Is Ebola a Disease of Poverty or a Function of a Dysfunctional Public Health System?

Source: http://www.channelstv.com/2014/04/26/experts-warn-ebola-virus-could-spread-across-west-africa/
Source: http://www.channelstv.com/2014/04/26/experts-warn-ebola-virus-could-spread-across-west-africa/

Here is a YouTube link to a video posted by WHO as it respond to the EVD in West Africa:

A lot has been said since the outbreaks of Ebola Virus Disease (EVD) in Southern Guinea, which subsequently spread in the sub-region to Sierra Leone, Liberia, and now Nigeria, Africa’s most populous country. In the past, the ebola virus was first discovered in Zaire in 1976 of what is now known as the Democratic Republic of Congo (DRC)-Kinshasa, not to be confused with the Republic of Congo (Brazzaville). A team led by a Belgian Microbiologist/Scientist worked with local health workers at Yambuku (the epicenter) of the outbreak at the time for three months and they were able to contain the virus and eventually stop the mayhem of the deadly disease, which at the time claimed the lives of 300 people.

The result of their work provided insightful hints on how to control the deadly virus from spreading and, if adequately contained, could subsequently eliminate the virus or prevent new cases. Some measures they proposed after their work in Yambuku included simple personal and public health measures. These include washing of hands, not using contaminated syringes, avoiding contact with infected individuals or if contact is unavoidable making sure you are well protected, quarantine those who are infected as well as those working with infected individuals, adequately and appropriately burying or cremating dead victims and the effective dissemination of information to the public in a timely manner encouraging people to come forward without been ‘threatened for not doing so’, which include building trust as all essential measures to contain the continuous spread of the virus are taken. These are all information that are widely used by community, public, and global health professionals as well as individuals against other forms of diseases/viruses that are usually spread through similar medium. The mentality of inducing public fear is a less effective recipe to control and contain any crisis.

These measures could also be more effective by instating a state of emergency to allow public health workers as well as other stakeholders to be able to adequately address the virus and help effectively treat those infected. Sierra Leone, Guinea, and Liberia with the exception of Nigeria (where a state of emergency was released immediately following a second dead victim) were delinquent to put in place this measure. Why were they careless? What was the psychology behind delaying a state of emergency when the outbreak was discovered and there are information on how deadly EDV is? Was their delay another public show to create a humanitarian corridor to feed into their greed and corruption at the expense of the Liberian, Sierra Leonean, and Guinean people? They could argue that well, “we did not know this was going to turn out this way.” Hello? This ebola period and that name alone, if not taken stereotypically, should evoke the inner consciousness of any public health authority, government official, and the president for that matter, to take it seriously. Their delay have caused the lives of those that are dead and infected with the virus. A state of emergency can not in itself stop the spread of EVD, but could facilitate and reinforce the process of controlling and containing the spread of the virus.

Recent statistics released by the WHO suggest that as of date, the recent outbreak of the EVD in Western Africa have killed about 1,069 people in the sub-region of which 3 dead victims were reported in Nigeria. This included a Liberian diplomat who flew there weeks ago after transiting at the Tokoin International Airport inLomé, Togo via a civilian aircraft from Sierra Leone. This new statistics more than triple dead victims reported when EVD first emerged in Zaire.

Figure 2: Deaths caused by the EVD by countries in Western Africa, [WHO, 2014]
Deaths caused by the EVD by countries in Western Africa, [WHO, 2014]
Figure 3: Peter Riot, the Belgian Microbiologist prepares to depart for Yambuku in 1976. In picture, a C-130 based on arrangements by President Mabutu prepares to take the Piot and his logistics to the infected area.
Figure 3: Peter Riot, the Belgian Microbiologist prepares to depart for Yambuku in 1976. In picture, a C-130 based on arrangements by President Mabutu prepares to take the Piot and his logistics to the infected area.
Figure 4: Piot (second from left) and the team in Yambuku in 1976
Figure 4: Piot (second from left) and the team in Yambuku in 1976

One of the weakest, ineffective, and poorly efficient public safety measure is the incitement of fear. Fear makes people to naturally build a defense system in which they fail to come forward provided that they are the supposedly target fearing that they would be stigmatized. Instead of inciting fear in people to try to contain a specific disease or virus, motivating them to come forward for their own good to seek treatment is much more effective,appropriate, and efficient.

Figure 5: Confirmed cases of EVD as of August 7, 2014.
Figure 5: Confirmed cases of EVD as of August 7, 2014.
Figure 6: Geographic distribution of EVD outbreaks in animals and humans [2014].
Figure 6: Geographic distribution of EVD outbreaks in animals and humans [2014].
Figure 7: Emerging and Dangerous Pathogens Laboratory Network (EDPLN)
Figure 7: Emerging and Dangerous Pathogens Laboratory Network (EDPLN)

Telling people they would be arrested because they fail to bring their infected relatives forward would do little good to contain the virus and risks the safety of the entire population. This is where an effective and well organize public health risk management system makes the control and containment of such crisis (EVD) more effective, measurable, and productive for the people who are infected to seek treatment, prevent new cases, and if all goes well, subsequently controlling and containing the virus.

