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Monday, September 15, 2014

Liberian Ebola burial teams stressed, traumatized


MONROVIA, 12 September 2014 (IRIN) - As the Ebola death toll mounts in Liberia, burial teams are having to contend with physical risk and trauma as they take charge of safely burying the dead, often in the face of local anger.

Ebola has killed 1,224 Liberians as of 6 September, according to the World Health Organization (WHO), with 68 percent of those deaths in the past three weeks. Cases are expected to continue to spiral across the country - 14 out of 15 counties have reported cases - with the bulk in the capital, Monrovia.

Government and International Committee of the Red Cross (ICRC) burial teams initially took charge of burying the dead but they could not begin to keep up with the needs and called on community members to take on this difficult task. Marcus Speare is the head of a burial team in Margibi County (next to Montserrado County), which is made up mostly of young men.

Each team is trained by the ICRC and Ministry of Health and members are paid US$300 a month.

"Even as I speak to you we just received calls from three communities to pick up dead people. The deaths are too much. Sometimes I get confused. I am in shock. Too many of our people are dying."
All day long Speare’s phone rings requesting his team to pick up more corpses. “We don’t rest. My phone rings all day every day. We are on our way right now to pick up dead bodies in the Palmwine Station Community and Tower Hill. Sometimes we get tired. But this is what we have chosen to do. We want to help our community. This fight cannot be left on government and partners alone,” he told IRIN by phone from Margibi County.

“It is too sad,” he continued. “We pick up all kinds of bodies. We collect women, men and what mainly bring tears in my eyes are innocent children who died from this disease… It is painful to bury our people in these kinds of numbers. It is too much to handle.”


Anger and fear

Team-members must contend with rejection from their own families and communities, and anger and resistance from families they are trying to help, which at times turns into violence.

“Our vehicle has been attacked by angry residents on many occasions,” said Speare. “They have stopped us from picking up dead bodies from various homes. They say to us that we are responsible for the spreading of the disease. One group of youths threw stones at our bus that is used to collect bodies. But we remain very calm with them. We tell them that we also stand at risk to do this job. And that we are just helping. So there is no need to attack us.”

Police now escort teams to pick-up points.

Sumo Wonder, a member of Speare’s team, told IRIN his parents have expelled him from the house. “They feel that I will infect them. Right now I am sleeping with my friend. They say I should return when the Ebola crisis is over,” Wonder told IRIN.

Team members must also cope with the shock of having to confront so many deaths, including those of friends and family members, says the Red Cross. A driver on a burial team in Kakata, capital of Margibi County, told IRIN he was exhausted.

“Even as I speak to you we just received calls from three communities to pick up dead people. The deaths are too much. Sometimes I get confused. I am in shock. Too many of our people are dying.”

Emmanuel Togar, member of a burial team in Kakata, the capital of Margibi County, told IRIN: “Sometimes I cry when I see someone my own age lying in a pool of blood. It is too sad. I am out of words.”


It is also stressful having to be mindful of one’s physical safety every minute of the day, says an IFRC briefing note on the psychosocial strain caused by Ebola.

Team members must wear a protective suit and goggles, boots and gloves covering every inch of their body, which can pose a high risk of heat exhaustion. “If we are not vigilant every minute of the day, then we too will die from it [Ebola],” said Togar.

Improved pick-up rate

As more burial teams are trained, the pace of picking up the dead quickened. In the first months overwhelmed burial teams would only get to bodies three or four days after they had died, greatly upping the risk of transmission to family members as the virus remains active even in a dead body. Now the pick-up rate is usually within the day, said Fiyah Tamba, secretary-general of the Liberian Red Cross.

Pick-up gaps are still leading to bodies piling up, however, particularly in Monrovia which is experiencing ongoing protests as a result - the latest one taking place in the Capitol bypass neighbourhood on 11 September.

But Togar says they are doing their best and need others to join them. “Now as soon as our phone rings we are on the move.”

As of 6 September 2014, some 4,269 probable, confirmed and suspected cases and 2,288 deaths had been reported in the current outbreak by the health ministries of Guinea, Liberia and Sierra Leone. NGO Médecins sans Frontières, WHO and affected governments have repeatedly called on international governments to step up their response if the disease is to be contained.

