HEALTH CARE PROFESSIONALS ABANDOM TELEWOYAN HOSPITAL

By: Emmanuel Wilmot Jackson, Sr.

The Telewoyan Hospital in Lofa County, the Republic of Liberia, West Afica has been abandom by the health care professionals assigned to that hospital. The hospital is only government referral hospital in the district of Vionjama. According to one of the nuses(name withheld) said that the abandonment of the facility came about as a result of the news of a positive case of Ebola at the hospital. According to the nurse, a male patient, 38 years, reported to the ER of the hospital with the chief complaint of severe headache, high fever, and bleeding. The clinician assigned in the ER carry out his assessment and decided to request laboratory investigations to conrifm his differential diagnosis. When the results came back, the patient was diagnosed with the deadly Ebola Virus Disease (EVD).

Upon hearing this news by the rest of the staff, they all started to flee for their lives. When questioned as to why they were leaving the hospital, some of them responded by saying that the facility does not a place to quarantine EVD patients, they were not trained to handle such a case, and to make matter worse, there was no personal protective equipment (PPEs) within the facility. The hospital has been out of PPEs for months now and there has not been in-service training for a protracted period of time now.

The staff are calling on the Red Cross, the ICRC, politicians, philanthropic organizations, and individuals to come to the aid of the hospital but at the same time, they are saying that they will not return to the hospital until the hospital is fully equipped with medical supplies and drugs, including PPEs. Mainwhile, politicians are begining to adhere and respond to the demand of the health care proffessionals. As seen in the photos below, Senator Saah Joaseph has just donated a truck load of medical supplies to the hospital and is calling on the health workers to return to work.

Covid 19 Vaccinations, from Hesitancy to Acceptance

Elizabeth Kavanaugh

The US national policy for Covid 19 vaccination needs the support of community agencies to carry the nation to herd immunity. With sights on 70%, large scale vaccine drives have succeeded in vaccinating 34% of Americans. The Southeast of the US, Tennessee, Arkansas, Georgia, Alabama, Mississippi, and Louisiana are lagging with 25-28% vaccinated.  Not all those remaining are opposed, but rather are hesitant to be vaccinated. Vaccine Hesitancy Map  We need to coordinate outreach to those who are hesitant to vaccinate for Covid 19.  We cannot contain the pandemic and achieve herd immunity without them.  We are still all in this together!

Lack of access and vaccine misinformation affect underserved populations disproportionately. The CDC has solutions to address these problems at the community level. They have designed rapid community assessment guide for use at the state and local level to coordinate an approach. There is a tool kit for community health centers with strategies for reaching underserved populations and those who are resistant to accepting the vaccine. Clinics can request vaccinated clients become ambassadors in their neighborhoods.  Power to the positive deviants! The CDC has published vaccine talking points in layman’s terms to promote confidence in promoting the vaccine.

In many communities, low digital literacy, poverty, food insecurity or homelessness complicate meeting ones needs.  Partnering with Meals on Wheels, shelters and food banks can reach those people.  Some who are hesitant just need support and information from a trusted source.  The message advocating vaccination can come from a bus driver, a teacher, a pastor, a sports figure, a celebrity, a local leader, a soldier, or a neighbor. Uber and Lyft are offering free rides to vaccination sites.

Imagine NOELA Community Health Center mobilizing the people of New Orleans.  The drivers of the New Orleans Regional Transit Authority talking to riders about vaccinations and providing free transit to vaccination centers. On the buses you see posters of Aaron Neville, Payton Manning and Tyler Perry promoting vaccination.  Meals on Wheels takes meals and vaccines to citizens of the city.  Imagine herd immunity!

A coordinated approach to addressing vaccine hesitancy is an opportunity to inspire communities to find solutions from within.  With tools like this a community can accomplish anything!  Covid containment is within our reach!

A banner reading “Thank You Helpers & Heros!” hangs outside of McGehee School in New Orleans, Louisiana, U.S., on Monday, March 30, 2020. New York has become the coronavirus epicenter in the U.S., but data shows that other cities from New Orleans to Philadelphia aren’t far off from experiencing similar outbreaks. Photographer: Emily Kask/Bloomberg via Getty Images

Chesapeake Bay Conservation

The Chesapeake Bay watershed covers 64,000 square miles and 18 million people. Pollution has been an ongoing problem for the bay. Many organizations are directed toward the rescue of the Bay.¹ Through improved conservation efforts, the health of the Chesapeake and its surrounding communities will improve. By enhancing conservation efforts, the impact could be an economic boost of up to 22 billion dollars per year.² This impact would be seen through climate stability, agriculture/food security, and improved water management. All of which would lead directly to positive economic change.

cbf.org

By forming partnerships with industries and conservation groups the goal would be to charge the dynamic from one of being adversaries to one closer to a mutually beneficial alliance. By being inclusive and bringing local fisheries and farms interests to the table and coming with a working group to handle the big issues relating to the health of the Chesapeake.

