DoD and Global Health

I just stumbled across an interesting article on U.S. Department of Defense efforts in global health and infectious disease. I thought it was particularly interesting since I'm currently working within one of the overseas laboratories it mentions.

Shedding light on the Department of Defense’s little-known contributions to global health
By Meredith Mazzotta

The U.S. Department of Defense might not incite thoughts of contributions to global health, but a briefing Thursday on Capitol Hill – hosted by The American Society of Tropical Medicine and Hygiene (ASTMH), Center for Strategic & International Studies (CSIS), Research! America and the Sabin Vaccine Institute (SVI) – shed new light on that thinking.

“The Walter Reed Army Institute of Research (WRAIR) is one of the largest developers of vaccines in the non-private sector,” said Peter Hotez, MD, PhD, president of the SVI and ASTMH, and a presenter at the briefing on DoD’s Essential Contributions to Global Health. “Most of the interventions that we have that we can use to fight neglected diseases in low- to middle-income countries are because of WRAIR.”

There are many reasons for that, according to fellow panelist Col. Kent E. Kester, MD – a former commander at WRAIR and a malaria vaccine researcher, scientist and soldier. “Our primary mission is force health protection – developing medical solutions to protect our deployed service members. If you have health threats that don’t discriminate between someone living in a small village in Kenya or an Army Corps of Engineers building bridges in country X, it has much broader implications and force health protection means much more,” Kester said.

What is more, “sick nations are dangerous nations – that’s a truism,” he said.

Hotez agreed, noting the “very intimate” relationship between tropical infections and conflict. “We can actually show that if you go to the countries with the highest rates of neglected tropical diseases, they were most likely involved in conflicts at some point over the past 20 years. Is it because these are places where there has been a lot of conflict and a breakdown of the public health infrastructure? That’s certainly true, but we think tropical infectious diseases have been shown to be highly destabilizing,” Hotez said.

The annual budget of the DoD is approximately $630 billion, .05 percent of which is going to produce some of the “most extraordinary interventions that are making a huge difference for bottom billion people who make no money, and at the same time they are having a huge potential impact on reducing poverty and conflict in low-income countries,” Hotez said.

The next challenge, panelists agreed, is to educate the public and the Congress about what we’re getting for that approximately $130 million annual investment. “The intimate relationship between disease and national security interests is an argument that needs to be better articulated than it has been to date,” Hotez said, and include how we are working to meet all the goals of the president’s Global Health Initiative, and take infectious disease research at WRAIR and link it to overseas labs.

“There’s no question that our U.S. servicemen and women rely on the work these laboratories perform,” said panelist J. Stephen Morrison, PhD, director of the Global Health Policy Center at CSIS, who issued a new report entitled The Defense Department’s Enduring Contributions to Global Health in late June. The global health benefits that are spread beyond the immediate target client base – diagnostics, vaccines, therapies, new knowledge – they’re a best buy… There’s not a lot of money going into these laboratories relative to the output, he said.

Some examples in the CSIS report of DoD contributions to global health include:

• in Thailand, the first successful HIV/AIDS vaccine trial,


• the demonstrated efficacy of Malorane, primaquine, and weekly tafenoquine to treat and prevent malaria,


• lab research that resulted in the first vaccine for Japanese encephalitis virus (JE),


• the first identification of new strains of dengue fever in Peru.

However, “The labs are under-resourced and under-acknowledged, within the DoD, on the Hill and in broader society,” Morrison said. He then outlined what is needed moving forward, including recommendations for modest adjustments in funding levels to create a balance where core research can be fulfilled, much better communication between levels [of government], better outreach to Congress and core constituencies, and cultivating champions to speak in support of them.

“All those steps can be achieved in the near and immediate term,” Morrison said.

Muneeb abattoir

Well today I did something I certainly have never done before and never thought I would do.

I may have mentioned before that I've been doing a lot of work with vector-borne and zoonotic disease (viruses and bacteria that can infect people but are carried mostly by insects and animals). One of my projects in this area is to develop innovative surveillance systems to detect outbreaks of these diseases before they spread and affect a large portion of the general population. This project therefore targets populations that are at high risk of being infected with these types of diseases, populations that have close interaction with animals and are in areas with high vector density. Specific examples include employees of abattoirs (slaughterhouses), live animal markets and animal quarantine facilities.

