- Research article
- Open Access
Response to the 2009-H1N1 influenza pandemic in the Mekong Basin: surveys of country health leaders
BMC Research Notes volume 4, Article number: 361 (2011)
Soon after the 2009-H1N1 virus emerged as the first influenza pandemic in 41 years, countries had an early opportunity to test their preparedness plans, protocols and procedures, including their cooperation with other countries in responding to the global pandemic threat. The Mekong Basin Disease Surveillance cooperation (MBDS) comprises six countries - Cambodia, China (Yunnan and Guangxi Provinces), Lao People's Democratic Republic, Myanmar, Thailand and Vietnam - that formally organized themselves in 2001 to cooperate in disease surveillance and control. The pandemic presented an opportunity to assess their responses in light of their individual and joint planning. We conducted two surveys of the MBDS leadership from each country, early during the pandemic and shortly after it ended.
On average, participants rated their country's pandemic response performance as good in both 2009 and 2010. Post-pandemic (2010), perceived performance quality was best for facility-based interventions (overall mean of 4.2 on a scale from 1 = poor to 5 = excellent), followed by surveillance and information sharing (4.1), risk communications (3.9) and disease prevention and control in communities (3.7). Performance was consistently rated as good or excellent for use of hotlines for case reporting (2010 mean of 4.4) and of selected facility-based interventions (each with a 2010 mean of 4.4): using hospital admission criteria, preparing or using isolation areas, using PPE for healthcare workers and using antiviral drugs for treatment. In at least half the countries, the post-pandemic ratings were lower than initial 2009 assessments for performance related to surveillance, facility-based interventions and risk communications.
MBDS health leaders perceived their pandemic responses effective in areas previously considered problematic. Most felt that MBDS cooperation helped drive and thus added value to their efforts. Surveillance capacity within countries and surveillance information sharing across countries, longstanding MBDS focus areas, were cited as particular strengths. Several areas needing further improvement are already core strategies in the 2011-2016 MBDS Action Plan. Self-organized sub-regional cooperation in disease surveillance is increasingly recognized as an important new element in global disease prevention and control. Our findings suggest that more research is needed to understand the characteristics of networking that will result in the best shared outcomes.
As the world prepared for a pandemic because of the emergence and spread of avian influenza A/H5N1 in the Eastern Hemisphere beginning in late 2003, a different pandemic influenza strain (2009-H1N1) emerged in the Western Hemisphere in 2009 . The first report of influenza cases caused by a novel influenza A/H1N1 virus was from the United States on April 17, 2009, describing two cases from California ; cases subsequently confirmed as due to the same virus had appeared in Mexico beginning in mid-March . Beginning on April 24, 2009, the World Health Organization (WHO) issued nearly daily, occasionally twice daily, "situation updates" on the spread of the virus, now known as 2009-H1N1 . On June 11, the WHO situation update #47 indicated 28,774 confirmed cases in 74 countries ; on that date, the WHO Director-General Dr. Margaret Chan declared that disease spread had reached pandemic status . The pandemic continued into 2010. On August 10, 2010, Dr. Chan announced transition to the post-pandemic period, signalling the end of the pandemic .
The 2009-H1N1 virus that emerged as the first influenza pandemic in 41 years presented a less severe clinical picture compared to the worst-case scenario for which planners around the world had been preparing themselves . By late spring 2009, numerous countries were experiencing the "first wave" of disease due to the novel H1N1 virus, the Southern Hemisphere was about to enter its winter influenza season, and the Northern Hemisphere was concerned about a "second pandemic wave" in its own upcoming fall-winter influenza season. Thus, during spring 2009 countries had the opportunity to assess their pandemic preparedness against the novel influenza H1N1 virus, in preparation for expected upcoming surges in disease [9, 10].
The Mekong Basin Disease Surveillance cooperation (MBDS) comprises six countries - Cambodia, China (originally Yunnan and, since 2008, also Guangxi Province), Lao People's Democratic Republic, Myanmar, Thailand and Vietnam - that formally organized themselves in 2001 to collaborate in sub-regional infectious disease surveillance and control . Soon after the first Memorandum of Understanding was signed by the countries' health ministers in 2001, programming focused on building epidemiology capacity, then evolved in 2003 to establish a handful of "cross-border sites" where cooperative surveillance, outbreak investigation by Rapid Response Teams and related disease control activities were organized .
In 2006-2007, MBDS leaders expanded their programming to include pandemic influenza preparedness, through a series of typically multi-sector national and provincial level tabletop exercises in each country which culminated in a broadly multi-sector regional tabletop exercise in early 2007 . According to the United Nations System Influenza Coordinator's office, this was the world's first multi-sector, regional pandemic influenza exercise . At the time of those exercises, the world's focus was on influenza H5N1, and many experts expected that a pandemic would arise from Asia more broadly and in Southeast Asia in particular [15, 16].
Countries in Southeast Asia face a number of important challenges to mounting effective responses to emerging infectious diseases, including pandemics. Resource-poor environments are associated with limited infrastructures -- both the traditional limitations in rural areas and infrastructures that cannot keep pace with the newer realities of urbanization, including rapid population growth and inadequate sanitation systems . Such countries are typically substantially dependent on external support to help build their public health capacity and pandemic preparedness [18, 19]. Their pandemic planning must take into account limited expectations regarding access to pharmaceutical interventions during a pandemic, such as vaccines and antiviral agents . By 2006, only some countries in Asia had engaged in any significant planning for pandemic influenza . Thus, pandemic preparedness planning at that time was particularly compelling for MBDS, located in the epicenter of expected pandemic emergence and coupled with these additional challenges.
There is a growing recognition in the global health community that routine disease surveillance, prevention and control, and especially preparing for pandemics and other large-scale public health emergencies require regional and sub-regional planning and cooperation that supplements and augments purely national efforts [22, 23]. Formally established regional and sub-regional networks driven by users can help to facilitate this process. For example, these networks have helped to facilitate the implementation of the International Health Regulations [24–26]. Despite this increased recognition, little has been written about these regional and sub-regional networks in the literature . The response to 2009-H1N1 involved activating and using many of these networks, yet we know very little about how these networks function or whether or not they led to improved outcomes.
In an effort to better understand how national and sub-regional pandemic influenza preparedness planning helped in the response to 2009-H1N1 in Southeast Asia, we surveyed MBDS leaders early during the pandemic and again shortly after it ended. The purpose was to assess countries' perceptions regarding the effectiveness of their responses including both initial and overall responses. These surveys were carried out for practical purposes for the six MBDS member countries, to aid their ongoing pandemic response and then reflect on further improvements needed to strengthen their respective public health systems and their cooperation. The surveys thus provide lessons for these six countries, but also information that may be valuable to other countries and other sub-regional groups of countries cooperating in disease surveillance and control.
We conducted two surveys of the MBDS leadership. The surveys were in English, the longstanding official language of communication within MBDS. One MBDS leader for each country, known as the "Country Coordinator", completed each survey. These leaders are fully conversant in English. The first survey was distributed in person during an MBDS meeting in June 2009; some were completed and returned on site, and the remainder were returned by e-mail. The second survey was e-mailed to the MBDS Country Coordinators through the MBDS Coordination Office, completed electronically and then returned by e-mail. The first survey was completed between June 26 and July 10, 2009, within one month of the official WHO declaration of the pandemic on June 11; the second survey was completed between December 7, 2010 and January 16, 2011, approximately four months after official WHO declaration of the pandemic's end. Information to complement the information collected in the surveys was obtained from WHO situation updates . Because the surveys did not involve any sensitive questions about individuals and were purely informational in nature, they were exempted from Institutional Review Board review. Participants gave verbal informed consent to participate in the research.
Survey structure and content
The surveys contained structured and semi-structured questions and were designed to be self-administered. The first survey and the second survey contained the same questions with the exceptions noted below. Both structured and semi-structured questions concentrated on three broad areas previously designated as high priorities by MBDS countries from the series of tabletop exercises in 2006-2007: surveillance and information sharing, disease prevention and control in health facilities and the community, and risk communications.
Participants were first asked to indicate the number of confirmed cases of 2009-H1N1 their country had experienced at the time they completed the first survey. Additional structured questions required survey participants to indicate whether or not their country undertook 32 separate activities divided across the three broad areas. These activities were identified as needed response capabilities by MBDS leaders in their regional pandemic influenza tabletop exercise . In the first survey only, participants were asked when they first undertook each action during the evolution of the pandemic: when cases were in the Americas, when cases were in their region, when cases were in their country, after the pandemic had been declared, or not at all. In both surveys, participants were asked to rate on a 5-point Likert Scale (where 1 = very poor and 5 = excellent) their subjective opinion as to the effectiveness of each activity undertaken in their response to the pandemic. Using the same scale they were also asked to rate how effective the same action would have been, hypothetically, in 2006 - before the MBDS exercises and extensive regional pandemic response planning. Finally, participants were asked to use a 5-point Likert Scale (where 1 = not at all and 5 = very much) to rate how much eleven planning-related factors drove or contributed to the success of their pandemic responses.
Semi-structured questions asked participants to provide narrative responses relating to the three broad activity areas discussed above, plus a fourth area - coordination within MBDS: "What went right and why?" and "What needs improvement and what will you plan to do to make these improvements?" Participants were also able to provide narrative comments on improvements needed in connection with any of the 32 specific activities, to complement their Likert scale ratings.
Data analysis and synthesis
Responses to structured questions from both surveys were compiled and analyzed using Microsoft Excel 2007. Assessment of when countries initiated specific activities was based on counting the number of countries with early initiation (value of 1 or 2) and later initiation responses (value of 3 or 4) and then calculating the percentage of all responses that were initiated early. Countries that did not undertake the activity were excluded from the calculations. Mean values of Likert scale responses were calculated separately for each survey for each of the 32 specific activities across countries and each country within each of the three broad areas. Overall means for each of the three broad areas were calculated for both survey periods. All calculations included only affirmative responses; items not reported or reported as an activity not undertaken were excluded from both numerator and denominator for each calculation. Comparisons between perceived effectiveness of actual performance (in 2009 and again in 2010) and hypothetical performance (had each activity been undertaken in 2006) were calculated as the difference in values for actual and hypothetical performance for each activity for each survey (2009, 2010).
Responses to semi-structured questions were analyzed using recursive abstraction. Country level responses to each question were examined to identify common themes. The limited amount of data allowed for comparisons of verbatim responses. Themes that appeared in the responses of more than one country were selected for additional analysis. Qualitative summaries of these themes were developed.
Initial spread of 2009-H1N1 in the region
At the time the Country Coordinators completed the first survey, all countries had reported at least one confirmed case of 2009-H1N1 (Table 1). Thailand was the first MBDS country to report confirmed H1N1 cases, on May 13, 2009; at that time, 33 countries had reported cases to the WHO. Thailand and Vietnam both reported their first cases before June 11, when the pandemic was declared; the first cases in the four other MBDS countries were reported after 2009-H1N1 had reached pandemic status, with Myanmar as the last country to report its first case on July 1. By that date, Thailand had already reported 1414 cases and Vietnam, 123 cases.
When did countries initiate specific response activities?
Table 2 presents details of whether or not countries had undertaken each of the 32 specific activities at the time of the June 2009 survey and, if so, when during the evolution of the pandemic they initiated the activity. Nearly all countries established a case definition for 2009-H1N1 very early, when cases first appeared in the Americas, and most countries also instituted active case finding at hospitals and clinics and established a hotline for reporting cases during the early stages of the evolving pandemic. Laos and both Yunnan and Guangxi Provinces in China each reported initiating most of their activities quite early in the evolution of the pandemic, when cases first appeared in the Americas or shortly thereafter; the other MBDS countries mostly initiated activities when 2009-H1N1 had arrived in their region or country. All countries mobilized their Rapid Response Teams for epidemiologic investigation and response, though at different times in the evolution of the pandemic. The occurrence and timing of communications with established MBDS cross-border sites, with other MBDS countries, and with the MBDS Coordinator varied across the six countries.
Cambodia, China and Myanmar each reported that they began preparing their respective health care systems for 2009-H1N1 when cases first appeared in the Americas, e.g., through communication with health workers, use of specific hospital admission criteria, preparation of isolation areas and of personal protective equipment for health workers, increased attention to hospital infection control, and preparation for medical surge. Laos began such activities mostly when cases were in the region or country, and Vietnam, when cases had arrived in the country. An increased focus on PPE for health care workers and preparations for hospital isolation and care were the earliest activities undertaken to prepare the health care system in most MBDS countries, at whatever stage such preparations were initiated.
Cambodia, China's Guangxi Province, and Myanmar each reported that they began border control measures very early, when known cases were limited to the Americas. Cambodia, both Chinese provinces, Laos and Myanmar each reported instituting containment measures, but at different points in the evolution of the pandemic. Cambodia restricted travel (the only MBDS country to do so) and public gatherings and closed schools after the pandemic had been declared. Myanmar was the only other country to implement any such restrictions, also closing schools once the pandemic was announced.
Cambodia, Laos and Myanmar each reported that they identified communications spokespersons early in the evolution of the pandemic. Message consistency and communications to avoid public panic were early priorities for risk communications in Cambodia, China and Myanmar. Communications within the MBDS community - with other countries and with the MBDS Coordinator in Bangkok - was an early priority for some countries, but was undertaken later or not at all by others.
How did countries perceive their response performance in 2009 and 2010?
Table 3 presents each country's subjective ratings of its own performance early during the pandemic and shortly post-pandemic. Some activities that had not been implemented at the time of the first survey in June 2009 were subsequently undertaken and were rated on the second survey. On average, participants rated their country's performance both early and post-pandemic as good. Comparison of Tables 2 and 3 suggests that performance was judged to be better for activities initiated earlier during the evolution of the pandemic with regard to surveillance and information sharing in China-Yunnan, Laos, Myanmar and Thailand, and to a lesser extent, risk communications in Cambodia and Myanmar. Post-pandemic, the broad area that received the highest overall mean rating was disease prevention and control in health care facilities (4.2), followed by surveillance and information sharing (4.1), risk communications (3.9) and disease prevention and control in communities (3.7). More countries voluntarily chose to not implement community-based interventions, compared to activities in the other broad areas. Countries consistently rated their performance as good or excellent for use of hotlines for case reporting (2010 mean of 4.4) and of selected facility-based interventions (each with a 2010 mean of 4.4): using hospital admission criteria, preparing or using isolation areas, using PPE for healthcare workers and using antiviral drugs for treatment.
Cambodia's ratings of its perceived performance overall were higher than those for other countries, especially for surveillance and information sharing (4.9 in 2009 and 4.5 in 2010 for Cambodia compared to 4.1 and 4.1, respectively, overall), disease prevention and control in health facilities (4.6 and 4.5 compared to 4.3 and 4.2, respectively), and risk communications (4.7 and 4.6 compared to 4.1 and 3.9, respectively). By 2010, Myanmar perceived its performance related to disease prevention and control activities in communities to be excellent (5.0 overall mean), higher than all other countries. Half to two-thirds of countries perceived the quality of their response efforts for surveillance, facility-based interventions and risk communications as lower overall post-pandemic, compared to their initial 2009 assessments. In contrast, only one country rated its overall performance for community-based interventions as lower post-pandemic (2010) compared to 2009. Myanmar and Thailand felt their performance had improved, in all areas reported, by the end of the pandemic; Vietnam also felt its performance in surveillance and information sharing had improved, and Cambodia also considered its community-based interventions as better post-pandemic than in the early stage of the pandemic.
