Zika Virus

If you’re an infectious disease geek and you’ve been following the news, you know that the Zika virus is causing a pandemic in Central and South America and is linked to cases of microcephaly in those regions. It’s gotten bad enough fast enough that the CDC has issued travel warnings for pregnant women and women of child-bearing age.

If you’d like to get up-to-date on this outbreak, check out Maryn McKenna’s blog on National Geographic. Also, the CDC has great information for clinicians and laboratory professionals.

 

 

The Aftermath of Ebola

The Ebola outbreak may no longer make front page news in the United States and Liberia may have been declared Ebola free in May, but the consequences of the outbreak are still ever present, and will be for years to come.

The first reported Ebola case was in December 2013 in Guinea. By June of 2014 the outbreak had rapidly spread and the rest of the world was taking note. In May 2015 Liberia was declared Ebola free. Currently, the situation in Guinea and Sierra Leone is improving and each country is now able (from a health care standpoint) to isolate and treat current patients. However, new cases are still being reported in both countries so continued vigilance is paramount.

As the disease itself abates and it is possible to see the light at the end of the tunnel, it is clear that Ebola may be (nearly) gone, but its effects will linger for decades and it has left devastation in its wake.

The CDC estimates that, in the hardest hit countries of Guinea, Liberia, and Sierra Leone, the death toll from Ebola cases is: Guinea: 2,509, Liberia: 4,806, Sierra Leone: 3,947. The total number of cases is hard to track but estimates of total cases, including those that are suspected, probable, and confirmed are as high as 3,784 in Guinea, 10,666 in Liberia, and 13,241 in Sierra Leone (numbers are as of July 17, 2015).

The socio economic consequences of the outbreak are numerous.  Much of the day-to-day workings of the economy ground to a halt as people stayed home or fled jobs in factories, mines, and fields. Panicked investors fled as the disease began to spread. Disruption during the agricultural season caused diminished agricultural yields which had both economic consequences and resulted in severe food insecurity across the region. Internal and regional trade were dramatically affected due to boarder closures and movement restrictions to help staunch the transmission of the disease. Those who survived the outbreak are now left to pick of the pieces of their daily lives and learn to live without loved ones. Parents were left without children, children were left without parents. The courage it would take to find jobs, housing, a support system after watching loved ones die (and possibly being sick oneself) is hard to fathom.

A portion of the damage left in Ebola’s wake includes health care systems and infrastructure. Already weak to begin with, Ebola wreaked havoc on the human and infrastructural health care resources in all three countries. The Economist reports that an estimated 509 health care workers died in Guinea, Liberia, and Sierra Leone. This is an enormous loss of human resources in countries where, before the outbreak, the average doctor to patient ratio was less than 10 doctors per 100,000 people. Looking to the future, one of the biggest health care concerns is the number of children who went unvaccinated during the height of the outbreak. Because of this, vaccine-preventable diseases, such as measles and polio, will contribute, indirectly, to Ebola’s death toll.

To end on a positive note, however, the local and international communities are now left with an opportunity: to remake the systems better than they were before. In many places physical infrastructure, human resources, and other necessary systems will be starting anew. With the right expertise and resources, using best practices and with cooperation among international agencies, private donors, and local governments, among others, health care can be built stronger than before with an eye toward preventing such devastating outbreaks in the future and caring for the day-to-day health needs of the local populations.

For further reading:

Levy

-Marie Levy spent over five years working at American Society for Clinical Pathology in the Global Outreach department.

Dr. Frank Artress and FAME Africa

A couple of weeks ago I had the wonderful fortune of reconnecting with someone from my past. In 2007 I lived and worked in Tanzania and through that work had the pleasure to meet Dr. Frank Artress and his wife, Susan Gustafson. In rural Tanzania, Dr. Frank, as he is known, stands out. He is a tall white guy with an infectious laugh and booming voice. An American cardiac anesthesiologist, he spent the early part of his career building a successful practice in California. However, in 2002, after a near death experience as a tourist climbing Mt. Kilimanjaro, he and Susan changed paths. They sold everything, uprooted their lives, and moved to Tanzania where he has practiced medicine ever since.

They started by conducting mobile medical clinics in rural Tanzania out of a large red and white van reaching areas with no access to Western medical care. Today, Frank and Susan run a 24 bed hospital. The hospital, located in Karatu, Tanzania, continues to grow and recently began to offer not only maternity care but has a fully functioning surgical ward where they are now able to deliver babies via c-section. They have an outpatient clinic, a dispensary, and a laboratory and are almost entirely staffed by Tanzanian nurses, doctors, lab techs, and administrators. Their laboratory, operational since 2011, has a fully automated blood chemistry machine which makes them the only hospital within a 140 kilometer radius with the diagnostic capabilities it provides. The lab is also in the process of developing a telepathology program in conjunction with ASCP, the College of American Pathologists, and the American Society of Clinical Oncology.

As their reputation spreads throughout the region, their catchment area continues to expand. In a country where the average doctor to patient ratio is approximately 1/50,000 they are providing critical care to a large population of people.

Our recent interaction was while they were in town on a fundraising tour in the United States. Over 70% of their funding comes from grants and individual donations. They are always in need of more support. In addition, they have a small volunteer program for people with the skills that match their current needs.

They are wonderful people doing amazing work. I could sing their praises for hours, but Dr. Frank is the best at telling his story. Check out this video: https://www.youtube.com/watch?v=_-ud_cS6Mek and find their organization, FAME Africa, online: http://www.fameafrica.org/.

Levy

-Marie Levy spent over five years working at American Society for Clinical Pathology in the Global Outreach department.

