The best of yesterday’s @reddit_AMA: http://www.reddit.com/r/IAmA/comments/2i3cyg/we_work_for_local_and_international_aid_groups/?sort=top
I’d like to hear more about what life is like in your communities right now on a day to day basis. How easy/hard it is for families to get information on the status of a loved one or friend who is sick?
It’s hard. The Ebola Treatment Units are overwhelmed. Many families don’t have ways to communicate with each other besides face-to-face contact so often, a family member will be taken to a clinic and then the family doesn’t find out their fate unless they go with them, which can be very dangerous. People are dying of Ebola and their bodies are being burned. There are no ceremonies, and their names may or may not have been recorded before they died. It’s incredibly heartbreaking.
Life on the ground in Liberia continues almost as normal. People can at one point be in denial, full of fear, while rumors of miracle cures are rampant and the next moment with a group over a beer relaxing. It is very complicated. Communities have taken it upon themselves to monitor any household where there is a suspected Ebola victim. There are not enough treatment beds, or testing facilities therefore many remain at home until it is too late and thus infect the entire family.
Life is full of fear, uncertainty and feeling of powerlessness. Quote – “The people in the community are in a state of extreme fear as people very close to them are losing their lives to Ebola… The aftermath of this epidemic would be massive. Bread winners have been cut off from families. Children and dependent relatives are afraid of the future.” Quote from – http://developafrica.org/photo-album/ebola_personal_develop_africa_volunteer_nurse_passes_away. Information about the status of a loved one is often limited.
There’ are very few first-hand accounts of living during the outbreak on the web. I curate and repost any I find nightly at ebolastories.wordpress.com. The best and most complete journal to date is here:https://ebolastories.wordpress.com/2014/09/19/ebola-liberian-doctor-journal/ and I’ve started an Ebola Listening Brigade as a Facebook Group to help organize more reports getting out here:https://www.facebook.com/groups/578457595613431/
Do you support a quarantine on any of the three nations? If the situation continues to deteriorate, will you? Is there an alternate ‘grand plan’ at this point for fighting the outbreak?
I haven’t heard of a complete strategy. Some things that got results were the 3-day home arrest (close the economy) in Sierra Leone, and the idea of home-isolation to keep the disease from spreading faster. But none of these strategies have stopped the spread entirely.
I think the focus is less on tracing to a source and more on changing behavior to limit exposure to anyone else on a daily basis. But I’m not there in the meetings, so I can’t say any more.
We can’t give pills, but there is no pill to give, no cure for Ebola. What we can do is put a human face on a crisis and facilitate the flow of money and ideas, and allow the people there to speak for themselves.
Yesterday there were 100+ #ebola tagged blogs on wordpress. I did not encounter a single one written by a West African. Other days are better, but that is not how you treat an outbreak. Not only is there a power balance problem, but health experts NEED LOCAL knowledge in order to change local behavior and stop the spread. The idea of a “Quarantine” is going to evolve for this context, or it won’t work.
You bring up a good point about infrastructure, which hasn’t been able to keep up with the number of new cases that are emerging. What we do know is that there are ongoing efforts to build new treatment centers in Liberia, and in the meantime USAID has said they are using a three tiered response: treatment centers for confirmed cases, holding centers for those who might be infected, and home care for those unable to access other levels of care (for which kits are supposed to be distributed)
How lethal is ebola compared to SARS, H1N1, etc? Is the media doing a fair job?
Lethality: 82% (though at any given time you might hear reports of “5000 infected and 2500 died” because of the 2-week-lag-time between infection and death.
Transmission: R0 of 2. Meaning each patient infects TWO others. It needs to be less than 1 for the outbreak to be “contained.” This is why when the media scares the public by saying 100 in Texas are being monitored, it doesn’t mean 100 or even 50 people are likely to get infected. The likeliest number is 2.
Compared to other outbreaks? I don’t know. It happened to be more fatal and hit a place with much weaker infrastructure than SARS and H1N1 did, so the effects were drammatic. Also – highly corrupt countries are at greatest risk (Liberia and Sierra Leone are more corrupt than neighboring countries like Guinea and Ghana). People with power and privilege don’t obey laws, including quarantines, and therefore spread the disease as they try to flee and save themselves at the expense of others. This has been the heart of why the disease was spreading in West Africa the way it did.
Media coverage: USA media has really jumped on the Texas case in last 24 hours in a sinister way. Watch last night’s daily show as they show a clip of CDC saying “nothing to worry about” over the news media’s omenous music. It’s obvious that their agenda differs from the public health perspective.
