ER life, from a nurse working as a lifeguard in the shallow end of the gene pool.
Monday, December 22, 2014
Paradise, Bitchez
For the first time in two decades, I got the holidays off for personal vacation. (Seniority, or the gods of random fortune, thank you).
Consequently, by the time this goes up, I'm sitting on a beach much like this one.
Just because.
Happy Holidays, &c.
Back after New Year's.
Tuesday, December 16, 2014
@$$Clown Of The Ides: Chuck U Very Much, Senator...
The real motivation for all that Ebola preparedness comes out:
(PORKVILLE) -Senator Chuck Schumer on Monday called on U.S. secretary of health and human services Sylvia Mathews Burwell to recognize the enormous amount New York hospitals have spent preparing for and treating the Ebola virus, and use some of the money she was given by Congress to reimburse hospitals for their expenses.Try and look surprised at the prospect of a Democrat senator trying to shove both arms armpit deep into the taxpayers' pockets and keep everything he can get his hands on.
Burwell has 30 days to come up with a spending plan for the $733 million her agency received from the latest continuing resolution, a $1.1 trillion spending package that allotted a total of $5.4 billion to combat Ebola.
Most of that money is headed to West Africa, where the epidemic continues to claim thousands of lives, but some can be used domestically.
Schumer said he would like New York hospitals to receive roughly $50 million
“I am urging secretary Burwell to make sure all of New York's institutions are completely reimbursed for their funding,” Schumer said at a press conference today outside Bellevue Hospital. “That was the purpose of the fund when we push for it and created it.”
Mayor Bill de Blasio has already reimbursed Bellevue, a part of the city's Health and Hospitals Corporation, $20 million for the expenses it incurred when treating Dr. Craig Spencer, the physician who contracted Ebola while working with Doctors Without Borders in West Africa.
But other hospitals have spent tens of millions of dollars preparing for the virus, Schumer said.
Montefiore has spent approximately $7.5 million building a biocontainment unit and training staff, Mount Sinai has spent between $7 and $8 million, and New York Presbyterian has spent roughly $3.3 million, according to Schumer's office.
Ken Raske, president of the Greater New York Hospital Association, estimated the ten Ebola-designated hospitals in New York have collectively spent between $50 million and $75 million on capital construction, the purchase of protective gear and training.
Webster's Dictionary could save space by consolidating the entry for Chuck and the entry for chutzpah. Or at least using the same picture.
Like Getting Ebola Wasn't Bad Enough
Kenema, Sierra Leone (Al Jazeera )- Massah Kamara sat patiently with her brother Momoh, her haunted eyes focused somewhere in the middle distance beyond the walls of the post-Ebola clinic.
Three months earlier, doctors gave her the good news - after weeks of fighting the disease, she had finally beaten Ebola. She would live.
Back in her home neighbourhood of Nyandeyama, a quiet suburb of sandy streets and mango trees, she found out 22 members of her family were dead, including her parents. She had no money, so was unable to go back to her tailoring business, and many of her possessions had been burned by terrified neighbours.
Then, just when she thought things couldn't get worse, she began to lose her eyesight.
"My eyes are dark," she said sadly. "Even when the sun is shining, my eyes are dark." Kamara said she was happy to have survived Ebola, but fear and misery were etched onto her face.
Kamara is one of 40 percent of Ebola survivors to have gone on to develop eye problems, according to a recent study carried out by the World Health Organisation and Kenema's District Health Management Team. It has been more than a month since the district saw it's last case of Ebola, and attention is turning to the plight of survivors.
The results of the survey, a copy of which was seen by Al Jazeera, outline a raft of physical, social and psychological problems the survivors are experiencing.
Seventy-nine percent, for example, now suffer from joint pain; 42 percent have problems sleeping, while more than one-third of those surveyed experienced peeling of the skin. Many others reported problems with their reproductive system.
Post-survival effects
"There is so little written about post-Ebola problems," said Maggie Nanyonga, a WHO consultant working with Ebola survivors in Kenema district. "We don't know if it's the drugs that are causing it, or the disease, or just stress."
In a small room at the government hospital in Kenema, now known simply as "Psychosocial", volunteers busily transcribed forms with survivors' complaints. "Serious backbone pain. Difficulty breathing. Properties burned but not replaced," reads one.
"Ear and joint pains. Poor health with red eyes," reads another.
