Fragile States

Fragile States (including Afghanistan, Democratic Republic of Congo, Haiti, Liberia and South Sudan)

{Photo credit: MSH staff, Afghanistan}Photo credit: MSH staff, Afghanistan

In 2013 diarrhea killed 578,000 children under the age of five, 9 percent of all deaths in this age group globally. The tragedy of these deaths is that they are avoidable at many levels. The risk of contracting diarrhea can be drastically decreased through basic hygiene measures, such as consistent and exclusive use of a latrine and washing one’s hands with soap. Once a child becomes ill with diarrhea, most cases can be managed with oral rehydration salts and zinc. But the gap between what is known in the public health community regarding prevention and treatment of diarrhea, and what is practiced in many settings, is wide and deadly.

In Afghanistan, diarrhea killed 13,000 children under the age of five in 2013 and was the third most frequent cause of mortality (after neonatal conditions and pneumonia) in the age group. Many organizations, including Management Sciences for Health (MSH), have worked to improve access to treatment for children with diarrhea, but less attention has been paid to prevention.

 {Photo credit: Morgan Wingard for USAID}Liberia.Photo credit: Morgan Wingard for USAID

The October/November issue of the Global Health Impact Newsletter (subscribe) focuses on the Ebola outbreak in West Africa and MSH's response, including what is needed to save lives, contain Ebola (or any similar outbreak), and maintain essential health services: stronger health systems.

A Note from Dr. Jonathan Quick

[Dr. Jonathan D. Quick]Dr. Jonathan D. QuickThe Ebola outbreak in West Africa is unprecedented. Already, over 13,000 people have been affected and over 5,000 lives lost. What’s more, this outbreak was preventable.

Devex #Healthymeans graphic.
On October 27, Devex launched , a month-long online campaign to raise awareness about global health challenges and opportunities. Throughout the month of November, Devex and partners are encouraging discussion around the question: What does healthy mean to you?

Join Nov. 13, 1 pm EST with hashtags  and

On November 13, MSH () and partners are leading a Twitter chat from 1:00-1:30 pm EST on "Maximizing Global Health Synergies in Post-2015 Era". Led by Jonathan Jay (), guest-tweeting with , we'll discuss:
  1. What health target or outcome is your top priority for the post-2015 era?
 {Photo credit: Fred Hartman/MSH}Dr. Logan and two women Ebola survivors at Annex 3.Photo credit: Fred Hartman/MSH

Tuesday, November 4, was my first day back at MSH headquarters since returning from Liberia nearly three weeks ago on October 21. I volunteered to go to Liberia—one of three West African countries at the center of the Ebola outbreak—because MSH has a wealth of experience to offer to help resolve one of the great public health challenges of our time. 

I started my career in smallpox eradication, and through the years have worked on other outbreaks: hemorrhagic fevers, SARS, avian and pandemic influenza, and multi-drug resistant tuberculosis (TB).  These diseases were—and are—highly infectious and carry significant mortality if proper infection control procedures are not followed.

 {Photo credit: Ian Sliney/MSH.}"Let's prevent Ebola together" billboard in Liberia.Photo credit: Ian Sliney/MSH.

Management Sciences for Health (MSH) hosted an interactive, three-day, online seminar on the West African Ebola outbreak on LeaderNet.org, October 28-30, 2014. Edited summaries from seminar facilitators (MSH Global Technical Lead on Malaria and Communicable Diseases, A. Frederick Hartman, MD, MPH, Days One-Three, and co-authored by Independent Pandemic Planning Advisor, Lisa Stone, Day Two), appear below. You can access seminar archives, including resources for preparedness and response, by joining LeaderNet.org.

Day One (Oct. 28): Mobilizing community-based care

Many thanks to the 240 individuals from more than 50 countries who have signed on to participate in the LeaderNet Ebola seminar so far. I am very impressed with your interest and enthusiasm in discussing, and ultimately controlling, this massive Ebola outbreak.

 {Photo credit: Anthony Yeakpalah/MSH.}Meeting community volunteers to update them on malaria case management measures during the Ebola crisis.Photo credit: Anthony Yeakpalah/MSH.

The unprecedented outbreak and spread of the Ebola virus in three West African countries (Guinea, Liberia, and Sierra Leone) continues to wreak havoc on the lives, economy, and already-strained health systems of the region. The outbreak is particularly high in Liberia with 2,413 people killed by the disease to date.

While the Government of Liberia and partners are mobilizizing all efforts to control Ebola, there is evidence that other diseases are being neglected as a result of health facilities closing down, fear of seeking treatment at health facilities, and the Ministry of Health’s policy to focus its resources and staff to manage Ebola, maternal and child health, and emergency services.

In its early stages, malaria symptoms closely resemble those of Ebola infection: fever. The unrelenting influx of suspected Ebola cases to health centers raises serious issues of capacity, safety, and ability to identify Ebola cases in time for isolation and management.

Ebola outbreak response: Regional confirmed and probable cases, 20 October 2014. World Health Organization (WHO) map

Are you interested in preparedness and response to an Ebola outbreak? Join us for a three-day interactive, web-based seminar on the West African Ebola outbreak from October 28-30, 2014. 

Hosted by Management Sciences for Health, the LeaderNet seminar on Ebola will provide a broad overview of the current West African Ebola outbreak, identify trends and specific interventions that are needed, and show specific MSH technical approaches that can help countries prepare for and respond to any Ebola outbreak.

The seminar is free of charge and available in English and French. The discussion will be moderated and facilitated by:

{Photo credit Ian Sliney/MSH}Photo credit Ian Sliney/MSH

Dr. Fred Hartman is in Liberia with the MSH Ebola response team; he shared some of what he's seen with the Boston Herald.

There isn’t the panic there was at the beginning, but the cases continue to rise. The paradox is that everything on the surface feels normal, but in the neighborhoods this infection is still blazing away and people are still dying of it....

It’s a new norm. By nature, Liberians are ebullient people. They like to laugh and hug and shake hands and touch. But there’s not as much laughter, and there’s no shaking hands. And there’s certainly no hugging....

You can’t control the disease until you detect and isolate every single case. That’s why we’re opening up these centers.

Unpublished
 {Photo credit: Ian Sliney/MSH}Liberia.Photo credit: Ian Sliney/MSH

Co-host Robin Young interviews Ian Sliney and Arthur Loryoun of Management Sciences for Health (MSH) about MSH's work with Liberia's government and community leaders to rebuild the health system, stop the spread of Ebola, and restore community confidence on today's NPR/WBUR Boston's Here & Now.

Sliney, senior director for health systems strengthening at MSH, says:

The idea of the community care center is to put a triage facility close to a health center that will allow people who think they may have Ebola to come and receive a very rapid diagnosis. Other people who have a fever or symptoms similar to Ebola can also come. There will be a very rapid turnaround of the diagnostic procedures to accelerate treatment for the people who catch this terrible disease.

Loryoun, technical advisor at MSH and a pharmacist, says:

Initially people were very resistant to the idea of opening any form of treatment centers in the [community], for fear that would further spread the virus. People are now beginning to appreciate the effort of setting up of the community care centers.

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