I think the fact is that the locals are being lied to in terms of individual risk so as to protect public health. For an individual who is feeling ill, it might be that they have something minor, and by seeking medical attention they increase their odds of actually being exposed to Ebola. They may be put into quarantine for a month with a bunch of other sick people and while the staff can protect themselves, the patients are not isolated from each other.
On a public health level, identifying potential cases and taking them out of the community is overwhelmingly what needs to happen.
Very few people want to sacrifice themselves for the greater good.
Were you all established outreach programs before the outbreak and changed your focus because of it? And as the outbreak spreads, are there more community organizations out there, to continue to help or will you all travel with the movement of Ebloa in Africa?
I’ll let the nonprofit reps speak for themselves regarding how much they have needed to pivot their work, but there are two articles below about how they have adapted to the situation –
Imani house was not a clinic equipped for Ebola but is quickly creating a quarantine Ebola clinic (http://www.dnainfo.com/new-york/20140930/park-slope/park-slope-man-survives-brush-with-ebola-plans-return-outbreak-zone)
More Than Me works to educate girls in West Point and is now housing kids who are orphaned and abandoned due to the outbreak (http://time.com/3453660/ebola-orphans/)
Would you have any advice for those who would like to work in the field of humanitarian relief in the future? … I am studying biomedical engineering and I have been watching The Strain, so I find all this very interesting.
Liberia and Sierra Leone are large outbreaks that have not been contained yet – study them. Fund efforts to help. Ask what kinds of behavior change methods work in that context. An outbreak in USA is a very remote hypothetical possibility right now, and more of a distraction from the tens of thousands of people in West Africa that need our immediate attention.
Don’t major in “international development” in college, or anything like that. Get hard skills. I got a PhD in Neuroscience and would’ve done the same had I done it over. Learn to code. Study the future, and psychology. Avoid theories and people who talk a bunch but don’t speak a foreign language – they’re probably only listening to other people like them.
I am an epidemiologist with a background in biology and secondary training in biostatistics and epidemiology. I have peers that come from engineering backgrounds (biomedical and even mechanical). In some cases, they have received secondary/graduate training in biostats and epi, but not all. There are many jobs in disease modeling, health care infrastructure supply chain management, and health systems modeling, which you may find interesting. If you want a job out of college, I would suggest you look into learning some coding platform, as this would be a tangible, sought after skill. I use SAS, but some people prefer SPSS or R. Look into taking some courses in biostatistics, if you have not already. If you are really passionate, you could look at graduate training, like an MPH degree, although I suggest trying to get a few years work experience as a coder first. Depending on where your undergraduate education is, you may even be able to take a course at a school of public health.
Wow I had no idea you could combine those two areas of expertise. This sounds straight up my alley! Thank you for all the information, I really appreciate it. 🙂
I’m glad to answer any questions if you PM me. I actually think an engineering background is a great approach to some of the problems we try to solve. My engineer friends are able to do innovative modeling that I don’t always understand, but I’m glad someone is doing.
Excellent question: Travel widely and immerse yourself in other cultures. Learn another language. Explore eating food at different cultural restaurants. Go on short-term volunteer trips. Learn to be flexible. Develop an appreciation for the good in other cultures. Celebrate cultural diversity. Be open to learn from and befriend people who are different from you. My quick 2 cents.
I work at GlobalGiving as well, and my background is in mechanical engineering (i.e. not nonprofit work). That said, I use lots of the math/programming/stats skills I got out of engineering everyday at GG (I’m a Business Intelligence Analyst). /u/marcmaxson has a similar story.
For those looking to get a start in nonprofit work, Idealist is an excellent resource for finding jobs, internships, networking etc. LinkedIn Groups are also rich sources of more specific information, if, for example, you’re particularly excited about Public Health.
Nonprofits have a huge range of needs, so if you’re interested in getting some experience but aren’t in a position to make the leap full-time, part-time volunteering can be a great way to go while you’re working a day job. I was in exactly the same situation and did the same thing at my last job before coming to GlobalGiving. Organizations post opportunities for this sort of work all the time on Idealist, Craigslist, etc. There are also options at GlobalGivingTime
Also, if you’ve been in the private sector and are considering a switch to non-profit work, ProInspire is a fantastic resource.
I’m in the army and on my way there within the coming weeks to provide helicopter support for USAID. Anything beyond the obvious I should know before I get there? I’m somewhat excited about going as this will be my first humanitarian type mission in the 12 years I’ve been in the army. I look forward to working with you guys.
