Transcripts For CSPAN2 Key Capitol Hill Hearings 20141021

And aerosol is when people are coughing with those droplets but not really contaminate the air that a brief so that is how i looked at it. Order what it teat dr. Fauci was talking if this was just transmissible or like influence though influenza. You had cases when people across the hall were getting a infected but nothing like that is happening with ebola. But i would say how we take steps with prepared this and has steps in place so there was something we could do with the airborne virus so we need to be ready for anything even though in this case it is nothing that any scientists anticipate. We will be back with our live town hall. [applause] teeeighteen the ebola virus arrived on the tray table or an arm rest on a plane or the inanimate object of what should people do tuesday uninfected . The question were always asked in some respects that if you take ebola and have blood or diarrhea or vomiting if the inanimate object it last 20 minutes or so. That directly definitively give you the minute by minute the chances of someone coming into contact in a public place is finishing below particularly with nobody around with ebola. My recommendation so washer hands a lot. And not worry about getting ebola from a coffee cup or a plate. And from all the contacts these are people that have much more opportunity for compact than someone on an airplane or a public space. From the perspective in maryland a number of people are quite sick with the flu and in doing something to protect themselves to get the vaccine you are reducing the spread of. So the fact that duncans Family Members did not contracted it is hard to get it . It is proved it is difficult to get it, as you come into contact with bodily fluids of the sick person. We say all these things and they are true and we are trying to dispel the myth. But dont interpret that as overconfidence. But what we need to do to suppress the epidemic in africa and someone comes with a suspicion of ebola or travel history, isolate them to make sure you protect the people are around. If they wind up having ebola and it is conceivable there will be other ebola patients to take care of them in a way to protect society and most of all projects the worker. One of the concerns is somebody could be infected and we dont know that there is a long incubation period someone could be a symptomatic to register a normal temperature boarding the Airline Flight and then obviously shows signs of days or weeks later. How do we watch for that or monitor that . And in that realm can you talk about the travel ban for people traveling here from west africa . We have heard many people propose a travel ban and i understand the appeal that somehow you can keep this out. But we have heard reasons why that could backfire. The most important those coming to the country how their tract and then dont get medical care when they feel sick. Then someone to spread the virus under the radar but i do think we need to ramp up the procedures that if they develop any problems to identified but if we dont have a travel ban to keep an eye on the travelers that in addition we should consider doing more to discourage nonessential travel to and from these countries. But probably we could do more to do the cdc guidelines. Dr. Fauci you talked about the travel ban. First of all, make sure everybody understands those that oppose a travel ban that is not a reasonable approach and well understand that. To say that is a stupid idea those who end good faith it just happens to be a disagreement if it will be where we want to go but having said that listening to any proposal of one of the reasons it feels like that capability to track more easily the u. S. The question with 36,000 people in west africa tried to get on the plane 77 were not allowed because they felt sick or had of fever. Of those 77 and of those had ebola. Nothing is 100 percent but that tells you that there is not major people trying to get into the country. We know there is of vaccine in trials. You have experience with fda i need to repeat the regulatory hurdles but where does the ebola vaccine stand now . I think first of all, it is important for the public to understand there is a tremendous publicprivate effort going on so even the two vaccines that are the furthest along and to be in the safety study just because it works in the animal model does not mean humans so it is extremely important before anything is used in a widespread manner to know it is safe and that it works and as dr. Fauci knows there was an example of the hiv vaccine that seemed to increase infections. You dont want any tragedies like that happening. The fda have all come forward to develop more manufacturing capacity and then get the answer as quickly as possible. I am sure there is nothing the fda wants to see more in the ebola virus right now and just like they were able to move through the age one and one vaccine they will do Everything Possible to get the data needed cynically will be back with our town hall broadcast live on wtop and wtop t. Com. [applause] while we have you here you are attending to the nearest you contracted ebola while caring for the patient in her care she is in the area at the clinical studies unit, she doing . She is in fair condition. She is comfortable per cushiest able. She is still up it knocked out. When you get an infection as serious as ebola it is very draining on you. But i can say i had a very long conversation with her last night and she is in good spirits. You hopeful for a full recovery . Title speculate when you deal with the disease such as ebola. But i fully intend to walk out of the hospital with her you have all been mentioned how important it is to fight it in west africa so what are we doing and how do we incentivized more doctors and personnel . Dr. Goodman . I am proud of the fact our country has made a tremendous offer of thousands of troops building 17 hospitals. That is the great thing to be proud of to help liberia to deal with this. We need to do everything we can to speed that up and also we need to see many other countries come forward even more than they have to make this happen. In terms of volunteers, i think organizations are starting to see many dedicated Health Care Workers volunteer. The cdc put on a tremendous trading program. Were seeing positive movement in that direction but just like the Health Care Workers here in this important they be saved there so the infrastructure of command and control it is also essential. The president is exactly right the rest of the world needs to match the commitment the United States has made. 1. The founder of Facebook Dave maurer than the nations of japan and china put together. We have sent a tremendous amount because we will never end the l break and the rest of the world needs