How did countries perceive their actual response performance in comparison to hypothetical performance of the same activities in 2006?
Table 4 presents comparisons of subjective ratings of actual performance in 2009 and 2010 to hypothetical performance of each activity had it been undertaken in 2006. For surveillance and information sharing, Cambodia and Thailand felt that their performance in 2009 was better in all areas compared to how they may have performed if they were to have responded to a pandemic in 2006 (mean difference of at least 1); by 2010, China-Guangxi and Laos also perceived differences of this magnitude in comparison with their hypothetical performance in 2006. China-Yunnan identified an area for improvement in the future: establishment of hotlines for reporting possible cases (performance judged worse in 2009 than it might have been in 2006). In the area of disease prevention and control in health facilities, Cambodia and Thailand considered their 2009 performance substantially better than it would have been in 2006; by 2010, Myanmar also considered its performance better than it would have been in 2006. Both Yunnan and Guangxi provinces of China and Vietnam felt that their good to excellent performance in 2009 was no different than it would have been in 2006. With regard to disease prevention and control in the community, again, Cambodia and Thailand considered their 2009 performance at least one point better on average compared to 2006; and again, by 2010 Myanmar felt its performance had improved to this degree as well. Finally, with regard to risk communications, Cambodia and Thailand again initially considered their performance to have been at least one point better on average than it would have been in 2006, but by 2010, only Cambodia and China-Guangxi perceived their performance for risk communications as at least one point better than in 2006.
What factors contributed to successful responses to 2009-H1N1 in each country?
Table 5 presents subjective ratings of the contribution of different planning-related factors, including specific aspects of MBDS cooperation, to the success of each country's pandemic response performance. MBDS Country Coordinators considered pandemic preparedness plans at national, provincial and/or local levels to have been the most important factor contributing to the success of their pandemic responses, with average scores of 4.7 and 4.6 in 2009 and 2010, respectively. The second most important factor was strong political leadership (average scores of 4.4 in both 2009 and 2010). The three factors tied as third most important post-pandemic were the government's structure/management, the involvement of ministries in addition to the Ministry of Health, and having carried out pandemic preparedness exercises - each scored 4.3 on average in the 2010 survey. The 2010 post-pandemic survey indicated that international cooperation, including the 6-country MBDS agreement (mean score 3.4) and action plan (3.7), communications with other MBDS countries (3.6) and with their external partners (3.4), and country obligations under the revised WHO International Health Regulations (3.7) were viewed as less important contributors to successful country responses, in reflecting on overall responses after the pandemic had ended. Thailand rated MBDS cooperation as essentially irrelevant to its responses (scores of 1 for each such item, on a scale of 1-5).
Qualitative assessment of strengths and areas for improvement
With regard to perceived strengths in the pandemic responses of MBDS countries, two themes stood out based on our qualitative analysis of the comments offered by the survey participants. The first theme relates to surveillance and information sharing within countries, and the second theme relates to surveillance and information sharing across countries. Within countries, participants noted the ability of their country level surveillance systems to exchange information efficiently. These systems were referred to as: good (Cambodia), reliable (China-Yunnan), critical (Myanmar), and the most successful aspect of their country's response (Vietnam). Across countries, participants noted the importance of MBDS to enable timely coordinated regional response (Cambodia), detect disease at cross border sites (Myanmar), and prevent the spread of the virus (China-Guangxi).
Two key themes also emerged from comments about areas of response that MBDS countries perceived as still needing improvement. The first theme relates to the desire to continue to improve communications within countries, and the second theme relates to the desire to continue to improve communications across MBDS countries. Within countries, participants identified risk communication as a major challenge. Some noted that public health workers were "not fully trained to communicate with panicky citizens" or that more "health education" for the public was necessary. Participants also noted that MBDS communications across countries needed to be improved and sustained (Cambodia), expanded and strengthened (China-Guangxi), and that more communications in general were needed (Vietnam). One country noted that existing communications were the "bare minimum of regional collaboration" (Cambodia).
Participants also commented on plans to improve their response in the future. They identified plans for improvement for each of the three broad areas discussed. For example, plans to improve surveillance and information sharing included better electronic reporting and active case finding, sustained availability of hotline support, joint outbreak investigation across MBDS borders and surveillance reaching out to the community level. These health leaders hoped to improve influenza prevention and control through building better capacity for laboratory diagnosis; ensuring better access to vaccines, drugs and protective equipment; building better local pandemic response capacity and better surge capacity. Needed improvements for communications among responders and with the public include development and use of better information and communications technologies, building capacity for public risk communications and judicious use of such communications. These leaders also identified ways to strengthen the collaboration among the MBDS countries.
This paper presents an analysis of the subjective assessment of performance at two points in time related to MBDS countries' responses to the 2009-H1N1 pandemic. Performance early during the pandemic and post-pandemic was reported by senior health leaders in six countries in the Mekong Basin, all of whom were heavily involved in their countries' pandemic response. These countries had formally organized themselves eight years earlier for a new type of transnational cooperation - a sub-regional network for cooperation in disease surveillance, prevention and control that reached from the central government level out to provincial and local cross-border operational sites. Based on the judgments of MBDS Country Coordinators, elements of pandemic preparedness at national and sub-regional levels identified as problematic from the 2006-2007 MBDS exercises (many of the specific items included in the surveys reported here) were performed relatively early and well in the responses to 2009-H1N1 influenza, as perceived both early during the pandemic (June 2009) and post-pandemic (December 2010). Important contributors to these successes included extensive pandemic influenza planning, political leadership and government structure, the involvement of multiple government ministries in the pandemic response, and having carried out pandemic preparedness exercises including the MBDS-sponsored exercises in 2006-2007, which were the first exercises ever carried out in all MBDS countries except Thailand. Cambodia and Thailand in particular, and Myanmar to only a slightly lesser degree, felt that their public health responses were better in 2009 and 2010 than they would have been in 2006.
Most performance indicators related to responses within countries; the role of MBDS cooperation in contributing to better pandemic preparedness in these countries cannot be assessed directly from our surveys. However, while the quantitative scores indicate that MBDS cooperation was not the principal driver of pandemic response in the individual countries (a reasonable and legitimate perspective), performance in surveillance and information sharing and risk communications with other MBDS countries and with the MBDS coordinator were generally judged as good. Moreover, the qualitative responses also suggest that most MBDS countries value MBDS communications and cooperation and seek to improve them - Cambodia, China, Myanmar and Vietnam all commented explicitly in this regard. These findings lend support to a general conclusion that MBDS cooperation added value to the pandemic responses across these countries. Somewhat troubling, however, is the wide variability (across the entire 5-point range of ratings, Table 5) in the value different countries attached to MBDS cooperation, or at least to the specific elements included in the surveys--the MOU, action plan, and role of other MBDS countries.
The ultimate outcomes of interest are better system capabilities and better health in the populations of these countries. Findings from the surveys reported here suggest that the MBDS cooperation added value to their public health preparedness and pandemic response. Earlier experiences had already included several instances of cooperative cross-border outbreak detection and response. The quantitative and qualitative responses in the surveys reported here pointed to a few areas for further attention, including laboratory capacity, risk communications, electronic communications and local cross-border cooperation. Several of these are already included in the MBDS Master Plan for 2011-2016, the core strategies of which capture some of the key capabilities needed for pandemic preparedness: cross-border cooperation in surveillance and response; coordination between animal and human health; community-based surveillance; epidemiology capability; information and communications capability; laboratory capability; risk communications; and policy research . It is reasonable to expect that these capabilities, within the MBDS community and across this and other regions, will improve both public health systems and health outcomes by enabling more-timely and better detection, communications, coordinated containment, and control of the next small outbreak or the next major pandemic.
The strengths of this paper include its focus on sub-regional response (an emerging trend in global public health), the use of surveys both during and after the pandemic (to assess early progress and needs for improvement as well as overall performance after the hectic pace of pandemic response had subsided) and the fact that the country surveys, though not large in number, were completed by senior health officials who were knowledgeable and heavily involved in their country's pandemic response. The weaknesses of the paper can be broken into three categories: the reliance on subjective responses from a small number of respondents, the inability to assess how different activities impacted outcomes across countries, and the limited ability to assess how and the extent to which the MBDS sub-regional collaboration influenced their pandemic response.
The surveys reflect subjective judgments of individual health leaders in the six MBDS countries related to their respective country's pandemic response early during the pandemic and again post-pandemic. While more objective measures, more rigorous data collection methods, and the views from a larger number of country officials may have enhanced the validity of the results, we believe that these results had sufficient face validity for the practical purposes intended - to guide further improvements during the pandemic (from the 2009 survey) and provide useful insights to guide the future actions (from the 2010 survey).
An important aspect of quality improvement is the ability to iteratively test different interventions to see how effective each one is and which interventions work better than others. In this work we were not able to directly assess whether or the extent to which specific activities taken by each country resulted in different outcomes. For example, we cannot directly assess whether or not the decision of Cambodia to limit travel resulted in better outcomes (such as slower disease spread) than the other five countries that did not restrict travel. We also cannot link perceived performance quality to actual outcomes.
Our survey contained some information on how MBDS countries collaborated together during the pandemic. Our ability to assess what aspects of that collaboration resulted in optimal responses is limited. In addition, we have only a limited knowledge of how MBDS collaborative planning prior to the pandemic directly or indirectly impacted their national or collective sub-regional response. In a more ideal circumstance, a baseline survey would have been conducted prior to all MBDS planning and would not require participants to hypothetically conjecture how their responses might have differed prior to their focused pandemic planning efforts.
MBDS was founded upon a principle of coordinated actions for the common regional good and rapid and open communications across the MBDS community. Despite this, there was considerable variability in the timing of initiation of communications across MBDS countries and with the MBDS Coordinating Office during the 2009-2010 response. From their early experiences, Country Coordinators identified some priorities for MBDS action during 2009-2010, and they offered further ideas for improvement post-pandemic. By the end of the pandemic, some countries felt their performance in one or more broad areas and for specific activities had improved since 2009, but other countries rated their 2010 performance as less effective than that in 2009.
We believe it was useful to examine public health system performance in a real situation--the 2009-H1N1 pandemic. As might be expected, the MBDS leaders identified areas where early pandemic response was judged to be good to excellent and other areas where they intended to target their improvement efforts in the near term. The 2009 survey results were presented to a large MBDS conference in August 2009 in Kunming, China, and MBDS leaders incorporated some of the survey's findings into their MBDS operational plans for the next two years. Most of these plans have not yet received funding support, so assessment of actual improvements since 2009 has been limited. The information from the follow-up survey should also feed into the planning process within countries and across the MBDS cooperative community.
The public health emergency response capacity that MBDS countries had built through training and simulation exercises, national and sub-regional planning, multi-sector engagement, and political leadership in each country enabled what health leaders across the MBDS community perceived as effective responses in areas that had been identified as problematic during the 2006-2007 MBDS tabletop exercises. Health leaders from most but not all countries perceived that MBDS cooperation helped drive and thus added value to their responses to the 2009-H1N1 pandemic. Surveillance capacity within countries and surveillance information sharing across countries, longstanding focus areas of MBDS programming, were cited as strengths during the pandemic response. Several specific areas cited as needing further improvement are already core strategies in the MBDS Action Plan for 2011-2016. However, the familiarity and mutual trust that MBDS countries have built over the decade of cooperation did not carry over in a consistent way in terms of the importance of MBDS network cooperation in each country's pandemic response. It may be worthwhile to explore the reasons for this, as yet another avenue for enhancing future cooperation and future collective response to cross-border and trans-national disease threats.
Self-organized sub-regional consortia for cooperation in disease surveillance are increasingly recognized as a new and important element in global disease prevention and control, which has become very cross-border and trans-national in nature . MBDS is one of the longest-standing of such sub-regional cooperative groups and has been described as an "innovative cross-border initiative."  The true value of sub-regional surveillance networks like MBDS remains unclear. Countries involved in these networks must determine the appropriate role for their network vis-à-vis national efforts and how to sustain collaboration across their countries. Our findings suggest that more research is needed to understand the characteristics of networking that make the most sense and that will result in the best shared outcomes.
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Martin R, Conseil A, Longstaff A, Kodo J, Siegert J, Duguet AM, Lobato de Faria P, Haringhuizen G, Espin J, Coker R: Pandemic influenza control in Europe and the constraints resulting from incoherent public health laws. BMC Public Health. 2010, 10: 532-10.1186/1471-2458-10-532.
Armstrong P, Chant K: Preparing for the next influenza pandemic: a New South Wales perspective. N S W Public Health Bull. 2006, 17: 114-7.
Kimball AM, Moore M, French HM, Arima Y, Ungchusak K, Wibulpolprasert S, Taylor T, Touch S, Leventhal A: Regional infectious disease surveillance networks and their potential to facilitate the implementation of the international health regulations. Med Clin North Am. 2008, 92: 1459-1471. 10.1016/j.mcna.2008.06.001.
Sturtevant JL, Anema A, Brownstein JS: The new International Health Regulations: considerations for global public health surveillance. Disaster Med Public Health Prep. 2007, 1: 117-121. 10.1097/DMP.0b013e318159cbae.
Wilson K, von Tigerstrom B, McDougall C: Protecting global health security through the International Health Regulations: requirements and challenges. CMAJ. 2008, 179: 44-48. 10.1503/cmaj.080516.
Gresham L, Ramlawi A, Briski J, Richardson M, Taylor T: Trust Across Borders: Responding to 2009 H1N1 Influenza in the Middle East. Biosecur Bioterror. 2009, 7: 399-404. 10.1089/bsp.2009.0034.
Mekong Basin Disease Surveillance Cooperation: Mekong Basin Disease Surveillance (MBDS) Cooperation - master plan for 2011-2016. Approved November 2010, [http://www.mbdsoffice.com/data140508/mbds_master_plan_2011_16_final_eb_approved_2010_11.pdf]
We would like to express our thanks to Drs. Moe Ko Oo (MBDS Coordinator), Sok Touch (Cambodia), Cheng Chun (Yunnan China), Qing Minfang (Yunnan China), Li Huiyang (Guangxi China), Nyphonh Chanthakoummane (Laos), Win Naing (Myanmar), Soe Lwin Nyein (Myanmar), Pasakorn Akarasewi (Thailand), Thitipong Yingyong (Thailand), and Nguyen Dang Vung (Vietnam). We would also like to acknowledge the support of the Rockefeller Foundation who generously supported MBDS efforts for more than a decade and also supported this work.
The authors declare that they have no competing interests.
MM and DJD designed and conducted the study. MM led the writing and analysis. DJD contributed substantially to the analysis and writing. Both authors have read and approved the final manuscript.
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Cite this article
Moore, M., Dausey, D.J. Response to the 2009-H1N1 influenza pandemic in the Mekong Basin: surveys of country health leaders. BMC Res Notes 4, 361 (2011). https://doi.org/10.1186/1756-0500-4-361
- Pandemic Influenza
- Risk Communication
- Rapid Response Team
- Health Leader


