Strengthening Health Systems While Responding to a Health Crisis: Lessons Learned by a Nongovernmental Organization During the Ebola Virus Disease Epidemic in Sierra Leone.

An epidemic of Ebola virus disease (EVD) beginning in 2013 has claimed an estimated 11 310 lives in West Africa. As the EVD epidemic subsides, it is important for all who participated in the emergency Ebola response to reflect on strengths and weaknesses of the response. Such reflections should take into account perspectives not usually included in peer-reviewed publications and after-action reports, including those from the public sector, nongovernmental organizations (NGOs), survivors of Ebola, and Ebola-affected households and communities. In this article, we first describe how the international NGO Partners In Health (PIH) partnered with the Government of Sierra Leone and Wellbody Alliance (a local NGO) to respond to the EVD epidemic in 4 of the country's most Ebola-affected districts. We then describe how, in the aftermath of the epidemic, PIH is partnering with the public sector to strengthen the health system and resume delivery of regular health services. PIH's experience in Sierra Leone is one of multiple partnerships with different stakeholders. It is also one of rapid deployment of expatriate clinicians and logistics personnel in health facilities largely deprived of health professionals, medical supplies, and physical infrastructure required to deliver health services effectively and safely. Lessons learned by PIH and its partners in Sierra Leone can contribute to the ongoing discussion within the international community on how to ensure emergency preparedness and build resilient health systems in settings without either.

The acute effect of whole-body vibration on the vertical jump height.

To determine the effectiveness of a single, 1-minute bout of whole-body vibration (WBV) as a viable warm-up activity, 90 subjects (30 men; 60 women, mean age = 19 ± 1 years) were recruited and randomly assigned to either a nonvibration control group or 1 of 8 WBV treatments (4 frequencies × 2 AMplitudes). Subjects stood with the feet shoulder width apart and the knees flexed 10° on a Next Generation Power Plate for 1 minute with the frequency (30, 35, 40, or 50 Hz) and amplitude (2-4 or 4-6 mm) settings at the assigned levels. Before, 1, 5, 10, 15, 20, 25, and 30 minutes after the WBV or control treatment, subjects performed a series of countermovement vertical jumps (CMJs) measured using a Vertec vertical jump tester. Comparisons were made of changes in the countermovement vertical jump height (CMJH) over time and between groups, frequencies, and amplitudes using repeated measures analysis of variance (α ≤ 0.05). There were significant differences in CMJH over time (p = 0.008); however, these were similar for all groups, frequencies, and amplitudes (p > 0.88). Some athletes may benefit from using WBV as a warm-up activity, if the timing of WBV is optimized. The effect of WBV on performance is likely variable and minimal, with a small window of effectiveness. Gender differences were not examined, and the optimal duration, intensity, and postural position are still unclear and warrant further study.

The acute effect of whole-body vibration on the hoffmann reflex.

The extent to which motoneuron pool excitability, as measured by the Hoffmann reflex (H-reflex), is affected by an acute bout of whole-body vibration (WBV) was recorded in 19 college-aged subjects (8 male and 11 female; mean age 19 +/- 1 years) after tibial nerve stimulation. H/M recruitment curves were mapped for the soleus muscle by increasing stimulus intensity in 0.2- to 1.0-volt increments with 10-second rest intervals between stimuli, until the maximal M-wave and H-reflex were obtained. After determination of Hmax and Mmax, the intensity necessary to generate an H-reflex approximately 30% of Mmax (mean 31.5% +/- 4.1%) was determined and used for all subsequent measurements. Fatigue was then induced by 1 minute of WBV at 40 Hz and low amplitude (2-4 mm). Successive measurements of the H-reflex were recorded at the test intensity every 30 seconds for 30 minutes post fatigue. All subjects displayed a significant suppression of the H-reflex during the first minute post-WBV; however, four distinct recovery patterns were observed among the participants (alpha = 0.50). There were no significant differences between genders across time (P = 0.401). The differences observed in this study cannot be explained by level or type training. One plausible interpretation of these data is that the multiple patterns of recovery may display variation of muscle fiber content among subjects. Future investigation should consider factors such as training specificity and muscle fiber type that might contribute to the differing H-reflex response, and the effect of WBV on specific performance measures should be interpreted with the understanding that there may be considerable variability among individuals. Recovery times and sample size should be adjusted accordingly.