Fear would not make this happened, instead it would reinforce and facilitate the spread of the virus, create a social divide amongst the population, which could potentially lead to something else. Fear makes people to naturally become resistant and would psychologically avoid seeking treatment, even if treatment were available. Given the historical past of the civilian population of Liberia, Sierra Leone, and Guinea where civil conflicts have caused significant damages, deaths, and trauma, fear would be a less effective tool to combat EVD, given that communities in these countries are still reintegrating, rehabilitating, and reconstructing from periods of senseless, baseless, and bloody civil wars or political upheavals. Fear was a recipe that was used which promoted, enhanced, and reinforced these events. So, psychologically fear would be less effective tool and if use, it could trigger unprecedented mental and personal health problems.

Fear also promotes the possibility of infected victims been stigmatized against. Fear reinforces stigmatization and reduces personal motivation, which leads to social isolation and discrimination of the victim. If President Ellen J. Sirleaf of Liberia wants to the operations to contain and control the EVD, the fear she has provoked into public consciousness should be undo. Telling people that they would be arrested and persecuted for not bringing love ones, relatives or friends infected with the virus to be quarantine and treated makes people to naturally resist.

While it is true that her point is about public safety and the objective is to control the continuous spread of the virus, fear would do little to achieve those objectives. The outbreak of the EVD and the increasing deaths have already provided much fear to induce victims to consciously seek treatment. One of the reasons victims are not coming forward is their lack of confidence in the government and its health programs. The public has all reason to fear the continuous lies, mistreatments, deceptions, and corruption that are so commonplace in the Liberian government and the health system is not exception. What they lack is the motivation to trust the government’s ability in the presence of a fail and poorly managed health system to provide the necessary treatment to keep them alive. This trust is what the current government of Liberia should be trying to rebuild instead of inciting fear in the people.

With the continuous reports of new cases within the affected countries and evidence of cross border spread of the disease through the movements of people, all air travels, border crossings, and costal travels should have halted or if not, strict health and safety measures put in place to control and contain the disease. These were not happening! The inability for the respective government agencies in these countries to have instituted proactive and robust public health safety measures at all entry points reinforces and continues to facilitate the spread of the disease. The absence of these, which should have been to enforce public health policy prior to the outbreak of the disease serve as a clue that EVD is not just a poverty-oriented ideas, but a product or function of a dysfunctional public health system, which needs significant reforms at the local, community, regional, and national levels.

Ebola may be seen as a poverty based virus, however, I would argue that there are equally poor countries where ebola hasn’t occur even though these countries could have their own social, political, and health problems. Associating poverty as a recipe for the outbreak of ebola is distracting us from the true reason why ebola outbreaks do occur. If you notice carefully, most of the countries where ebola has emerged or re-emerged over the last several decades including the 2014 outbreaks are countries that are either politically unstable, emerged/emerging from long political and civil unrests/conflicts, which left social, political, economic, and health infrastructures severely damaged. EVD emergence in Nigeria, though is an exceptional case because it will be controlled and contained earlier, given the Nigerian government’s earlier response.

However, this doesn’t erase the fact that people have to take their own health with caution. Poverty could be a contributing factor to the outbreak of ebola, but not exclusively the main recipe. Poor governance, which focuses its development operations and apparatus within a centralized system without decentralizing services (including health and other social services) throughout the country is the driving force for the spread of ebola. Health authorities in Guinea, Sierra Leone, and Liberia should have known enough from information already available out of the enormous public and global consciousness from the devastating emergence of ebola in Zaire to which we all derive clue on how to control and contain the spread of the virus, treat infected victims, appropriately bury dead victims, and how to adequately disseminate health and safety information without fear and discrimination.

Ebola may be a poverty-based disease, but it is mainly caused by poor public and personal health practices and systems, which could spread quickly most especially in regions prone to civil unrest, which left social and health systems severely damaged or technically dysfunctional making the population more vulnerable to respond. The spread of EVD could also be potentially unprecedented in countries with a vulnerable centralized health system as evident from the cases of Sierra Leone, Guinea, and Liberia. EVD outbreak in Nigeria would short-live given Nigeria’s robust, effective, and decentralized health system. The earlier instatement of a state of emergency in Nigeria and other measures taken give insights to the rigorousness and robustness of the health sector and the overall government’s response to ensure public safety.

