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Ebola outbreak highlights need for IU-Liberia health collaboration

Aug. 7, 2014

The Ebola outbreak in Liberia provides a dramatic illustration of the importance of an IU initiative aimed at strengthening the public health and medical infrastructure of the West African country, say IU and Liberian officials involved with the collaboration.

The outbreak also highlights the immensity of the challenges facing Liberia, which has struggled for the past decade to rebuild after 30 years of devastating conflict and civil war.

Public health practicum students

Certificate in Public Health practicum students serve as liaisons between the community and health facilities. During the Ebola outbreak, they were the first to be mobilized as educators and monitors throughout Liberia. | PHOTO COURTESY OF THE CENTER FOR EXCELLENCE IN HEALTH AND LIFE SCIENCES

Launched in early 2012, the Center for Excellence in Health and Life Sciences seeks to build up Liberia’s capacity for meeting health care needs by providing training for the public health workforce and strengthening the curriculum and instruction in medical and nursing education programs.

The partnership brings together IU with the University of Massachusetts Medical School, the University of Liberia and the Tubman National Institute of Medical Arts in Liberia. A $7.2 million grant from the U.S. Agency for International Development funds the project.

“The Ebola crisis is a perfect example of why this project is so important,” said Michael Reece, associate dean of the IU School of Public Health-Bloomington and IU’s coordinator of the public health component of the project. “It’s a textbook example of the value of IU’s global emphasis and leadership.”

More than 1,600 people have contracted the Ebola virus in Liberia, Guinea and Sierra Leone since the outbreak began in March, and more than 900 have died, according to the World Health Organization. There is no vaccine or cure for Ebola, and past outbreaks have been fatal in 60 percent or more of cases.

Ebola spreads through contact with bodily fluids, with health care workers often at high risk. U.S. medical missionaries Kent Brantly and Nancy Writebol, who contracted the illness in Liberia, were flown to Atlanta for treatment. Brantly is an IU School of Medicine graduate.

Emmet Dennis, president of the University of Liberia, was in Bloomington this week to meet with IU administrators about the Center for Excellence in Health and Life Sciences. He said the center has been invaluable as Liberia seeks to rebuild its infrastructure and its systems of K-12 and higher education.

“We’re not there yet,” said Dennis, a Liberia native who earned a master’s degree in biology from IU Bloomington. “And to have something like Ebola … This took us by utter surprise, and we did not have the ability to contain it.”

The project includes training community workers in a Certificate in Public Health program through a partnership with Liberia’s Ministry of Health and Social Welfare. It has also provided advanced education for leaders in Liberia’s nursing profession and upgraded curriculum, equipment and textbooks for medical education and college-level science instruction.

With the Ebola outbreak, the public health students have become “trainers of trainers” and served as a bridge between health care facilities and local communities. Others involved with the IU project have dived into basic public health duties, such as sharing information about how Ebola is spread and systematically tracing the contacts of people who have contracted or been exposed to the virus.

But the efforts face challenges as a result of Liberia’s underdeveloped transportation and communications systems, which were left weakened by many years of civil war – situations that University of Liberia President Dennis called “casualties of recovery.”

Amos Sawyer, a faculty member at IU’s Ostrom Workshop in Political Theory and Policy Analysis, chairs the Governance Commission of the Liberian government and was in the country last month.

He said Liberia is a small country, with only about 4 million people, and the impact of Ebola is impossible to overstate. “Just about everybody in the country would have known, or known of, somebody who’s been stricken with the virus,” he said.

Sawyer, who was Liberia’s interim president from 1990-94, said the crisis has cast a harsh light on the country’s lack of public health capacity. “Clearly Liberia needs many more health professionals in the area of preventive care,” he said. “The work that Indiana University is doing is very, very important.”

One of the people doing that work is John Berestecky, a microbiologist who spent the past year helping establish an undergraduate biology curriculum at the University of Liberia. He was working this summer with key faculty to develop the second year of the program, but the outbreak pre-empted the effort. Last week, he was mobilizing students to create Ebola educational materials.

Berestecky said an attitude of complacency may have allowed the situation to grow worse than it might have. “In my view the situation is critical,” he said via email. “There are reliable reports of multiple bodies in houses in numerous neighborhoods. These remain unconfirmed because the case identification teams sometimes can’t get to them for four or five days – they are simply overwhelmed.

“The overarching issue is that there are unknown numbers of people wandering around with symptoms of Ebola, and probably more who are incubating the disease but not yet symptomatic. The epidemic has decimated the very fragile health system that used to exist here.”

Berestecky said Liberia is “a very poor country with practically no infrastructure,” making it hard to mobilize an effective response to Ebola. He said Mosoka Fallah, a colleague on the CEHLS project, “has been working heroically with (Ebola) contact tracing crews in the greater Monrovia area.”

Dennis, the University of Liberia president, said his country desperately needs stronger academic institutions that can produce an educated populace and provide training for doctors, nurses and public health professionals – not only to respond to a crisis like Ebola but to support Liberia’s long-term wellbeing. That, he said, is what makes the collaboration with Indiana University so important.

“I’m looking at the present,” he said. “But I’m also looking at the future.”

How to help

IU Health and the IU School of Medicine are soliciting cash donations and assembly personal protection equipment for health care workers at IU’s partner institutions in Monrovia, Liberia: the University of Liberia’s Dogliotti School of Medicine and the John F. Kennedy Memorial Hospital. Donations can be made online.

The organization Friends of Liberia is soliciting cash donations to help Liberian communities respond to the Ebola crisis. Donations will be divided between two organizations working in Liberia, Doctors Without Borders and Global Health Ministries. Write checks to Friends of Liberia and mail to Pete Murdza, FOL Treasurer, Ebola Crisis Fund, P.O. Box 164, Etna, NH 03750.

Read more

Tracy James with the IU Newsroom blogs at Health & Vitality about IU alumna Tiawanlyn Gongloe, who lives in Liberia and works for the Ministry of Health and Social Welfare.

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