6 Ways Technology is Helping to Fight Ebola

By Timo Luege, TC103: Tech Tools and Skills for Emergency Management facilitator via TechChange

As Ebola continues to ravage Sierra Leone, Guinea and Liberia, people from all around the world are working together to stop the disease. In addition to the life saving work of medical staff, logisticians and community organizers, information and communication technology (ICT) is also playing a vital part in supporting their work.

After consulting the TechChange Alumni community and other experts in international development and humanitarian assistance, I pulled together a list of different technologies being applied to manage Ebola. Below are six examples showing how ICT is already making a difference in the current crisis.

1. Tracing outbreaks with mapping and geolocation
Aside from isolating patients in a safe environment, one of the biggest challenges in the Ebola response is tracing all contacts that an infected person has been in touch with. While that is difficult enough in developed countries, imagine how much more difficult it is in countries where you don’t know the names of many of the villages. It’s not very helpful if someone tells you “I come from Bendou” if you don’t know how many villages with that name exist nor where they are. The Humanitarian OpenStreetMap Team has helped this process through creating maps since the beginning of the response.

See: West Africa Ebola Outbreak – Six months of sustained efforts by the OpenStreetMap community.

Monrovia OSM pre-Ebola
Map of Monrovia in OpenStreetMap before and after volunteers mapped the city in response to the Ebola crisis. (Humanitarian OpenStreetMap)

In addition, the Standby Task Force is supporting the response by helping to collect, clean and verify data about health facilities in the affected countries. The information will then be published on UN OCHA’s new platform for sharing of humanitarian data.

2. Gathering Ebola information with digital data collection forms
Contact tracing involves interviewing a lot of people and in most cases that means writing information down on paper which then has to be entered into a computer. That process is both slow and prone to errors. According to this Forbes article, US based Magpi, who just won a Kopernik award, is helping organizations working in the Ebola response to replace their paper forms with digital forms that enumerators can fill out using their phones.

Digital forms not only save time and prevent errors when transcribing information, well designed digital forms also contain simple error checking routines such as “you can’t be older than 100 years”.

If you are interested in digital forms, check out the free and open source Kobo Toolbox.

3. Connecting the sick with their relatives using local Wi-Fi networks
Elaine Burroughs, a Save the Children staff member who is also TechChange alumna ofMobiles for International Development, shared that they are using their local Wi-Fi network to connect patients in the isolation ward with the relatives through video calls. Both computers have to be within the same network because local internet connections are too slow. In situations where video calls are not possible, they provide patients with cheap mobile phones so that they can talk with their relatives that way. Elaine added: “Several survivors have told us that what kept them going was being able to speak with their family and not feel so isolated when surrounded by people in hazmat suits.”

4. Sharing and receiving Ebola information via SMS text messages
I have heard about a number of different SMS systems that are currently being set up. Some are mainly to share information, others also to receive information.

mHero is an SMS system specifically designed to share information with health workers. It works with UNICEF’s RapidPro system, a white label version of Kigali-based TextIt which is one of the best SMS communication systems I know. RapidPro is also at the heart of a two-way communication system that is currently being set up by UNICEF, Plan International, and the Scouts.

The IFRC is of course using TERA to share SMS, a system that was developed in Haiti after the 2010 earthquake and already used in Sierra Leone during a recent cholera outbreak.

5. Mythbusting for diaspora communities via social media
Social media also has a place, though not as much as some people think. With internet penetration at less than 5 per cent in Liberia and less than 2 per cent in Sierra Leone and Guinea, it is simply not relevant for most people – unlike radio for example. However, all of these countries have huge diasporas. The Liberian diaspora in the US alone is thought to be as many as 450,000 people strong – and they all have access to social media. Experiences from Haiti and the Philippines show that the diaspora is an important information channel for the people living in affected countries. Very often they assume that their relatives in the US or Europe will know more, not least because many don’t trust their own governments to tell the truth.
Social media can play an important role in correcting misinformation and indeed, both the WHO and the CDC are using their social media channels in this way.

6. Supporting translations of Ebola information remotely online
Last but not least, Translators Without Borders is helping NGOs remotely from all over the world to translate posters into local languages.

SoundCloud Widget: https://soundcloud.com/bbc-world-service/world-update-translators-without-borders-take-on-ebola

Low tech does it
As a final word, I’d like to add that while technology can make a real difference we must not forget that very often low tech solutions will be more efficient than high tech solutions – it depends on what is more appropriate for the context. So don’t start an SMS campaign or launch a drone just because you can. It’s not about what you want to do. It’s not about technology. It’s about what’s best for the people we are there to help.

A Summary Infographic

TechChange Ebola Infographic

We will be discussing these technology tools, Ebola, and many similar issues inTC103: Tech Tools and Skills for Emergency Management and TC103: mHealth – Mobiles for Public Health. Register by October 31 and save $50 off each of these courses.

Do you have additional examples of how ICT is helping in the Ebola response? Please share them in the comments!

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Ebola: Still outpaced, nurses strike, and why West Africa?

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Ebola crisis: ‘We are still being outpaced by epidemic,’ MSF head tells MPs

Via The GuardianEbola crisis: ‘We are still being outpaced by epidemic,’ MSF head tells MPs. Excerpt:

The Ebola epidemic is still outstripping efforts to contain it, according to doctors from Médecins Sans Frontières who have mounted most of the early response in west Africa. Speaking to MPs from the House of Commons international development committee, MSF’s head of UK programmes said the apparent decline in numbers in Liberia did not signal the end of the epidemic. “We are still being outpaced,” said André Heller-Perrache . ”There are far more actors on the ground but we are still being outpaced by it, with Sierra Leone being the most concerning case we have.” Dr Javid Abdelmoneim, a UK-based doctor in emergency medicine who has recently returned from Sierra Leone where he was a volunteer with MSF, said there was “too little of everything being done in terms of intervention”. He described how doctors in MSF’s treatment centre in Kailahun would don protective suits to meet an ambulance that could have been travelling across the country for 10 hours expecting dead bodies, which are highly infectious. “Usually there is a patient who is dead,” he said. “There was [in one ambulance] one dead woman and two who were alive but terrified. They have watched this poor woman die a wretched death and they are thinking, ‘I’m now going to die as well.’” Prof John Edmunds, from the London School of Hygiene and Tropical Medicine, who in September called the outbreak a potential doomsday scenario, said he would not say that the nightmare had been averted. “Things have improved dramatically in Liberia now – cases were doubling every two weeks. Now there is a turnaround and they are declining. “The number of cases in Liberia has flattened out. The increase has stopped and come down, but we haven’t got rid of Ebola. In Guinea and Sierra Leone the rate of increase hasn’t really changed much at all.”