Ghana investigating suspected Ebola case


Ghana investigating suspected Ebola case

Ghana, according to the Ghana Health Service, is currently investigating a suspected case of Ebola.
The latest suspected case is a Nigerian patient, who sought medical attention at the Achimota hospital in Accra Sunday after battling fever for a while.
Ebola virus is currently spreading across West Africa and is believed to have killed over 2000 people in Guinea, Liberia, Sierra Leone and Nigeria since the outbreak began in February, according to the World Health Organisation.
Ghana has so far investigated 37 suspected cases of the deadly virus with all turning out to be negative.
Citifmonline quotes Dr. Badu Sakordie, Head of Disease Surveillance as saying the health authorities are closely monitoring the patient.
“We are just getting it like you are doing so we are yet to follow up so I don't have too many details to come out. Let's investigate,” he said.
Asked if blood samples of the patient had been sent to the Noguchi Memorial institute for further tests, he said: “they take a sample but then this one we just had the information… they haven't given us a report, these things we can't preempt, let's do the proper investigation and come out.”

Ebola Claims The Life Of Another Doctor In Sierra Leone

14 Sep 2014

Ebola Claims The Life Of Another Doctor In Sierra Leone

A fourth doctor, Dr Olivet Buck has died of Ebola in Sierra Leone after a failed bid to transfer her abroad for treatment. The doctor passed away last night after the World Health Organization, WHO said it couldn’t help to move her to Germany.
Sierra Leone had requested funds from the organisation to transfer her for treatment saying it could not afford to lose another doctor.
However, Chief Medical Officer Dr Brima Kargbo confirmed today September 14 that the Sierra Leone national had died on Saturday night. WHO had said it could not meet the request but instead would work to give Dr Buck 'the best care possible' in Sierra Leone, including access to experimental drugs.

This will come as a huge setback for the impoverished country that is battling the virulent disease amid a shortage of health care workers.
A total of 301 health workers had become infected with the disease as of September 7 in Guinea, Liberia and Sierra Leone, according to WHO. Of that number, which included suspected and probable cases in addition to confirmed ones, 144 had died.
Due to the fact that the virus is only transmitted through contact with the bodily fluids of people showing symptoms or from dead bodies of Ebola victims, health workers have been especially vulnerable as they respond to the worst outbreak in history.
In Nigeria, the virus has claimed the lives of two doctors.  http://real9jagists.blogspot.com/2014/09/ebola-claims-life-of-another-doctor-in.html

Ebola crisis: Australian doctor at frontline of outbreak says time is running out to contain disease

Ebola crisis: Australian doctor at frontline of outbreak says time is running out to contain disease

Updated
The Ebola outbreak in west Africa is already a crisis; it could very easily become a catastrophe.
Dr Ian Norton, chief of foreign medical teams with the World Health Organisation (WHO), is a contributor to ABC News coverage of the Ebola crisis. He says it is a race against time to build a number of massive field hospitals in Monrovia, Liberia, as the death toll nears 3,000.

We have only a narrow window of opportunity in which to contain this outbreak.
If we ignore it, we will find the disease much more difficult to control and can expect infection rates to escalate.
Not to put too fine a point on it: we have a closing window of perhaps weeks now before we will not be able to manage all the cases on the ground in the way that we normally would.
Already the WHO and the ministries of health of the three most affected countries are thinking of other ways to contain and manage the large numbers infected.

This is new for everybody. The only team that has built a field hospital for Ebola treatment before has been from Medecins Sans Frontieres (MSF), and their standard operations are for only 40 people.

We are building five 100-bed field hospitals in Monrovia, in addition to the 200-bed facility which already exists there and which will soon be expanded to at least 300, perhaps 400, beds.

Profile: Dr Ian Norton

  • Currently chief of foreign medical teams with the World Health Organisation in west Africa
  • Previously Director of Disaster Preparedness and Response at the National Critical Care and Trauma Response Centre in Darwin
  • Involved in the emergency medical response when 44 asylum seekers were badly burnt in a boat explosion at Ashmore Reef in 2009
  • Team leader of the Australian civilian medical response to the Pakistan floods in 2010
  • Has worked in India, Indonesia, Europe and East Timor

We are calling for foreign medical teams across the world to come and assist us.
We are not looking for huge numbers of foreign doctors and nurses and logistics staff but at least a core group of 30 to 40 who would help manage these large centres and then work alongside national medical staff and nurses.
Tragically, Liberia - which already ranks fourth-last in the world for numbers of doctors per population - has lost almost 20 doctors to Ebola. They only produce 10 doctors per year in a medical class.

