1. Health System Strengthening in Africa and Building Resilience
Prof A D Redmond

2. The UK-Med Response to Ebola in Sierra Leone
Redmond AD, MD1,3, Tubb P2 ,MA, Alcock R3,4FRCEM, Alcock C3 RGN, Carr J3MA, Daley RA3, Dyehouse J BA, Hughes A1,3 Jasani R1PhD, O’Neill K3, Redmond HM3 MA, Sheridan D3
Humanitarian and Conflict Response Institute (HCRI) University of Manchester, Manchester, UK 
Well Travelled Clinic (WTC), Liverpool School of Tropical Medicine
UK-Med, Manchester, UK
Forth Valley Royal Hospital, Scotland, UK

4. Source: http://www. theguardian

5. UK-Med Ebola Response Programme
Applications by Profession
Total number of applicants via UKIEMR/UK-Med
1643
Total no. doctors
557
Total no. nurses
601
Total no paramedics
212
Total no. of other professions
273

6. One week training in the UK
(MoD or Red R)
Five Weeks in Ebola Treatment Centre in Sierra Leone
Three weeks of restricted activity – UK as per PHE guideline

7. Ebola Treatment Centre

8. Returning Home
The most commonly reported problem amongst the 142 volunteers who were interviewed on the telephone following their deployment was the social stigma experienced on their return home. (n=58, 40.1%).
A number of volunteers were put under pressure by their work-places to have no contact with their co-workers during the incubation period and were asked not to return to their hospital accommodation during the 21 days.
P. Tubb LSTM

9. Source: http://www.who.int/mediacentre/news/ebola/25-august-2014/en/

13. While applauding unreservedly the giving of oneself as demonstrated by this outpouring of volunteering, we also have to reflect upon how too often these disasters in low or middle income countries can be framed exclusively in the picture of heroic “Westerners” riding to the rescue of the hapless and the helpless. Not only is this a gross misrepresentation of these countries, their capabilities and their peoples; it is too often played out alongside a history of the earlier actions, or inactions, of “The West” having produced, contributed to or exacerbated their vulnerability in the first place. So no more. We need to work together as partners; supporting and strengthening our national systems and matching the emergency response with support to capacity building.

14. Crown Agents 1863 “Crown agents to the colonies”
1969
Humanitarian relief
Britain supplied substantial humanitarian aid to victims of the Biafran war, Nigeria, and gave Crown Agents the job of buying and delivering it. The scale of the operation prompted Crown Agents to set up a department solely engaged in humanitarian relief work.

15. ODA Ministry of overseas development 1964-70 lab
Absorbed into FCO 1970 as ODA con
Ministry1974 lab
Back into FCO as ODA 1979 con
1997 DFID lab

16. Let’s also accept that there are no natural disasters; only natural phenomena. The ensuing disaster marks a failure of preparation and/or response, coupled with an underlying vulnerability.
The poor are always the most vulnerable and the very poorest the most vulnerable of all. But poverty is not inevitable. Preparation and response can be strengthened. They are all functions of politics and economics; and so can (must) be changed.

17. Diseases that might threaten us “over here” can be contained “over there” and the experience we gain overseas can be drawn on here when these diseases arrive.
Policy needs to formally recognise and promote the link between our safety and the vulnerability of others, and overcome any political, philosophical or funding separation and address the two together.

18. It’s a sad truth I accept, that these vulnerable countries can be plagued by corruption that saps both the aid itself and the willingness to give more aid from those trying to help. We have to tread carefully, preserve and maintain public trust, and spend our/your money wisely.

19. In emergency healthcare, the noise from cries from outside of “something must be done” can mask the pleas from inside for “something that we need” and inappropriate care measures can ensue.

20. Spending money on things that were not needed, let alone practicing unlicensed in another country and carrying out procedures for which you are not qualified, is just another form of corruption; but this time imported.

21. But it is unlikely to be the poorest member of society struggling to get by on a daily basis that is at the heart of any national corruption. It is the elite, the already-haves, not the have-nots, that are stealing on a grand scale.
I would hate to see the final acts of treachery and theft by those at the “top” of society to be the robbing of the most vulnerable of people at the “bottom” of any aid at all. As the distinguished economist Mary B Anderson says, “just because aid can do harm, it is a moral and logical fallacy to assume that the absence of aid will do no harm”.

22. FACTBOX-Humanitarian aid hits record $27
FACTBOX-Humanitarian aid hits record $27.3 bln, ……Emma Batha Thomson Reuters Foundation Tuesday, 20 June :01 GMT

23. Caroline Fiennes
Nature June 2017

25. The principle that Emergency Departments are no longer places where those in need of training go to gain experience from those in need of care, but rather places where those in need of care go to gain from the experience of those already trained, needs to be extended outwards to the management of large-scale international emergencies .

26. Asian Tsunami 2004

27. “…….in most cases, providing people with training and building materials or cash following a large-scale disaster means that more people can start rebuilding their lives more quickly”
DEC chief executive Saleh Saeed
where-did-indian-ocean-tsunami-aid-money-go

28. “International organisations providing surgical services are diverse in size and breadth....yet with consistency provide rudimentary analysis postoperative follow up care and both education and integration of health services at the local level” McQueen et al World Journal of Surgery 2009

29. Negative Effects of Aid
Distorts local economies
Relieves burden of provision from local governments
Creates dependency
Promotes corruption
Inappropriate to local needs
Promotes the superiority of the foreign

30. “It is a moral and logical fallacy to conclude that because aid can do harm, a decision not to give aid would do no harm.” Mary B Anderson

31. Capacity Building Kenya Malawi Uganda Egypt Mass casualty management
Paediatric life support
Uganda
Emergency medical systems
Egypt
CeTC

32. Lessons… There are no natural disasters. They are all man made.
It is the poor that are most vulnerable to disaster
That poverty is a product of politics and economics and therefore can be changed.