"Tired legs and weakness. Cannot see clearly," reads a third.Health education officer Michael Vandi said the eye problems are of particular concern. "We just weren't expecting this. A lot of them are experiencing it, often combined with headaches," he said.The head of the hospital's eye department, Ernest Challey, said he believes he has found the cause - a condition called Uveitis that occurs when the innermost coating of the eye becomes inflamed.And it gets worse, according to the rest of the story: the locals treat survivors like pariahs, having burned their few belongings, and shun them afterwards, so they're left with no place to live and no job, as all the health problems pile on.
It is triggered by problems with the immune system, a viral infection, and sometimes trauma, he explained. It leaves patients with dim and blurred vision, and pain when they're in bright light. If left untreated, said Challey, it can lead to blindness.
But the physical symptoms are just a part of the immense challenge many Ebola survivors face. "Sometimes I cry when they tell me their stories," said one nurse after writing down Kamara's details in the post-Ebola clinic, the first of its kind.
There's never been a post-Ebola clinic, because historically, the Ebola Survivors Clubs have usually been able to meet in a phone booth.
But with a few thousand survivors this time out of at least 20,000 victims, medical science is getting a new chapter in Ebola treatment: follow-up prognosis for survivors. And it isn't pretty.
Not least of which because what little assistance is going there is aimed at trying to curb the actual outbreak, not deal with the aftermath.
We never had to do much of that before...
Monday, December 15, 2014
Some People Don't Know When The Music is Over
"Can I just get five more seconds in the spotlight? How about four? Okay then...three...?
Speaking of Slow Learners, today's NPR blast of woulda-coulda-shoulda:
Speed. That's key to ending the Ebola epidemic, says the director of the U.S. Centers for Disease Control and Prevention.
Dr. Thomas Frieden is visiting West Africa this week to figure out how to reduce the time it takes to find new Ebola cases and isolate them.
Otherwise, Ebola could become a permanent disease in West Africa.
"That's exactly the risk we face now. That Ebola will simmer along, become endemic and be a problem for Africa and the world, for years to come," Frieden tells NPR. "That is what I fear most."
Frieden plans to spend several days in each country where the virus is still out of control — Guinea, Liberia and Sierra Leone.
The biggest challenge right now is in Sierra Leone, he says, where the epidemic shows no signs of slowing down. New cases continue to rise exponentially. Last week, the country reported nearly 400 cases, or more than three times the number of cases reported by Guinea and Liberia combined.
Since February, there have been nearly 18,000 reported Ebola cases globally, the World Health Organization says, with more than 6,000 deaths.
But Frieden is still confident that the three countries can eventually reach zero new cases and end the epidemic.
Why?
Because the world has stopped every Ebola outbreak before, Frieden says. "Even in this epidemic, we are stopping individual outbreaks. The challenge is doing it at a scale and with a speed that we've never done before."
When Frieden visited West Africa last time, in August and September, the disease was "raging out of control in Monrovia," he says.
Since then, the epidemic has slowed down in Liberia. "But we haven't been able to get it under control," he says.
"As the weeks have gone by, we have been able to intervene faster [in Liberia]," Frieden says. "We've found that we can stop outbreaks in weeks instead of months."
So a hot spot in one town or county ends up having only a handful of cases instead of hundreds, he says.
Now the CDC and international aid groups need to figure out how to do that in Sierra Leone.
But even then, the response may not be fast enough. All it takes is one sick person to travel to a vulnerable town and ignite a new hot spot. That's been happening in Guinea for months.
"It's not like a forest fire, so much," Frieden says, "as a country full of bush fires in different places."
Tom, check your spam filter: President Obola sh*t-canned you back in October, when he appointed Flounder to be the new Invisible Disinformation On Ebola Czar. The memo you missed is probably in there.
So, a few pointers:
* If you've noticed a lot of space on your Day Planner lately, it's because you're officially dead in D.C.
* The first hurdle to tracking Ebola contacts in West Africa, is getting the countries involved to admit that they have them. When everybody admits that there's a "fudge factor" of between 2 and 200 to multiply official reports by, going back to, oh...forever in this outbreak, that's how many cases you'll never track, times the 10-100 contacts they create.
* The second hurdle would be teaching 20,000,000 people there how to count. If the illiteracy rate there was the growth rate of GDP, they'd all be driving Beemers and flying in Gulfstreams. As it is, they wear sandals in case they have to make change for a quarter.
