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7 Ebola and Acute Disruptions
Pages 51-74

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From page 51...
... In this instance, the most vulnerable being an infant born to a mother who would die of Ebola only hours after giving birth. The discussions that followed, at Patterson's urging, grounded the conversation in the full range of complex issues that the vignette highlighted as a way to move the conversation beyond child survival to thriving and also looking toward the future.
From page 52...
... Betancourt's longitudinal study began as the civil war was ending and sought to identify risks and protective processes in children's psychosocial adjustment and community reintegration to inform programs and policy. Betancourt and her team began their work with qualitative studies to glean information on how individuals think about constructs related to parenting, risk, resilience, and child mental health and development given the context in Sierra Leone (Betancourt, 2010; Betancourt et al., 2010a,b,c, 2011, 2013)
From page 53...
... investigated mental health and protective factors in children across three groups: those who were HIV positive, children who were affected because a caregiver was living with HIV, and unaffected children. Finding depression and mental health issues in both the HIV positive and HIV-affected children compared to the unaffected, Betancourt's team sought to build interventions based on existing resources at the individual, family, and community levels.
From page 54...
... Taha also presented a hypothesis that explains how EVD moved from the remote jungles of Central Africa to West Africa in the most recent EVD outbreak. The hypothesis he presented indicates that Ebola has always been in West Africa and misclassified as Lassa fever.
From page 55...
... The most recent EVD outbreak resulted from a single unspecified animal reservoir to human transmission event in Guinea (see Box 7-1)
From page 56...
... LESSONS LEARNED TOWARD BUILDING RESILIENCE Janice Cooper, Country Lead of the Liberia Mental Health Initiative at the Carter Center, provided her perspective on service delivery after the recent EVD outbreak, particularly related to mental health and disabilities, where in Liberia there are few trained mental health providers. Cooper was at the frontlines of the Ebola crisis as the country representative to the Liberia Mental Health Initiative of the Carter Center, which had three initiatives in Liberia involved in the Ebola response (see Box 7-2)
From page 57...
... . More than 95 percent of live births were to mothers who received prenatal care, however, even in these cases only 56 percent were at health facilities (LISGIS et al., 2008)
From page 58...
... According to Cooper, water and sanitation issues were quite prevalent in Liberia prior to the EVD outbreak, where open defecation remains a problem, as does access to safe drinking water. In terms of access to quality education, Liberia continues to have some of the lowest numbers of qualified teachers in sub-Saharan Africa, and only 35 percent of eligible children attend primary school (World Bank et al., 2013)
From page 59...
... Coordination largely occurred in subcommittees, one of which was focused on child protection and another on creating an EVD survivors network. Cooper elaborated on some of the collateral damages that were particularly impactful on children during and after the EVD outbreak.
From page 60...
... She argued that in the case of Liberia, the EVD outbreak has been used as a leveraging point for charting a more robust course for children in the future. Cooper noted that the Carter Center hopes to work with and build on efforts by other actors working in the early childhood space, such as the Open Society Foundation that worked with the MOE to craft a progressive intersectoral policy on early childhood development (ECD)
From page 61...
... Coutinho highlighted the ongoing collateral damages suffered by children across the areas of physical and mental health, social protection, education, and nutrition, particularly the disruption in health services that attend to the needs of children. While schooling resumed, Coutinho warned that the global health community does not yet know what the long-term impact will be on child outcomes, especially nutrition given the lack of agricultural activity in many countries during outbreaks.
From page 62...
... EFFECTIVE TECHNOLOGY APPLICATIONS TO INFECTIOUS DISEASE THREATS Steve Adler, Chief Information Strategist for IBM's efforts in the recent EVD outbreak, framed his perspective as an "outsider" insofar as he claimed to be a technologist, businessman, and process oriented rather than a child expert. Adler focused on his involvement with creating open data (see Box 7-4)
From page 63...
... What was clearly needed during the EVD outbreak was information, noted Adler. Adler organized an Ebola open data jam in New York where Liberian and Sierra Leonean expats living in the metropolitan area participated by scouring the Internet for available public sources of information about the EVD outbreak and then assembled this data in one place where any aid agency could locate and access it.