Ebola in Sierra Leone: Health workers go on strike

Via BBC News: Ebola crisis: Sierra Leone health workers go on strike. Excerpt:

More than 400 health workers involved in treating Ebola patients have gone on strike at a clinic in Sierra Leone.

The staff, who include nurses, porters and cleaners, are protesting about the government’s failure to pay an agreed weekly $100 (£63) “hazard payment”.

The clinic, in Bandajuma near Bo, is the only Ebola treatment centre in southern Sierra Leone.

In Mali, a nurse and the patient he was treating earlier became the second and third people to die from Ebola there.

Nearly 5,000 people have been killed in the outbreak of Ebola in West Africa, mostly in Guinea, Liberia and Sierra Leone.

The World Health Organization (WHO) has declared the outbreak a global health emergency.

The Bandajuma clinic is run by medical charity MSF, which said it would be forced to close the facility if the strike continued.

MSF’s emergency co-ordinator in Sierra Leone, Ewald Stars, told the BBC that about 60 patients had been left unattended because of the strike at the clinic in Bandajuma.

Meanwhile, Reuters reports that in the US, National Nurses United are organizing strikes and rallies over inadequate protection for healthcare workers.

Ebola: Why West Africa?

Thanks to Greg Folkers for sending the link to this conditionally accepted paper in PLOS Neglected Tropical DiseasesWhat factors might have led to the emergence of Ebola in West Africa? The abstract:

An Ebola outbreak of unprecedented scope emerged in West Africa in December 2013 and presently continues unabated in the countries of Guinea, Sierra Leone, and Liberia. Ebola is not new to Africa and outbreaks have been confirmed as far back as 1976. The current West African Ebola outbreak is the largest ever recorded and differs dramatically from prior outbreaks in its duration, number of people affected, and geographic extent.

The emergence of this deadly disease in West Africa invites many questions, foremost among these: Why now and why in West Africa?

Here, we review the sociological, ecological, and environmental drivers that might have influenced the emergence of Ebola in this region of Africa and its spread throughout the region. Containment of the West African Ebola outbreak is the most pressing, immediate need.

A comprehensive assessment of the drivers of Ebola emergence and sustained human-to-human transmission is also needed in order to prepare other countries for importation or emergence of this disease.

Such assessment includes identification of country-level protocols and interagency policies for outbreak detection and rapid response, increased understanding of cultural and traditional risk factors within and between nations, delivery of culturally embedded public health education, and regional coordination and collaboration, particularly with governments and health ministries throughout Africa.

Public health education is also urgently needed in countries outside of Africa in order to ensure that risk is properly understood and public concerns do not escalate unnecessarily.

To prevent future outbreaks, coordinated, multiscale, early warning systems should be developed that make full use of these integrated assessments, partner with local communities in high-risk areas, and provide clearly defined response recommendations specific to the needs of each community.

Focus on girls in Sierra Leone amid Ebola

Chernor Bah, a global youth advocate and education activist from Sierra Leone, recently returned from a visit to his home country. He discussed his findings with Judith Bruce.

Judith Bruce is a policy analyst at the Population Council, whose work helps build the health, social and cognitive assets of girls in the poorest communities in the developing world. Bah was one of the founders of the Sierra Leone Adolescent Girls Network, designed to reach vulnerable girls throughout the country.

Bruce: You have recently returned from Sierra Leone. In the course of your visit you focused on the impact on girls, and you also met with political leaders and those who control important policy decisions related to the national response to Ebola. How did you explain to them that we should also be focusing on girls at this time?

Bah: Here’s why we should be focusing on girls at this time: Dorcas is 17 years old. Her mom contracted Ebola when treating a patient in the clinic where she was a nurse. Dorcas took care of her mom when she was sick at home. Her dad, her elder sister and her mom were all infected and admitted. At the hospital, after her mom and elder sister died, Dorcas was helping to take care of her dad – even in the ward where they were both sick. Her father eventually died. Dorcas survived. She is left with her two younger siblings, who have become her primary responsibility. She is now the breadwinner and without support might be forced to engage in risky behaviors to fend for herself and her family. She is also unsure of returning to school, as there is no one to take care of her or pay her [tuition] fees.

Unfortunately, her story is not unique. Many of the 30-plus girl survivors of Ebola told me varying versions of a similar story. Girls in Sierra Leone are typically the primary caregivers in the home and in the community, especially for sick relatives.

Despite being primary caregivers, girls typically have less education and even lesser access to scientifically based information. And, despite carrying provisioning responsibility, they have less access to public services.

When emergency distributions are done in communities … girls, who bear the biggest burden, are the last to get anything.

If we don’t begin with the girls, we won’t get to them.

Bruce: We hear that there is a 70 percent mortality rate, but that also means 30 percent survive. How are female survivors being treated?

Bah: Girls who have survived Ebola are super girls. They are celebrated publicly for defeating the virus, but in their communities they have less social capital. They are stigmatized and have fewer friends; they might have lost parents, loved ones or benefactors, and have very little – if any – help from the government.

Fortunately, we mostly know who they are. If they have survived Ebola, it means they have been in a health clinic, where their data was recorded. Figuring out a way of first creating a support system for these girls will be crucial. Connecting them with each other in potential Ebola survivors’ clubs could be one way. It would provide social assets and capital, provide platforms to share their stories and support. They could also be powerful role models for girls, in a society where those are few and far between.

Bruce: Before Ebola, there was already a long-standing culture of sexual exploitation; that is, some girls depended on sexual exchange for basic necessities for themselves and their families. What is the situation now?

Bah: Every girl I spoke to expressed concerns about the increase in transactional sexual exploitation. In fact, girls in Port Loko, north of the country, which has been badly hit by the virus and is now under quarantine, told me that they have friends who are now pregnant and will never return to school. We have received reports of police officers – assigned to enforce the quarantine of households – sexually molesting young females. Bear in mind that typically during school holidays, when girls are at home, there is normally a spike in sexual abuse and exploitation and early marriage. Now you have communities that are shut down or economically depressed, men and young girls are home all day and no one knows when it’s all going to end. As one girl put it to me, it’s not a very safe time to be a girl.

Bruce: We’ve heard that many of the groups originally working on programs for girls have left the country or shut down their operations. Is that true?