* Ain't nothing happening there on a Western "right now" time frame. They make "island time" look like a FedEx Distribution Hub. "Just in time" in West Africa means "order three years in advance, double the needed amount, and keep a slush fund handy for last minute bribes, and there's a 60% chance we'll have this no later than a month after you need it."
Seriously, dude, try talking to any of your own people there about this.
* Once you tackle those paltry problems, you only have to get past two or three other minor details:
The cultural hurdles of a grabby/touchy/feely society
The religious hurdles of inshallah and the associated local burial rites and customs
The scientific hurdles of taking a country to accepting scientific germ theory accepted here since Pasteur, in one where this month 50-75% of the peoples there are more likely to believe that what's killing people is curses and witchcraft than "Ebola".
If you look closely Tommy, you might notice how curiously similar all that sounds to the phrase "nation-building". Something Britain and France couldn't do there in centuries. Maybe there's no TV in your lab or office, or you're more of a theatres-and-symphony kind of guy, but that phrase doesn't have quite the cachet now that it might have had in, say, 2003.
So why don't you respond to one of the 47 e-mails that career recruiter has been sending you for the last 8-10 weeks, and see about updating your resume.
You've "solved" quite enough geo-political epidemics for one lifetime, I think, and maybe you should get a new hobby to fill your golden years.
Oh, and nota bene, careful readers, that NPR and Frieden himself are still describing this outbreak as "out-of-control" in no uncertain terms, in all three countries.
Slow Learners Pay The Price
GENEVA (Reuters) - The failure of Sierra Leone's strategy for fighting Ebola may be down to a missing ingredient: a big shock that could change people's behaviour and finally prevent further infection.
Bruce Aylward, the head of Ebola response at the World Health Organisation, said Sierra Leone was well placed to contain the disease -- its worst outbreak on record -- with infrastructure, organisation and aid. The problem is that its people have yet to be shocked out of behaviour that is helping the disease to spread, still keeping infected loved ones close and touching the bodies of the dead. "Every new place that gets infected goes through that same terrible learning curve where a lot of people have to die ... before those behaviours start to change," Aylward told Reuters.The WHO's death toll from outbreak has climbed to 6,583 but the actual figure is likely to be far higher due to under-reporting of cases. The flare-up in Sierra Leone's capital Freetown and the country's more heavily populated western areas resemble the massive infections suffered in August by Liberia's capital Monrovia. "In Monrovia you had bodies on the streets, you had a riot, you had someone shot - awareness went through the roof in a very, very short time as a result," said Aylward. "You don’t want to see that kind of thing drive public awareness but it has an impact very, very fast. People changed behaviours in Monrovia - bang! Like that." Mali also learned through a shock. Just as it seemed nobody had been infected by its first Ebola patient in October, another cluster of deaths sprang up the following month. Aylward said he told Malian officials that the only way to stop the outbreak was to trace anyone who may be at risk. "That’s when the contact tracing... took a jump from around 60-70 percent completion to 98 percent," he said.Denial and ignorance are part of the problem but a weak healthcare system and logistics also play a part. Officials in Kono - where an explosion of infections was discovered this week - said the eastern district of 350,000 inhabitants had only one ambulance and no Ebola treatment centre."The forest area of these three countries has got some really special and concerning practices, where they share meals with the corpse, where they sleep with the corpse," he said.Some areas of eastern Sierra Leone that were hit hardest early in the epidemic -- around the towns of Kenema and Kailahun -- have seen a massive reduction in case numbers as people change behaviour. "The areas that are now doing badly are the areas that were affected last. They are still on the learning curve."
Amazing to hear the UN official in charge of the entire WHO response wistfully longing for the more resposible parties to shoot few stupid people to get their attention, but there it is, and in print.
And short of that or massive die-offs, currently in progress, about the only thing likely to wake them up.
And as noted by commentor geoffb, the lesson fades from view overnight:
ABUJA Nigeria (Leadership) -The declaration of Nigeria as an Ebola-free country by the World Health Organisation (WHO) in October has prompted many Nigerians to discontinue the practice of maintaining a good level of hygiene as a measure of containing the Ebola Virus Disease.
From schools to banks and other public places, the strict measures of screening for signs of the disease put in place while the outbreak lasted between July and October, have fizzled out in most places. Most Nigerians are now living a care-free life because, according to them, Nigeria has been certified Ebola-free by the WHO, which means there is no cause for alarm.
Hopefully Ebola got the same memo, or the remedial course is going to be a bitch there.
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