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PBS NewsHour

What’s the worst-case scenario if Ebola can’t be slowed?


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JUDY WOODRUFF: The prospect of an even greater Ebola epidemic is keeping health officials all over Africa awake at night.

Dr. Kevin De Cock, an American, is country director for the Centers for Disease Control in Kenya. He and members of his team have traveled to Liberia and the other affected countries in recent weeks.

Our Jeffrey Brown spoke to him this weekend in Nairobi, Kenya.

JEFFREY BROWN: Dr. Kevin De Cock, thanks for talking to us.

There is a report that a new estimate is in the works that may have a worst-case scenario of as high as half-a-million people. Can you comment on that?

DR. KEVIN DE COCK, Centers for Disease Control and Prevention: Yes.

The doubling time of new cases of Ebola virus disease in Liberia is about every 20 days. So there is a total number of cases doubling about every three weeks. We’re now up to 3,000, 4,000 cases, reported cases, which may be a slight underestimate.

So, very rapidly, we do expect to see some tens of thousands of cases, and quite possibly, by the end of the year, early next year, some hundreds of thousands, unless this is — unless this is slowed down.

JEFFREY BROWN: This is exponential growth. So, I mean, at this point, this is out of control?

DR. KEVIN DE COCK: At the moment, the increase in cases has been described as exponential, yes. And, yes, clearly the epidemic in West Africa in the three most affected countries, Liberia, Sierra Leone and Guinea, I do think it’s out of control. And many senior leaders have said that.

JEFFREY BROWN: You know Liberia and these countries well. And you were there fairly recently.

These are countries that have little health infrastructure to begin with, right?  What did you see?  What did you see there now?

DR. KEVIN DE COCK: I think it needs to be emphasized that these are amongst the weakest states in the world. If you look at per capita income, Liberia per capita income is less than 500 dollars per year. The literacy rate in Liberia is about 60 percent. These are very fragile countries. Sierra Leone and Liberia both have come out of civil wars.

So infrastructure is weak, systems are weak, and it’s a very difficult working environment. And for any country, an outbreak like this would be a challenge. But for these countries, it’s very serious.

JEFFREY BROWN: Can you give me an example of what you saw there that — I mean, to exemplify the kind of challenge for health workers?

DR. KEVIN DE COCK: The health workers have paid a very heavy toll in this outbreak. In Liberia, about at least 15 percent of cases of Ebola virus disease have been in health workers. And Liberia, of course, has not many health workers to start with, less than 200 doctors, for example, well under 200 doctors. And quite a few have died.

The epidemic, it has really had a major effect on the health care system, with many hospitals abandoned. But it’s the secondary effects we’re also beginning to see, the economy grinding down, the health care system halted, the fear in society, and so on and so forth. So the secondary effects of all of this are very, very serious as well.

JEFFREY BROWN: What about the legal of level of distrust among people there, a fear that this is a Western plot, or that it doesn’t really exist?  How much is that a concern?  How much is that an impediment to getting things done?

DR. KEVIN DE COCK: It is an impediment.

And you — I think we’re all aware of the tragic deaths of colleagues in Guinea just a few days ago, people who were kidnapped and ended up being killed. It is a tremendous obstacle. It’s gotten better in many places. But it remains a problem in some — particularly in some of the rural areas, in the three border areas.

And then it’s sort of it — it also is accompanied by an opposite, a sort of opposite reaction, which is tremendous impatience that more is not being done. So, it…

JEFFREY BROWN: You can understand that.

DR. KEVIN DE COCK: Which you can understand, so it’s a difficult working environment.

JEFFREY BROWN: We’re sitting here in Nairobi, far away. Do you sense a — or how much of a sense of fear, concern, even psychological concern, do you sense here?

DR. KEVIN DE COCK: There’s a low-level concern.

And I think the government is doing the right things. They certainly are investing in preparedness, in screening at the airport of incoming travelers, particularly from West Africa, in strengthening surveillance and preparedness in hospitals, having an isolation facility ready and so on.

So the right things are being done. I think what this whole experience demonstrates is that we really are an interconnected world and the — you know, we have to pay attention to the weakest links in the chain, because we’re — vulnerability is shared between us all because of that.

JEFFREY BROWN: Because the government in Kenya has stopped flights between here and the West African countries. But people can still go via other countries, right?

DR. KEVIN DE COCK: Yes. And the stopping of flights is something that needs to be discussed, actually. We…

JEFFREY BROWN: Discussed or changed?


JEFFREY BROWN: Changed?  What concerns you?

DR. KEVIN DE COCK: The World Health Organization and CDC and other public health authorities, you know, say that’s probably not the best thing to do.


DR. KEVIN DE COCK: It’s understandable — because it gives a false sense of security.