The core of conservation efforts are already present in these industries. Groups like AFS and the Maryland FB have conservation components to their organizations. It makes sense that they would want to be involved in sustainable practices. The purpose of creating a coalition between the Industry and the conversationalist is to make the Chesapeake watershed both a natural and an economically sustainable region for generations to come.

This coalition framework is similar to CBF, however, what is noticeable is the lack of agriculture and industrial representation. With the creation of a coalition of industries and conservationists, the goal would be to develop a mutual understanding of the issues and develop a framework that will create a sense of ownership in the project and improve buy-in from both sides of the issue and ultimately strengthen efforts to improve the health of the Chesapeake that is economical and sustainable.

HIV/AID Prevention in Sub-Sahara Africa

HIV/AIDS is a public health challenging issue globally, but Sub-Sahara Africa faces an enormous prevalence and incidences rates among all nations. Overall, 20.7 million people living with HIV, 6.7 adult HIV prevalence (ages 15-49), 730 new HIV infection, and 300,000 AIDS-related deaths. Currently, 73 percent adults ARV, and 58 percent children receives ARV treatment (Avert, 2019).  In this region, people are at high risk contracting HIV/AIDS due to engaging multiple sexual partners without use of appropriate condoms, and or proper precaution when having sex. The region has another significant public health issues not only HIV/AIDS, but also malarial and TB (https://www.avert.org/professionals/hiv-social-issues/key-affected-populations/children). TB remain the leading cause of death with PLWA, because in 2016, 40 percent of HIV death was due to TB (https://www.afro.who.int/health-topics/tuberculosis-tb). About 92 percent of the global malarial cases is in Africa (https://www.afro.who.int/health-topics/malaria). The The countries MOH help priorities allocate funding to regional, sub-regional, districts, rural areas and the most affected communities to deliver health policies plans. They also work with foreign donors and develop policies in accordance with MDGs with intent to decrease NCDs. UNAID help fund target HIV/AIDS prevalence, track treatment, and to end the disease. Global Fund provide assistance to countries MOH distribute of HIV/AIDS, malarial, TB treatment and vaccines. PEPFAR tackle HIV/AIDS by providing funds to many countries and distribution of ART treatment to mitigate the disease prevalence and incidence rate in the region. UNFPA help distribute effective way of using condoms, provide sex and HIV/AIDS education in the most affected communities. US bilateral assist with funding to create guideline and implementation programs related to PLWA in the region.

https://www.afro.who.int/health-topics/hivaids

There are many people in the region who are HIV/AIDS affected due to poverty, lack of education, place they live, people of same characteristic such families or parents with low job opportunities, and children who have no access to healthcare. The region politicians are not really focusing their attention to these current pressing endemic issues, help mitigate the spread in the areas affected communities, but diverted and uses the HIV/AIDS money from foreign donors to different other things.

ACTION:  

To improve HIV/AIDS in the region the regional MOH and gov’t, local NGOs should take a massive interpersonal campaign, and a holistic educational approach with the assistance from foreign stakeholders in the affected communities. The local NGOs and countries MOH, gov’t should build a robust coalition together with international donors or stakeholders to contribute more funding for HIV/AIDS treatment (PrEP and ART), testing options, counseling sites, and education. The coalition partners should provide more funding to promote universal healthcare coverage to anyone, and everyone regardless to age or sex. The countries MOH, local and international NGOs should promote more networking connections to reduce stigma of PLWA, so that this population to seek treatment to better their lives. Last but not the least, the coalition should collaborate and promote safe sex by encouraging appropriate condom use in all at risk communities.

Can New Policies Provide Safer Roads In Montana?

There are only 5 states that do not require ignition interlock devices for repeat DUI offenses, and Montana is one of them. An ignition interlock device is placed in vehicles and is designed like a breathalyzer to measure the alcohol content of the driver. The driver is to blow into the device and if the alcohol level is above regulation (usually 0.02%) the ignition interlock will prevent the car from starting. These ignition interlocks help keep offenders driving (without these, courts would typically suspend the license), help reduce recidivism rates, predict future DUI offenses, and help save lives. In 2018, and at a rate of 8.28 deaths per 100,000 people, Montana ranked number one in having the highest alcohol-involved fatality rate when compared to all other states.