They have also lost a large number of nurses, and Ebola care is all about the nursing care. There are only a couple of thousand nurses in the country and we know that at least 90 have died from the infection and another 50 or 60 have survived.
The nurses and doctors are actually willing to come back to work, with measures in place to assist them including protecting equipment, training and a payment scheme which reflects the danger of the work.
Without medical care, the mortality rate of this Ebola outbreak is about 90 per cent. While it is a devastating disease, it is not universally fatal, even with minimal care.
But with better care, and certainly with the new Ebola treatment centres and with the right number of staff treating them, we can gradually escalate the level of care and have better outcomes.
For example, we have seen in Guinea for several months that with good supportive care we can bring the mortality rate down to 30 to 50 per cent at most.
So we can see a several-fold improvement in survival if we can just get the teams in here and get these Ebola treatment centres up and running.
We have to stop this spreading beyond the point of no return.
This interview with Dr Ian Norton first aired on the ABC's PM program.
 

CDC issues Ebola checklist: 'Now is the time to prepare'

CDC issues Ebola checklist: 'Now is the time to prepare'

By |
The Centers for Disease Control and Prevention, warning hospitals and doctors that “now is the time to prepare,” has issued a six-page Ebola “checklist” to help healthcare workers quickly determine if patients are infected.
While the CDC does not believe that there are new cases of Ebola in the United States, the assumption in the checklist is that it is only a matter of time before the virus hits home.
For example, one part reads: “Encourage healthcare personnel to use a ‘buddy system’ when caring for patients.” Another recommends a process to report cases to top officials:
Plan for regular situational briefs for decision-makers, including:
-- Suspected and confirmed EVD patients who have been identified and reported to public health authorities.
-- Isolation, quarantine and exposure reports.
-- Supplies and logistical challenges.
-- Personnel status, and policy decisions on contingency plans and staffing.
The checklist has been distributed to major hospitals and even little ones, including an urgent center in Leesburg, Va.
“Every hospital should ensure that it can detect a patient with Ebola, protect healthcare workers so they can safely care for the patient, and respond in a coordinated fashion,” warns the CDC.
“While we are not aware of any domestic Ebola Virus Disease cases (other than two American citizens who were medically evacuated to the United States), now is the time to prepare, as it is possible that individuals with EVD in West Africa may travel to the United States, exhibit signs and symptoms of EVD, and present to facilities,” it adds.
Several hospital and medical websites have just begun to post the checklist online.

Ebola: Expatriates flee Port Harcourt


As a result of the deadly Ebola virus disease, which a Nigerian diplomat, Olu-Ibukun Koye took to Port Harcourt from Lagos, expatriates are leaving the country.
Investigations reveal that foreigners, especially those from Asia countries, who work in multinational companies located in Port Harcourt, are leaving the city in droves for fear of contacting the dreaded virus.
Many foreigners, mostly of India extraction, were seen at the Port Harcourt International Airport with their families making efforts to board international flight back to their countries.

Some of the expatriates, who spoke to reporters, said they were afraid of contacting the dreaded virus and decided to go back to their countries. One of them who spoke under the condition of anonymity said, “We are very scared because Ebola has no cure. So we want to go back to India. We don’t want to take chances; hence the reason why we want to go back to our country. I am here with my kids and wife. We want to leave Nigeria for our country.’’
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Since the Ebola outbreak in Port Harcourt, the Garden City has lost its peace. Residents now live in fear. Body contact, backslapping and the traditional handshake have become a taboo in the city. Nightlife, which the Rivers State capital is noted for, has become a nightmare. In churches, the spiritual laying of hands by clergies has stopped. In various hospitals, mere symptoms of fever and diarrhea have become a dangerous venture medics don’t want to trade on. Hospitals in Port Harcourt and its environs now reject patients with symptoms of malaria and diarrhea.
The prices of hand-gloves and sanitisers have increased tremendously.
 Addressing traditional rulers and religious leaders in Port Harcourt on the Ebola disease, Governor Chibuike Amaechi of Rivers State enjoined them to sensitise the people in their different domains and partner with his administration in its rescue efforts.
The state government is also getting assistance from multinational companies in Port Harcourt in its fight against the virus.