We — you know, we cannot close our borders and live like an island. Plus, the fact, actually, this is now — if the flights do stop or if those that have stopped don’t recommence, it actually complicated the response to the epidemic, because we have to get people and supplies into these countries.

JEFFREY BROWN: The worst — I guess a truly worst-case scenario that some people look at would be a spread to other major cities outside that region, to places like this, Nairobi.

DR. KEVIN DE COCK: I think the worst-case scenario would be exportation of infection into some other urban center that is not well-equipped to address the epidemic.

And there’s — I think Kenya is trying to assure the appropriate preparedness. But there are, of course, many vulnerable cities across the continent or even in other parts of the world.

JEFFREY BROWN: And so, as we sit here, how concerned are you about the ability to control this or its spread?

DR. KEVIN DE COCK: I think we can control this.

But I think we’re in this for quite a long time. We’re in this for a long haul. And I think a lot more needs to be done.

JEFFREY BROWN: All right, Dr. Kevin De Cock of the CDC in Kenya, thank you.

DR. KEVIN DE COCK: Thank you.


The post What’s the worst-case scenario if Ebola can’t be slowed? appeared first on PBS NewsHour.

How Nigeria has succeeded in containing Ebola


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GWEN IFILL: The World Health Organization reported today that the Ebola virus has now killed more than 2,800 people in West Africa. The majority of deaths have been in Liberia, Guinea and Sierra Leone.

But the deadly illness has been relatively contained in nearby, and much larger, Nigeria, which counts 21 cases and only nine deaths.

Tonight, special correspondent Fred de Sam Lazaro takes a look at how Nigeria has controlled Ebola’s spread.

Fred’s reporting is a partnership with the Under-Told Stories Project at Saint Mary’s University of Minnesota.

FRED DE SAM LAZARO: Not much moves in a hurry in Nigeria’s commercial capital, Lagos, also Africa’s most populous city.

And basic services, like roads and covered sewers, have yet to reach slums like Otumara. But the Ebola message has, what it is, where to report it, how to prevent it.

MAN: You need to wash your hands. It’s very, very important for you.

FRED DE SAM LAZARO: Nigeria’s Ebola response has been comprehensive in communities and the media. There’s temperature screening at all the country’s entry and exit points — fever is an early warning sign — and extensive surveillance by public health workers. It’s driven by sound epidemiology and, the American consul in Lagos, Jeffrey Hawkins, says, fear.

JEFFREY HAWKINS, U.S. Consul General: One thing that people really don’t want to hear is Ebola and Lagos in the same sentence. This is a city of 20 million people, and a major urban outbreak here could have been apocalyptic. But the response was quick.

FRED DE SAM LAZARO: One early leader of that response was Babatunde Fashola, governor of Lagos state, which includes the city.

GOV. BABATUNDE FASHOLA, Lagos State: On this kind of job, fear is always healthy. If you lose fear, something is wrong.

FRED DE SAM LAZARO: Nigeria’s response began soon after the first confirmed Ebola case in late July. A Liberian-American traveler fell ill at the airport at Lagos. His circle of contacts was limited to the health workers who cared for him, and then there were their contacts. One of them carried the infection to the southern city of Port Harcourt, causing a second outbreak.

DR. FAISAL SHUAIB: Within a question of just a few days, we had as many as 500 contacts that were being traced, just to cast a wide net and ensure that anybody that has potentially had any contact with a case is under our purview, taking temperatures, asking them if they have any symptoms.

FRED DE SAM LAZARO: Dr Faisal Shuaib of Nigeria’s Health Ministry heads the Ebola command center. The response team includes several international agencies that have been in Nigeria for years fighting other diseases, like malaria, HIV and polio.

They quickly redeployed. Dr. Nancy Knight, with the U.S. Centers for Disease Control and Prevention, says the CDC had earlier trained many field epidemiologists here.

DR. NANCY KNIGHT, Centers for Disease Control and Prevention: One of the things that has really helped keep the fear in check and to keep it from turning into widespread panic has been the number of boots on the ground. We have had, between Lagos and Port Harcourt, more than 1,000 people that have been working on containing the epidemic.

FRED DE SAM LAZARO: Despite Nigeria’s many problems, sectarian violence, Boko Haram insurgents kidnapping schoolgirls, the country has a more developed public health system than its smaller neighbors reeling from Ebola. Having international experts on hand also helped reassure key political leaders like Lagos’ governor.

GOV. BABATUNDE FASHOLA: That helped a lot to make decisions and to communicate with all of the stakeholders, religious leaders, primary health care workers, school teachers to reassure them that we could turn this around.

FRED DE SAM LAZARO: The aid group Doctors Without Borders has trained health workers on handling patients, on using the airtight personal protective equipment. The group has built isolation centers in Lagos and Port Harcourt that would handle a fresh outbreak. For now, there’s just one suspected case left.