to rise to the challenge. We have a question from a doctor in the audience reports from who and Glaxo Smithkline indicate the likelihood that the epidemic will be over before the vaccine to be licensed for efficacy this been a guy cannot comment on someone elses pronouncement i did not hear that but if that was said i would say right now i do think we can predict when the epidemic will be over it is still escalating as opposed to declining. So it is not very prudent to predict when it will end i think the best way is to make sure that we as a Global Community put in sufficient resources. Is their concern about the blood supply at all . Now here in america . In this country . I think at this point there are few cases that can be clearly identified and is not with blood donors i know the fda will keep an eye on this. How important in the medias role is . What can the media do better . And our area is has done a good job and a Critical Role to tell the facts there so many rumors how hard it is to be transmitted in a casual setting but the a break is a beer in west africa to work together. It is important not to give so much attention. I saw one person say the ebola virus but it is fueled by fear and it is important for the media not to mix the fear that transmit the facts to help people understand. We have had wonderful comments but a lot i think does happen is the 24 7 this save images over and over the same stories updated 10 times provide personally was asked to comment within 30 seconds of the event be reported in type could not possibly be informed enough to make a comment. So the media needs to stand back to look at the big picture to keep the message in mind. Actually the fact we have a candidate vaccines it is a rare disease affecting only a few hundred people at a time with an outbreak in africa but this is the area of bipartisan investment on the part of congress to prepare our country for an emergency it couldve been a natural threat. I think it is an opportunity to turn Public Health as a National Security issue and something both parties ought to work together. Now we have social media. The media can be an important source so in general it does a very good job but unfortunately my friend say that 24 new cycle you always look for a new angle for the breaking news. When the patient came she was listed in Good Condition that we evaluated her more conservative the into fair conditions the headline was patient deteriorates she was not deteriorating she was exactly the way she was. But yet the headline was different she was not deteriorating. And other social media example win another nurse was transported about protection it turned out there is unease in he did not need protection. She was in a tent and they had personal protection. A couple questions from the audience. We have a Critical Care paramedic who wants to know about a prehospital treatment and safe transport of suspected ebola patients. Should ems personnel be kept in mind with potential ebola cases as they dont have the biohazard suits and protective clothing. Is there something that should be done about that dr. Sharfstein . Absolutely the front line that includes the ems workers absolutely need full measure of support. Just as much as firefighters go into the burning building dealing with the threat all the time. And those emf leaders and people from the area of west africa and it is at the front of our mind the entire spectrum speeeight we will come more back more with our live broadcast on wtop and wtop day. Com. [applause] we are back with our town hall on ebola with dr. Fauci and dr. Goodman and dr. Sharfstein. A question whether or not with whole man security or the Defense Department and maybe were not as unprepared as it seems but if that is the case how we handle that . Give maryland where governor omalley with Emergency Management Team Authority has work between the agencies going statewide with the ability to have a Public Information center between the different parts of the government and this is something that is the major priority the last few years. What if there is up of to do was arm . We do have the first real major push of value handle live always been concerned with the nine above an attack followed by the anthrax attack that launched of major will agency multi agency endeavor from fundamental basic research, clinical research, fda involvement involvement, homelands security prepared this preparedness. But there is a tremendous amount of coordination going on. Calling attention and response to the budget difficulties of the federal and state that over the years we have lost a tremendous amount of people in the front line like those that could trace the case is. I dont think it is a partisan matter but just with the tight budget that has been lost for those front line and others is. I hope that theyll look at it is a fact of what we need to endorse. Talk about the appointment of the ebola is our czar how effective can that be . And also address the fact we dont have a Surgeon General apparently in the United States. Whether or not that ebola situation and should be geared toward something the medical community or Surgeon General should oversee or under the purview of the drug czar . It is not a czar but the Ebola Response commitment he is highly experienced, highly talented managers chief of staff from Vice President by dint and will be coordinating among a multi agency endeavor. Each has their own responsibility then did dod, usaid and security and on with bill to all agencies right now coming to the white house with a whole man security advisor and susan rice they have really important day jobs to reduce like isis. To the second question we do have a Surgeon General and it is embarrassing that the narrow ideological political consideration that dr. Murphy is a very good doctor in keeping him from being confirmed. I dont think it is physical to be prepared but publichealth should not be up political component there should be Adequate Funding and people should not be held up for ideological reasons. Let me ask about politics the timing just before the election does that make things worse. [laughter] i did think were in a polarized environment the country has a lot of anxiety right now like isis it has been politically adversarial for many years and add to that each new ingredient when there is of unknown attached to it becomes part of the political debate. That is not all bad because it is important to be challenged. We need to answer these questions. But i do think that as i centcom this is an issue where both sides of any National Debate should not but is our countrys wellbeing to speak to the population and irresponsible and a knowledgeable way to work together. Just like you deal with a hurricane or any natural disaster. Dr. Goodman should we stockpiling gloves