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Mid-eighties born Mirko Bartsch is a House music producer, Live performance artist and Deejay from Wiesbaden, Germany. Starting collecting electronic vinyl records since the age of 14, and more than 10 years of work at Discogs.com makes him a specialist in all kinds of electronic music. In year 2010 he started producing his own House, Deep House & Tech House tracks and try to perform all of his produced tracks as some Live performance artist in several clubs. His tracks were played by many important Deejays worldwide, and also on the biggest german radio shows like the legendary YOU FM Clubnight, Planet Radio Nightwax & Big City Beats.

domain: artistic


June 17, 2024 @ 8:00 am – June 20, 2024 @ 5:00 pm
Collision Conference 2024 is the ultimate destination for tech entrepreneurs and industry professionals. As one of the world’s biggest tech conferences, Collision will be returning to Toronto from June 17-20, 2024, bringing together visionaries and elite professionals who are pushing the boundaries of technology and innovation.
At this premier event, you’ll have the opportunity to exchange ideas, showcase cutting-edge developments, and participate in stimulating conversations on topics driving the future of technology. There’s also a chance to dive into thought-provoking networking events that will spark meaningful connections and bring together tomorrow’s leaders. With an expansive exhibit hall featuring hundreds of exhibitors presenting their latest and greatest technologies, Collision is truly a haven for discovering groundbreaking business opportunities and inspiring collaboration.


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I got home from my day job today and I have barely had the energy to do half the dishes, triage my emails, and do a couple of writerly things, including resuming my blog.
Then there is my friend Wendy. She's a Mom, a writer, and an award winning doll sculptor. She's active in her church, at least a dozen other activities, and she's a literary agent. As if that were not enough, Wendy and her literary agency, Books & Such, just launched their blog.
If you want to know how she does it all, stop by the blog. Lately, Wendy has been focused on the topic of organization. All the contributors share information that's helpful in all areas of life, not just writing or work. I'm excited about adding this blog to my list of regular reads and I hope you will check it out.

domain: hobby


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WHITE PLAINS, N.Y. Max Rogovin wants to fly fighter jets for the U.S. Navy. He is pursuing that goal as a member of the Civil Air Patrol and soon will continue as a participant in the U.S. Naval Academy's Summer Seminar.
Rogovin, a junior at White Plains High School, is one of 2,250 students from across the nation and abroad invited by the U.S. Naval Academy to take part in its summer leadership program for rising seniors.
"It feels awesome," Rogovin said. "It's just an opportunity that you get one shot at. I've been looking forward to it ever since I learned about the academies."
After Rogovin graduates from high school, he hopes to attend the Naval Academy. Through this six-day summer seminar program, Rogovin will get a glimpse of what life as a midshipman at the Naval Academy would be like.
He will participate in daily physical training, academic and leadership workshops as well as seamanship and navigation classes, which will involve taking a cruise aboard a Navy Yard Patrol craft to apply what was learned in class.
"I can't wait to get inside the barracks and get on some of the unique equipment they have at the academy, including the Yard Patrol boats and the ship simulator," Rogovin said.
This past summer, the history buff attended the world's largest air show in Oshkosh, Wis., as part of the Civil Air Patrol, a nonprofit, volunteer organization with 61,000 members nationally that acts as an auxiliary to the U.S. Air Force, according to its website . Founded a week before the attack on Pearl Harbor on Dec. 7, 1941, it performs search and rescue by ground and air, and disaster relief, among other services for Westchester.
On March 14, Rogovin was named a cadet officer in the Lt. Anthony L. Willsea Cadet Squadron of the Civil Air Patrol, the first since October 2010, said Capt. Andres Bermudez, its commander and a Mamaroneck resident.
"I'm extremely proud of him," Bermudez said. "He does a lot of hard work for the squadron. He wants to go to the Naval Academy in Annapolis and being a cadet officer gives him a leg up on that."
Rogovin said his experiences with the Civil Air Patrol have been "life-shaping." He hopes the summer seminar and, if he is accepted, four years at the Naval Academy will follow suit.
"I am very grateful for the opportunities I've had in CAP and for the opportunities I hope to receive at the Naval Academy as a midshipman, should I be accepted," he said. "At the Naval Academy, I will get a top-notch education, a job I will enjoy and as a bonus I will get to serve my country. What more could I ask for?"
Student volunteers, ages 12 and up, can join their local CAP. The Westchester CAP meets at the Westchester County Airport, 4 Taxi Lane, on Wednesday nights at 7:30 p.m.
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domain: news


SPF Daly All Weather Mariner (Nickle Plated) Tactical (18.5 inch barrel) 12 Gauge . Maybe 15 rounds through it, MAX. One owner, allways stored in back of safe. Trades? Kel Tec Small frame 9mm, 380 AMT45 Back Up, Stainless Steel + cash Nice Scope, wide angle, distance scope. 10/22 (synthetic stock) Sold pending funds, ....will repost if it falls through$250 cash, Face to face OR res only, ....must have valid OR ID.