Image Source: Montana Department of Transportation  

As of June 2020, there are 34 approved county-level DUI Task Forces, like Drive Safe Missoula, that spread out over 38 counties. Statewide task forces, like the Montana DUI Task Force and the Montana Substance Use Disorder Task Force, meet with various stakeholders (government bodies, prevention specialists, treatment organizations, etc.) to go over new legislation, best evidence-based practices, DUI prevention education and opportunities, and new treatment methods.

To date, when it comes to public health initiatives, Montana has seen the most progress when collaborating with various stakeholders and working towards a common goal. By investing various stakeholders into new policies and goals, they tend to be sustained for a longer time period and do better. For example, since Montana passed its open container law in 2005, alcohol related driving fatalities have trended downwards. Even though we are seeing a downwards trend, Montana consistently ranks in the top 5 states.

Image Source: Grover Law  

The requiring of ignition interlock devices for repeat DUI offenses is imperative for Montana to lower their alcohol related fatality rate as well as provide safer highways. The involvement of a variety of stakeholders is crucial for getting this new policy passed. Within these stakeholders it is highly recommend that law enforcement and probation and parole officers are included. These officers are needed because they will be working with the target audience on a regular basis and are able to provide invaluable insight. Other stakeholders include judges, alcohol recovery programs and organizations and the state licensing office. For this policy to get the recognition it deserves, it is essential that these stakeholders maximize their efforts in advocacy and engaging the public and political leaders.

Screening saves lives: Creating a cancer screening program in Dominica

Dominica, a small island nation in the East Indies that is known for its natural beauty and approximately eight active volcanos is has a small economy and many of its citizens live below the poverty live. Agriculture is its primary source of GDP, which becomes more difficult with recurrent hurricanes making landfall. Recently, tourism and an international medical school, Ross University, increased to bring in further capitol, however Hurricane Maria destroyed enough of the island that these were not options anymore. This has caused poor infrastructure leading to may socioeconomic disparities, including in the healthcare sector.

One of many “hidden waterfalls” in this beautiful country

The human papilloma virus has been linked to the development of cervical, anogenital, and pharyngeal cancer and the burden of this disease globally is high, in fact the third most common cancer among women worldwide. In Dominica there is no current screening and treatment program for the HPV virus which is completed by a pap smear.

The annual number of new cases of cervical cancer is unknown, however in the Caribbean it is close to 4,200.(3) With this screening program vital data can be collected on the incidence, prevalence, and rate of HPV infection and cervical cancer that Dominica desperately needs.

There are local NGOs, the Ministry of Health, regional alliances such as the Caribbean Public Health Agency, and international agencies such as Global Initiative Against HPV and Cervical Cancer sponsored by the WHO that can implement a screening program utilizing funding from the government as well as international organizations. This endeavor will be great as the data of why screening programs haven’t been implemented and the root cause analysis is a good place to begin. The Dominican government has recently made a commitment to citizen based initiatives, and along with local NGOs and the local Peace Corps volunteers, the engagement with the citizenry could be beneficial to gathering data and making healthful changes. This can then be branched out into a other healthcare screening programs when the culture of preventive medicine is adopted.

Development of HPV to cervical cancer

Global cervical HPV infections rates

Resources:

1. Figures 2: Crow, J. HPV: The global burden. Nature 488, S2–S3 (2012). https://doi.org/10.1038/488S2a

2. Figure 3: WHO/ICO Information Centre on HPV and Cervical Cancer; De SanJose, S. et aWHO/ICO INFORMATION CENTRE ON HPV AND CERVICAL CANCER; DE SANJOSE, S. ET AL. LANCET INFECT. DIS. 7 453–459 (2007).

3. https://www.who.int/news-room/events/detail/2020/11/17/default-calendar/launch-of-the-global-strategy-to-accelerate-the-elimination-of-cervical-cancer

4. https://carpha.org/Who-We-Are/About

Got MAT?