blood from the patients as it helps to recover . Let you are alluding to there is information from previous outbreaks some individuals the received blood from the recovered ebola patient may have recovered and the doctor has done it in his blood several times but the truth is we dont know yet if that works or helps people. That in the best model it does not help. So we need to rapidly mobilize studies and research to find out. And were doing that now. But that being said it is not like the experimental drug addict is important to answer the question now and it is reasonable to use it in individual cases. We cannot do things based on rethinks this should work sometimes it turns out not to work. We will come back with our town hall broadcast live on wtop t and wtop day. Com. [applause] we are back with our town hall on ebola with dr. Fauci and dr. Goodman and dr. Sharfstein. Following up from something earlier we mentioned in africa helping the hospital workers their standing in pools of infectious fluids without protective gear. How can that transmission declined if there is not enough skier gear . There is mixed issues. I cannot comment on Health Workers standing in infectious material. That may have been that i can tell you from a physician that i know over there they are pretty well protected but the problem is the overburden of too many patients but make sure you dont pick up things like how you spread the virus. It is tragic but they know enough if they are at risk to monitor and quarantine themselves but that is not how the virus is spread in west africa. It is spread because there are not enough facilities to take care of the people who are infected. So they go to their homes and their family takes care of them and the family gets infected. They died and they get buried without the proper approach so it is spread in the community not by the Health Care Worker that would likely quarantine himself but sped by the fact that Health Care Structure in these countries is and has been not optimum. That is the reason. Do they generally have more protection than we think . Look at the pictures they have the personal protective equipment but however what happens peopled mostly get infected because they dont know someone is infected or one of the things recognized is taking your personal protective equipment you are fatigued and accidents happen. We have another twitter question somebody wants to know what is the next aziz to be on our radar after ebola . Dr. Sharfstein . The image that is breezy exactly the reason to invest right now it is still an issue there will probably be a new one coming around the corner it is not the right way to think about it to go from crisis to crisis it is Biomedical Research and Public Health preparedness to allow us to feel we can handle things. Is this a drill for the other potential threats . It is always the drill and those of us involved try to learn as much as we can for the new challenge to be better prepared for any future challenge. It is probably always what we expected people preparing for avian flu and we got the 2009 pandemic instead. But we were pretty well prepared not perfect because we were working together with publicprivate partnerships and to have the platform to help citizens was the Counter Measure response. That is what we need to do. This is a really good time to put forth of fundamental principles it is very easy to get people enthusiastic about responding to something they are afraid of. Trust me it is very, very difficult to get people excited about something that is not here that might not ever come here. That is called preparedness. You cannot imagine how little enthusiasm about preparing in this country for ebola. We were interested at the nih and the cdc but the general public could not care less. Now that it is here everybody is excited about ebola that is the same thing that what about the next we are concerned about . It is not on anybodys mind and tell people get excited. What dont we know at this point we need to learn fast . Dr. Goodman at . Were still learning and we dont know what we dont know. We need to better understand transmission. Like the Health Care Setting what is the risk and how do we reduce those. That is one of the biggest. In terms of the longterm we need to understand how does the vaccine worked how can these candidates potentially worked but to contain this epidemic so we could prevent another one. Is no major surprises with the things that we dont know obviously when you have a virus that replicates it might change some of the characteristics i dont think it will do something grossly but it could a bit the reason why you have to keep an eye on it and to develop a the countermeasures. The confidence to the point of American People a should not worry about it. But i should do the worrying not the American People. We will let you do thats. Thankyou very much. Dr. Fauci, dr. Goodman, dr. Sharfstein. [applause] that concludes our talk on ebola thanks to the museum during the talk in the night studio and here at the new cm thanks for your insightful questions and your participation. [applause] [inaudible conversations] we are delighted to have cspan and today we have the beatings think years and actors from the ebola crisis with us today and were delighted to welcome you here. Let me begin by introducing myself and the Vice President of the institute from Global Health and development this program is coasted bypass been Sister Program Health Medicine and science with them active doesnt seem to put this event do together were delighted to welcome you here today money introduce my panel and i want to jump right into the conversation there is a lot to be covered the with by to get your questions. To my immediate left the executive director of the African Center for Global Health and transformation and sits on the board of my organization and we have known each other about 10 years. One of the zero leading thinkers on Health Systems in africa and the First Executive director of the coble Health Work Force alliance and one of the up architects also own a the highlevel forum said chair for a Global Alliance independent review committee and as a graduate of the leading Battle School on the continent of africa and then to be recognized by the government and asked to be the director of medical services when they had the first Ebola Outbreak in 2000 so a number of incredible innovation in san accomplishments so lets have of round of applies. [applause] so delighted you traveled with us today we have the president of the World Medical association and is a Senior Consultant psychiatrist and to solve the crisis to work tirelessly them standards of care the regulation of doctors and with the community for this group and one of the leading doctors from africa away are glad to have you here today. In