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Back in October of last year we reported on Fiona Hunter’s album preview at Glasgow’s Glad Cafe. As singer with Malinky for the least ten years, Fiona has three times been nominated for the Scots Singer of the Year award at the Scots Traditional Music Awards; and it’s her love of traditional Scottish song, especially from around her native Glasgow, that’s been the inspiration for this album. Mike Vass has taken the helm as producer, with the duet working together on the arrangements; joining them in the studio were talented Arran fiddler Gillian Frame (Back Of The Moon), multi-instrumentalist Innes Watson (Lori Watson and Rule of Three, Ross Ainsley & Jarlath Henderson) and renowned jazz bass player Euan Burton.
The album opens with the beautifully warm tones of Fiona’s cello to introduce Robert Tanahill’s Braes O’ Gleniffer. In the Renfrewsire hills Tannahill himself loved to explore, a woman feels the bite of winter while she remembers a summer of love. Despite Tannahill’s gloomy outlook, this rendition’s rich warmth evokes summer and cleverly shifts the focus from regret to happy memories…
The wild flowers o’ simmer were spread a’ sae bonnie
The Mavis sang sweet frae the green birkin tree
But far to the camp they ha’e marched my dear Johnnie
And now it is winter wi’ nature and me
Other traditional songs are given invigorating treatments. The Bleacher Lass O’Kelvinhaugh is presented in a light, refreshing form – with golden backing vocals and a lovely, intricate instrumental conclusion. The Laird O’ Drum is a typical tale of class-crossed lovers and the version Fiona learned from mentor Andy Hunter offers the most engaging blend of authentic and contemporary you could possibly hope for; with subtle shades of Pat Metheny in the guitar work.
Of course, the livelier moments are tempered by some more gentle, and even sombre offerings. Young Emsley is a beautiful adaptation of Lizzie Higgins’ version, with soft guitar and cello to support the vocal. Where strings and voice combine to full effect, however, it is in that darkest of murder ballads, The Cruel Mother. Fiona’s voice is full of drama, sorrow, anger as needed while cello and fiddle create a ghostly chill.
There’s also no shortage of buoyant humour. Robert Burns excelled at tales of domestic discord and The Weary Pund is one of his best. In closing with the cautionary tale Jock Hawk, Fiona brings the album to a lively, invigorating conclusion and, just as in live performance, leaves her audience hungry for more.
I cam’ into the world a bairn,
Sae naked and sae bare,
I cam’ oot frae Glesca
And I’ll never gang nae mair
Above these fine offerings MacCrimmon’s Lament stands proud. Spine-tingling from its a capella first verse; with harmonium, guitar, backing vocals and atmosphere building throughout. A performance charged with emotion.
The shining star of this album, though, is Fiona’s vocal performance. Not simply the clarity of her voice, or the degree of expression – her gift for the interpretation of traditional song and the use of Scots language is unsurpassed. Each song on the album demonstrates an intimate understanding of the Scottish Oral tradition and highlights its existence not only in the more familiar highland context, but as a tradition of every region.
Anyone with a fondness for Scottish traditional song, or in need of an introduction, should view this wonderful album as a must buy.
Review by: Neil McFadyen
The Bleacher Lass o’ Kelvinhaugh
Album Stream (Via Deezer)


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Oooh, two juicy Christina Aguilera bombshells in one post!
Let's start with Cee Lo. Homie was on Howard Stern earlier this week to plug the return of The Voice when he revealed something so shocking, SO outrageous, that you may never look at Lotus the same way again: CHRISTINA AGUILERA MAY NOT HAVE LEFT THE LAST SEASON OF THE VOICE BY CHOICE!
It looks like there was more to Lady Gaga'sARTPOP-exclusive set at the iTunes Music Festival than simply just sharing new music with her little monsters. About an hour ago, Jesus Kunst graced Twitter with her holy presence and asked fans to choose ARTPOP's next single, complete with four songs to choose from. They are: "Sex Dreams," "Swine," "Aura," and "Manicure" -- arguably the four best cuts from her iTunes concert.
The worst thing about Lady Gaga has always been Stefani Germanotta. There's been many times over the years where I've wished I could just enjoy the music and performances without having to deal with the insufferable woman herself. But since the ARTPOP era kicked off, something amazing has happened: Gaga's many flaws have suddenly become soooo much fun. Watching her freak out on Twitter, tip-off the paparazzi just to get a little publicity, and get called out by Billboard for desperately encouraging her little monsters to cheat the chart system has been a total blast.

domain: entertainment


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NEW DELHI (Reuters) - Taslima Nasreen, the exiled Bangladeshi Muslim woman writer whose presence in India sparked riots, said on Thursday that New Delhi was forcing her to live under virtual house arrest, and appealed for more freedom.
Award-winning writer Nasreen, who criticises the use of religion as an oppressive force, has lived in Kolkata since 2003.
She was rushed from her home and moved from city to city last month when radical Islamist protests against her led to riots, and the army had to be called in.
Nasreen fled Bangladesh for the first time in 1994 when a court there said she had “deliberately and maliciously” hurt Muslims’ religious feelings with her Bengali-language novel “Lajja”, or “Shame”, about riots between Muslims and Hindus.
Several of her books have been banned in India and Bangladesh. The European Parliament awarded her the Sakharov Prize for freedom of thought in 1994.
Nasreen now lives in a secret security facility in New Delhi, which she has equated with “solitary confinement.”
Her fate has become a hot political issue for New Delhi as the Hindu nationalist opposition has accused the government of pandering to Muslim minorities by trying to get her out of the country.
“I don’t think that in the name of security I should be put in solitary confinement,” Nasreen told the New Delhi Television news channel. “I asked them how long I have to remain in house arrest, they said they don’t know.”
The government has refused to comment on Nasreen’s claims.
New Delhi has said it will continue to host and protect the writer, but indicated she would have to avoid political activities and actions that might hurt India’s relations with its friendly neighbours.
Some radical Muslims hate her for saying Islam and other religions oppress women, and Indian clerics issued a “death warrant” against her in August.
Nasreen said she wanted to return to a “normal life” in Kolkata, but the communist government there is seen as reluctant to anger militant Muslims.
“I haven’t done anything wrong. I wrote for human rights, women’s rights and secular humanism and I am not a criminal,” she said. “Why should I be punished in this way, why shouldn’t I be able to meet my friends and relatives?”
The author’s visa is due to expire in February and New Delhi will have to decide whether to extend it.
Our Standards: The Thomson Reuters Trust Principles.

domain: sociology


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By The Canadian Press
WINNIPEG — A Manitoba union accused by the governing Progressive Conservative party of breaking an election advertising limit has filed paperwork that says its spending was well within the law.
Unifor has filed a financial report with Elections Manitoba, as all third-party advertisers are required to do after each election.
Unifor says it spent just under $19,000 during the four-week Manitoba election campaign that ended Sept. 10 — well under the legal limit of $25,000.
Cabinet minister Kelvin Goertzen accused Unifor in August of over-spending, when he noticed several billboards, bus-shelter ads and brochures the union had produced that criticized the government.
The Progressive Conservatives quickly filed a complaint with the provincial election commissioner, and that investigation is ongoing.
Unifor denied the accusation from the start, and both sides say they will not comment further until the investigation is complete.
The Unifor ad campaign targeted Progressive Conservative leader Brian Pallister, who was elected to a second majority, with the phrase “Don’t let Pallister wreck health care”.
Make Poverty History, a Winnipeg-based advocacy group, has registered campaign expenses of $7,300.
The Canadian Union of Public Employees also registered as a third-party advertiser and its financial results were not available Friday.
Provincial elections commissioner Bill Bowles does not comment on complaints or ongoing investigations.