There’s no panic, but there’s still a lot of stigma surrounding Ebola in Nigeria. As outsiders, as a camera crew, we were not allowed to go near the contact tracers. These are public health workers who fan out each day to keep tabs on people who had any contact with someone infected with Ebola.

Dennis Akagha knows firsthand about stigma.

DENNIS AKAGHA: I lost my job while I was taking care of Justina.

FRED DE SAM LAZARO: And he lost Justina, his fiancee who was two months’ pregnant. On her first day on a new job, the 32-year-old nurse’s first patient just happened to be that first Ebola case, the Liberian-American. Akagha too became infected, but he pulled through. Survivors of Ebola become immune and are no longer contagious. But that hasn’t helped Dennis Akagha.

DENNIS AKAGHA: Ebola is not a death sentence. I wouldn’t have lost my job if they had been informed.

FRED DE SAM LAZARO: Early detection has helped the survival rate in Nigeria. Fewer than half the cases have resulted in death. But the stigma only worsens the public health threat, says Dr. Ndadilnasiya Waziri, who heads the contact tracing effort.

DR. NDADILNASIYA WAZIRI: A lot of contacts that were (INAUDIBLE) couldn’t even come out to get food in their communities because they were being stigmatized. So, that’s a big worry because that will make people to hide.

WOMAN: Washing of our hands regularly is one of the best ways to avoid and prevent all of these diseases flying around, like Ebola.

FRED DE SAM LAZARO: Nigeria’s influential film industry, popularly called Nollywood, has stepped in to help.

TUNDE KELANI, MOVIE Director: This is like — like UFO, you know, suddenly descended on Nigeria, you know, and we had to do something about it.

FRED DE SAM LAZARO: Tunde Kelani, a top director, says Nollywood’s leading lights came together in record time, responding, he says, to the biggest existential threat anyone here has felt.

TUNDE KELANI: I think they responded very well, because we put together a list of about 18 of these celebrities.

FRED DE SAM LAZARO: Now he’s thinking, why not expand the idea beyond this Lens on Ebola effort?

TUNDE KELANI: For instance, we can do lens on polio. We can do lens on malaria.

FRED DE SAM LAZARO: In the distressed Otumara neighborhood, Alaja Jatto is also thinking beyond Ebola.

MAN: Well, she says she has something to tell the government, that they don’t have piped water, that their roads are bad, and that they need development.

FRED DE SAM LAZARO: Whether the government delivers on those improvements is unclear. But the Ebola campaign will continue and on high alert. That’s even though the number of contacts being tracked is now down to about 300. Each day, more people cross the critical 21 days since their exposure to the virus, the window in which symptoms can occur.

Ironically, this success is a worry. Dr. Faisal Shuaib fears Nigeria could attract Ebola patients from nearby countries like Sierra Leone, Liberia and Guinea.

DR. FAISAL SHUAIB:  We have had record levels of people surviving Ebola virus disease. And they might start feeling, well, maybe this is the place to come.

FRED DE SAM LAZARO: The U.N. has called Ebola a threat to global security. And many people here say Nigeria, the regional economic hub, a nation of 170 million, will remain the most vulnerable frontier.

The post How Nigeria has succeeded in containing Ebola appeared first on PBS NewsHour.

Why so many people die in hospitals instead of at home

Photo by Getty Images

Photo by Getty Images

It was September 2012 and it was life-long smoker Paula Faber’s third cancer in a decade, but she did not hesitate.

“She was going to fight it every inch of the way,” says her husband Ron Faber.

By August 2013 after much fighting, Paula Faber died at age 72. Ron Faber now regrets the intervening 11 months of chemotherapy, radiation, painkillers and side effects that reduced his wife to 67 pounds of frayed nerves. Instead, the pain could have been managed so she could focus on the quality of life.

“I would have rather have had a really okay four-and-a half months than this endless set of treatments,” the stage actor said.

As they confronted Paula’s terminal diagnosis, the decision the Fabers made is among the most difficult anyone can make. But it turns out that in the New York metropolitan region, patients opt for aggressive treatment much more often than other Americans.

“New York City continues to lag in serious ways with regards to providing patients with the environment that they want at the end of life,” says Dr. David Goodman, who studies end-of-life care at Dartmouth College’s Geisel School of Medicine.

The reasons they do this are many, but most experts agree that it has less to do with the unique characteristics and desires of people in New York and New Jersey than the health care system and culture that has evolved here.

The result: More people dying in the hospital, often in an intensive care unit on a ventilator or feeding tube; more doctor visits leading to tests, treatments and drug prescriptions; and more money being spent by the government, private insurers and patients themselves.

Specialists at the Dartmouth Healthcare Atlas maintain that one of the main drivers of this phenomenon is quantity: people end up in hospitals here so often, they say, because this region simply has a lot of hospital beds.