The first project that's actually getting off the ground is going to take place in an abattoir here in Cairo. Today I had to visit the abattoir to do an assessment before we actually begin work. Definitely something I never thought I'd do. I'll spare you the details and just leave it to say that we were given a tour of the facilities by a representative from the division of the Ministry of Agriculture that oversees the abattoir and then had to watch a couple animals being slaughtered. It wasn't quite as bad as I had expected but I certainly felt a little queezy by the end of it.

I have to go back three times next week so perhaps I'll write more then...

University of Ghana

NAMRU-3 has a detachment in Ghana that is currently running studies in acute febrile illness and leishmania but will most likely begin work in acute respiratory infection, diarrheal disease and zoonotic pathogens in the very near future. So I've been in Ghana this week working with the local team to get set up for all these upcoming studies.

The detachment is housed within the Noguchi Memorial Institute for Medical Research (NMIMR) which is part of the University of Ghana, so tonight, after a long day in the office and the laboratory, one of the Ghanaian professors with whom we were working invited us to join him for a drink. He's the head of one of the five colleges within the university (the University of Ghana is set up on the Oxford model) so we joined him at the faculty lounge of his college. After a brief tour of the college, we sat back and relaxed with he and several other faculty members.
There were a few things that made this experience - which would have been completely normal in Rwanda or any other African country - noticably different from any situation one could imagine in Egypt:

1. It was quiet and peaceful, and we were surrounded by greenery.
   
2. Everyone around the table was drinking beer.
3. We (by which I mean myself and my colleague, Lisa) sat down at a table of seven men (all Ghanaian except one) and no one batted an eye or treated us as though we were any different from any of them.

It was perfectly lovely.

H1N1 in Egypt

The Egyptian government announced today that the first case of H1N1 in Egypt has been confirmed. An Egyptian-American girl traveling to Egypt to spend the summer with her family was stopped at the airport (apparently they're checking the temperature of everyone who arrives and quarantining those with fever) and tested positive for the virus.

In my opinion, though, it was only a matter of time before the virus made its way into Egypt, and, really, I'm not convinced this is the first case to enter the country. It's just the first case the government has identified. I do feel a sense of relief though. After the scandalous rumors a couple months ago about NAMRU-3 being responsible for bringing H5N1 to Egypt, I'm glad the Egyptian government found the new virus before we did so we can shirk any responsibility for its introduction to the country and, for that matter, to the continent.

E-bulletin on Djibouti

I just found out that the April issue of NAMRU-3's e-bulletin (which of course came out in April, but I'm only just now seeing) focuses on Djibouti. Check it out here for a few pictures and a better understanding of some of the initial work we're doing in the country.

Animal facilities

Warning: There are a few somewhat graphic/disturbing images toward the end of this post.

Another area of interest in Djibouti is related to vector-borne and zoonotic disease (pathogens carried by insects and animals). Each year, over three million animals are transported from Ethiopia, Somalia and Sudan, through Djibouti, to the Arabian peninsula and Gulf states, so there's huge potential for an outbreak of an emerging disease or the spread of an endemic disease. To develop a surveillance system for these types of diseases, I first met yesterday afternoon with a representative from the Ministry of Agriculture. With his support, today, I am trying to visit three main animal facilities in the country - the animal quarantine facility, the national slaughterhouse - to determine if any would be suitable for disease surveillance and/or research.

This morning, I started the day with a trip to the animal quarantine facility which receives all animals for quarantine as they arrive in Djibouti. I was given a full tour of the facilities and learned about the systems by which animals are received and shipped. Unfortunately, I didn't get many pictures inside the facilities (it's owned by a private Saudi Arabian company and the owner who was showing me around didn't seem very pleased when I asked if I could take pictures) but I took a few pictures of the camels just outside the gate.

Camels waiting to enter the quarantine

Camels being herded into the quarantine - each one is inspected and vaccinated as it enters

After gathering all the information I needed at the quarantine facility, I headed to the slaughterhouse. In Djibouti, animals are slaughtered over night to avoid the heat of the day and so that the meat is available in the market first thing in the morning, so by the time I arrived, no animals were being killed, but I still had a full tour of the facility. First I walked through the holding areas where animals are kept before slaughter.
From here, the animals are brought inside to the slaughtering areas.
The carcasses are then loaded onto trucks to be transported to the markets for sale.
Their hides are treated with salt and laid outside to dry in the sun before being sold in bulk to leather producers.
I spent a lot of time at the quarantine and slaughterhouse facilities, so I wasn't able to visit the livestock farm near town, but I felt like I had seen enough. By the end of my time in the slaughterhouse, I was pretty much ready to move on and hop on a plane out of Djibouti.