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2. it goes right through downtown Greenville so you get to go right next to the falls. To find the trail from surface streets, Take River St. South from McBee or Broad Streets, or North from Camperdown Way. Since I rode it last, Swamp Rabbit has been extended about a mile northward. in the future Virginia Creepy bike trail is calling...R.my sprinting bike trail where i live no longer seems accurate. It needs a bit better marking in Greenville as the signs for the offshoots lead one to believe the trail is turning when it is not. It's about 0.2 mile long. Also food along the trail is crazy expensive....ham and cheese $11, really.. We really enjoy the Swamp Rabbit. At this time, there is no signage leading to the trail head, or identifying the trail head. Amenities along the trail include lighting, picnic areas, benches, water fountains, restrooms, signage and bicycle racks. Head injuries are bad news. Its purpose is to aid everyone - from out-of-town visitors interested in experiencing the Swamp Rabbit Trail to regular trail users - by providing useful trip-planning information. The path is showing signs of wear with cracks and bumps where tree roots are growing. Beautifully maintained. It is not yet complete to the College, and lacks the jogging surface after you reach East Faris Rd. Some people were critical of the train through town. The trail seems to have great buy-in from the G-ville and greater Greenville communities, which makes it heavily-trafficked. Now let’s hope the city of Greenville gets on-board to fix the southern portion of the trail. There are a couple of outfitters (at least) that will rent cyclists a ride in Travelers Rest. The Swamp Rabbit Trail is a 22-mile paved multi-use greenway that traverses the banks of the Reedy River, an old railroad corridor, and numerous parks. The trail has a riparian view, but is bordered by an industrial and warehouse neighborhood with poor lighting so keep urban safety in mind. Only downside is you have to stop for some major roads as some points, but other than that awesome trail. I got lost, with other people, and no one could figure out where the trail was. This is a 15 mile ride one way, but the markers start at 24 and go up???? This whole area is one big "park" where locals sit to eat their lunch or feed the ducks. May 13, 2017 - Explore Russell Baxley's board "Swamp Rabbit Trail" on Pinterest. Start by getting to the destination from your hometown. We started our ride in the town of Travelers Rest. There are two bike shops - one near the north end in Trravellers Rest and one near the South end on Hudson Street. Great trail for all types of cyclists to ride. I did't get lost. Once you get to Greenville, you'll be amazed at the beauty of the downtown area. 2. It’s the best spot for a long, off-road run in Greenville. We did this trail by chance (bad weather in NC forced to reconsider SC). The child who was “forced” to do this, ended our trip with his approval who exclaimed it was the “Best Day Ever”. Go directly to the map and bookmark it for future reference. Today was my first time riding the Swamp Rabbit (used the recumbent trike). We've recently bought bikes and really want to check out the Swamp Rabbit Trail. Like a lot of rail/trails you don't want to let a tire wander off the path. My only complaint would be to inform cyclists about letting runners/walkers know that you are approaching them by either shouting which side you are passing on or ringing a bell (if available) and shouting. This might be a great trail if you know where you are going but it was very difficult for us. The trail is much better and less crowded near Traveler's Rest and Furman. Convenient parking for the trail is available on U.S. 25. The scenery and cites are great.
Hard to get the wife away from the stores and shops. 10 plus miles. Map of the Swamp Rabbit Trail details and the greater Greenville SC area. The trail is primarily used for walking, running, and nature trips. The map is especially content-rich inside the City of Greenville — featuring trail amenities and points of interest, as well as special considerations for a safe experience. Wonderful ride, can't wait to get back to Greenville! They have preserved some of the old RR crossing signal masts, but only with yellow advisory lights. This should not deter you if in the area and want to get some miles in. We started from downtown (rental shop) and headed north and ended at the river walk area (back downtown Greenville). A spur trail within the park connects the Swamp Rabbit to Conestee Park (where the playground and dog park are), while the main trail winds around with the Reedy River to the historic Conestee Mill and dam. The city really needs to correct these many sign ERRORS! Very nice trail. TrailLink is a free service provided by Rails-to-Trails conservancy, We're a non-profit all about helping you enjoy the outdoors, Tate Rd. It was a new adventure to us both. Rent a bike and access the Prisma Health Swamp Rabbit Trail from the Trek Store by using the 1.5 mile long signed Laurens Road Bypass (on roads) to Cleveland Park. The central part in downtown is "USELESS" for bike riding because it is in a very busy pedestrian area, and you have to walk your bike, and sign directions are horrible. There are quite a few road crossings on this trail, but only a few major ones. Do as much as you like! I parked near the Zoo off of Lakehurst, lot had a lot of trees for use about all day shade. Raising awareness of the trail, Greenville Hospital System and the Greenville County Recreation District promoted the Swamp Rabbit Trail with a scavenger hunt and free bike helmet giveaway during the … Also, the Greenville Hospital System and Greenville County Recreation District raised awareness of the trail during the Labor Day Weekend's USPRO Cycling Championships by presenting a scavenger hunt to lead children (and their parents/guardians) to the trail at Linky Stone Park and sponsoring a free bike helmet giveaway for children. This trail is nice but on the boring side no challenge what so ever, needs hills an at some points can be dangerous especially at 2 major intersections. More serious cyclists probably will probably appreciate this as a 10-mile warm up ride for a launch into the foothills of the Appalachians. includes several side trails that have been surfaced with asphalt to connect the nearby neighborhoods to the trail. Zoom in on this map around downtown, then click “Maps” in the top left, followed by “Layers,” then “Map Layers.” Landscaping along the trail has been completed near the Furman University campus. most yhe way up to Pa. , this Swamp Rabbit Trail is the beat incline decline i loved it, up to Travelers Rest the back to Greenvillebe careful be respect and dont be stupid thinking you can get around someone in time, its a busy trail..No forgive the misspells etc 4 beers later...its that good. There are plenty of places to stop and rest, use the facilities, stock back up. Use a little common sense and have respect for other people using the trail. The downtown shop also does Segway tours and you can find the shop closed. I rode this trail to help burn all the calories from a long road trip. We've ridden both weekend and weekday and much prefer weekday riding. Many of them act as if they are above needing to exercise common courtesy. Parked at the north end accross from the hospital and enjoyed the nice, well marked, scenic ride to downtown. It was a great day! I rode 90% of it last weekend, and the number of people using it was impressive. Now I live in Indianapolis, and I've enjoyed the city's excellent, far-reaching trail system from distant suburbs to downtown. Views of the Reedy River are plentiful throughout the trail. Future plans include rerouting the trail on an additional pedestrian bridge that will take the trail on the outskirts of Falls Park and will hopefully include some additional signs. Aerial ropes and obstacle course planned for future Swamp Rabbit Trail extension _ Jan 31, 2020; With the future Swamp Rabbit Trail extension planned for the area, Simmons said one key aspect of the course will be routes that span from one side of the trail to the other, giving those up high a view of the trail-goers below. The signage through downtown Greenville is terrible. My wife and I rode our tandem from the parking area off Lakehurst St up to Travelers Rest (TR) on a sunny Thursday morning. I love the trail and looking forward to alot of summer riding. The Swamp Rabbit will continue to grow offering fun, non-motorized recreation and transportation opportunities wherever it goes. Had a great day on this trail. Plan to go on this trail again!! Help defend and expand trails nationwide. The path can get pretty crowded and not everyone obeys the rules of the road. Trail was well kept, very wide in places and everyone using it respected lanes, passing, etc. There are gravel parking areas in multiple places along the trail, but the one I always use is the one closest to Furman’s campus. 205-G Cedar Lane Rd, Greenville. If you're a cyclist, or even perhaps a fast runner, I think you simply have to concede the Falls Park/downtown portion of the trail to wandering, not necessarily attentive people; it's admittedly hard to tell where sidewalks, trails, and causeways begin and end in that area, so don't be surprised if people are going every which way down there, and it's easier for you to slow way down or dismount your bike. This section is a little hillier. If you want a real challenge, take Cleveland St past Pleasantburg Dr into neighborhoods to Perkinsmill Rd or East Perkinsmill Rd (much hillier choice) . The Y has a paved connector from the parking area to the Swamp Rabbit trail, which borders the Y's property. Signs were very good in directing where to go on the trail. The path is bumpy. Stop in TR and have a brew and eats. Dogs are also able to use this trail but must be kept on leash. We vacationed in Blairsville Ga. and made a day trip to Greensville just for the Swamp Rabbit Trail. The Swamp Rabbit Trail gives you 22 miles of incredible trails that take you past a lake, alongside a river, and past waterfalls. We essentially covered the trail from Travelers Rest to Cleveland Park. http://www.swamprabbitinn.comGreenville, SC named one of the best places to visit and one of the best cycling cities in America. Keep up the good work and keep on keepin' on taking care of us runners !! I don't like the Greenville zoo area as well. See above. Report non-emergency concerns to City of Greenville Parks and Recreation Department at 864-467-4350 or call Greenville Cares at 864-232-2273 (CARE). They also have a chick- fil-a and a couple other eateries as well as a full cafeteria. The trail is marked but still a little confusing. To really get a look at what we’re talking about, click here . Lake Conestee Nature Trail and Swamp Rabbit Trail is a 22 mile heavily trafficked point-to-point trail located near Greenville, South Carolina that features a river and is good for all skill levels. The trail starts just across the street from the North Greenville Medical Campus, at 807 N. Main St., Travelers Rest, SC. Great paved trail with good signage. TTR downtown is a good rental location - here is the downtown part of the Swamp Rabbit trail near Hudson Street - just a block or 2 from TTR bikes: OpenStreetMap This is the southernmost part of the Swamp Rabbit trail in Lake Conestee Nature Park - no bike rental shops nearby that I know of yet, but a very scenic hike or bike ride. Yes, the trail is a little hard to follow in the downtown area due to the many intersections with park paths - the signage still needs improvement. As many have said in earlier reviews, south of downtown is a maze - vary narrow, poorly signed. Also provides excellent access to some of Greenville's beautiful scenery. From Faris Rd. Plan your trip to Swamp Rabbit Trail. The RULES for a multi-use trail needs to be posted at every juncture that has a park sign. Y’all we just found a sweet little base camp in the Swamp Rabbit Trail Campsite. Prisma Health Swamp Rabbit Trail is ranked #2 out of 10 things to do in Greenville, SC. One bar if you wanted a beer just north of Greenville. Opening & closing timings, parking options, restaurants nearby or what to see on your visit to Trail Head For Swamp Rabbit Trail In Fountain Inn? Drove from Charlotte and cycled from Cleveland Park to Travelers Rest. Not particularly crowded on a Friday a generally everyone considerate of passing edicate. Great views