“One of the truisms of healthcare is that whatever resources are available, or whatever beds are built, they tend to get filled,” Goodman says.

A second driver is that every region has its own medical “culture,” and the one in New York is built around highly trained specialists and sub-specialists who see it as their job to cure illness. Dr. Diane Meier says that means, “that if there’s a cancer it needs chemotherapy, that if there’s heart failure, it needs a procedure.”

Meier is a geriatric specialist at Mount Sinai and the director of the Center to Advance Palliative Care.

She says also driving the culture of heavy treatment is the high proportion of specialists and sub-specialists who constantly refer patients to each other — both because that is how they were trained and because it is good for business.

“If I’m an endocrinologist, if I refer to the cardiologist, the cardiologist will refer back to me for endocrine problems,” says Meier. “It’s like a cottage industry.”

Insurers, Government Pushing Back
More and more, though, hospitals are getting a single payment from commercial and government insurers for each patient and losing money when treatments and tests pile up. Meier says hospital care needs to adapt.

“The sort of open faucet of money, where whatever you do, the more we’ll pay you, and the more complicated thing you do, the more we will pay you, and the more risky thing you do, the more we will pay you – there’s a recognition now that, really, the party’s over,” she says.

At Mt. Sinai, the chair of surgery now demands his staff discuss hospice alternatives with terminally ill patients — and make an electronic note of the conversation that can be tracked. If it does not happen, he demands to know why. Meier said every hospital doctor should follow this example.

“All of medicine needs to be willing to say, ‘Why did this person with end-stage dementia have three or four hospitalizations in the last three months of life and die in the intensive care unit? This was a terrible experience for the patient and family. A lot of unnecessary suffering. Over a million dollars cost to the taxpayer. How did that happen?’ ” she says.

Ron Faber is still asking that question.

A year after his wife Paula died, he still believes her oncologist at Beth Israel Hospital was strangely optimistic about her prospects. Faber acknowledges it was Paula’s decision to fight the cancer “every inch of the way,” but he thinks she might not have, if her doctors had told her more about the upsides of palliative care and the downsides of aggressive treatment.

“I think they sold her on it,” he says. “She was so afraid of death that she was ready to buy, and they knew it. And I think it happens a lot.”

Hospice had come up before as an option, but the Fabers thought of that only as a place to go and die, and no one had told them otherwise. Then a social worker explained that hospice is something that can happen at home, too. Belatedly, Faber said, the couple chose that option, and hospice workers from the Visiting Nurse Service of New York came to their apartment in Greenwich Village.

“Once they arrived, it was like putting everything together,” he said. “And from that moment on, everything was right.”

It turned out to be the Fabers’ final five days together, after almost 50 years.

This story is part of a partnership that includes WNYC, NPR and Kaiser Health News. Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

The post Why so many people die in hospitals instead of at home appeared first on PBS NewsHour.

Has the focus on physical activity ruined playtime for kids?

Photo illustration by Getty Images

Photo illustration by Getty Images

A third of children in the U.S. are obese, and encouraging more active play is frequently cited as a great way to keep kids in shape. But creating scheduled playtime built only around physical activity might be draining the broader benefits out of play, a new study in Canada found.

parenting now logoA team of scientists at the University of Montreal set out to discover how children define play. 25 kids between 7 and 11 were interviewed and asked to take photographs to describe their favorite ways to play. The results of their novel study are published in the journal Qualatative Health Research.

The researchers found that physical activity is only one part of what kids like about playing, and that regimented physical play built around fitness doesn’t satisfy all needs for many kids, or meet their own definition of “play.” “By focusing on the physical activity aspect of play, authorities put aside several aspects of play that are beneficial to young people’s emotional and social health,” said the study’s supervisor, Professor Katherine Frohlich.

The researchers isolated four key elements of play from their interviews with the children.

  • Play happens only “as an end in itself.” Children understand play only for fun, not as a means to get physical activity or to improve their social skills.
  • Many forms of play the kids preferred were not active, including playing games, reading, or watching movies.
  • Children didn’t feel attached to scheduled activities. The study described their feelings as “ambiguous.”
  • Risk is a central and pleasurable part of play, and building too much safety into playtime subtracts this important element for many kids.

The study’s abstract concludes that there is “a dissonance between children’s play promoted for physical health and the meaning of play for children as emotionally contingent, intrinsically motivated, and purposeless.” The researchers hope their findings will encourage parents and educators to think about how to better structure playtime.

For more on play, don’t miss the PBS NewsHour American Graduate report on California’s Playmaker school, where educators have tossed out desks, seating charts and grades in favor of a curriculum based on play.

The post Has the focus on physical activity ruined playtime for kids? appeared first on PBS NewsHour.