Coalition Of Inaction: Outrage On The Ebola Front Line In Liberia

Coalition Of Inaction: Outrage On The Ebola Front Line In Liberia

In Monrovia(John Moore/MSF)
MONROVIA— "Welcome to hell." There is no cynicism and no irony in the voice of the young French volunteer from Médecins sans frontières (Doctors without Borders). The deep rings of fatigue under his eyes tell the same tale.
This "hell" is Elwa in Monrovia, the capital of Liberia. Elwa is the largest treatment center ever set up by the French NGO to fight an epidemic, a camp of big white tents where its staff is trying desperately to fight Ebola, the terribly contagious virus that causes often fatal hemorrhagic fevers and has already killed more than 2,000 people in west Africa, over half of them in Liberia.
Dealing with death is not even the hardest part for the young volunteer. What haunts him is that for three days through the chain link and padlocks of Elwa’s high gate he has been sending infected people to die elsewhere, because the center is too crowded. 
"There is nothing worse for us, both humanly and hygienically, because we don’t cut the chain of contamination," says a discouraged Laurence Sailly, emergency coordinator of Doctors without Borders Belgium, the branch of the French NGO with the most expertise in the fight against Ebola. "We are swamped but we have to keep the center under control for both the people who work there and the patients. So we refuse people. It’s awful."
When it opened on August 18, Elwa had 120 beds. That number was soon increased to 160, then 400. This is a first for Doctors without Borders, which took over the treatment center after the departure of the evangelical American NGO Samaritan's Purse at the beginning of August. Elsewhere in town there are 80 other places managed by the Liberian Ministry of Health, in this country still ravaged by the last civil war that ended in 2003. Local doctors and nurses are paying a heavy cost in the fight against Ebola: 152 health professionals have been infected in Liberia, 79 of whom have died, according to the World Health Organization.
But all of this is not enough for Monrovia and its population of some one million people, many of them crammed into squalid slums transformed into viral powder kegs. "We would need 1,000 beds now to fight against this epidemic, the like of which has never been seen before, and Liberian authorities would have to call for help from the outside," says Sailly.
In Elwa’s muddy alleys indignation is mounting. "Where are the other big NGOs so ready to show up when there are humanitarian disasters? They’re afraid of the epidemic and are hiding behind their lack of expertise," says one volunteer, adding that the larger UN agencies move very slowly.
"It’s a coalition of inaction, it’s shocking," says Christopher Stokes, director general of Doctors without Borders Belgium.
A family story
The situation has become so critical that Doctors without Borders has called on American military health services and its logistics. Washington, which sent aircraft carriers, GIs and helicopters to the rescue in Haiti when it was ravaged by earthquake in 2010, is looking into the matter. 
"International organizations and various countries have promised tens of millions of dollars as well as equipment to implement the World Health Organization’s emergency plan, but who’s going to coordinate all this?" Stokes says angrily.