them have head of the board of said director for Network Development and integra and integration with the department of medicine in the medical and surgical Response Team with the department of health and human services. And then flee their Disaster Relief work the number of places all over the world like a very and chatted around the up Dominican Republic and also serves on the Ethics Committee at the hospital. From the university of vermont from the university of North Carolina and completed her in internal medicine at cornell. Just returned from liberia where she is the chair of one of the front line organizations helping to serve the current outbreak. Welcome. I would ask the panel is for opening remarks. We will start with you. But clearly these issues we have been asking for and praying for are now put on our agenda over in africa. Sue had been begging and shouting for african help. So from each and every country to embrace the population with the risks for the apparatus systems. We have had disappointments so basically they have told us unless and until every country the primary system for the Health Care Needs of the population you are at risk and exposing the whole world with ebola. That to me is from the courage Ebola Outbreak in west africa. Can you speak for a moment when you were leading the medical service and speak a little bit about that experience and what was different about that than what we face right now . Is in the year 2000 uganda had as big outbreak of ebola. It went back to nothingness but this epidemic we had the record for the largest outbreak 425 patients. 425. What happened is the diseased was killing people. High fevers and the doctor in the hospital called the ministry of Health Something funny is going on. Please come. So the next day the ministry sent people to with that site and they can back with specimens three days later with the diagnosis of ebola. As soon as the administrator of health care of it was ebola, we got the news about 2 00 in by 4 00 p. M. We had a new meeting with the minister of health chaired by the minister of health himself may got people to go into the internet to a understand why ebola was. And we also found because of the infrastructure that was already present in the country that the local Health Workers together with the government had already organized themselves and the people treating them were aware of that. You have to be careful to get this disease whenever it was. And from then on the National Task force commander daniel h. Joe came two weeks later but they came with new knowledge. And they do then another three weeks the cdc from here arrived and that was the first time they used it and it made our work so much easier because thou instead of taking specimens from suspected patients 400 kilometers away, it would just be made on the spot. Then we could say this patient is native to go back to the committee or this is positive. So there was a robust response. In the end, we ended depp with the response led by the communitys. Uganda had a lot of the upheavals that when we had settled down that system that was established in the country every village had a system of leaders and a takeover for the centers and then if the leaders do someone was not well theyve fled intervene. So it is the same people to transmit the message. And why has this not happened in liberia and sierra leone . I dont know. They need to tell us more but in those countries a group of them because of that experience of the big one we have a few more outbreaks but the number of cases was going down downtown. Because in the Public Awareness is now there. So i suspect to of those countries had just come out. And just 50 years after the big war. Is likely the local governments is not enough to Say Something wrong is here. But there is no system. And to also from what i hear there has been a lack of trust. I have emails from colleagues from the west african countries to say that population says it is the trick by the government Health Workers. And that needs to change. That needs to change to answer your question. But the focus should be on getting the communities themselves to stop it. Hospitals is good but the effort more than anything else so they dont carry on with practices to spread ebola then to not pick up those that are suspected with the Health System. So i am not quite sure of the investments if you compare community of reach. Out to reach them in developing today have we stopped it may answer is to get them mobilized for control. Thank you. Will also talk about your book and also francis you pointed the title which is who solves the ebola crisis. So let me turn to margaret. Doctor could you provide opening thoughts what is happening now and what should be done . Maybe dishes start with the correction i did say i handed over the president brian the immediate past president end the second african to hold the post since 1947 the first african woman to hold this post to be elected it is the association to present more than 9 million positions over the world now 110 countries all over the world. So i will speak as a Health Professional and i will say that the leadership is a concept and it shows that they show they a understand what it is about the proverb says the leader without followers is just taking a walk. So i think what he has been saying is to develop the of leadership and to talk about leadership in the Health Care Professions i keep saying says with the generals and colonels and that is what is happening on the african continent. But those Health Workers that should take those decisions outside day continent we just need to see those Young Professionals on the continent in terms of reassurance and it is another area to the healthiest countries where the professionals are scarce but those of us who were still there in the african countries the professionals who were there we are not being consulted by anyone. Decisions are made and no one says this should happen on the ground. There are a few of us there but i think that is happening to continue consulting. You speak about the whole community which is very important that the last case that we had was the one case in uganda that got infected. I was in charge of the Case Management and i prepared my staff for that Case Definition but nobody turned up because that one person had their contacts but what i want to say it did not take much resources by then it was controlled 21 days later so it was is costeffective so lot of money goes into treatment and Health Promotion and prevention. And dealing with this epidemic and outbreak is not to say that we a deal with this one but we need to move on to strengthen the system with disease prevention when elected africom as whole those countries are more developed with integrated diseases and emergency preparedness. There is