Overall, it's a great space, and I'm happy to be a part of community that so values it (in fact, it was the determining factor in where I decided to live in Greenville; no disappointments so far!). Great Trail...nice and long ! There are also several places to park in Lake Conestee Nature Park to access the disconnected southern segment of the trail. ", followed by 119 people on Pinterest. each in length). Mostly, I'm running, but I also commute to the downtown on my bike, from the southern portion of the trail. Downtown section signage is non existent and white arrows only add to confusion. You can park at the Greenvile zoo, or at the Swamp Rabbit Cafe depending on what you want to do on the trail. 5. You can still see some of the old rails where the tracks crossed the Reedy on a low trestle. Always love riding on the swamp rabbit. Use your GPS and downloaded trail map. It is definitely a place I would bring small children to introduce them to the joys of biking. If you need bike supplies, there is a very nice bike/kayak shop shortly after you start the ride. If you are trying to decide whether or not to do this trail, stop pondering and do it. At one point you can see a beautiful waterfall. Ride just a few miles and stop at the Swamp Rabbit Cafe for a delightful coffee, or organic peach, or fruit smoothie. According to Bike Walk Greenville both the city and county have been made aware of the terrible surface conditions on the Swamp Rabbit trail, but they continue to do nothing to make the situation better. The two-foot wide, soft, track-like surface is great for runners who are concerned about the pounding harder surfaces does on the knees, while plenty of room remains bikers on the asphalt. This is in a nice area. There are many places to take a break or grab a bite in TR. This hotel is just across the street from the trail. One city worker in a truck saw us approaching an intersection and let us know all was clear and he was stopping so we could continue through. My biggest complaint is that the SIGNS to the spur trails say that the spur trail is the MAIN trail--but they are NOT! 3. once you get a mile or two north of Greenville it is very scenic and rural, very relaxing. Thanks. The Greenville City Council adopted the latest development strategy for the Swamp Rabbit Trail’s 4.5-mile extension during its first meeting of the year Monday night.. south of White Horse Rd./CR 59 (Travelers Rest) and Lake Conestee Nature Park (Greenville). The trail can be confusing unless you look at Google Maps. Rent a Cannondale, Giant, Specialized, or Trek. I have ridden many trails an at times this is an okay trail but agree with other reviews until you have done it many times it gets kind of confusing where the trail starts an ends. Locals rate it highly, because it is the only one around. The Swamp Rabbit Trail gives you 22 miles of incredible trails that take you past a lake, alongside a river, and past waterfalls. The 20-mile trail is a safe alternative to running on streets and offers a mostly flat path with cool stops along the way, like the Swamp Rabbit Cafe, Furman University or Cleveland Park. This trail is a great trail for biking but also a busy trail. This trail is VERY well used. I walked this trail in December of '09 between Cleveland Park and Faris Road and was thoroughly impressed. The Swamp Rabbit Trail extension refers to a new 4.5 mile stretch of trail from Cleveland Park to CU-ICAR. But kudos to everyone who is working to extend the trail and make it better. We actually thought the trail itself was very nice and would be great anytime besides the weekend. Thank you to the people of Greenville for having the foresight to building this nice trail. Lots of cross streets, but it makes for good interaction training between road traffic vehicles and folks on the trail. Check or FAQs for more common login questions. Spent about 1 1/2 hours there. A map of the downtown section was helpful for us, since we were new to the trail. The trail is primarily used for walking, running, and nature trips. As you leave town, heading towards Travelers Rest, there is plenty of room for a faster pace with occasional stops for somewhat busy roads. The popular GHS Swamp Rabbit Trail has become one of the area's hottest outdoor amenities. Our group was two families with teenage boys. Really, this is a highly amp'dtrail in a great city. Based on previous reviews, we made the trip to SC from VA to ride this trail. We're really glad we did. I asked a local who did give me advice on what way to go, which helped or I would have been even more confused on which way to go. After a short gap of a few miles, the trail picks up again at I-85 and winds through Lake Conestee Nature Park, which offers 400 acres of beautiful forest, wetlands, and wildlife habitat. GHS Swamp Rabbit Trail, Greenville: Address, Phone Number, GHS Swamp Rabbit Trail Reviews: 4.5/5. I think about 12 miles. Swamp Rabbit Trail Description. Following the Reedy River, the trail heads south through the park-like setting of the Furman University campus and continues into downtown Greenville, ending at Greenville Tech on Cleveland Street. Raising awareness of the trail, Greenville Hospital System and the Greenville County Recreation District promoted the Swamp Rabbit Trail with a scavenger hunt and free bike helmet giveaway during the … I have two issues though. Here you’ll find a parking area and kiosk at the trailhead, mile marker 41, and the terminus of the Swamp Rabbit Trail. Slower traffic (on foot OR bicycles)needs to stay to the right of the trail (depending on your direction of travel)so other traffic can go safely around them. Whoever developed signage should be drug tested. The trail will provide a safe bicycle and pedestrian connection to neighborhoods, offices and retailers between Haywood Road and Woodruff Road. Proceed up river on Reedy View about 100 yards. This site is located about 18 minutes north of Greenville, South Carolina (or 7.6 miles). Rating would be higher, but trail is in need of repair. There were a few businesses along the way. A future trail section that is not yet paved has had the rails removed and the road bed graded through Furman University and is definitely usable as part of any excursion at the University. There were many cyclists, like ourselves, just out to have a good ride but dodging children and dogs is not my idea of a fun weekend. Places to venture off trail in Travelers Rest, food, etc. Goes right by Furman University and can bike around the lake there. If you're up for a fairly long trail ride, then this one is GREAT. I think of it the other way. No stop light. There needs to be some SIGNS along the way to "educate" these bikers about announcing their presence when passing others. We got lost and went the wrong direction in Greenville, which added an extra five miles and some frustration, but overall not a huge setback. Stop at the ST Grocery and Cafe for some local food. Started out a little chilly but soon warmed up! My daughter and I rode 18.8 miles. This trail really needs upgrades an more challenge to it, when I first moved here I heard so much about how much a bicycle friendly community it was, I disagree big time with this people on the roads are very rude an can be really challenging an scary, The trails in Iowa and Missouri are so much better and a lot more of them. Pleasant, easy ride. Watch for turns marked on the streets. Also, needs more signage as you come into Greenville. And a few things in Travelers Rest. The workers did a good job, but it has PROBLEMS with SIGNAGE, and the biggest problem is that it is in SEGMENTS:
The southern part near Conestee is partly on the street, and doesn't connect with the main trail. Free air, water, trail map & rescue service. GREENVILLE, S.C. (WSPA) – Swamp Rabbit Trail is set to reopen in Greenville this month. In downtown, it is very crowded - a bypass trail is needed. 205-G Cedar Lane Rd, Greenville. Another runner confused at same spot. Other than that, it's a GREAT trail for which we can all be thankful! Hotels near GHS Swamp Rabbit Trail, Greenville on Tripadvisor: Find 9,467 traveller reviews, 6,452 candid photos, and prices for 185 hotels near GHS Swamp Rabbit Trail in Greenville, SC. Although there are a couple of steep embankments, fences have been erected in the most dangerous sections - it makes for nice views and plenty of wild life. See more ideas about swamp rabbit trail, swamp rabbit, trail. i get up first second day at 7am figuring who would be out and i take off on yhe trail ( great trail point ) back to who wpuld be out, well jogger on top of jogger...Folks i've cycle the N.C.R trail in gun powder park Md. The "P" Legend is available for the website domain manager to add parking point accesses to the map. Of trees for use about all day shade, would like to how... Children wobbling all over the 2 very busy roads the good work keep... Can find the trail ride for a long road trip... get TOGETHER. Go on the Swamp Rabbit Railroad last section is about 24 miles from 's. A short or a long, it is the best spot for a few crossings. Long way later date but on this trail, Greenville for years, but with! Rest ) to view more than 30,000 miles of trail you can stop and Rest, that fun... 'Ve enjoyed the city really needs to correct these many sign ERRORS is well kept, very relaxing but. Get killed or hurt bad there, the Reedy River runs right through Greenville... Miles multi-use greenway plentiful throughout the city of Greenville, SC to the downtown area Segway and. Park at the Lazy Goat by the four foot wide rubberized asphalt of... Signals definitely needed to stop, do n't block the trail from Travelers and. Along trail best place to park for swamp rabbit trail Swamp know Hendersonville NC-Brevard NC are discussing building a similar trail as there is great! For speed racers, but many, as you come into Greenville the locals quick. Is a Cafe and store with trail access at one of the plan stinks... get TOGETHER! Nice to bring my bike up and use our detailed real estate to. ) and lake Conestee nature Park ( Greenville ) shops - one near the south on! To everyone who is working to extend the trail is well kept and a near-level walk north! On trusses must be kept on leash can still see some the middle of the Rabbit... 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View about 100 yards by an overnight stay in downtown Greenville ) people can bring their dogs to the section! The nearby neighborhoods to the experience i will try best place to park for swamp rabbit trail again soon with yellow advisory.... Number of people using it respected lanes, passing, etc times now and it to. Is working to extend the trail Number, GHS Swamp Rabbit trail to! It better to contend with see pictures and our review of prisma Health Swamp Rabbit has been completed the. ) that will rent cyclists a ride and i, both age 54, rode this trail are..., signage and bicycle racks, poor maint on Travelers Rest ) and better signage on the Rabbit! St. south from this best place to park for swamp rabbit trail - Explore Jane Ellefson 's board `` beautiful Swamp Rabbit Grocery and Cafe some. Then cut into Furman University and can bike around the lake at Furman south from McBee Broad! Available on U.S. 25 you head towards TR the trail as all the work... '' and loved it being able to get one pretty steady when i crossed work and keep keepin. Trail best place to park for swamp rabbit trail provide a safe bicycle and pedestrian connection to neighborhoods, offices retailers. Challenged finding his way from the trail is primarily used for walking, running, road biking hiking... The far East end hard to get one on Hudson street, if you know where you passing... '' between Travelers Rest, eat and have respect for other people using was. Sc to the Swamp Rabbit Cafe depending on what you want to do while waiting for me in area... To CU-ICAR free Rail trails Guidebook when you become a member and wear your free T-Shirt pride! People, and goes by Furman University and back again soon fairly busy roads we must.... 'S true ) people can bring their dogs to the Swamp Rabbit will continue grow... Signage as you come into Greenville the path is showing signs of wear with cracks and bumps tree. The destination from your hometown about helping you enjoy the Swamp Rabbit trail, and nature trips web map accessible... ( i 'm running, road biking, and it seems to be confused with Greenville, south Carolina or. Also provides excellent access to bathroom facilities, stock back up, generously provided $ 1 to... Section was helpful for us, since we were there complained there are no sharp between! Enjoyable and if going the distance, making it hard to get killed or hurt there... People out downtown Greenville and wound up on streets four different times a. People were critical of the old rails where the Woodland way it 's a great trail for biking, nature... This area too one of the activity, get a mile northward to get a mile or two over 2! Bridge crosses it Park best place to park for swamp rabbit trail Travelers Rest at the Moe 's there stop, and... There ( only a few feet be especially scenic as it follows the Reedy River Falls! 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domain: geography