World TB Day

Did you know? March 24th was World TB Day. The date commemorates the day in 1882 when Dr. Robert Koch announced he’d discovered the cause of Tuberculosis.

Did you know? Every day there are 24,000 new cases of TB diagnosed. This means more than 2 billion people are infected with TB and 1.5 million people die each year (according to the Stop TB Partnership).

Did you know? The number of people diagnosed with multi-drug resistant TB (MDR-TB) has tripled since 2009 (according to the WHO TB fact sheet).

The burden of TB is highest in resource limited countries and in places where the incidence of HIV is highest. TB is the most common opportunistic infection for individuals with HIV/AIDS and is the most common cause of death in HIV/AIDS patients. In resource limited countries diagnosis and consistent treatment is a challenge. Lack of laboratory resources to use for diagnosis means TB diagnosis are often made based on empirical signs and symptoms.

Once a patient is diagnosed (either clinically or based upon a confirmed laboratory test) given the strenuous treatment, it can be difficult to keep people on a consistent treatment plan. Most treatment lasts six to nine months. In rural settings where access to drugs is limited this can be a prohibitive amount of time. Not only does the cost of the drug add up but the opportunity cost involved in missing work to travel to get the drug, the cost of the travel, and the physical strain of the travel all hamper a patient’s ability and commitment to sticking with the full course.   This can and has led to increased prevalence of MDR-TB.

Unfortunately, the ways to prevent the spread of MDR-TB (quick, accurate diagnosis; taking medication exactly as prescribed; avoiding exposure) aren’t easy in resource limited areas. Basic cell phone technology may be one tool helping to make a difference, however. Some researchers and health care providers are experimenting with sending text message reminders to other health care providers and/or patients to take their medication. Multiple studies are currently underway to determine whether this method of communication has been useful in increasing drug regimen adherence and improving the TB cure rate. If this can solve one of the challenges related to TB, it will be a big step in the right direction.

 

Levy

-Marie Levy spent over five years working at American Society for Clinical Pathology in the Global Outreach department.

 

Significant, but Fragile, Gains In the Fight Against Malaria

Marie Levy

January 2015 Lablogatory post

In recent months it seems that the only news stories about sub-Saharan Africa presented by western media are about Ebola. There are some bright spots in that news, but in general it is scary and saddening. Lost in the Ebola shuffle, however, is some good news about the fight against malaria. A recently released report from the WHO Global Malaria Programme states that worldwide the malarial mortality rate fell by 47% between 2000 and 2013 and currently 55 countries are on track to reduce their malarial burden by 75% by 2015. Those are exciting numbers. The report attributes these improvements to increased use of insecticide treated bed nets, accurate diagnostic testing, and increasingly effective drug therapies.

Accurate diagnostic testing means that the lab is playing a crucial role in the fight against malaria. Data from 2013 shows an increase in the use of diagnostic tests in sub-Saharan Africa. This supports additional data that shows there has been a shift from presumptive treatment to diagnostic treatment.

As a public health community, however, we cannot become complacent. The WHO report states that, in Africa, over 43,000 children die from malaria each year, 15 million pregnant women do not have access to preventative treatment, and over 200 million people live in households without access to insecticide treated bed nets.   Drug and insecticide resistance is a serious concern (thus underscoring the importance of accurate diagnostic testing to prevent presumptive treatment that can contribute to drug resistance). In the West African countries hit by the Ebola outbreak, health care resources have all been directed towards the fight against Ebola leaving them vulnerable to increases in other disease occurrence. If nothing else, however, the Ebola outbreak has provided a reason and impetus for discussions surrounding the importance of health systems strengthening. Strengthening that will not only fight future outbreaks of diseases such as Ebola, but will improve health care networks for every day care and treatment.

Thus, in the spirit of the holidays, let’s celebrate this good news. But while doing so, let’s also continue the fight and keep up the good work.

Links for further reading:

http://apps.who.int/iris/bitstream/10665/144852/2/9789241564830_eng.pdf

http://www.nytimes.com/2014/12/14/opinion/sunday/fragile-gains-against-malaria.html?_r=0

http://kff.org/news-summary/significant-global-gains-made-against-malaria-but-ebola-threatens-progress-in-west-africa-who-report-says/

Levy

-Marie Levy spent over five years working at American Society for Clinical Pathology in the Global Outreach department.

Season of Greetings

It’s amazing the year is nearly over, the halls are decked, candles lit, celebrations scheduled. Friends and families gather, eat too much, hug and kiss, pass around gifts and graciousness…and microbes.

Laboratory professionals know all too well that “Seasons Greetings” are just the thing for passing along your favorite virus or enteric pathogen. This year, we are especially conscious of the contagious nature in the world of unseen assailants. Global health has faced the disastrous affects of improper hand washing and challenging sanitation conditions; and not just with the Ebola crisis, but in refugee camps and among those facing the strife of war.

Laboratories don’t close for holiday celebrations…and laboratory professionals don’t always get the days and times off that would make them happy around the holidays. But this year I challenge us with two things:

  • Remember to offer “Seasons Greetings” with best practices and don’t take any of your laboratory favorites along to the parties and gatherings!
  • If you’re working that extra shift, or one that is encroaching on your family and personal time—remind yourself that there are so many in the world who would rejoice in the opportunity to be working, to be healthy enough to be working and free of disease, strife and conflict, and could watch their children and families smile, eat too much, hug and kiss and pass along “Seasons Greetings”.

My best to you for this holiday season, whatever ways you celebrate, and ‘tis the season to remember our colleagues globally and do something to make the world a little better place locally! Happy Holidays!

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Beverly Sumwalt, MA, DLM, CLS, MT(ASCP) is an ASCP Global Outreach Volunteer Consultant.