Centre Paul Faure

Tuberculosis (TB) is a huge issue in Djibouti, so my first stop was Centre Paul Faure (CPF), the national reference center for tuberculosis. CPF sees about 9,000 patients per year for diagnosis of TB and many more for follow-up and treatment. The patients are of all ages and come not only from Djibouti but also from neighboring countries such as Ethiopia and Somalia, where diagnostics and treatment are unavailable.
Even though Djibouti is estimated to have the highest prevalence of TB in the world, the laboratory capacity for diagnosis is very limited. Diagnosis is based primarily on smear microscopy, which only detects about half of all positive cases tested, and there is no testing for drug susceptibility that could identify drug resistant strains of TB and allow patients who have resistant strains to have appropriate clinical follow-up.

One of my biggest projects in Djibouti, then, is to improve laboratory capacity for TB diagnosis at CPF. We're going to introduce a new TB diagnostic called MODS (microscopic-observed drug-susceptibility assay) for the diagnosis of all new suspect cases of TB at CPF. The test provides more accurate results (it detects 97% of all positive cases tested!) and also allows drug sensitivity testing for first line TB drugs. Plus the results are available much more rapidly than traditional cultures (most of the time within 5-7 days) and each test costs less than $3.

MODS is a really promising new technology for TB diagnosis, especially in countries like Djibouti. The only issue right now is that we have to turn the following spaces into biosafety level 2 laboratories before we can implement the test. It's going to be a challenge but hopefully we'll be able to do it!

Back in Djibouti

I’m back in Djibouti for trip number three. It’s a quick one this time, planned at the last minute and just three days long, but hopefully it will be productive. The majority of the protocols and projects that I’m managing are in Djibouti so even though I’m only here for a short period of time, I have a lot to do. Over the next couple days I’ll be holding meetings, conducting assessments, visiting sites, making new contacts and following up on previous meetings for a number of projects including:

• Surveillance for vector-borne and zoonotic diseases in human, animal and insect populations at the local slaughterhouse and in the animal transport section of the port,
• Management of HIV-positive patients with suspected drug resistance to antiretroviral treatment,
• Study of drug resistant gonorrhea in patients seeking treatment for sexually transmitted infections at the national reference center,
• Study of sexually transmitted infections and HIV genotyping and drug resistance in commercial sex workers,
• Capacity building for diagnosis and surveillance of multi-drug resistant tuberculosis (MDRTB) at the national tuberculosis reference center,
• Construction of a central public health laboratory to serve as a reference laboratory and surveillance center, and
• Hiring of a local person to assist with the coordination of these and other activities.

There’s a lot to be done and I know that only gives a vague overview of what it all entails, but I’ll try to write more and post some pictures after each meeting.

"Transparency"

One more article about our scandal appeared in today’s news...

AUC in defense of transparency
by: Magdi el Gallad

Many are mistaken when they think that serious journalism has hidden agenda or targets campaigns against individuals.

I believe that our conspiratorial explanation for everything didn’t come from nothing, because for the past half century or more we have been under political and intellectual pressure for us to believe that behind any crisis, disaster or lapse there is a grand or foreign conspiracy by forces allied against Egypt or an internal conspiracy by some lost souls targeting the countries.

The result is that the ruling regime succeeded in making us prisoners of the theory of conspiracy, and accordingly, we are distracted from asking the most normal question “who is responsible for the incident and how did it happen, and how to avoid its repetition?

Regretfully, we thought this quality is purely Egyptian, but we thought wrong. The past few days revealed that others hide behind that “theory of conspiracy” when events get disclosed. The American University in Cairo (AUC) did that when “El Masry El Yom” exclusively uncovered AUC contract with “NAMRU-3” which is affiliated with the U.S. Department of Defense “US Navy”, to participate in studies and research in Egypt. In the beginning, the university’s response was absolute denial and then they disclosed the contract and its details without admitting that the contract with the Pentagon was an error and moreover, its non-disclosure in 2006 was a bigger error.

In spite of the AUC admittance to the contract, voices from AUC and the U.S. Embassy in Cairo expound that “El Masry El Yom” is leading a campaign to shut down or restrain AUC. Since we are not defending ourselves here, our response was to publish the entire facts, including AUC and Embassy responses, and the contract terms. But AUC and the Embassy committed a media “sin”, whether deliberately or just a mere misjudgment. The Egyptian Government has been repeatedly pressured by the American Government for the likes of such a sin.