Bah: Amid the shock of the epidemic, the government and the donors basically instructed that all programs that were not directly dealing with Ebola be shut down, and that funds all be redirected to fighting the epidemic. So these groups have, for the most part, been on the sidelines, watching helplessly as they see girls falling further behind. I worked with UNFPA (the United Nations Population Fund) to pull together a major meeting with the members of the network, and the first thing I should say was the sense of relief and excitement that they could come together to discuss how the virus was affecting girls and their programs. They were disappointed that their programs have generally been shut down, and many have been told they can’t proceed with their normal activities, including community outreach and other alternative social safety-net programs that they say are critical for the poorest girls they serve.

Some fear a spike in sexual violence and the exploitation of young girls, an increase in teenage pregnancy and forced marriages, an increase in fistula, an increase in maternal mortality and, of course, more girls will drop out of school permanently during this long, unprecedented break in education.

Bruce: How has the emergency affected policies and programs designed to reach girls and young women?

Bah: One of the critical challenges we often face in Sierra Leone is the invisibility of girls in national policies and programs. Youth programs, government policy and interventions – under normal circumstances – typically exclude girls. It gets worse in an emergency. As the president of the country told me in a private conversation, the government was shocked and overwhelmed by this epidemic, and has been playing catch-up ever since.

While in Sierra Leone I was able to review the Reproductive Health Strategy that was being proposed by the government and its partners to respond to the sharp decline in the availability of reproductive services during the outbreak. In some cases, there had been up to a 100 percent drop in the provision of basic contraceptive services for women and girls. The core concept of the strategy was to be the creation of 17 dedicated Reproductive Health Service Centers in each of the districts across the country, but it barely referenced the unique needs of girls or had mechanisms to foster their use of these services. Thankfully, working with the partners, especially UNFPA, we were able to review the proposal to include a stand-alone adolescent girls pillar. This will increase girls’ access to these services.

Stunned silence after scathing analysis of Ebola response

VIENNA—After Oyewale Tomori finished his talk on Ebola here at the International Meeting on Emerging Diseases and Surveillance, there was stunned silence. Tomori, the president of the Nigerian Academy of Science, used his plenary to deliver a scathing critique of how African countries have handled the threat of Ebola and how corruption is hampering efforts to improve health. Aid money often simply disappears, Tomori charged, “and we are left underdeveloped, totally and completely unprepared to tackle emerging pathogens.”

Trained as a veterinarian, Tomori was the World Health Organization’s (WHO’s) regional virologist for the African region in 1995 during the Ebola outbreak in Kikwit in the Democratic Republic of the Congo (DRC). ScienceInsider sat down with him at the meeting in Vienna; questions and answers have been edited for brevity and clarity.

Q: You said in your talk that Ebola was “swimming in an ocean of national apathy, denial, and unpreparedness.” What did you mean?

A: We were totally unprepared. After the first cases occurred in West Africa, it took almost 3 months for WHO to know. When the first patient came to Sierra Leone and died, his son brought him back to Guinea and as far as Sierra Leone was concerned, it was Guinea’s problem. People abandoned their duty, they denied the problem, and when it became a big problem they became incapable of handling it.

This is not the first time Ebola has appeared in Africa. There have been more than 20 outbreaks since 1976. Not one of them has been declared a global problem. Of course, circumstances are different this time. But if we had been prepared, if we had learned from the past, we wouldn’t be where we are today.

Q: You seem angry.

A: Yes, I am, because I know Africa has the capacity and the capability to solve most of her problems, but Africa will not enable her human resources to perform effectively and efficiently. African leaders have little or no respect for their experts and would rather act on advice from external sources. In the end, they become the experts on Africa’s problems, not the Africans. This is why I am angry with Africa.

We have seen so many Ebola cases before, in the DRC, in Sudan, in Gabon. … Ebola is Africa’s problem. We should have put something in place. I remember in 1995, when we had the Kikwit epidemic, at the end we sat down at a table and discussed what we should do. There was a laboratory in Kinshasa built by the French; it was almost completed, but then abandoned. We had raised almost $2 million at the time. And we said: “Why not take a bit of that money and complete this lab and maintain it? Then at least when we have issues like this we can do quick testing.” But nothing happened. The carcass is still there. Each time I pass the place, I think: “What a waste.”

Q: But your own country seems to have been prepared. Nigeria managed to contain the virus after it was carried to Lagos by a traveler in July. There were only 19 infections, and WHO called the containment of the virus “a spectacular success story.

A: We were not prepared, we were lucky. Patrick Sawyer was already sick when he arrived, so he went straight to the hospital. And because our doctors were on strike, the public hospitals were not open, so he went to a private hospital. If Sawyer had gone into a public hospital, we would have had a bigger problem.

But within 2 to 3 days of Sawyer coming in, we knew it was Ebola from laboratory tests done in two of our university laboratories, and then action was taken. I praise Nigeria for that. We had this emergency center from the polio network and we brought people in and traced almost 1000 contacts. This was not passive tracing; people went to contacts’ homes on a daily basis.

Q: So why are African countries so badly prepared? Is it a question of money?

A: People say African countries are poor. But it’s not poverty. It’s misuse of what we have. As we are talking, with all the crises that are going on, the presidents of our countries are still traveling in the best of conditions. Some will come to New York in their private jets, although their national airlines collapsed years ago; in addition, they will bring along a long retinue of private, personal, and public assistants, all lodged in the best hotels. I am not saying the president should not be treated well, but these are issues we need to look at.

Take my country: We do not have a national airline, but the number of private jets we have is more than all the airlines in Africa have together.

It’s a matter of priorities. I do not believe there is an African country that cannot buy gloves for its staff. Personal protective equipment may be very costly, they may need assistance on that. But let us participate. As long as we are wringing hands waiting for the next glove to come, we will never be ready. There are certain things we can do now, with the resources we have.

Q: So African leaders should be held more accountable for what they spend money on?

A: GAVI [a public-private partnership that funds vaccines for low-income countries] just sanctioned Nigeria after a critical audit report. GAVI gave us money to do certain things, and we could not account for $2 million or $3 million of it. GAVI insisted that Nigeria must pay back that money, and the government agreed. But our government should not just agree to pay back the money, the government should find out who misused the money, get the money back from those persons and not from public coffers. And those people should be brought before the courts to answer for the deaths of the children who did not receive the vaccines that the GAVI money would have provided.

Q: So how should African countries contribute to fighting the Ebola outbreak?