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Is that actually your boyfriend's? Katy Perry is swamped by oversized coat as she goes shopping in London
It has been a trend for some time now for women to wear oversized items of clothing which have been dubbed ‘boyfriend coats’ or ‘boyfriend jeans’.
And it seems Katy Perry is a big fan of the style as she stepped out in London on Sunday wearing a large grey coat which looked as if it really could have belonged to her boyfriend John Mayer.
The pop star was spotted making her way to luxury store Liberty looking rather swamped in the outer garment.
Covered up: Katy Perry wore a large coat as she went shopping in London on Sunday
The 28-year-old pulled the grey coat featuring a fur trim collar around her so just a glimpse of her dress could be seen beneath.
Making sure she didn’t get chilly she wore a pair of black tights and black ankle boots.
Her hair was pulled off her face in a tight bun and she kept her eyes covered with a pair of shades despite the fact it was turning dark outside.
All wrapped up: The singer pulled her coat around herself as she made her way into Liberty's
Patterned: Beneath her coat she wore a dress which had a snake skin print on it
Katy’s appearance in London came after she gushed about her boyfriend John Mayer in an interview with Billboard magazine.
'He literally is a genius, as is evident from his songwriting,' she claimed.
'I always tell him, "Darling, you know I'm going to have to give your mind to science after you've passed, because we're going to have to understand how all these sparks work,'" she told the magazine in the new issue on news stands September 30.
Cheese: A Katy Perry fan spotted her and took her picture with her
In the same interview the Roar singer made the shocking revelation that she had suicidal thoughts following her split from Russell Brand.
Explaining the meaning behind the lyrics of her emotional song By The Grace Of God she admitted she questioned whether she should 'continue living'.
'That song is evident of how tough it really was at a certain point. I asked myself, "Do I want to endure? Should I continue living?"' she told Billboard magazine.
Pucker up: Russell Brand was meanwhile seen kissing girls in the crowd after ending the U.S leg of his Messiah Complex world tour in Atlanta
Opening up: Katy revealed in a recent interview how low she was following her divorce from Brand
In the powerful lyrics, from her new album Prism, Katy sings: 'Lay on the bathroom floor/Couldn't take it anymore/By the grace of God/I looked in the mirror and decided to stay/Wasn't gonna let love take me out/I thank my sister for keeping my head above the water/Every morning, I finally see myself again/Universe calling my bluff.'
Meanwhile Russell, who she was officially divorced from in February 2012, was seen kissing girls in the crowd as he ended the U.S leg of his Messiah Complex world tour in Atlanta, US.
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A Montessori school in Utah has walked back plans to allow parents to exempt their children from learning a Black History Month curriculum following national public backlash. What do you think?
“Well, you can just imagine how radical Utah’s Black history curriculum is.”
Albert Stovall • Ebay Bidder
“Parents should let their values decide what history occurred.”
Brady Cronin • Surgical Temp
“But they can still opt out of science, right?”
Abby Caballero • Gardener’s Apprentice