It is not possible nor acceptable that Washington fills the world with talk about the right of information circulation, press freedom, transparency rules and disclosure, then blames an independent newspaper for publishing news about an unannounced contract signed by a civilian body “AUC” and a military body “Pentagon”, even if this didn’t breach the Egyptian national security.

“El Masry El Yom” published, publishes and will publish all available documented facts and information, because the reader has the right to know, and in defense of the Egyptian national security. AUC, the Embassy, the White House, and the Pentagon have the right to defend their stands on the newspaper pages without confiscating our right to publish and the reader’s right to know what’s going on in the country.

Definitely, we don’t need to confirm our faith in the significant scientific and civic role played by AUC for decades in Egypt and we always demand opening more science and technology windows in our country to benefit from the western evolution and scientific revolution which was much delayed for Egypt.

Today, by publishing the details of a new contract signed by the AUC and the Pentagon, the US Army, and not the US Navy, we are providing the reader with information and give him the right to adopt the point of view that he believes in.

AUC students are another issue since they are our Egyptian brothers and children, standing on our side, as they stood before against the admittance of Israeli academics into their campus. They represent the most competent and the best patriotic intellects and they participate in all incidents, therefore, we are not bidding on them or setting doubts on their university, but this is the mere truth that we and you always have to respect.

El Masry El Yom retracts accusations

The newspaper that originally published the accusations against NAMRU-3 and AUC also released a new point of view today...

El Masry El Yom Receives a Copy of the AUC and NAMRU-3 Contract
by: Ola Abdalla

El Masry El Yom received a copy of the officially signed contract by NAMRU-3 and AUC in Cairo, 26 September 2006, and its amendments over the past three years. The contract stipulates the specialized cooperation in the field of infectious diseases scientific research.

The Contract, which has been renewed annually for three years, states that both parties approves to select the AUC to cooperate and supervise all aspects concerning scientific, research and administrative specialties, and is obligated to recruit and hire a highly competent work team to cooperate with the unit in infectious diseases research, in Egypt and the region.

According to the contract terms, AUC is in charge of recruiting scientists with higher caliber of scientific knowledge, skills, and abilities requested and specified by NAMRU-3 from all universities, besides coordination with the unit’s management including researchers, program heads, department heads, and executive management to determine the employment goals for each member of the work team regarding academic specialty, programs, protocol details and objectives. The hiring contract obligates AUC to develop human resources regarding compensation, life and health insurance programs, benefits, travel, salaries, supervision, and performance evaluation.

On the other side, NAMRU-3 shall supervise and arrange local and abroad travel for the work team including tickets, accommodations; provide security and stability for researchers, and equipment to achieve their research goals.

Contract terms indicate that “it is not a contract to conduct personal research programs, but it is for public service in medical research arena, and the four amendments of the contract had not mentioned the hired researchers’ salaries.

Contract total cost is $600,000.000/year, 5% for administrative affairs, 4% for additional expenses such as grants programs, local legal expenses, and other expenses related to the program.

AUC responds to news

Today AUC published a formal statement in regards to the news program from two nights ago:

We would like to advise you that the article published by one of the Egyptian newspapers on Monday, 30 March, which is copied from an Arabic news site from Washington, and it states that the AUC received fund in a secretive and incon-ect manner from the Pentago.. which is inaccurate and wrong.

Since 2006, AUC signed in public a contract 'vvith the U.S. Medical Research Unit (NAMRU-3) to hire and provide employees specialized in science to assist in perfonning infectious disease research in the area especially those related to Avian Influenza. The value of the contract was $1,964,035 since 2006, which means $600,000/year for the basic grant in addition to $164,035 to cover cost of travel in the renewal of 2008.

I would like to add that the relation of Aue and NAMRU is within the frame of the continued university obligation to provide education, research, and service in Egypt.

Apparently I'm a spy

Well today was an eventful one at work! This morning the entire office was abuzz! Apparently last night NAMRU-3 was on all four major television stations in Egypt, and the story wasn’t good. A news station in town claimed to have uncovered a document issued by the White House about a contract between the U.S. Pentagon and the American University in Cairo (AUC). (As background, NAMRU-3 does have a contract with AUC, but it is solely a hiring mechanism for recruiting researchers and scientists to Cairo. It’s nothing dodgy, seriously.)