From page 64...
... Adler urged all workshop participants to keep the dialogue going with regard to inventorying capacity in countries globally and to also publish the information online in open data forms so that the actors who may respond to the next global outbreak will be able to take advantage of the information in the future. CHALLENGES AND OPPORTUNITIES FOR AN INTEGRATED RESPONSE Arnaud Conchon of UNICEF prefaced his presentation on challenges and opportunities for an integrated response by surmising that discussions from the workshop seem to converge on agreement that integrated interventions are what need to be done for early childhood, because of the complexity of children in situations of acute disruptions.
From page 65...
... NOTE: FAO = Food and Agricultural Organization of the United Nations; IFRC = International Federation of Red Cross and Red Crescent Societies; IOM = Institute of Medicine; UNDP = United Nations Development Programme; UNHCR = United Nations High Commissioner for Refugees; UNICEF = United Nations Children's Fund; WFP = United Nations World Food Programme; WHO = World Health Organization. SOURCE: United Nations Office for the Coordination of Humanitarian Affairs (OCHA)
From page 66...
... Worse, recounts Conchon, is the impact this has on individuals because they become susceptible to answering questions and being assessed by multiple organizations over the span of a very short time, raising expectations of those participating in the inquiries and assessments. In 2006, John Holmes put into motion the Humanitarian Reform, which included an 11-cluster approach to coordinating emergency response by area of expertise, stated Conchon.
From page 67...
... By doing so, these linkages point to where certain services can be delivered through each representative sector and highlight a point of contact who can then take responsibility for transferring knowledge and resources between the cluster and the needs of children on the ground. FRAMING POLICY GUIDELINES FOR CHILDREN IN ACUTE DISRUPTIONS Zulfiqar Bhutta, Robert Harding Inaugural Chair in Global Child Health and Policy at the Hospital for Sick Children in Toronto, and founding director of the Centre of Excellence in Women and Child Health at
From page 68...
... Bhutta noted that the breakout groups provide the space to discuss the latest learning from experiences across recent acute disruptions by considering existing guidelines and strategies for children in emergencies as a starting point to perpetuate awareness within those existing strategies of the importance of the protection of women and children and interventions that can promote and protect child development. Bhutta encouraged the breakout groups to move beyond the existing strategies to propose policy guidelines that also identify state actors and actors within the humanitarian response teams that need to consider different time periods, starting from an acute response to stabilization and to restitution of services in the aftermath of such disruptions and disasters.
From page 69...
... These individuals emphasized how important it is for communities to have the ability to self-report and to contribute this data toward national data collection efforts. Other Breakout Group participants also stressed the response phase needs to pay special attention to vulnerable populations be cause they typically are the ones that face some of the most challenging issues during natural disasters.
From page 70...
... In addition, these same Breakout Group partici pants noted there is a need for coordination of governance and finance in other sectors to better align democratic processes with health and education sectors and to respond to the needs before a conflict arises. During this discussion, several Breakout Group members emphasized capacity building within the government and among civil servants, in addition to strengthening existing platforms.
From page 71...
... To place primacy on community leaders and capacity to ensure an integrated and culturally and child-aligned response phase, and thinking about the response phase in the short term as well as the longer term
From page 72...
... Valerie Bemo, Senior Program Officer responsible for the emergency response portfolio within the Global Development Department at The Bill & Melinda Gates Foundation, provided some of these key distinctions for workshop participants. She indicated there are key differentiators among the three types of emergencies that need to be considered for particular emergencies surrounding natural disasters, conflict, or outbreaks.
From page 73...
... In addition to these distinct characteristics of emergencies made by Bemo, Adler encouraged workshop participants to consider the confluence of disasters in the future from climate change where there is inherent conflict that will arise from resource scarcity and food security issues. Adler stressed that it will be imperative to apply the lessons learned from previous emergencies to a new type of acute disruptions that will pose a threat in the future in a very changing global climate, including its impact on emotions, politics, and power.


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