more being done so we need to raise the profile in the west africa empire so ready to look at those systems as well. If anybody deals with this outbreak we should not think only immediate but also the mid term and the long term to strengthen the Health Systems to a greater disease surveillance. The queue margaret. Let me turn to you. Many in the room are afraid ebola will turn into a worldwide epidemic and phenomenon. You are immediately aware of what is happening right now. It was a 14 year civil war. And it destroyed communities and it destroyed family. And, you know, if one can imagine can country be left with a postherpetic stress disorder, i think it can be. So we are talking about a country where we have a president who is definitely building this country back. And we have gone in in our mission and it is really to reach this area and so we are supposed to come to the health center. And this includes professional staff of frontline Health Workers. And theres training, supervision, equipment, pay, ongoing supervision. And we have gone into an area thats 13,000 square miles 1500 square miles of dense rain forest and we have 100 coverage for childhood illness is right now. So its doable. So in liberia we are there. We are working with the minister of health under their leadership and then ebola comes and its changed everything. Weve got gone from longterm to being asked, could we now respond to be Ebola Response. But we are not disastrous. But we are there. And there is a moral imperative and we have a footprint there. So what we have done is the Health Care Workers, and we are working with ramping up the primary Health Centers in which most have been deserted and if you dont have the right equipment, we could talk about what is happening in the United States right now. So its understandable that we can bring them the education and bring them back to work and make this transition from the Community Health center to the primary health under to the major hospitals and ebola treatment units and we can get this under control. We just have to reach all the way into the communities as we were saying earlier. And so it wont happen just in the treatment unit. Can you respond to the question. That i didnt respond to . [laughter] yes. I do not think that this is going to be a worldwide phenomenon. And i think what so i think that we need to continue ramping up what is happening on the ground in west africa. And that is including many people in the United States are willing to go. I can speak to that end in one of the communities that we worked in, 20 other women are waiting and ready to be trained in an ebola treatment unit. This is in a remote area of liberia. It can be taken care of. What happened is that i think that we are seeing we are seeing such a fearful reaction in the United States. Tell us what is happening. Okay, let me just talk about the infection for a second. Its very frightening. I mean, i do not want to get ebola. Its a very frightening illness. But its very difficult to get it. So let me tell you that influenza, which kills many more people, is so much easier to get. Ebola, you have to have contact and i know that youve all heard this, but bodily fluids. So i want to be kind of graphic here. So you can envision a Mother Holding a baby that is vomiting or a sister or brother that is vomiting or we have children. But i think the this is what we have to understand here. And so if someone has this and has a fever and muscle aches with it, you cant get it from them unless they spit on you or Something Like that. But its not a very contagious disease in that way. And so i think the fear in the United States, we are being that if somebody has this, keep them away. Well, yes, we need to do appropriate management. And i will just circle back and hope that i have is all correct. But in the creamy units i was in and liberia, it was the best care and its well productive in the Health Care Workers have to be protected. And and standards have been set earlier do not include full protective gear and some of that takes place in texas, which is why the nurses got sick. But i want to address why it is okay for that good at injured of protective gear in africa and not here. Consolatory fine to me. The standard should be the same everywhere. Let me ask you. Are you worried about all of this will take attention away and people will say that this is hopeless, that theres no ability to address it. What is the narrative that you want people to understand about how to stop this . I think that that is a good question and i think that the thing that im trying to say is yes, this is frightening. Yes, this is serious, and yes, we can take control of it. We can absolutely control this. And the issue is we need to have people like you support getting resources into the communities and that we develop our Health Care Workers and i will just put in a plug that we are following this up very quickly with primary health care with teaching in our community Health Workers. This is not a dropin thing. Because it will be back in a couple of years. This has to be a full continuum of managing this. Thank you. Let me ask all of you this question. I was imagining that this was in october. But you said actually it began at the end of 2012 and the first identified cases were in march. So seven months later. So how about understanding what happens and why this was not enough to allow countries to address this. [inaudible question] thats right. Again, we go back from this with primary health care in and started mainly at this place and far away from the capital. And so then what happens the message is that if we are looking at creating us, but we are looking to protect the americans and australians and the chinese, that we should focus on investing in primary health care so that in each and every country we have [inaudible] and this includes handling an outbreak both infections like this on those that were diagnosed. We wouldnt care as an International Community. It is doable. This is the world organizing and ensuring that each and every country is able to help the people. In respond to that question as to how things have gone wrong and what more should the International Community be doing now and what should we look at doing . There are three countries that we have told her about and theyre not the only countries heard and we need to recognize this [inaudible] that their countries that we were able to watch deal at this and i think that we need to do a bit more in terms of finding out exactly why the other countries are around there and they have the same situation. And i think never has the crochet Global Village been more real and when you have a village and [inaudible] it is certainly the other side of the image and i think that clearly the need for us to look at the world as part of this. And