Celebrating World Health Worker Week (April 5 -11, 2015), a new story map from Esri, The Earth Institute at Columbia, and Direct Relief, aims to raise support and awareness for the life changing contributions of community health workers.

In dozens of countries, tens of thousands of women and men get up each morning to travel miles over rough roads and across rivers and streams to provide primary health care in some of the world’s most remote, vulnerable, and hard-to-reach places. At any given moment, these people, known as Community Health Workers (CHWs), are monitoring Ebola contacts, counseling an HIV-positive person, surveying basic health needs, or helping a newborn at risk of pneumonia.

On Front Lines of the Ebola Crisis

When the Ebola epidemic swept through West Africa last year, international organizations had difficulty establishing and maintaining community trust. Community Health Workers, many of whom are from the communities they serve, stepped in to bridge the gap. Not coincidentally, the organizations with the most durable results to show also relied extensively on CHWs for case tracking, diagnosis, sensitization, referral, and follow up. Such groups include Partners in Health and Last Mile Health in Liberia, UNFPA in Guinea, and Medical Research Centre (MRC) and Wellbody Alliance in Sierra Leone.

Arguably, CHWs are the key for the countries now rebuilding their health systems to be more comprehensive, effective, and resilient following the shock of the Ebola epidemic. They may also be the best defense against a repeat of these events in the future.

Beyond Ebola: One Million Community Health Workers

While the Ebola epidemic spotlighted the crucial work of CHWs, their value extends far beyond Ebola and West Africa. The One-Million Community Health Workers (1mCHW) Campaign was formed by the Sustainable Development Solutions Network (SDSN) and the Earth Institute at Columbia University to advocate for CHWs and document their far-reaching value.

Direct Relief and Esri teamed up with the Campaign last year to build the Operations Room; a suite of mapping applications that track the scope and enable a detailed comparison of CHW activities.

29 Stories. 24 Hours. 13 Countries

A Day in the Life: Snapshots from 24 Hours in the Lives of Community Health Workers is the latest map in the 1mCHW Campaign. It aims to convey not only the importance of the work that CHWs perform, but the everyday texture and genuine beauty of the lives they improve. This map is a guided tour of 29 CHWs in action during one long day across 13 countries in sub-Saharan Africa. Through the CHW story map, people can learn about and become more deeply engaged in one of the great causes of our time — ensuring that every person on Earth has access to health care.

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The trip to the Wellbody Clinic in Kono District, Sierra Leone, run by Direct Relief partner Wellbody Alliance, began with a drive to an air force base on the other side of the country’s capital, Freetown. The route followed a tree-lined beach and then veered inland to a lively thoroughfare of people tending road-side shops or working construction – occupations that would fetch a middle-class wage in the U.S.

For every few billboards displaying an advertisement, an Ebola advisory or cautionary graphic rose above the city’s densely packed buildings.  As pedestrians and motorbikes threaded the gaps of morning traffic, vehicles bearing the insignia of the U.N. or other response agencies served to remind the city’s two million residents of a crisis they likely won’t forget.

At the air force base, we met Raphael Frankfurter, Wellbody’s Executive Director, and boarded the helicopter after a brief precautionary talk by a UN safety officer.

The flight lasted a little over three hours, landing several times along the way to drop off aid workers in other towns. It takes ten hours by car to navigate the 225 miles between Freetown and Kono, an area hit hard by the war more than a decade ago.

People there can rarely afford a visit to the capital, but Raphi told a story during a brief refueling stop of a woman who made the drive in search of care for an abdominal fistula that formed from a Caesarean-section.

When the woman arrived in Freetown, she learned the hospital would only perform the surgery after confirming she was Ebola-free – a prudent measure on the hospital’s part, but with testing resources in short supply, certainty could mean a wait of several weeks.

The treacherous conditions brought on by Ebola have often compelled medical staff to weigh their inclination to treat the sick against the risk of doing so.

With impressive calibration, the team at Wellbody manages to balance high-quality care with a palpable sense of community at their clinic.

Kids play happily on the well-kept grounds while mothers and their babies gather on the steps of the bright blue and white buildings and talk casually among themselves and the staff.