A: To give you one example, there are 600 Nigerian health care workers who want to go to Liberia. But the process of getting them there has been going on for months. If the African team, the African Union, the Economic Community of West African States, and the West African Health Organisation all get their acts together, there are more than enough people in Africa—health care workers from Gabon, DRC, Uganda, Sudan—who have experience with this.

But we must find the funds to provide insurance for all national and international health workers who are currently working or have volunteered to work in the Ebola-affected areas of Africa. Bear in mind, in Africa we do not have a welfare system. I am the welfare system for my family, my brothers, my uncle. So when I go to an Ebola region, I am thinking of the 23 other people that depend on me. If there is no insurance, I will stay home.

Q: There has been a lot of criticism of the WHO regional office in Africa.

A: I am angry at them, too. They should take the lead of Ebola control efforts—not Geneva, not Washington, not New York. The [Centers for Disease Control and Prevention] can help, [Doctors Without Borders] can assist, but it is WHO’s African region that should coordinate and take the lead. It’s all meetings and reports. Nothing on the ground.

Q: As it happens, they are meeting in Benin this week; on the agenda is the election of a new regional director.

A: These elections are just horse-trading. If the person who wants to get elected requires the vote from Nigeria for example, because it is the ministers of health who do the voting, I might say: “OK, I will vote for you, but I need one directorship from my country.” If he accepts that, he has to accept whoever I bring, regardless of how competent the person is. That is what has messed up Africa. WHO’s regional office has never been able to solve Africa’s problems because of this system of electing its leaders.

You want to find the most competent person. Vote on that basis. Not because I visited you and I promised you this or that.

Q: Do you think this unprecedented outbreak will change things?

A: I wish I could say with confidence that in 10 years’ time we will not be where we are now with Ebola. But the countries have totally lost control of what is going on. If you go to Sierra Leone or Liberia today, there must be at least 10 international groups there. At the end of this epidemic, everybody will pack their bags and leave. The African countries will be left not really knowing what has happened to them. Like someone hit them smack in the face, totally disoriented. There will be millions of scandals about how money was misspent and so on. We will focus on those and move on. Ten years from now, people will have forgotten that there was Ebola and we will be back to where we started.

source: The Ebola Files: Given the current Ebola outbreak, unprecedented in terms of number of people killed and rapid geographic spread, Science and Science Translational Medicine have made a collection of research and news articles on the viral disease freely available to researchers and the general public.

Science Magazine: How many Ebola cases are there really?

Every couple of days, the World Health Organization (WHO) issues a “situation update” on the Ebola epidemic, with new numbers of cases and deaths for each of the affected countries. These numbers―9216 and 4555 respectively, according to Friday’s update―are instantly reported and tweeted around the world. They’re also quickly translated into ever-more frightening graphics by people who follow the epidemic closely, such as virologist Ian Mackay of the University of Queenslandin Brisbane, Australia, and Maia Majumder, a Ph.D. student at the Massachusetts Institute of Technology in Cambridge who visualizes the data on her website and publishes projections on HealthMap, an online information system for outbreaks.

But it’s widely known that the real situation is much worse than the numbers show because many cases don’t make it into the official statistics. Underreporting occurs in every disease outbreak anywhere, but keeping track of Ebola in Guinea, Liberia, and Sierra Leone has been particularly difficult. And the epidemic unfolds, underreporting appears to be getting worse. (“It’s a mess,” Mackay says.)

So what do the WHO numbers really mean—and how can researchers estimate the actual number of victims? Here are answers to some key questions.

Does WHO acknowledge that the numbers are too low?

Absolutely. In August, it said that the reported numbers “vastly underestimate” the epidemic’s magnitude. WHO’s situation updates frequently point out gaps in the data. The 8 October update, for instance, noted that there had been a fall in cases in Liberia the previous 3 weeks, but this was “unlikely to be genuine,” the report said. “Rather, it reflects a deterioration in the ability of overwhelmed responders to record accurate epidemiological data. It is clear from field reports and first responders that [Ebola] cases are being under-reported from several key locations, and laboratory data that have not yet been integrated into official estimates indicate an increase in the number of new cases in Liberia.”

Where do the reported numbers come from, and why are they always too low?

Officially, the governments of Guinea, Sierra Leone, and Liberia transmit the numbers to WHO, which then passes them on to the world. But WHO is also closely involved in helping determine the numbers. The data come from several sources, says WHO epidemiologist Christopher Dye; the three main ones are clinics and treatment centers, laboratories doing Ebola tests, and burial teams.

Getting the numbers right is hard for many reasons. Many patients don’t seek medical care, for instance, because they don’t trust the medical system or because they live too far away. Of those who do, some die along the way, and some are turned away because treatment centers are overloaded. Of Ebola people who die at home, some are buried without ever coming to officials’ attention. It can also take time for recorded information to be passed on and entered into data reporting systems.

Testing is a big problem as well. The reports break down the numbers into suspected cases, based mostly on symptoms; probable cases, in which someone had symptoms and a link to a known Ebola case; and confirmed cases, in which a patient sample tested positive in the lab. In an ideal world, all suspected and probable cases would eventually be tested, but testing capacity is lacking. In WHO’s 15 October report, only 56% of the cases in the three countries was confirmed; in Liberia, where testing is huge problem, it was just 22%. (Friday’s report did not break down Liberia’s cases and said the data were “temporarily unavailable.”)

Dye says WHO and other groups are trying hard to improve the reporting on the ground. Among other things, they are trying to set up a system that would provide every patient with a unique identification number. Now, Dye says, patients who enter an Ebola clinic and then have a sample tested in the lab may enter the reports twice, because there is no way to know that the lab and the clinic were recording the same patient.

Are there ways to estimate the extent of the underreporting?

There are. For instance, In a technique called capture-recapture, epidemiologists visit one area or district and determine what percentage of the Ebola cases and deaths there has found its way into official records. “You throw out the net twice, and you compare,” says Martin Meltzer of the Centers for Disease Control and Prevention (CDC) in Atlanta, who is modeling the Ebola epidemic. (The term capture-recapture was borrowed from researchers who study the size of wildlife populations using two rounds of trapping.) But this method is logistically challenging and possibly dangerous, given the hostilities that some Ebola response teams have met, Meltzer says: “I’m not going to ask people to risk their lives to collect some data.”