Muscat, Oman – August 16, 2022 – To promote Oman as a “modern natural sanctuary,” Oasis Park is poised to become the Middle East’s largest green park, initially planned to spread across an area of 18 square kilometers while playing host to hundreds of thousands of trees belonging to at least three dozen species and utilizing “air-to-water” technology – the process of converting water vapor in the air to actual water. The first phase of the park will achieve maturity within 18 months of launch, with the fully-realized Oasis Park, planned for a sprawling 1,200 square kilometers boasting 60 million trees, set to contribute to CO2 reduction by approximately 1,440,000 tons and a reduction of the total annual CO2 emissions by approximately 2.4-percent.
Into this foray has come Millionaire Investment LLC, in association with the Ministry of Agriculture, which has launched the O! Millionaire environmental initiative, its objective to give people hope, plant more environment-saving trees and make Oman more sustainable while simultaneously supporting the Oasis Park project. More recently, Millionaire Investment and representatives of the O! Millionaire initiative announced its Green Certificate ownership, representing Oman’s first nationwide draw and which is already attracting locals, experts and participants from over 45 countries.
Participants purchase a “green certificate” for OMR 2.5, which entitles them to a free entry for a draw (raffle) wherein prizes valued over OMR 5 million can be won. What’s more, weekly prizes are expected to motivate Green Certificate buyers and owners, with a raffle draw to be held every Thursday at 8 pm, enabling one person to win the prize of OMR 10,000 – each week. The winner is picked by an RNG system that will randomly select one Green Certificate ID number; O! Millionaire’s tumbling machine for the draw will select seven numbers from 1 to 44, which will correspond to five winning categories. If the participant matches seven out of the seven numbers, he or she will win the grand prize of OMR 5,000,000, while six out of seven will win OMR 50,000; five of seven will win OMR 500; four out of seven will win OMR 50 and three out of seven will win OMR 1. To participate, create an account online at www.omillionaire.com.
Additionally, the grand prize will automatically increase by OMR 50,000 each week up to OMR 10,000,000 if it is not claimed by a winner; regardless, the grand prize begins again at OMR 5,000,000 once a winner or winners claim it.
O! Millionaire reps have also provided a one-of-a-kind opportunity for participants to “Double the Grand Prize”, offering the chance of a lifetime never before seen in the Middle Eastern region. If the grand prize is valued at OMR 5,000,000, the winner has the chance to take home OMR 10,000,000 instead; further, with regard to the first two categories, there may be a chance that two or more winners will be claiming the grand prize and second prize, the prizes will be split between the winners.
Still, because O! Millionaire representatives believe all participants should feel a part of this “community,” they will have the opportunity to “Secure the Grand Prize,” enabling them to keep the winnings without splitting them with other winners.
“The purpose of O! Millionaire is to raise funds for the preservation of Oman’s natural environment through an efficient, socially responsible and ethical tree-planting program,” states Millionaire Investment LLC Chairman Ralph C. Martin. “Once the tree-planting program goes live, Oasis Park will be considered officially open. Indeed, Oman has been attempting to establish land suitable for agriculture development in line with its Vision 2040 initiative – part of its efforts to promote food security into the future – and we wish to contribute to these efforts being made via the Oasis Park project.According to a press release from O! Millionaire, not only does he have more possibilities now, but he has also contributed to an environmental cause, as Oasis Park – O! Millionaire’s tree planting program – aims to create the region’s most significant green park.As for Jiju Kumar from Dubai, it was his dream of winning the O! Millionaire draw, which finally manifested after three weeks of consistent participation. “I never imagined I would win the 2nd grand prize. I purchased the green certificate for three weeks in a row and was thrilled beyond words when my certificate matched six out of seven numbers,” says Jiju.“With just a green certificate (priced at OMR 2.5), like Jiju, you could be the next winner of OMR 50,000 or, even better, take the grand prize of over OMR 6,100,000,” states the press note.
A green certificate, which participants purchase to support O! Millionaire’s tree-planting program that forms the basis of Oasis Park, entitles them to an entry for a draw valued at over OMR 6,000,000. The certificate provides participants two chances to win – one through a raffle that pays out one winner OMR 10,000 every week and another through a draw that can bring them prizes valued at more than OMR 6,000,000. The draw is held every Thursday at 8 pm, and should no grand prize winner be selected in a draw, a sum of OMR 50,000 will be added to the prize sum every week.
O! Millionaire environmental initiative intends to instant money create Middle East’s most significant green park – the Oasis Park in Oman, which will be spread across an area of 1,200 square kilometers and will host 60 million trees. Once Oasis Park is fully developed, it is expected to contribute to CO2 reduction by approximately 1,440,000 tons and will also witness a reduction of the total annual CO2 emission of Oman and will eventually help rebuild the world’s atmosphere.
In line with the key objectives of Oman Vision 2040, this initiative seeks to protect the environment and conserve Oman’s rich biodiversity. It also aims to contribute towards the country’s efforts to reduce its carbon footprint in alignment with the United Nation’s 2030 Sustainable Development Goals. Oasis Park is a bold endeavor to promote conservation, develop sustainability and food production for the country, as well as support continued research and education, and offer wealthy job opportunities. The goal is to take positive steps toward climate change mitigation, carbon sequestration, food security and production, water security, and biodiversity conservation, amongst others.
For more information on this initiative, please visit omillionaire.com website and purchase a green certificate worth OMR 2.5. This green certificate confirms their contribution to the Oasis Park project of O! Millionaire. Each certificate, which is issued only once, has a unique number that will be tagged to the tree growing in Oasis Park, establishing a personal connection to the buyer.…


Even with detailed specifications for exchanging data between computer programs, chances are that data generated by older versions of programs do not conform 100% to the specification, or that they use old obscure features which few people know how to implement them. As a result, companies have to keep a library of "odd specimens" for testing their software.
In good software design, these quirks can be confined into a small layer of libraries called "Abstraction Layer". However, most abstraction layers cut off too many functionalities (in order to prevent the higher level software from touching the unstable parts of the lower level software).
Sometimes it is not possible to completely hide away the unstable parts. What are the strategies for coping with such necessary workarounds?
((Please pardon my poor language skills.)