Sources:

Figure 1: http://www.popularmechanics.com/science/health/med-tech/seeing-the-impossibly-small-10-wild-scientific-visualizations-7#slide-7. Accessed: 07/30/2014.

Figure 2: Deaths caused by the EVD by countries in Western Africa, 2014 cited in http://www.bbc.com/news/world-africa-28769678. Accessed: 08/14/2014.

Figure 3: http://www.bbc.com/news/magazine-28262541. Accessed: 07/30/2014.

Figure 4: http://www.bbc.com/news/magazine-28262541. 07/30/2014.

Figures 5: Confirmed cases of EVD in West Africa as of August 7, 2014. http://www.who.int/csr/disease/ebola/maps/en/. Accessed: 08/14/2014.

Figure 6: Geographic distribution of EVD outbreaks in animals and humans. http://www.who.int/csr/disease/ebola/maps/en/. Accessed: 08/14/2014.

Figure 7: Emerging and Dangerous Pathogens Laboratory Network (EDPLN). http://www.who.int/csr/disease/ebola/maps/en/. Accessed: 08/14/2014.

Associate Research Fellow/ Research Fellow at IFPRI

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The International Food Policy Research Institute (IFPRI) seeks a qualified candidate to serve as an Associate Research Fellow/ Research Fellow to conduct research on issues related to policies and institutions toward reducing climatic risk.
The International Food Policy Research Institute (IFPRI) seeks sustainable solutions for ending hunger and poverty. Founded in 1975, IFPRI is a member of the CGIAR Consortium, a global research partnership for a food secure future. The mandate of IFPRI is to identify and analyze alternative national and international strategies and policies for meeting world food needs in ways that conserve the natural resource base, with emphasis on low income and on the poorer groups in the countries.

IFPRI offers a multicultural, collegial research environment with competitive salary and excellent benefits. IFPRI is an international and equal opportunity organization and believes that diversity of its staff contributes to excellence.

Knowledge

For the role of Associate Research Fellow, applicants should have expertise or demonstrable interest in the modelling of climate risk management and sustainable agricultural intensification. The position is a two-year, fixed-term, renewable appointment based in New Delhi, India.

APPLICATION DEADLINE: August 25, 2014 or until a suitable candidate is identified

Essential Duties:

Conduct research on policies and institutions for upscaling climate smart agriculture.
Support the CGIAR Research Program on Climate Change Agriculture and Food Security in scaling-up climate smart agriculture through policies and institutions: linking it with national agenda of food security
Integrate and apply biophysical and socio-economic models for climate risk management.
Work with a variety of stakeholders, including donors, partners from other CGIAR centers, partner institutions to stimulate new policy-relevant research on climate change;
Required Qualifications:

Ph.D. in Economics, Agricultural Economics or related discipline
Demonstrated competence in computer software for simulation modeling (such as GAMS)
Demonstrated ability to publish in high-ranking peer-reviewed journals
Demonstrated ability to work in multi-disciplinary and multi-institutional teams with a variety of stakeholders on multi-sectoral projects.
Experience in communicating results in different multicultural and multi-stakeholder settings
Excellent written and spoken English
Willingness to travel extensively as required
Excellent interpersonal skills
At the Research Fellow Level:

3+ years of post-PhD experience relevant to the job and demonstrated fundraising experience
Excellent publication record in peer-reviewed journals.
Major external recognition within peer professional network due to publications and other leadership activities.
Demonstrated leadership skills and strong experience building and managing teams.
Demonstrated leadership in developing global/regional research programs for policy analysis.
Preferred qualifications

Familiarity in modelling in the area of agriculture and climate change.
TO APPLY:

Internal Candidates: Please send cover letter and resume—via email—to Carla Tufano/Monica Dourado.

External Candidates: Go to www.ifpri.org. Click on “Careers” and “Research Positions” to link you to Position # 14-152 –Associate Research Fellow/Research Fellow/NDO. Please complete the on-line application, including a complete curriculum vitae and a detailed letter of interest. Also, make sure to complete the section providing 3 references.

For more information on IFPRI, please visit website at www.ifpri.org

Request for Applications: U.S. Borlaug Fellowship for Global Food Security

Warning: This announcement was initially released by the Center of Global Food Security at Purdue University. The posting of this request for application is not in any ways associated with the initial post. As a Borlaug Fellow who just recently completed field work in Loas as part of this wonderful opportunity, I would encourage members of my network who are U.S. Citizen and currently enrolled in an accredited U.S. Graduate Program to apply. Good luck!! J. Macedo

Request for Applications (RFA)

Request for Applications

U.S. Borlaug Aluminus: Jenkins Macedo in Laos at IWMI from Clark University
U.S. Borlaug Aluminus: Jenkins Macedo in Laos at IWMI from Clark University

This RFA solicits applications to support U.S. students conducting research on topics related to the U.S. Government’s global hunger and food security initiative – Feed the Future (FTF). All topics that relate to food security (e.g., agriculture, nutrition, ecological resources, poverty) and are linked to the research strategies of the Feed the Future initiative are admissible. We welcome applications from US Borlaug Summer Institute on Global Food Security participants who meet eligibility requirements.