the other thing is the information. We should not take it for granted that anyone has that information. And we need to make sure that this is the Communication System and its the same situation when we first had this problem. And so when this is the case, its very important. So we need to make sure we have this information and its everywhere in the world and everyone has this. That is a very good point in communication. Because it depends on what you need to know in what you believe and this includes the Communications People as well. And this includes part of this that is very strongly [inaudible] and we saw this yesterday in this country [inaudible] and so it is like this. [inaudible] the minister of health has indicated this as well. That is the correct one and we are sort of like watching the international tv. And so where is the president of liberia and so we had a lot of International People under the command of the government of uganda. And this was you know, it was okay. But they couldnt compete with that with the opinions of the country and that could be one of the problems that we have been. Where are the local people . Because it also increases this in my opinion is basically that we should support local leadership and local communities. Because you cant say that we are not there. This is a great moment for us today. Doctor nigel crist, he is ahead of the uk health am and why did you write this but . And why did you want to name this discussion today . Yes. Well, the book is about making changes and claiming the future. And a lot is happening in africa. A lot of things that we can talk about. So we have that situation. One of them is an englishman and the book has [inaudible] who in some countries have made a difference using their own communities as an example in this includes the way the west works in the world. And so that includes the Vice President as she engaged to get women and be a part of this where women can come and wait and so on and so forth. And so in 2001, america was there for africa. Because the drugs just take time. [inaudible] and they said it was not that. So we have done it in moderation in regards to help in africa. But that is because of the determination and commitment and it was a study with the Prime Minister and others. They were independent, and so its starting to be a part of this and now that program has done so well and you dont have to have this because in some countries it can be a part of this. [inaudible] so that is my message. Its this sort of thing. And this is about us. People like you and me. And we know so much. Like we believe in the book that we have let our people down. And the leadership that we should be showing has been wanting. And that is what i call them in the book. Asking them to step up. Africa now is a different africa. And this includes two forces. One is transformed to the eu, which is more than also zerotolerance. Its not allowed. Until because of that it is time for people like margaret and me and some of the africans who are here, lets get up and lets show leadership. And that includes the situation in liberia so on and so forth. And so the people who can lead our fantastic in this includes institution in each and every country and this is people like me and others who are becoming transformed. And we need your help during this time. The book is for sale. And im going to leave enough time for q a. Margaret, i believe that we cut you off and i want to apologize. Talking about leadership, talking about the political leadership, in this situation i think this is what happens in that it is one thing including with what we should have done in this country. And its more in terms of stepping up. And also in the african government, it is the implementation as well as leadership and we need the implementation to happen. And so i think that this is part of this country. And Everything Else is part of this. And so we will talk about this. And i was just saying that the african government has agreed. And its a great tradition in this way. And so in a way you are trying to deal with this and you are not engaging in the community and you are not going to be able to get through this and therefore that alone shows another weakness of the system. So i come from a country of 46point people and we have countries in africa in this way. And so this is a big situation. And so the Health Problems relate to this. And so we are working towards the traditional system that they believe that they have and so we need to put forward a little bit more money into the health of africa and make sure that we have services for people and to be able to work on this. Lets go ahead and go to questions. We have microphones. One on this side of the room and one on the other side of the room. Please come over and tell us your name and your organization, please. Thank you. Rosemary from the dc historical society. You said that again it could be another year. But i was going to ask, i was told that there are specific concerns the disease come if you have a clear idea of which animal would catch the disease among you think this will happen every couple of years two by the return . Okay, thank you. Would you like to take that . I will start with that and if you would like to jump in. You know, it was originally traced to a bat. And it comes from an animal. And in some of the areas of guinea, it is called bush meat. And now it is actually more persontoperson and there has been and that does exist and so at some point we will come up again. It seems that a resident in the animal population somewhere along the way, humans will get in contact and pick up the disease. And up to now ebola has been an endemic in Central African regions. Uganda, south sudan, and so forth and so on. And we have seen what this is in west africa. And it is going to be there now. And its a matter of ups and downs in countries like ours should be prepared for it now. I would like to just say that there are other issues like the environment in terms of of this and theres a bit more with that happening in terms of getting near to where these animals are. One of the recommendations of this include what they call integrating and linking Animal Health Surveillance Systems and uis talk about this before it people began to die. And there was the Animal Health in that area gets evaluating before we do. So we should recommend that of the two. Let me take a few other questions from the back. Please tell us your name and your question. Okay. Next question . Eskimo here on the site. This gentleman right here in this woman. Lets take a couple questions. The gentleman in the roman and the woman in the row behind that. Hello, i work in a Company Based in washington dc and my question is what are some of the challenges in the supply chain that are going on in terms of you being