For a paper published last month, Meltzer and his colleagues used a different technique. CDC has a computer model that, among other things, calculates how many hospital beds should be in use at any given time based on the cumulative number of cases at that moment. For 28 August, the time the paper was written, that number was 143 beds for Liberia; but people in the field told Meltzer that the actual number of beds in use was 320, a factor of 2.24 higher. (These numbers can be found in an annex to the paper.) “We had heard some other numbers that were higher, so we rounded that up to a correction factor of 2.5,” Meltzer says. But it’s a very rough approximation. Also, underreporting is likely to vary greatly from one place to another and over time, he says.

The CDC team’s widely reported worst case projection of 1.4 million cases by 20 Januarywas based on the correction factor of 2.5, and assuming control efforts didn’t improve. It included only Liberia and Sierra Leone; in Guinea, the reported numbers of cases have fluctuated too much to make a reasonable projection, Meltzer says, which could also could be partly due to underreporting.

What does WHO think is a reasonable correction factor?

WHO hasn’t published an estimate. “It’s a point that has been greatly discussed but there is a tremendous amount of uncertainty,” Dye says. For its internal planning purposes, however, WHO uses a correction factor of 2.0. When WHO’s Bruce Aylward said at a press conference last week that the agency is expecting to see between 5000 and 10,000 cases per week by early December, “the difference between the 5000 and the 10,000 is that factor of two,” Dye says. A correction factor of 2.0 would mean that the total number of cases has now crossed 18,000 and the number of deaths 9000.

If the numbers are that far off, should they be published at all?

Even if many cases are missed, the trends in the numbers are still very meaningful. They clearly show that the number of cases has roughly doubled every 3 to 4 weeks and that this trend is continuing. If underreporting  gets worse, however, it may be even more difficult to discern such trends.

Is there any good news in the recent numbers?

There is. The number of new cases in some areas at the epicenter of the outbreak—Kenema and Kailahun districts in Sierra Leone and Liberia’s Lofa County—has been dropping, and that’s not a result of underreporting, Dye says. “It has happened for a sufficiently large number of weeks now that we are confident that it’s a real reduction in incidence on the ground, probably related to control measures,” he says. “Our colleagues working on the ground believe it is, too.”

One important factor has been the increase in safe burials, Dye says. (The bodies of Ebola victims are very infectious.) People in the affected areas have resisted abandoning traditional burial practices that carry a high risk of infection, but in these three areas, local leaders, supported by WHO and others, have come to advocate a change. If that happens elsewhere, Dye says, “we expect to be able to cut out a substantial amount of infection in the community.”

*The Ebola Files: Given the current Ebola outbreak, unprecedented in terms of number of people killed and rapid geographic spread, Science and Science Translational Medicinehave made a collection of research and news articles on the viral disease freely available to researchers and the general public.

Leaked documents reveal behind-the-scenes Ebola vaccine issues

My commentary (synopsis):

Time and Money: GSK could have 24,000 doses ready by January 2015, but they don’t want to invest too much money ramping up production of a drug that isn’t 100% sure to work, be re-sellable, and provide their return on investment. Also – none of the global agencies have offered financing to cover R&D costs and early production if the vaccine fails.

Scaling Up Safely: GSK could make hundreds of thousands of doses if the health safety guidelines were relaxed, and they could use their mega-virus growing vats under bio-safety level 2 conditions instead of bio-safety level 4. That would increase the risk that their facility could be a source of ebola, as workers could get contaminated. So when the public asks why drug companies can’t make millions of doses right away, this is the reality.

From other sources: Current ebola-antibodies coctail from a competitor ZMapp faces similar production limits. There are only about a dozen doses available at the moment, which is why they haven’t sent any to West Africa.

From SCIENCE INSIDER

 By 23 October 2014 2:30 pm

The Ebola virus

Extensive background documents from a meeting that took place today at the World Health Organization (WHO) have provided new details about exactly what it will take to test, produce, and bankroll Ebola vaccines, which could be a potential game changer in the epidemic.

ScienceInsider obtained materials that vaccinemakers, governments, and WHO provided to the 100 or so participants at a meeting on “access and financing” of Ebola vaccines. The documents put hard numbers on what until now have been somewhat fuzzy academic discussions. And they make clear to the attendees—who include representatives from governments, industry, philanthropies, and nongovernmental organizations—that although testing and production are moving forward at record speed, knotty issues remain.

At the meeting, GlaxoSmithKline (GSK) of Rixensart, Belgium, which has the vaccine furthest in development, spelled out how it might scale up production in parallel with the safety and efficacy trials now under way so that the product could be ready for wider distribution by April if warranted. The company expects to have preliminary data in November from phase I studies that analyze safety and immune response in small numbers of people not at risk of contracting Ebola. If those data are positive, efficacy trials could start as early as January in Guinea, Sierra Leone, and Liberia, the three West African countries hard hit by the epidemic.

Earlier discussions suggested that efficacy trials should recruit health care workers and first-line responders like those who do burials or track contacts of known infected people. WHO estimates that there are about 12,000 health care workers in the three affected countries and another 17,500 “community” responders.

GSK is considering two efficacy trials. The largest would take place in Liberia and involve 12,000 people. This study, which could begin in mid-January, would randomize half of the participants to receive the vaccine and the other half a placebo. The study could also have a third arm, GSK said: A vaccine made by NewLink Genetics of Ames, Iowa, that has just entered phase I studies in the United States. The U.S. National Institutes of Health indicated that it was interested in leading this study.

A second trial would start simultaneously in Sierra Leone, Ripley Ballou, who is heading the GSK Ebola vaccine project, told ScienceInsider. “One of the trials may fail for logistics reasons,” he explained. “We only have one shot to get this right.” The trial in Sierra Leone would not use a placebo but instead would offer groups of health care workers the vaccine at different points in time. This “stepped-wedge” trial could involve up to 8000 people, and the U.S. Centers for Disease Control and Prevention has had preliminary discussions with affected countries about staging these studies. Although Guinea is also hard hit, it has the least infrastructure in place to do a trial, Ballou says. “It would be the most challenging place to do a phase III study.”

GSK estimates (see table below, and here) that it will have 24,000 doses of its vaccine ready by January for the efficacy trials. If it cranks up production to full capacity before the those trials are complete, the company could have 230,000 doses available in April, and then could steadily increase capacity to produce more than 1 million doses a month by December 2015.

GSK has made modest investments in scaling up production of its vaccine, and this table projects what it might be able to produce over the next year if it went all out and added several new production lines. The “at risk” noted by the asterisks refers to the company doing quality control without needing to wait for regulatory agencies to repeat the tests.