The U.S. Borlaug Fellows in Global Food Security graduate research grants are intended to support students interested in developing a component of their graduate research in a single, developing country setting by supporting the student’s work in-residence at an International Agricultural Research Center (IARC), or a qualifying National Agricultural Research System (NARS) unit. Note, all research centers of the CGIAR consortium are eligible partners; if you are interested in working within an IARC or NARC outside of the CGIAR system, or in multiple countries, please contact us at borlaugfellows@purdue.edu before developing your application.

The students are expected to have a faculty advisor at their home institution and a research center mentor from the IARC or NARS that is serving as host for the student’s international fieldwork. The applicant must demonstrate that there is strong support for the proposed project by both his/her faculty advisor and the IARC/NARS mentor. We encourage students to seek guidance from both their faculty advisor and research center mentor(s) as they develop their project. Applicants are required to describe in detail how their proposed research leads to a significant impact on food security.

Students are encouraged to think creatively about the needs of their particular project and plan a budget that best suits their educational needs and circumstances. Grant funds can be used to support a variety of research needs including student travel to the research site, research materials and supplies, living expenses while abroad, and travel for the faculty advisor and/or research center mentor to the IARC/NARS or the student’s U.S. university, respectively. Funds cannot be used to pay tuition, salaries, institutional overheard or to support applicant’s dependents.

The grants have a maximum value of USD 15,000 for students applying for 6-month long international research stays; USD 20,000 for 1-year long international research stays; and USD 40,000 for 2-year long international research stays. Students are expected to stay in-residence in the host country for the majority of the time (85%) with some time available for short-term absences. Grant funds are not intended to cover all costs of the proposed research, and applicants are expected to leverage outside funding in support of their work plans.

Students applying for 1-year long research grants may split the year into two, 6-month long stays over a period of no more than 18 months. Fellows who do so still must spend 85% of their time during those two, six-month long stays in the host country.

New: The U.S. Borlaug Fellows in Global Food Security Program graduate research grant is an overseas research grant; however, in extenuating circumstances and with adequate justification, the Borlaug grant may also support up to one semester (no more than four months) of student support costs in the U.S. in order to carry out data analysis or writing a thesis or dissertation stemming from overseas research. Up to 15% of the total budget can be applied in the US to defray student research costs, preparing manuscripts for publication or finalizing thesis/dissertation. Costs that will be budgeted include housing, meals, local transportation, data processing, lab fees, printing and travel to a professional conference to present a paper or poster. As a point of reference, for a $15,000 six month grant, applicants may budget up to $2,250 for states-side support for a total of $17,250. For a $20,000 one-year grant, up to $3,000 may be budgeted for US support (for a total of $23,000) while a $40,000 two-year grant can budget up to $6,000 for states-side support (for a total of $46,000). Borlaug funds cannot be used to pay tuition, taxes of any type, equipment, research/teaching salaries (assistantships), general university fees not associated directly with the Borlaug overseas research program, or research outside the Borlaug program. The application must include a detailed description of states-side activities with a timeline, a detailed breakdown of costs in budget, and a statement on why you are not able to secure funds from other sources. Borlaug funds used states-side must also be managed by your university in a similar manner to the funds applied abroad.

Application Deadline: Fall 2014 Application Round – Applications announced August 11, 2014. Deadline for fall applications is November 10, 2014.

Application: To submit an application, follow the instructions here.

Applicants who need assistance in making contact with international mentors should contact a representative at the various International Agricultural Research Centers (IARCs). Please note that we do not match students with mentors, but the Purdue Center for Global Food Security staff is able to provide recommendations and to provide contact information for potential centers and mentors. Please see our website for a list of IARCs and their contact information.

Eligibility Criteria: Applicants to the graduate research grant program must be a U.S. citizen, and must be enrolled in an accredited U.S. graduate program.

Review of Applications: A selection committee will review applications and the top-ranked applicants may be interviewed before a final selection is made.

Awards are made on a competitive basis to students who show strong scientific foundation and possess leadership potential, propose a well-coordinated research plan that clearly articulates concepts and objectives that are innovative and feasible, and project a commitment to international development. Emphasis will be placed on proposed projects that are interdisciplinary, but students approaching an issue through a single discipline will also be considered. We welcome research projects in any developing country that has a significant food insecurity problem. Applications to Feed the Future countries will be reviewed favorabley. Review the evaluation criteria: http://www.purdue.edu/discoverypark/food/borlaugfellows/research-fellowship/rfa.php