in liberia . So what is happening in the supply chain. Okay, please go ahead. Hello, i am kathleen, im an educational consultant. I would like to know how are these traditional medical people and are they supportive and do they have authentic information since this is the first person that infected people go to see. A few. Thank you. There is a question also write your. Hello, i am doctor susan blumenthal, former United States Surgeon General. Theres been two dozen outbreaks of ebola. Were the lessons that we have learned new Taco Bell Community outreach and Community Workers and how did they work. And so number two, there are people who have been exposed that have not developed ebola. Further other things being formed by some of these people, do you think . And then we will have one more question over here. Hello. I have a question. You seem to think that someone can contract ebola affair saisons by an individual that has a virus. Doctor black, you seem to think that that is not a concern and that you would have to be thrown up on or have diarrhea on yourself to contract this disease. And so it seems very drastic here. So it happens so infrequently, so that would be a major concern and almost make the disease airborne. The first, what are some of the challenges in the supply chain and then traditional medical personnel, are they useful or not in this tuition. Third question is what lessons have we learned in terms of contagion. So lets begin with those questions. Sure, i will start with the traditional things because that is something that we work with in liberia. Another they usually operate with their own traditional systems and they have not as a rule integrated as to what has been known as western scientific medicine. And so this is why it is so foreign that we actually in the Community Reach out to the traditional healers and to the religious leaders. Because those are the people that will inform the community and have the trust and the communities. And that is part of what we need to do. Because fear right now is driving so much of what is happening. And people are able to go to the ebola treatment unit is they dont understand what is going to happen to a Family Member, they are separated from them. And they are afraid that if a Family Member dies this is a very culturally and religiously sad thing to happen to a Family Member. And so i think that they really arent part of the system. Okay, lets keep going on now. But on. This is practiced by the people and they actually help the people. Otherwise no one would be using them at all. Particularly we have a psychiatrist with that. And this is a practice which is part of communication for the patient. Which is very powerful. And so another point which i think margaret was pointing out here. The african unit itself, together with w. H. O. Has plans to integrate Traditional Health system to the normal Health Systems. And it can vary from country to country and the platforms within this in the message as well. [inaudible] to integrate the traditional Health Systems so that we are one system. Okay. So talking about this we talked about three months of tradition and we fought alongside the tradition and this was intended to change our attitude towards them and therefore that needs to happen as we integrate into the Education System so we can work alongside each other. To the traditional healers in the countries have the information that they need right now . If you havent been apart of the system and youre out there and you cant get to them, i aint bad theres a lot happening in many countries and we are working a lot here. Thats right, and it needs to happen. What other challenges . The first is this having enough materials that we need and the agents for the blood testing and then we start to deal with how to we get them out to the remote areas. And its about 350 miles and we can make that in about seven or eight hours. And so what happened to her colleague last week was they started and went off the road and they had to spend a night in the truck and then in the middle of nowhere in the next day locally another truck came by and pulled them out and it was a twoday journey. So imagine if you are sick and you need to get from one place to the next place. And so the supply chain is an area that really needs to be addressed aggressively right now. Especially to getting materials out. What would be your one recommendation for people who want to support . One is contributing to requesting supplies to go. I dont think its a good idea to say we have this, is, why dont we go around and send them. But to find out what is actually requested and needed, and then you go on through and there are a number of Good Organization getting the material over there. Thank you. And the next piece is supporting Ongoing Development about the infrastructure. Telecommunication and we need those support systems from those areas with telecommunications right now which are too small and most of the calls are getting dropped. Lets talk about teasing and contagion. You have to get in contact with this at the time when the disease is active. So if i sneeze i will be contaminated and infected and it can can emanate and in fact. And this includes how she has indicated its more graphical. But lets are key that ebola is not contagious. And so myself you can see here what i am talking about. Okay. [inaudible conversations] the fact that you are still here brings back that question about antibodies. And i would like to just talk about that. It made me think about that. Okay, so i think this antibody question is a very good question and i dont have data on that right now. That is one of the things it is imo that in addition to investing in looking at ways before someone becomes symptomatic and that is something that is incredibly helpful. So is this part of the diagnosis. But we want to know that the people who have had ebola and have survived and developed antibodies, we believe that they are resistant to the disease for about 10 years. And so shifting a little bit to the stigma of this which is so profound. We are going to Start Talking about people that have had ebola. What better person to come help work with us than someone who has experience that the season has antibodies against it and what would that do to their stature in the community that they are an esteemed Health Care Worker. Are there any other questions in a. [inaudible conversations] please go ahead. [inaudible question] okay. [inaudible question] how do we think that we are protecting people . [inaudible] on me just say that i aint dead we need to talk about Infection Control because if you look at this situation, the fact that it is more than just even that. And we are being cautious at this thing can happen. So what we have done is that somebody has something that might be part