Fanta, a community health worker (CHW), embodies what Wellbody works to achieve.

She told us of her first days at the facility as a patient in 2009. She was gaunt from HIV before Wellbody staff provided a regimen that restored her health. They also offered her a job. She brims with pride as she explains what it’s like to help people in her community through situations like the one she overcame five years ago.

Wellbody employs hundreds of community health workers like Fanta. Many joined at the height of the crisis and have played a crucial role in the response ever since.

Early each morning CHWs begin their daily rounds, going door-to-door in their neighborhoods to meet with residents and conduct surveys for Ebola symptoms. They accompany those who are symptomatic to a nearby community care center for further evaluation.

Beyond Ebola, the investment in additional CHWs has revealed a large number of conditions that would otherwise go undiagnosed. In a single day last month, CHWs identified 27 people with HIV who weren’t receiving treatment.

The care provided by doctors and nurses is crucial, and the right supplies are essential to their efforts, but a case-count of zero will only be achieved through community participation. As Wellbody’s efforts clearly illustrate, a community’s role in the fight against Ebola–and for better health overall–is paramount.

Related posts: From the Field: Battle Against Ebola Continues in Sierra Leone; From the Field: Health Facilities in Sierra Leone Work to Restore Services

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With the substantial decrease in new Ebola cases in recent weeks, the airlift represents a pivot toward helping local health facilities deal with both the pre-existing health challenges exacerbated by the outbreak as well as the still serious threats that Ebola presents.

Dozens of primary care facilities shuttered during the crisis; malaria and other conditions went untreated; vaccination programs were suspended, prompting a recent measles outbreak; and pregnancy-related complications saw an uptick as more women gave birth at home.

“As the focus shifts to long-term health systems strengthening in West Africa, these items will help restore confidence in health care for both providers and people seeking care,” said Andrew MacCalla, Director of Emergency Response and International Programs at Direct Relief.

Each module contains 36 of the essential supplies needed to operate a functional medical clinic for two months, including items such as surgical gowns, gloves, masks, lanterns, medical disposal bins, and non-contact thermometers. The contents were developed in consultation with the Centers for Disease Control and Prevention, the Ministry of Health of Liberia, and Last Mile Health.

The supplies contained in the modules were donated, in part, by the City of Yokohama, 3M, BD, California Nurses Foundation, and One Million Lights. Additional supplies were purchased through a grant from The Paul G. Allen Family Foundation.

Another 17 modules will ship later in the month for a total of 100 modules. In Liberia, 40 modules will be distributed by Last Mile Health. In Sierra Leone, 10 modules will be distributed by Wellbody Alliance and 50 modules will be distributed by Medical Research Centre. Prescription medicines contained on the airlift will also be delivered to all three of these partners, as well as to Africare in Liberia.

The pharmaceutical supplies were made possible by Accord Healthcare, Inc., Actavis Pharma, Inc., Bayer Corporation – USA, Baxter International, Inc., GSK, Hospira, Inc., Mylan Inc., Prestige Brands, and Teva Pharmaceuticals.

Since Direct Relief began responding to the Ebola outbreak last spring, the organization has sent 40 shipments of Ebola relief aid valued at $25 million (wholesale), which have been distributed to more than 1,000 clinics and health centers in West Africa, in coordination with partner agencies.

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The shipments – valued at $4.8 million (wholesale) – contain items urgently requested by health workers in the field such as gloves, soap, IV fluids, and the antibiotic ciprofloxacin to help treat secondary bacterial infections.

The supplies are headed for Last Mile Health and ELWA Hospital in Liberia and Medical Research Centre (MRC) and Wellbody Alliance in Sierra Leone.

While the number of people who have died from Ebola is still rising, Direct Relief continues to hear word from the field that with the right supplies and staff in place, health partners are making a difference.

On Nov. 15, 54 Ebola survivors were discharged from the Hastings Treatment Centre, a facility that receives medical supplies in collaboration with MRC and Direct Relief. They follow 63 others who were discharged the previous week as well as a two week old baby – the youngest Ebola survivor – who was dispatched from the center in early November.