Kitchen staff provide food to Ebola patients in Sierra Leone.(Photo - P.K. Lee, MSF)
Meanwhile, Doctors without Borders has stretched to the point of importing a crematorium that can burn over 100 bodies a day. "Normally that’s not out job," Stokes adds.
Still, time is short. On Monday, under sweltering sun in this muggy rain season the frail silhouette of a woman delirious with fever is curled up on the cinderblocks in the shade of the fence surrounding Elwa. Passersby eye her with looks ranging from disquiet to indifference. Indeed in Monrovia lately, a dead body or a person in agony are not such a rare sight. From the other side of the fence the sick woman’s daughter has received a sanitary protection kit: a little white plastic box that contains chlorine, gloves, an apron and a mask to limit contamination. The girl is gathering water bottles discarded by other contaminated people.
How many other contaminated people lie in agony in family compounds, ostracized by their neighbors? How many Ebola orphans are wandering the streets? Nobody can say with certitude. 
"The figures have been underestimated so we can’t make projections," says Pierre Rollin, a specialist in hemorrhagic fevers at the American Center for Disease Control and Prevention.
The figures put forth: 10,000 dead, 20,000 by the end of the year"We’re not seeing the light at the end of the tunnel," Rollin, an Ebola specialist admits. "Previous Ebola epidemics were on a human scale. This is a real natural catastrophe. We cannot explain why there are so many new cases being registered in such a short period of time."
And the meter is running. "On average every case is in contact with ten people and generates 2.4 new cases," Rollin explains. The result is that none of Liberia’s 15 counties — including those bordering on Ivory Coast — has been spared by the epidemic, which probably began in December with one case in neighboring Guinea.
In this region people and hence the virus weave in and out of forested frontiers where the state is nonexistent. Funeral rites are as much a transmitter of the disease as are bodily fluids.
In Monrovia, the authorities have plastered the city with posters that read "Ebola is real." For those who are not illiterate, the message is on every street corner. "Ebola exists," concedes Abdu Aziz Kromah, a student met in one of the muddy alleys of West Point, a slum in Monrovia where a quarantine has just been lifted.
Finda Fallah can bear witness to the reality, which now also includes some hope. On Saturday this young woman of 30 emerged healed from the Elwa center with two of her children, aged three and six, and her young sister of 15. They are now immune to Ebola. But the virus killed her mother, husband, one of her children, a sister, and nephews and nieces, eight people in all with whom they shared a single sordid room in West Point transformed into an Ebola incubator dirtied by blood diarrhea and vomit.
When we saw her the next day, Fallah managed a smile. But she’ll sleep outdoors this night. The roof she used to sleep under is already occupied by others following a visit from the disinfection service. "People don’t come near us, the pharmacist refused to serve me," she says. 
"Cured, you say?" says another local, Abdu Aziz Kromah, keeping a skeptical distance. Fallah responds: "That’s what Doctors without Borders said? Well, maybe. But we don’t believe the government."  http://www.worldcrunch.com/mobile/#a:16989

Bracing for Worse: WHO Scaling up 120-bed Ebola Facility

Monrovia - The deadly Ebola virus continues to claim more lives in Liberia as health centers become completely overwhelmed to continue receiving new patients daily. On Friday, September 12, 2014, a high powered delegation led by Dr. David Nabarro, Senior United Nations System Coordinator for Ebola and DrKeiji Fukuda, WHO Assistant Director-General, Health Security and Liberian health officials took a tour of the facility.


The World Health Organization in collaboration with the Liberian government is working to complete the 120-bed facility at the former Island Clinic located on the Bushrod Island in Monrovia to meet the demand for more hospital beds for Ebola patients.

Friday construction works were ongoing as contractors were seen busy putting together what will be the second Ebola Treatment largest facility after the medical humanitarian group, Medecin San Frontier, MSF. Workers at the hospital told FrontPageAfrica that they are already seeing an influx of sick people from the disease and that they have to turn them away because the center was not ready.

“People are coming here every day, thinking the center is ready because of the information that is out there,” said Stephen Chea, Deputy Chief of Security at the hospital now renamed the Oniyama Specialist Hospital. “There are a lot of things that we’ve been doing here. It is just that the government wants to use this place so urgently, but the work that needs to be done here could take another 30 days.”

Men at work said they had been given an ultimatum to finish the center in two days and that they (worker) were under a lot of pressure to deliver. During a tour of the facility, Dr. Fukuda seemed impressed by the level of work that was ongoing and said he hopes the facility will help meet the needs of Ebola patients and break the chain of transmission of the deadly disease.

“This example here, we have had contractors working overnight for ten days, to really achieve a miracle in putting together a wonderful facility,” he said. “It really shows you that the international community, both within Africa and outside have been working with the countries in order to turn around this fight and as Dr. Nabarro said, it is still a difficult fight, but this is really how it is going to turn around.”


The opening of treatment centers across the country is urgently needed as available Ebola treatment facilities around the country are turning patients away because they have run out of beds. Suspected Ebola patients who turned themselves into various treatment centers last week were seen lying around in front of the gates, many of them too weak to walk.

But the government said late last week that it is working around the clock to provide the needed resources to open treatment centers where patients could go to receive treatment. The government said it has expended close to five million United States Dollars to fight the deadly Ebola Virus.

GoL Funding to health sector

The government said to date, it has mobilized a total of US$5.7 million dollars consisting of US$5.6 million and LD$9.4 million paid into the Ebola Trust Fund at the Central Bank of Liberia as donations from the government, private individuals and organizations for the fight against the deadly Ebola virus.