While that initial story may not seem significant (I myself laughed when my coworkers started telling me about the story), the story just grew from there. Reporters continued, explaining how NAMRU-3 employees are actually spies for the U.S. government, how NAMRU-3 brought avian influenza and other diseases to Egypt through experiments done on Egyptians, how NAMRU-3 is secretive and no one from the outside is allowed inside the premises, how NAMRU-3 works with the Israelis against Egypt, etc.

The story was not good. Although it sounded moderately ridiculous to the Americans who work at NAMRU-3, many of our Egyptian colleagues were worried and some actually received phone calls after the television programs that accused them of being traitors to their nation. Once the rest of us realized the severity of what had happened, we began to wonder what effects this would have on our work. Would people refuse to join our studies? Would organizations refuse to work with us? Would the Ministry of Health refuse to approve our studies?

I tried to find an English-language article about the story, but could only find one. Even though it’s not very good, I’ve included it below.

American University in Cairo signed contract with the Pentagon to provide confidential information about Egypt
by: Washington – America in Arabic

AI-Masry AI-Youm has obtained an official US document issued by the White House on the 2007 budget. For the first time, the document reveals that the American University in Cairo (AUC) won a LE 3.4 million contract to provide the U.S. Pentagon with Information about Egypt. This is the first publicly-disclosed evidence recognized by the U.S. Administration that the U.S. military used a U.S. university on Egyptian soil to collect research and Information. This is just one of the hundreds of thousands of documents released by the White House on how the U.S. Administration spends its budget.

According to the document, exclusively obtained by America in Arabic news agency, the U.S. Department of Defense awarded a contract worth $600,000 to the AUC to carry out research for the U.S. Navy on infective diseases, applied research and development in Egypt. The White House said the contract was signed in two parts, the first on June 26, 2007, and the second on August 22, 2007. The AUC would implement the provisions of the first part of the contract from July 1, 2007 to September 21, 2007 (81 days) for LE 3.4 million. As for the second part, it would be implemented from September 26, 2007 until September 21, 2008. The contract required the contract to be implemented in Egypt. This military contract, according to its summary, was signed directly with the AUC and no tender was held.

In its USASpending program for budget transparency, the White House did not provide the other details of the contract due to their confidentiality. The document points out that the name of the interior section of the U.S. Navy which signed the contract with the AUC was symbolized with N68171.

Another document posted on the Pentagon's website says this contract was part of another one between the U.S. Department of Defense and the AUC which was implemented over two years. This contract brought $1,200,000 to the AUC in 2006 and 2007 in exchange for sociological and humanistic research.

AUC President David Arnold told the U.S. Council on Foreign Relations in New York in March 2007 that the university received scientists and academics from Israel as long as they obtained a legal entry visa for Egypt. He added the university was doing its job for a calm change without the Egyptian authorities knowing anything. He added that the Egyptian government was aware that his university operated under different laws than those governing the Egyptian society and public universities in Egypt, adding he thought they enjoyed very much freedom regarding the work they did.

Coolest nameplate ever

It's taken right at six months, but I have fianlly truly "arrived" at work. Today I received my "official" nameplate for my desk and it might be the coolest nameplate I've ever seen. Just under my English name is my name written in Arabic, with the outline of pyramids of Giza on the right and a camel on the left. Pretty crazy cool.

Integrated public health training

For the next two weeks we will be hosting an integrated public health training workshop for 70 junior-level Ministry of Health staff from Morocco, Libya, Egypt, Sudan, Djibouti, Jordan and Afghanistan. We've been developing the curriculum and organizing logistics since I arrived in Cairo last fall, so it's exciting to finally see the event happening. But, at the same time, it's stressful to try to make sure everything comes together and we're able to pull of a professional, valuable training program.

The workshop is sponsored by the U.S. Department of State and provides an opportunity for junior-level laboratorians and epidemiologists to learn more about public health from an integrated approach that includes epidemiology, biostatistics, microbiology, virology, bacteriology, molecular diagnostics, entomology, biosafety, biosecurity and numerous other topics. During each morning of the ten-day workshop, the entire group will meet together for lectures and discussions covering various topics; then, in the afternoons, the group will be divided into specific areas of focus for more specialized training. At the end of each week, we will bring the entire group back together for an outbreak simulation during which the group will be divided into teams and will have to work together to conduct a full outbreak investigation.

Hopefully everything will go smoothly and the participants will return to their home countries with a greater understanding of public health and improved skills for their work.