In an update from the Government of Sierra Leone, MRC Director Abdul Jalloh said the continued collaboration with Direct Relief has contributed immensely in complementing government efforts in the fight to contain Ebola.

Additionally, the Sierra Leone Ministry of Health and Sanitation sent a letter of thanks for the support, which was only possible because of people like you. Read the letter: Letter of Appreciation

Direct Relief thanks Airlink and UN Logistics Cluster for getting this shipment to the places where it is most needed.

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As confirmed Ebola cases in the region approach 5,000, with 2,453 deaths reported, the WHO and other public health experts warn of an exponential increase if greater assistance is not provided.

“We must do all we can to prevent further human tragedy caused by this deadly outbreak and help countries avoid an even deeper setback than has occurred already,” said Thomas Tighe, CEO of Direct Relief. “Direct Relief mobilized this airlift in recognition that the failure to act now will make the crisis all the more severe.”

Aid efforts to increase the flow of resources into the Ebola-affected areas have been limited by several factors that have arisen since the outbreak’s spread: commercial passenger and cargo flights have been severely restricted, prices have spiked on the few remaining commercial transport options, and the affected countries have by necessity diverted existing health budgets to combat the crisis, deferring essential action on other health priorities.

Ebola’s effect on regional supply chains is mirroring that of natural disasters – the distribution pipeline for medical essentials has contracted when it should be expanding. In light of the growing crisis and urgent need to replenish medical inventories, Direct Relief made the decision to charter this aircraft in the absence of other viable air transport options.

The shipment, the eleventh from Direct Relief to Ebola-hit regions, contains 9.8 million defined daily doses of medications; enough pre-mix oral rehydration solution (40,200 liters) to supply two Ebola wards for one year; and enough coverall gowns (170,000), masks (120,000), and gloves (2.8 million) to meet the annual needs of approximately 280 health workers.

Each item and quantity in the airlift was shared with respective national Ebola task force members and Ministries of Health, and each end-recipient placed and confirmed orders via Direct Relief’s VAWD-accredited inventory system.

The medical supplies will support the efforts of local nonprofits that include the Medical Research Centre and Wellbody Alliance in Sierra Leone, and Africare and Last Mile Health in Liberia. The Clinton Health Access Initiative will also assist in the national distribution of supplies.

“This airlift truly exemplifies the spirit of the Clinton Global Initiative – to see a pressing issue in the world, and work together to commit to bringing their specific resources and specialties to bear on the problem,” said Bob Harrison, CEO of the Clinton Global Initiative. ”I’m looking forward to seeing the additional work and commitments at our 10th CGI Annual Meeting this week, that will provide immediate and long-term assistance on the ground in West Africa to fight the Ebola Outbreak.”

Valued at nearly $6 million (wholesale), the 370 pallets of cargo contain product donations from companies, including: 3M, Actavis Pharma, Inc., Allergan, Inc., Ansell, BD, Baxter International Inc., Cera Products, Inc., Chattem Inc., Covidien, Hospira, Inc., Kimberly-Clark, Merck & Co., Inc., McNeil Consumer Healthcare, Mylan Laboratories Inc., Omron Healthcare, Inc., Prestige Brands, Pro2 Solutions Inc., and Teva Pharmaceuticals.

“Ansell is in a unique position to provide support to leading organizations through Direct Relief in response to this crisis,” said Anthony Lopez, President and General Manager of Ansell Medical Solutions — a company that has donated millions of gloves to the Ebola response effort. “Our hope is that today’s shipment to the affected areas will serve to contain and, especially, eradicate the ongoing suffering caused by this epidemic.”

The airlift is privately funded through charitable donations. While Direct Relief has received contributions ($406,000) and pledges ($215,000) that has partially offset the cost of the airlift and other Ebola response activities, the Ebola crisis has not generated financial contributions comparable to the 2010 earthquake in Haiti, the 2011 earthquake and Tsunami in Japan, or the 2013 Typhoon Haiyan in the Philippines.

Direct Relief’s website contains a detailed policy to explain how financial contributions designated for Ebola are used.

