the World Health Organization developed the Directly Observed Short Course Treatment (DOTS) guidelines for countries with high TB burdens. DOTS requires that a health worker or trusted individual physically observe the patient take her dose of TB medicine. The idea is that the patient will be less inclined to stop taking her medicine once her symptoms disappear, but before the TB is gone from her system. (If treatment is interrupted, the TB can re-appear, or, worse, the TB can develop resistance to the treatment–and much more expensive second line drugs would be required.)

The medicine to treat first line TB is not expensive. But the infrastructure to implement DOTS can be costly. After all, to maximize impact, you want the treatment options to be as convenient as possible for patients. Authorities in China — to their credit — decided to invest in a DOTS strategy for their provinces with their highest burden of TB in the 1990s, then expanded to the entire country in 2005.

The Lancet review offers evidence that this strategy worked. It also shows that other countries with similarly high burden can sharply reduce TB incidence by implementing the World Health Organization’s guidelines.

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