In one of the background documents, GSK noted that a “critical issue” is what’s known as fill capacity. GSK said there is a shortage of facilities that can fill vaccine vials under sterile conditions in a facility that meets what are known as biosafety level 2 conditions. It suggested the regulatory agencies relax their biosafety requirements. If GSK alone must do the filling, this will affect the company’s ability to produce other vaccines already on the market, including ones that protect against rotavirus, measles, mumps, and rubella, the document said.

The GSK document also outlines a number of proposals to make the first batches of vaccine quickly available, like running some of the quality control tests in parallel and changing the test used to prove sterility of the vaccine from one that takes 14 days to an assay that takes half the time.

Additional studies of the NewLink vaccine will start soon in Geneva, Switzerland, and Hamburg, Germany. A first lot of the vaccine arrived in Geneva on Wednesday, Marie-Paule Kieny, an assistant director-general at WHO, told ScienceInsider. The Canadian government has donated 800 vials of the vaccine to WHO, but is sending them in three separate shipments, Kieny explained. “It just felt too risky to put all eggs in one basket,” said Kieny, who has volunteered as a subject for testing the vaccine herself.

Janssen, a division of Johnson & Johnson, described its plans to speed development of yet another Ebola vaccine strategy that has yet to enter human studies. A delegation from Russia planned to discuss Ebola vaccines being made there, too.

A highly detailed, 28-page document by the Norwegian Institute of Public Health offered “crude cost estimates” for scaling up mass production of Ebola vaccines. By these calculations, 27 million doses of vaccine would cost up to $73 million, and the cost of the vaccination campaigns themselves will add another $78 million to the bill.

Several analyses laid out the complex regulatory and liability issues. The U.K. government argued that “there is a need to provide some form of relief of liability for the producers and distributors of the vaccines” and that WHO should coordinate discussions with regulators. The U.K. government also noted that “affected African countries will have the primary role of authorising or allowing use of investigational vaccines” and said “buy in” from those communities about the clinical trials must be obtained as soon as possible.

As far as financing, the U.K. government contends that a “multi-donor club” should pay for the vaccine development in “the medium term.” But for now, the United Kingdom says it will “unilaterally” cover the costs for purchasing vaccines in Sierra Leone, and it asks the governments of the United States and France to make the same commitment for Liberia and Guinea, respectively.

In a planning document, WHO pointed out multiple logistical issues, including “the ability to safely and securely transport the intervention to the delivery site, the existence of safe and secure storage facilities with appropriate cold chain capacity, the availability of sterile equipment to administer injections.” But to Ballou the greatest question hanging over the vaccine trials is the stability of the countries. “The thing that is going to have the biggest impact is what is happening to the trajectory of the epidemic curve,” he says. “If you progress the current trends 2 months into the future are we still in an environment where you can even consider doing a trial?”

*The Ebola Files: Given the current Ebola outbreak, unprecedented in terms of number of people killed and rapid geographic spread, Science and Science Translational Medicinehave made a collection of research and news articles on the viral disease freely available to researchers and the general public.

Delaware Liberians rally to send food, supplies overseas

by Jen Rini, The News Journal 9:16 p.m. EDT October 23, 2014

Source: Local Liberians rally to send food, supplies overseas

Sei Boayue’s uncle was just trying to do the right thing.

His uncle had seen how Ebola had seeped into his beloved Ganta, a town nestled on the border of Liberia and Guinea.

The market there was teeming with people forced to purchase food every day because of a lack of refrigeration. But in the market, there is no way to tell who is infected.

So his uncle made the decision to travel there every day alone, and keep his wife, son, daughter-in-law and grandchild at home away from the risk.

It didn’t work.

“They all passed from the virus. No one survived it. The unfortunate thing is this is now becoming a commonplace thing,” Boayue, 57, of Townsend, said. “After my uncle died, you sit here and everything seems to be so daunting. You wonder: is there anything I can do?”

Boayue didn’t sit for long. Just weeks after the deaths of his relatives, Boayue and other Liberians living in Delaware are fueling an effort to send as much food and supplies as they can to their remaining family and friends trying to survive in Liberia.

To date, 4,555 people in West Africa have died from the virus, 2,705 in Liberia. And those numbers continue to grow.

Boayue is working with the Delaware Community Foundation to start a charity dedicated to sending nonperishable foods abroad, a luxury for those living in the heart of the Ebola crisis.

He still has nine siblings who are living in the affected areas. He hasn’t heard from one sister in over a month. There’s no communication to say where she is, or even if she is alive, he said.

In Liberia, the tragedy is there is no such thing as “local” food. Traditionally, most of the food ending up on Liberians’ plates has been imported, he said. After a string of civil wars over 14 years, and now the Ebola disaster, food prices have doubled and tripled.

Even if he raises enough money to buy food, copious amounts of red tape stands between his group and getting those goods on the ground to the people that need it most.

“How many kids will die within that time period,” he said.

“The situation in Liberia is such that cultural attitudes also had a big part to play in the out-of-control nature of this crisis. What would help most people is food security.”

Jarso Jallah Saygbe, a Liberian living and working in Dover, agreed that sanitizer and Clorox are not enough.

“The approach needs to be holistic,” Jarso said. Her family living in Liberia takes each day at a time. Jarso talks to her sister almost every day and tries to send as much money and supplies as she can.

“You never know when the phone rings what’s going to happen,” she said.

Jarso’s brother-in-law, Moses Ndama, pastor of the Freedom Christian Fellowship in Dover, held an informal meeting Wednesday evening to jump start planning for an organized donation effort for children in need abroad.

Food, clothes, rain boots and school supplies are all needed, said her husband, Moses Saygbe, who is Ndama’s brother. The church is hosting a meeting Saturday at 10 a.m. to gather Delawareans from all walks of life, from West Africa to Seaford, to mobilize against the Ebola crisis.

As the planning takes off to send aid abroad, Moses said it is important for the local Liberian community to work with the state to preemptively prepare for an Ebola case in Delaware.

He’d like to see the state institute special residential centers in Delaware used to screen and house West Africans traveling into the state from the affected areas. Efforts like this would erase the stigma that every Liberian is living with Ebola, he said.

“We need to end prejudice. We are not the virus,” Ndama added.

For now, the Freedom Christian Fellowship is working to send goods directly to a sister organization in the Brewerville community in Liberia.

Last weekend, the community received Clorox, hand sanitizers and soap, Ndama said. It still took a month for the goods to get there, but it’s better than nothing.