Despite the enactment of efforts that resulted in a 37% ($90.5 million)reduction in opioids prescribed from 2014 to 2019, a nearly 50%increase in fatal overdoses deaths was obsevered.^1,2,3  Due to the proliferation in use of synthetic opioids, the third wave of the opioid epidemic is proving to be more deadly indicating a heightened need for medication-assisted treatment (MAT) therapy.⁴ In recognition of this unmet need, the  SUPPORT Act was passed to increase access to MAT in the primary care setting which resulted in 19,000 newly waivered MAT providers.⁵ Even with the observed gains, “40 percent of counties in the United States did not have a single waivered provider in 2018”.⁵   The SUPPORT ACT increased provider panel limits, however, research by the Office of Inspector General indicates,  the overall MAT capacity in the United States fails to meet demand for which the causation is believed to stem from: 1 . Disparities in access in rural communities, 2. A lack of provider capacity to serve more patients in more densely populated areas, and 3.  A greater proportion of low-limit waivered MAT providers.⁵

Rates of Patient Capacity in the United States by County, 2018⁵

Consistent with the Office of Inspector General recommendations which are supported by the Substance Abuse and Mental Health Services Administration (SAMHSA):

• The American Public Health Association must develop a policy statement addressing the disparity in opioid treatment among rural and underserved communities to spur congressional action to increase MAT provider panel limits by amending the SUPPORT Act for those communities.⁵  
• Organizations and associations that deliver patient care must encourage their members and/or employees to “obtain waivers, treat more patients,” and utilize telemedicine technologies to expand access in rural and underserved communities⁵
• TheNational Association of State Alcohol and Drug Abuse Directors, in partnership with the National Council for Mental Health Wellbeing and National Alliance for Medication Assisted Recovery, must partner with SAMHSA to develop and implement state-level plans. The aim should be to ensure adequate MAT access in each county by exploring barriers to treatment through consultation with individuals on their lived experience and with their families.⁵

Lastly, access to MAT is a recognized prerequisite needed to support any subsequent treatment and recovery initiatives that results from linkage to MAT.  As such, all organizations engaged in efforts along the behavioral health continuum of care are encouraged to contact their congressional representative to advocate for expansion of SUPPORT Act patient limits and other enactment of targeted incentives to increase number and /or treatment capacity of MAT waivered providers.⁶

Stop Brucellosis in the Negev

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Brucellosis is a disease transmitted from infected animals (e.g. sheep, goats) to humans. It occurs primarily through the consumption of infected, unpasteurized animal products or via occupational exposure to infected animal tissue or fluids. In humans, brucellosis can affect any organ and even result in death. There are no vaccines available for humans, although vaccinations are available for livestock. Treatment of brucellosis involves antibiotics for humans and slaughtering infected livestock.

Brucellosis has an incidence of 500,000 human cases annually. The World Health Organization (WHO) classifies brucellosis as a Neglected Tropical Disease (NTD). “Neglected” describes the minimal attention, paucity of disease burden data, and lack of influence that marginalized populations have on decision making about disease control.

Israel’s Negev Desert
Wikimedia Commons–public domain

Shepherd–by Sahl Abdelrahman

Yazan Zayed and his father prepare a sheep for Eid al-Ahda, the Feast of the Sacrifice.

Brucellosis is endemic in the Negev Desert in southern Israel.  The desert is home for the Negev Bedouins, a Muslim Palestinian minority making up 3.5% of Israel’s population. Today, approximately 2000 Bedouins care for most of Israel’s livestock numbering 400,000 sheep and goats. Most brucellosis cases in Israel occur in the Bedouin population. Although there is an incident rate of 4 cases per 100,000 people, there have been significantly higher rates among Bedouins in recent years, even 38 times higher in 2014.

The Israeli government must prioritize funding for programs like the veterinary control campaign of the early 1990s in order to eliminate brucellosis. An interdisciplinary approach involving the Ministry of Health, Ministry of Agriculture, and Ministry of Education is needed for actionable policy and development of programs focused on treatment of individuals, surveillance of communities, mapping and vaccination of flocks, culling infected animals, regulation of pasteurization, and increased culturally relevant health education. Successful strategies must involve Bedouin community leadership in decision making processes and acknowledge barriers posed by a historically low-trust relationship between the Israeli government and Bedouin communities.

Expanding “Malaria Smart Schools” in Uganda will help end malaria

Uganda suffers from one of the highest burdens of malaria in Sub-Saharan Africa and in the world. Many Ugandans are familiar with bed nets and many have visited health clinics for malaria treatment. But still, malaria affects a high percentage of the country’s population.

In 2019, I traveled to outside of Kampala, Uganda to visit a malaria education and prevention program run by the National Malaria Controlle Program within the Ugandan Ministry of Health and USAID’S President’s Malaria Initiative (PMI). The program is referred to a Malaria Smart School where education about malaria is incorporated into the curriculum of each grade.

Each classroom has what is called a “malaria corner” where students’ projects on the anatomy of mosquitos, malaria parasite life cycle, the spread of malaria, and artistic expressions about malaria are featured.