Good for you! Follow basic precautions as you would for any new place. You’re more likely to get a GI infection from the water than any serious disease, so just wash hands, keep clean, and wear protection when working in places where ebola patients are likely to be found.
Avoid shaking hands and hugging. Use your hand sanitizer frequently. You understand protocol very well. Follow it rigidly.
How much bleach needs to be added to the water to make a good sanitizer?
First,I am hearing that the virus mutates…and has up to 50 times already. Has this impacted the efforts to stop it in West Africa, or are the procedures the same? … Thirdly, if an aide worker contracts and gets through a bout of Ebola, is he/she then immune? And finally are we anywhere close to a vaccine?
All viruses mutate 1000 times faster than bacteria because they have no machinery to regulate mutations like bacteria and people. Most mutations have no effect or make the virus even weaker. It takes a combination of dozens of coincident mutations to make a virus more powerful, on the order of tens of thousands of them, so the 343 recorded mutations in Ebola since 2013 is not unusual or particularly alarming. Flu viruses are different every year too. When a scientist says ‘it mutated’ that doesn’t mean the function of the proteins that make the virus work have changed, just that the DNA sequence has changed.
Resistance: If someone has Ebola, their blood has antibodies, giving them resistance. And this is one way that experimenters have treated Ebola – through blood transfusions.
Vaccine: ZMAPP is a first round experimental vaccine that worked on all 18 monkeys tested, and two humans, but clinical trials use thousands of people, so months to years away.
So, maybe this is stupid, but I am an American in the midwest with a severe anxiety disorder and I have been sent into a complete spiral of fear.
The comments on Reddit have ranged from “I’m an expert, everybody calm down” to “I’m an expert, and nobody is taking this seriously enough.” Rumors are flying all over the place and a lot of them are terrifying. How scared should I really be? Because right now all I can do is cry and hide in my house.
If you live in America, calm down.
It should comfort you that we can take the temperature of people in airports. People without a fever are not contagious.
It should also lower your anxiety that there is one doctor for every 400 people in America compared to one for every 20,000 in Liberia. We can AND WILL contain this one case in Texas. Their healthcare system is overwhelmed right now. No hospital beds have been free for weeks. If you were in Liberia, you have good reason to be anxious.
Also note that our best modeling of ebola spreading estimates that the one case in Texas will only result in two other people being infected. The 80-100 people being quarantined are just to be sure nobody else has any remote possibility of being affected.
Yes – temperature screening is taking place at airports – both arrivals and departures
We do not believe that this crisis will spiral out of control. Experts have stated that in the United States, we have the infrastructure and capacity in place to ensure this virus does not become an epidemic:http://www.cdc.gov/media/releases/2014/s930-ebola-confirmed-case.html . At the same time, we do believe that it is critical for people to understand the disease, how to avoid it, how it can be contracted and what to do if someone is infected. We believe that information is the best weapon against this disease. The better we can spread this vital information, the better chances we have at beating this serious issue.
Are you facing resistance from these communities, even though you’re offering help and resources?
On a community level – we have found out that due to misconceptions, myths, cultural and traditional beliefs, some communities strongly deny the existence of the disease and resist any efforts of response. However, continuous sensitization and dialogue with community leaders and evidence of death of close relatives from the disease are helping some people to change their negative perceptions and cooperate in the response interventions.
No resistance experienced so far. We work alongside them in partnership – letting them know we are supporting their efforts. This helps to secure “buy in” and on-going good cooperation. We do extensive local research and ask what they specifically need help with. Being responsive to their specific needs helps a lot.
I think that speaks volumes about the fact that you are so well-rooted in your local communities already. It’s so important that we support folks like you that were already present before the outbreak. (And will be present helping with recovery long after the epidemic has subsided!)
Great question. We have experienced some resistance from the powers “in charge” as you say, but are working as best we can with the procedures in place. A small organization like ours is able to act more quickly than a government agency with bureaucracy and red tape, and that’s where we experience resistance. Misinformation can come into play here as well and we work hard to ensure that all partners understand what we are and aren’t doing on the ground and how we can work together. We also recognize where we need to wait for permission before taking action.
Thanks, As to the Ministry of Health, we are doing our best through our clinic, to be supportive of their objectives.
We are close to our community and are providing inclusive community outreach and awareness. Imani House honors their opinions, concerns and misconceptions that have been spread throughout Liberia.