Another case of H5N1

Egypt had yet another case of H5N1 today - the 56th case in the country. A two-year old boy contracted the virus and is in critical condition in the hospital.

Although I'm not really surprised anymore when I hear about cases of avian influenza in Egypt, I was surprised by this case because of the age of the boy. Two-years of age is a lot younger than most cases of avian influenza. It's not uncommon to see cases in children five- to six-years old because rural children often help their mothers care for and slaughter chickens and are thus exposed to particles from feathers and chicken blood. But two-years old seems too young to be exposed by helping with any of these tasks.

After a few discussions, we finally resolved that the infection is most likely due to the cold weather this week. When it's cold outside like it has been lately, rural families bring their animals into the household to stay warm. It's most likely that the chickens were cooped up under a bed where the child played, and unfortunately the child was probably exposed by close interaction there.

Port of Djibouti

Today was meant to be filled with scheduled meetings - with the Secretary General of the Ministry of Health, the director of the country's only medical school, the director of the government's Center for Research and Development (CERD) and the director of the U.S. Agency for International Development (USAID). At the end of the day, though, one more meeting was added to our schedule as a surprise - a meeting with the Harbour Master and head of security at the Port of Djibouti.

As I already hinted earlier when discussing why I'm working in Djibouti, the Port of Djibouti is at the crossroads of one of the most important shipping routes in the world.
The reason for the meeting with the directors of the port, though, was not directly related to transportation or shipping, but rather, more appropriately, to health, specifically the health of port employees and the animals that are shipped through the port. Over two million animals are transported through the port each year, coming from Ethiopia, Somalia and Sudan and going to Yemen and Saudi Arabia. The directors of the port expressed concern that these animals may carry diseases, to which port employees are then exposed, either by direct contact with the animals or by airborne transmission from the animal pens to nearby offices. They requested our help in developing a surveillance system to monitor these animals for vector-borne and zoonotic diseases. Although we couldn't make any promises up front, I think I may have the perfect project in mind to meet their needs. I'll discuss more later!(Random note: Photography is normally prohibited in the port, but since we were guests of the Harbour Master and the head of security, we were allowed to snap a few shots!)

National HIV/AIDS Program

My main purpose on this trip to Djibouti is to spend a few days working with the country's National HIV/AIDS Program, trying to improve their surveillance system, develop their capacity for testing patients for sexually transmitted infections (STIs), plan a system for monitoring drug resistance in patients on anti-retrovirals (ARVs) and build epidemiologic capacity among program staff. It's been a lot of work to try to accomplish in just a few days, but I've enjoyed it significantly. The staff of the National HIV/AIDS Program in Djibouti is great. The director of the program is a quiet Djiboutian man; the deputy director is a kind-hearted Congolese man (from Congo-Brassaville, not the Democratic Republic of Congo); the technical advisor is a bright Burundian woman; and the head of surveillance is an energetic Djiboutian woman. It's obvious that each has a true passion for and interest in the work they are doing, so it was a pleasure to work with each of them. I just wish I had more time so that I could do more!

Medical diplomacy

Our work in Djibouti (and many of the other countries where NAMRU-3 works) is essentially "medical diplomacy," a term which was once described in the Boston Globe by Tommy Thompson as follows

"...If we have any hope of spreading democracy and ending tyranny in every corner of the globe, it is vital that we use all of the weapons of freedom at our disposal. That includes our most effective arsenal against terrorists and the forces of oppression: education, compassion, and medicine.

That is the principle at the heart of what I call ''medical diplomacy" - the winning of hearts and minds of people in the Middle East, Asia, Africa, and elsewhere by exporting medical care, expertise, and personnel to help those who need it most.

Medical diplomacy must be made a significantly larger part of our foreign and defense policy, as we clean up from costly and deadly wars in Afghanistan and Iraq. America has the best chance to win the war on terror and defeat the terrorists by enhancing our medical and humanitarian assistance to vulnerable countries. By delivering hope we will deliver freedom."

New pictures from Damanhour

I just added a bunch of new pictures to my previous posts about Damanhour. Check them out here and here and here and here.

IEIP Damanhour laboratory

Our last stop in Damanhour was the official ribbon-cutting of the IEIP Damanhour laboratory. This laboratory will serve as the main laboratory for our surveillance projects in Damanhour. We have redesigned and rebuilt the laboratory and trained the staff there, and now the work is really about to begin. After speeches from Ministry of Health officials, project coordinators and CDC representatives, the ribbon was cut and the lab is now officially open!