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Facing a severe shortage of medical supplies and protective gear, health workers operating in the hot spots of the West African Ebola crisis are risking their own lives to help others.

That’s why Dr. Dan Kelly, co-founder of Wellbody Alliance in Sierra Leone, has returned to the frontlines of the Ebola crisis to help train health workers on how to protect themselves from infection.

Sadly, his return follows the death of his dear friend and colleague who was infected with Ebola. The heart-wrenching reason: “The protection needed was simply not available,” Dr. Kelly wrote in an op-ed. “Every health worker in the country must be supplied with protective gear.”

So far, nearly 170 health care workers have been infected, and more than 80 have died, according to the World Health Organization.

Direct Relief is working with local partners like Wellbody Alliance to protect those risking their lives on the frontlines by providing the urgently requested personal protective equipment – like gloves, gowns, masks, and boots – to help keep them safe from the highly contagious virus spread through contact with bodily fluids of those infected.

Read Dr. Kelly’s full op-ed in the San Francisco Chronicle and follow Dr. Kelly’s Twitter account @DanKelly_MD for live updates from the field.

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“The Direct Relief shipment is absolutely critical, as we are almost out of our existing stock of gloves and gowns,” said Raphael Frankfurter, executive director of Wellbody Alliance.

Their team is sharing the supplies with Koidu Government Hospital, Kenema Hospital, and some remote public clinics on the border with Kailahun, Kenema, and Guinea.

Ebola is highly contagious through infected bodily fluids like sweat, blood, and saliva and remains infectious even after the victim has died, which is why it is important to protect health workers treating infected patients.

According to an update from Wellbody Alliance, hundreds of people have been affected in the bordering districts, so the staff and clinic have been preparing for the disease to come to Kono. The epicenter of the outbreak is approximately 50 miles from Wellbody’s clinic.

Wellbody has implemented strict screening procedures with a protocol for isolating, providing supportive care, and rapidly transferring Ebola patients to designated treatment centers.

“This public health crisis requires sensitive and direct education and advocacy to create a more unified and informed response from the ground-up,” write Wellbody staff.

Additional shipments of essential supplies are currently being prepared for Wellbody Alliance and the Medical Research Center in Sierra Leone as well as Last Mile Health and the Ministry of Health in Liberia.

Click here to donate to the response

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The shipment – valued at more than $337,000 wholesale – contains basic antibiotics and most importantly, personal protective equipment, such as exam and surgical gloves, disposable gowns, and masks to prevent the highly contagious disease from spreading to health workers – one of the greatest resources in containing the epidemic. Without these basic supplies, health providers are in danger of contracting the virus.

Help save a life at risk. $25 can outfit a health provider with the protective equipment they need to treat patients for one day.Click here to donate.

Ebola is an extremely deadly virus with a case fatality rate of up to 90 percent. The death total for the current outbreak in West Africa has climbed to more than 500. Ebola does not have a cure, but chances of survival increase dramatically if adequate treatment is received early on.

Often mistaken for malaria, ebola symptoms include fever, vomiting and diarrhea. It sometimes results in severe internal and external bleeding, and many of the deaths are a result of shock or organ failure. Ebola is highly contagious through infected bodily fluids like sweat, blood, and saliva and remains infectious even after the victim has died.

Wellbody Alliance, a nonprofit that operates a 55-bed clinic in rural Kono District, Sierra Leone is reporting need for medications, supplies, and emergency staff.  In the last two weeks, the total number of Ebola cases in Sierra Leone has almost doubled and the number of confirmed deaths has nearly tripled, according to the World Health Organization.

Direct Relief is also in touch with partner Last Mile Health and the Ministry of Health in Liberia, where the outbreak is not yet as severe, as they develop a full assessment of needs. Earlier this spring, Direct Relief sent medical aid for Ebola to ELWA Hospital in Liberia.

Direct Relief thanks Ansell Healthcare, Basic Medical, Baxter International, Inc., Cera Products, Inc., Covidien, Kimberly-Clark, McKesson Medical Surgical, Inc., Merck, Mylan Laboratories, Inc., Prestige Brands, Teva Pharmaceuticals, and Sempermed USA for supporting this response.

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