Partners In Health from Origins to Ebola: Lessons Learned from Haiti. Cate Oswald, MPH Senior Program Officer, Haiti Partners In Health

Transcription

1 Partners In Health from Origins to Ebola: Lessons Learned from Haiti Cate Oswald, MPH Senior Program Officer, Haiti Partners In Health

2 Cange, 1984 Cange, 2006

3 Investing in Cange Finding the right partners Investing in medical infrastructure AND public health infrastructure Strengthening social services

4 Launching a virtuous social cycle

5 Engagement Humility Fundamental Values Accompaniment Integrity

6 Prevention Integrated with Care Providing ART to those most vulnerable Strengthening primary healthcare systems Introducing essential drugs to the formulary Establishing a laboratory Training and stipending community health workers Complementing MOH personnel with PIH/ZL-trained staff Aggressive TB and STI case-finding and treatment Focus on women s health

7 The Partners In Health Model Clinics and Community Hospitals Teaching Hospitals Community-based Care

8 Public-private Partnerships University Hospital in Mirebalais, 2014 Tertiary care center with referral area of 3.4 million people 205,000 sq feet 320 inpatient beds Patients visits daily 800+ jobs created, 500 coming from the Central Plateau 289 nurses, 48 residents, and 51 doctors Links to investment in education, light manufacturing, etc. Nicholas Clark Architects

9 History of providing support in times of crisis: 7.0 Mw Earthquake: January 12 th, 2010

10 Our Response: Patients sent to 3 primary ZL sites because of damage to the Port au Prince General Hospital Hinche Cange St Marc

11 History of providing support in times of crisis Cholera: October 22 nd, 2010 Cholera confirmed by Haitian Ministry of Health and CDC within 48 hrs of outbreak of acute watery diarrhea in the lower Artibonite As of October 2014: ~900,000 cases >9,000 deaths Artibonite and Centre departments most heavily affected

12 Our Response 16 Cholera Treatment Centers and Units Partners: MSF-Spain, MSF-Belgium, Project Medishare, Cuban Delegation, MSPP, British Red Cross, J/PHRO Community water filters permanently installed; water trucks sent to most-affected communities Partners: Operation Blessing, Yele Haiti Community, school, radio education campaigns Partner: MSPP ORS & hygiene kits distributed in rural areas by CHWs; referrals to hospitals for severe cases 2,500 new CHWs trained in ORS & community-level prevention

13 Ebola Crisis and Our Response

14 History of Ebola 1976: 318 cases of acute viral hemorrhagic fever occurred in northern Zaire. 280 deaths, 38 survivors Lasted 6 weeks 14 outbreaks between 1976 and 2006 Death toll of all previous outbreaks < Epidemic As of Oct 14: 9,216 probable, suspected and lab-confirmed cases 4,555 deaths 5% of deaths among health workers

15 Barack Obama stated, speaking at a special session of the United Nations, Do not stand by, thinking that somehow, because of what we ve done, that it s taken care of. It s not.

16 Economic Impact of Ebola Source: World Bank, The economic impact of the Ebola epidemic : short and medium term estimates for West Africa, Oct. 2014

17 Ebola Transmission Cycle Infected persons aren t contagious until onset of symptoms Infectiousness of body fluids increases as patient becomes more ill and continues after death Transmission may also occur by contact with objects or surfaces

18 Ebola Symptoms Incubation: 8 to 10 days (range, 2-21 days) after exposure to body fluids of a person sick with Ebola. Early: fever, fatigue, weakness, malaise, anorexia, headache, hiccups, and abdominal pain. Other: Sore throat, Erythematous maculopapular rash, Conjunctival injection ~5 days: severe watery diarrhea and vomiting leading to dehydration and electrolyte imbalance Late: hemorrhage (18% of current epidemic), encephalitis-like symptoms

19 Ebola Care and Treatment Supportive care: fluids, electrolyte replacement, anxiolytics, pain control Empiric therapy for other illnesses (malaria, bacterial translocation Psychosocial support for family and survivors

20 Under 5 mortality Maternal Mortality Health expenditure ($ per capita) Private health expenditure (% of GDP) Public health expenditure (% of GDP) GINI Index Guinea Liberia Sierra Leone The eating of bush meat can t possibly explain the epidemic, but grotesque and growing disparities in access to care in the context of a globalized political economy can. - Paul Farmer

21 What is Needed Stuff Personal protective equipment ( PPE) Food, fuel, medication Closing of the borders Systems Staff Space

22 5 pillars of PIH s Ebola Response: Direct effort and support of governments Stop transmission Treat Ebola Strengthen health system Train health professionals Generate new knowledge

23 Comprehensive Strategy for Ebola Prevention, Care, Treatment ETU Dist rict ECC PHC HBRR CHW

24 Community Health Workers Trusted local person Can provide assistance to family Connected to health system Compensate

25 Law and Order vs. Compassion and Solidarity

26 Nigeria s Success July 25, 2014: Ebola patient from Liberia dies in Lagos. September 22, 2014: 20 cases and 8 deaths in Nigeria (40% death rate) October 20, 2014: Nigeria declared Ebola-free

27 What can we learn from Nigeria? Polio and HIV experience Medical care, lower death rate Health teams visited 18,500 homes >150 contact tracers were deployed Tracing teams monitored 894 people

28 I have no idea what's awaiting me, or what will happen when this all ends. For the moment I know this: there are sick people and they need curing. Albert Camus, The Plague