They hear stories every day that are heartbreaking, but the kids are the hardest hit, Ndama said. Schools have been closed since late July. Children, many orphaned, are forced to beg on the streets and scrounge for money.

The future of Liberia rests with nurturing these children, he said.

“If we don’t invest in the kids, we will lose the future generation,” Ndama said.

“We can defeat Ebola, but can we survive after?”

Jen Rini can be reached at 302-324-2386 or jrini@delawareonline.com. Follow @JenRini.

CHURCH OUTREACH

What: A statewide meeting hosted by the Freedom Christian Fellowship to discuss donations, plans for more community outreach.

Where: Freedom Christian Fellowship, Dover, 4164 North DuPont Hwy. (North Dover Shopping Center)

When: Saturday, 10 a.m.

Here’s what I’m doing to protect my family

Reposted from Violent Metaphors – Jennifer Raff —  October 23, 2014

We Americans sometimes seem to have only two settings when it comes to public health issues;  “unconcern” and “panic”. (I think the media deserves a great deal of blame for this, but that’s another blog post).  The last few weeks have seen the switch flipped to near panic about Ebola, after the recent infection of two Texas Health Presbyterian nurses who were treating infected patient Thomas Eric Duncan, and possible exposure of additional people after one of the nurses took a commercial flight.  The fact that forty three individuals who had direct contact with Mr. Duncan have now passed the 21 day incubation period for the disease without signs of infection, that Senegal has been declared free from Ebola (no new infections have occurred there for 42 days), that Nigeria is close to the same milestone, and that the two nurses who treated Mr. Duncan, Amber Vinson and Nina Pham, are doing much better, don’t seem to make much of a dent in the fearmongering I’ve seen in recent weeks.

And now with the report that a physician with Doctors Without Borders, who recently returned to his home in New York City from West Africa, has tested positive without Ebola, the “Ebola panic” is just going to get worse.

So given the fact that I live so close to the “Ebola hospital” (just two hours!) I thought I’d share with my readers what precautions I’m taking to protect my family’s health.

1. I’ve gotten a flu shot (and encouraging my friends and family to do the same), because influenzais a far bigger threat to our health than Ebola.

2. I am donating to Doctors Without Borders, because the crisis is in West Africa and it’s critical that we stop it there. Those brave physicians and nurses are on the front lines of the battle against Ebola, and they need our support. Strangely, while stopping the outbreaks in West Africa is absolutely crucial, there’s almost no public charitable response to this crisis, in contrast to the many campaigns we see after natural disasters. I just came across #tackleEbola on Twitter, and that seems to be another good effort. I hope it takes off.

3. I am calling out misinformation that’s being spread to provoke a panic response. One of the reasons why we’re so excited by this particular infectious disease despite the fact that it is FAR FROM the most dangerous threat to our health, is because the media has stoked fears of it, with sensationalistic coverage, and we citizens have allowed ourselves to be entertained (yes, entertained!) by epidemics. Remember “The Hot Zone”? “Outbreak”? Any zombie movie, ever? Turns out they’re scientifically inaccurate, but these trifling details don’t deter people like Alex Jones from crazed melding of fiction and real life:

Alex Jones is, of course, an extreme example. But truthfully, how are we influenced by our entertainment? We love a good “outbreak” story–they’re deliciously scary. But this is the real world, and there are consequences when we allow our fantasies to inform our decision making. Epidemics are not entertainment, and treating them as such, ironically, allows them to get much worse.

Furthermore, the panic that we are indulging in has hurt many people unnecessarily. Schools in Texas and Ohio have closed. A cruise ship was sent back home to the United States from Belizebecause it was carrying a Texas hospital lab worker (the worker was following CDC protocol and 19 days had passed since any possible exposure: she posed no credible danger to her shipmates). Despite health experts’ recommendations politicians and the majority of the public favor a travel ban from West Africa. A Texas college has a policy of rejecting applicants from Nigeria, despite the fact that there have been no new cases in that country since September 8th.

And idiotic conspiracy theories are rampant, as well as quack remedies, and bizzare warnings of ‘psy ops’ about competitors’ quack treatments. (This could make an entire post by itself.)

But the simple truth is that Ebola actually isn’t particularly easy to catch. From the CDC:

From http://www.cdc.gov/vhf/ebola/pdf/infographic.pdf

You can read additional reputable information about Ebola here, and from Doctors Without Borders.  Despite irresponsible rumors to the contrary, Ebola isn’t airborne, nor is it likely to become airborne in the future through mutation.

So how should a reasonable person think about this?

It is absolutely appropriate to criticize the CDC and Texas Health Presbyterian for their initial mishandling of the first infections. But there is a difference between criticism and fearmongering. I have spoken with a Texas physician who was extremely critical of Texas Health Presbyterian, but told me that physicians’ and nurses’ training has drastically changed in recent weeks to include live simulations, supervisors, and other critical measures. He feels a lot more confident that their hospitals will be able to competently handle any cases, and was convinced that this wouldn’t have happened had they not learned from their earlier experiences. (I hope that this is true nation-wide).

I think we should be mindful of how our popular media has influenced us, and alert to the possibility of the press stoking our fears for attention. I think we need to think carefully about who constitutes a credible source of information here–who are the experts?–and listen to what they’re saying, rather than conspiracy theorists seeking to profit from our fears.

By cutting through the hype and panic, by thinking critically about Ebola in the context of relative risks, we can make much more rational decisions to protect ourselves and our families.

Daily ebola reporting from Freetown via OnOurRadar

Reposted from ebola.OnOurRadar.org

Riots in Kono after Ebola team intervention

– Mariama Jalloh, Kabala

“There was riot in Kono yesterday…I heard the information in the night so I called my friend living in Kono to find out more. According to her, an old woman was sick and the Ebola team came to carry her away. Her relatives refused, so there was a quarrel which locals got involved with. The police started firing and two civilians allegedly lost their lives.”

“They said they are going to stay in the forest as they will be better able to protect themselves from this trouble”

– Mariama Jalloh

Coping is not easy – in fact, I want to share this story with you:

I met two women in the market buying some basic things. They said they are going to stay in the forest with their family, as they will be better able to protect themselves from this trouble.

They said the illness is worse than the war, because we cannot see it.

“We are determined to fight to win back our status as an Ebola-free district”

“We are so worried…we are in trouble now… Everybody is praying for survival.”

Sierra Leone’s Koinadugu district was the only district in the country to have successfully kept the Ebola virus at bay, until Wednesday when two cases were confirmed. This has caused panic in the community.