of this. And we have immediately a system with what we have in the contact and anyone who can be a part of the contract. And so we check on them in this situation in terms of contact cases. And that includes the awareness that you have to have to make sure. Its much more easier, its cheaper and its something that the media can do. And so you need to have skills and you need that. [inaudible] and also having a community or a population that understands what should be done. Yes. There are ones that play a key. And every country needs to have where the Health System as an we will be able to know that the funny thing is up in this area and that is one. And then in the case of ebola and other situations [inaudible] and its important. And that seems obvious. Once an outbreak takes place, a better action needs to take place around indication and then around isolation. Whatever that includes heard and even when we know what to do. We dont always match. And that includes the ropes of management and government a lot and so that Government People did and that includes how this works in the health situation. And that happens. And the people who died need to have someone who cared about them. And so then we have these areas. And that includes him we had that outbreak. [inaudible] and so when we were at one of the funerals, there is a gentleman who is speaking. This is part of this as well. We even have a department of men and its very striking to me. We have the same situation. And we have a number of question please state your name and affiliation. Hello, i am from the center for Science Technology and i heard that theres another outbreak and that includes [inaudible] and is there an other example related to culture and is there another solution about it . Lets talk about the gentleman in the white shirt and then we will go over here. Yes, hello, i am part of the international committee. At least 70 members of congress have opened the support of a travel ban from the area. Can you just cant talk about the effect of the travel ban of the area on the disease . Hello, my question is very short end of for building this, lets talk about widespread corruption. Would you say . Widespread corruption. Okay, this gentleman right here two. Am wondering what adjacent countries are doing to fortified the Health System and has been a part of this . We had a handout haired. See that yes, please. Tell us who you are. We are talking about the african Health System. My question [inaudible] [laughter] are you from their . Ive looked in their in regards to seeing how we are prepared in this case. And we are need to be prepared to deploy this and try to reform. And [inaudible] we have a weak Health System. And so this is lots of this in regarding to the disease. So its a good system and we had talked about how this disease will come. But we have been looking at this as hard as an advocate for Breast Cancer and nobody put money in the Health System. So this is something that we need to think about. So it responded in this way. Why . Because we have the Human Resources in place in that system and it can be done in this region. And a some people die in regards to this disease. But we need to talk to the community so that we understand the situation. Because this is a practice that we have been using for ages. Communication and talking with the community to get their trust is part of the key. Thank you so much. I think that we all have a couple of restaurants and we only have a few minutes to close this round and the first question is about the travel ban and then we have hounded situation will affect this. And the fourth is from adjacent countries and how that affects that. Would you like to respond to restore anyone else up their . Again, i can not respond the mall, but ill start at the top. I do want to be there and not make it sound like it is crazy. And this is how people care, this is how they honor their amway. And so this is not i want to be very careful as we describe this death rituals, its not something that is very bizarre. Its the washing of the body which is a ceremony. But i think you said it very eloquently. It is the education engaging religious leaders and people need to know that if they dont do that, their mother or father or child, brother or sister, they will be okay. And they are not deserting him. And i think that that is part of how i would answer that. I also want to Say Something about the corruption. Corruption is everywhere. And it isnt just over there. Corruption is everywhere. And i think it does need to be dealt with and the way that can deal with it is simultaneously the strengthening. And you cant just get rid of corruption and bring Something Else then. Its a simultaneous prospect. Until the question is a good one and many people have asked, is it just went onto corruption and i dont think that is the case with the situation at all. But i do think it is a good one. We are running out of time and we want to talk about the travel ban. Can anyone respond to the effects of the proposed travel ban in africa . I would like to talk about a number of countries and when you go to this airport, every Single Person is helpful and we feel comfortable about that. I think that when you start this that comes from west africa and we have individuals going to south africa, to europe, and the other thing is because of the nature and that you take these days. And by the time you get to washington, you now. So the other thing is that we do need help up there and so we need to be able to go and come out and do this. Okay. Quickly because we are out of time. Okay, i think that we do know that it is part of the Health System and it goes into corruption. And the thing is as we talk about tradition in government and the government sector, we must make sure that it continues to be part of the official groups. Thank you. This book even about the way you approach the question, lets start about this. They are all corrupt and nothing would change. And they are very good things happening in africa and we are about strengthening everything, including addressing corruption. And i beg you not to repeat the question. I will not get a question. Thank you. We will need to bring this to a close. I would like to ask the asked the panelists to say one thing that they are hopeful about one thing that you would ask anyone in this room. Very quickly. Im very hopeful that we will address the ebola epidemic because there are people like you in the audience who will do what you can in situations like this that you can do to help this and i am very grateful. And im so grateful for the liberians that i have worked with. And if you want to hear about role models and people that will inspire you and will bring you to your knees with the work that they are doing, that is what really gives me hope. Thank you