A “malaria corner” in a Malaria Smart School classroom

Inside the first grade class of a Malaria Smart School

Walking in between meetings with a group of students at the Malaria Smart School

Malaria corner

The Malaria Smart School also incorporates education on malaria into song, dance, and art. In this way, students are learning more about how malaria is spread than any generation before them, which is also an important factor considering their population is so large! Pictured below is a poem written by the malaria smart school students. The poem was recited along with dance and acting.

Page one of a poem written by the students at a Malaria Smart School

Page two of a poem written by the students at a Malaria Smart School

The Ugandan Ministry of Health and PMI have been pleased with the Malaria Smart School program. It was evident during my visit that the students have gained a comprehensive knowledge of malaria and a knowledge they share and are passing onto their families and people they live with. In fact, one of the primary goals of this program was to break behavior cycles in the community regarding malaria through the students’ learning. The result of this program is that children are able to teach older generations proper preventative strategies about malaria, treatment options, and even basic scientific epidemiology of malaria.

This is already disrupting behaviors, leading older generations to seek proper care and follow proper mitigation efforts to combat malaria. If these programs were to expand to other regions in Uganda, within even a generation, there would be a significant decline in malaria cases because of the knowledge learned and passed on by these children. The Malaria Smart School program is one many countries should model in their national malaria control programs, and with outside support from partnering organizations like PMI, this model could really impact the global burden of malaria.

Expansion of the Washoe County Detention Center (WCDC) with a new Medical Housing Unit

The WCDC is outdated and urgently needs expansion to provide improved numbers of specialized cells, a modern medical facility for a proper working environment including offices for medical staff. The housing and care of sick inmates including those with serious mental health problems is seriously compromised by the current facilities. The population of Washoe County has grown approximately 12% over the last decade according to the US Census Bureau. In terms of mental health services, Nevada is ranked 47th in accessibility to services combined with a high prevalence of patient with mental health problem. There are mixed views by various stakeholders over the advisably and feasibility for this expansion project.

The Sheriff’ and his Executive leadership team at the WCDC feel that this is an urgent priority. Support by the County Commissioners has been mixed but currently they support the expansion. The COVID-19 crisis resulted in a severe curtailment of revenue from tourism and the County Commissioners halted a planned expansion last year. The medical staff are working from separated workspaces and in offices that are not conducive to proper medical interviewing and examination. The medical team includes administrative personnel, EMT’s, LPNs, Licensed Clinical Social Workers, Mental Health RN, Psychiatrist, Charge nurses, Intake nurses, a Medical Director and several midlevel providers that all have a high interest in having better facilities. Currently there is only one treatment room with a Nurse Practitioner’s desk all located in the treatment room.

The Mental Health unit of nearly sixty beds is now overflowing into another housing unit. Some inmates with severe mental health issues are housed in other units. Scattering of these patients makes the logistics of their interactions with the mental health team more problematic. Moreover, severely mentally ill patents are frequently housed in the medical unit because there is insufficient space in the mental health unit. Recently the census of patients with severe mental health issue has been rising. Some of this is psychosis fueled by the methamphetamine usage rate in Washoe County. The rising census within the community has also caused an expansion of needs generally. Currently, there are only six cells designed for Suicide Watch (SW) patients and this is causing housing problems especially during busy periods of the year. Inmates are considered a medically underserved population.

Moreover, there are Federal judiciary mandates requiring that inmates have medical care comparable to the standards of care in the community. Therefore the judiciary serving Washoe County have a high interest in the quality of medical care and services that can be provided at the WCDC. There are also federal courts and inmates that are located or housed in Washoe County. Federal judges and courts have a high interest in the quality of the facilities and the medical care of the inmates. The people of Washoe County have mixed interests in an expansion of the “jail.” Many are opposed to spending any money for the inmates but many see that this is necessary but are concerned about the budget shortfalls from the COVID-19 crisis. There was a report in the local newspaper in 2017 (https://www.rgj.com/series/deathsbehindbars/) highlighting a high number of in-custody deaths in the jail over an 18 month period. This sparked an outcry from the community and a response by a few judges as well. It became problematic when some judges tried to manage medical treatment and care at the jail in the absence of the appropriate medical credentials.

After several County Commissioners made personal visits and spoke with the Sheriff and his leadership team they came to see the wisdom and necessity of the expansion. Recently the project has been given a green light to proceed with planning anew but until the facility is contracted and built, the issue will remain in doubt. The goal now is to maintain the momentum with the County Commissioners and the Sheriff’s Office as we move toward new elections in a few years. importantly, we will need the support and interst of the community. The Medical contractor on site and the medical personnel working at the jail will not need any convincing.