Speaking Thursday at a news conference, Finance minister Amara Konneh said after one month of implementation, the government through the finance ministry has disbursed approximately US$4.7 Million to the various implementing agencies, leaving an undisbursed balance of approximately US$1.1 million.

“The Ministry of Health has received US$2.8 million, constituting 61.7% of the initial funding, as part of the government’s initial support to the health sector in dealing with the crisis,” he said. “Of this amount, US$1. 4 million disbursed for the payment of per diems for deploying health workers; US$600,000 to procure 12 ambulances.”

Konneh said the government disbursed US$300,000.00 as an advance on the construction of various treatment facilities across the country, including ElWA II Liberian-run Ebola Treatment Unit, Foya Treat Unit, and Gbarnga Treatment Unit; bringing the Island Clinic online and the Congo Town Ebola Treatment Unit online. He said as part of the government’s effort to fight Ebola Virus Disease (EVD), it has prioritized key activities within the Health and Security Sectors through the National Budget for Fiscal Year 2014/2015.

“We have to date disbursed US$6.2 million over the period July to August to the Health Sector, targeting the Ministry of Health, John F. Kennedy Hospital, Jackson F. Doe Hospital, Phebe Hospital, Tellewoyan Hospital, C.H. Renney Hospital and other county health centers and systems across the country through the Ministry of Health and Social Welfare,” he said.

“Separately, we have disbursed through the budget a total of US$1,276,339.00 to the Security Sector for their regular operations based on the one-twelfth provision of the PFM Law in the absence of an approved budget.”

Konneh said the government has disbursed a total of US$556,150.00 to counties to assist county health teams in their effort to fight Ebola: Mon
tserrado US$276,500; Gbarpolu US$127,650; Margibi US$77,000; Bong County US$50,000 and Grand Gedeh US$25,000. WHO, has predicted an increase in the number of Ebola virus infections in Liberia in September. About 60 percent of Liberia's cases and deaths occurred within the last three weeks, WHO data shows.

Liberia’s Infrastructure was devastated by a 14-year civil war, which killed about 250,000 in the conflict that ended in 2003. The country is estimated to have one doctor to treat nearly 100,000 people before Ebola outbreak, which began in March this year. There have been 2,046 cases since the outbreak with 1,224. In a country of 4.4 Million people it is not good news at all.

EU mechanism to coordinate evacuation Ebola

It will create EU mechanism to coordinate evacuation Ebola PDF Print out E-Mail
Active Image Brussels, Oct 15 (Prensa Latina) The European Union (EU) today announced the creation of a mechanism to coordinate the evacuation of active physicians and workers in West African countries affected by the epidemic of Ebola .
The proposal was made for a high-level meeting devoted to analyzing the EU response to the advance of the disease.

In the same among the European commissioners development and health, along with representatives of EU states, the World Health Organization and the United Nations coordinator attention to Ebola.

"We agree on the crucial importance of reliable medical staff in countries affected systems for medical evacuation and humanitarian workers, in order to maintain an effective international response on the ground," said a statement released here.

In the document, Kristalina Georgieva, EU responsible for Humanitarian Aid and Crisis Response, said that those attending the meeting endorsed a proposal by France that "could form the basis for further discussions on this mechanism."

He also reiterated that the risk of Ebola virus circulating in Europe is low, but warned the need to continue the work of preparation and coordination of risk management to be ready for any eventuality.

He also stressed that the EU is committed to help African countries not only in fighting disease but also in its development in the medium and long term.

"It is very important to strengthen health systems and health in those countries. Try to also provide transportation to and from the region," he said.

For its part, the Italian Minister of Public Health, Beatrice Lorenzin, noted that the Ebola epidemic is a "great tragedy" that must be stopped with coordinated international action.

"This is an emergency that must be addressed throughout Europe with a common and coordinated commitment, both in Africa and here, with new media and new resources, seen so far were insufficient efforts," said Lorenzin.   https://translate.google.com/translate?sl=auto&tl=en&js=y&prev=_t&hl=en&ie=UTF-8&u=http%3A%2F%2Fwww.prensa-latina.cu%2Findex.php%3Foption%3Dcom_content%26task%3Dview%26id%3D3081651%26Itemid%3D1&edit-text=