John F Sillah reports on the community’s response and their determination to regain its status as an Ebola free district.

Read the full story on Channel 4 News: 

Screen Shot 2014-10-17 at 10.16.13

 

“People are beginning to think Ebola is a man made disease”

-Mohamed Camara

People are beginning to think Ebola is a man made disease as only man made diseases have an end date and natural diseases do not.

The local radio show Monologue, mostly listened to by Sierra Leoneans revealed that, according to the government, Ebola will be eradicated by November. The show also said that some patients who have been admitted are not Ebola positive.

“The 117 team says people are responsible of complaints about corpses left on the streets”

On Tuesday in Freetown clashes broke out between security forces and people protesting against delays in removing a corpse of an Ebola victim.

– Mohamed Kamara

The 117 team said the people are responsible because when they are called and arrive to collect a corpse, people stop them and they must provide the results [if it is an Ebola case or not] before going away with the body, so this is why there are complaints about corpses left in the streets.

“In this part of the country most students don’t own radios”

-Moses Kortu 

In this part of the country, students are not able to listen to the radio; most of them don’t own radios. This is farming time, parents are looking for food- how will they tell their children to listen when there is no food at home. Generally, children in this community are not benefiting from it.

“The country’s level of education is very poor and not all parents are educated to guide their children”

Sierra Leone government officials launch a project that offers lessons via the radio for children as schools are closed indefinitely.

-Mohamed Camara 

The education program on the radio is not really necessary for primary school because when we take a look at the country’s level of education, it is very poor and not all parents are educated to guide their children. Not all parents listen to the radio nor have someone to stay by their kids, and because of all this my mother said she will prefer my young brother to wait until school reopens and will not waste time on the radio.

 

“The ban of bike riders (“okada”) has been lifted on the 11th of October in the city of Makeni.”

– Sixty Kamara

The ban of bike riders (“okada”) has been lifted on the 11th of October in the city of Makeni by the Resident Minister-North Alie D. Kamara. As reported previously, on the 29th of September there were false rumours about the end of Ebola spread by bike riders. This led to the ban. Now the Minister raised four points regulating bikes circulation: bikes must be licenced and insured; there will be no underage riders allowed; bikes must be registered; and riders should obtain licences. Above all, only bike riders are allowed to travel between 7 am and 7 pm.

“Workers have threatened to down their tools today following the non-payment of their allowances”

– Abu Bakarr Kargbo

Workers at the Ebola case management centre at the government hospital in Kenema have threatened to down their tools today following the non-payment of their allowances for over four weeks now. It has been confirmed that the Ebola case management centre at the government hospital in Kenema is presently housing 7 confirmed Ebola patients and  10 awaiting laboratory results.

313 children in Sierra Leone have lost their parents to Ebola

(image: Tamba Tengbeh)

-Tamba Tengbeh 

The Sierra Leone Association of Non-Governmental Organisations (SLANGO) meet to discuss the role of the Ministry of Social Welfare towards orphans who lost their parents due to the Ebola epidemic.

There are 313 orphans in Sierra Leone so far, according to the Gender Advocacy Officer, the Ebola focal person, and the Ministry of Social Welfare.

 

“The way cars and vans were overloaded is my concern…touching, sweating might be [fateful]“

-Sixty Camara 

Muslims prayed their congregational prayers in different places including the town field (Wusum) during Eid, where they took water and soap and even preached on the preventive methods of the epidemic. But the way cars and vans were overloaded is my concern, as the touching, sweating might be [fateful] if ebola affected are amongst.

The stories still hard to find: The local responses to Ebola

Reposted from How-Matters.com

This morning when I googled “local response” + “ebola”, here’s some of the headlines I found:

Nurse’s visit spurs Ohio Ebola fears 

Florida: County and hospitals prepare for Ebola

As KU Hospital tests patient with Ebola-like symptoms, Lawrence agencies coordinate response

Denton City Council to be briefed on virus response

Ohio residents fear Ebola precautions could prompt panic (What’s up Ohio?)

Patrick Poopel holds his certificate that informs the world he is Ebola free in Monrovia in September. Photo: Morgana Wingard / MSF

Not exactly what I was looking for. With all this drummed-up fear and stereotypes and prejudice flying around, I guess it’s easy for Americans to miss that Nigeria has been declared ebola-free, as was Senegal on Friday. And it’s easy to miss stories of people fighting the disease, like survivor Alhassan Kemokai in Sierra Leone who caught it while caring for his ailing mother, independentambulance workers in Monrovia, or 6-year-old Patrick Poopel (pictured) whose smile who the only thing left that is infectious. Nursing student Fatu Kekula saved her father, mother and sister by inventing her own protective gear from trash bags. Apparently international aid workers heard are now teaching her ”trash bag method” and to others who can’t get into hospitals.

This is more of what I was looking for, but these stories are unfortunately often hard to find. So I thought I’d share a few others on the local response to Ebola that I’ve been collecting since the outbreak hit the international media – please share any others in the comments:

  1. The Hidden Heroes Of Liberia’s Ebola Crisis, by Jina Moore
  2. Ebola must be fought from the grassroots, by David Norman and Saran Kaba Jones
  3. The Rain after the Drought: Ebola, International Assistance and Community Initiatives in Liberia, by Charles Lawrence
  4. The West ignores the stories of Africans in the middle of the Ebola outbreak, by Ishmael Beah
  5. Liberian Ebola Survivors Return to Help the Sick, by Heidi Vogt
  6. Ebola: the story of the Sierra Leone diaspora response that no one is telling, by Katherine Purvis

Is Ebola in West Africa a “crisis of governance” or “the ugly face of a global aid system that is broken“? These questions are an abstraction to those who are facing sickness and suffering this very day.

Malonga Miatudila, MD, who was part of the first team that dealt with Ebola first in 1976, describes how they contained the disease without the knowledge we have today: “Engage with communities. Give them the leadership of the fight…International experts are there to support local communities, and not to substitute.”

If you want to give to local efforts, see GlobalGiving and the Ebola Survival Fund. Unfortunately this Indiegogo campaign by 5 grassroots organizations in Sierra Leone didn’t meet their goal, but you can still be in contact with them directly via email. Diaspora, share how you’re responding to ebola here.

When I was a boy and I would see scary things in the news, my mother would say to me, “Look for the helpers. You will always find people who are helping.” ~Fred Rogers

Look for the helpers. Reach out. Invest in those that are there for their communities, whether funding is available or not.