Liberia’s Ebola Response: The Lull, the Storm and the Aftermath, by Charles Lawrence

Monrovia, 11 August 2014

In this article, the writer urges the need to humanize the response to the Ebola Virus Disease in Liberia. Persons affected by the Ebola virus do not make them to be less human – they are human persons…fathers, mothers, sisters, friends, love ones, neighbors…the capacity to care for affected persons and to protect those health workers who are in direct contact with such persons because of their professional line of work, should be given priority.

Liberia reported its first case early in the year. There was an ebb, a period of lull when the virus appeared to have been contained. Just as the lull came, followed by this period of seeming storm, so there will be an aftermath, a period without Ebola.

This is a human tragedy that affects families, communities and society. That a person died from Ebola does not make the loss less shocking or painful. Fear should not replace people’s compassion for the sick and for those who are bereaved. Yet the health advice that people should not handle dead bodies of persons suspected to have died from Ebola should be taken seriously since it is a known route for the transmission of the virus; just as it is the case with persons who are sick with the symptoms of the Ebola virus.

The Ebola symptoms include high fever, vomiting, bleeding and nervous system damage. Some of these symptoms are similar to endemic diseases in Liberia such as malaria, dysentery and typhoid. This does not make the situation any easy. It is therefore important to enhance the capacity of the authorities to test suspected cases and provide quick feedback to communities. This kind of feedback can lend credibility to the Ebola response and to people’s confidence in the authorities and their response.

Each day, there are reports on radio airways, by callers from different communities in Monrovia about dead bodies waiting to be attended. This appears to be an apparent response by families and communities afraid to provide burial for suspect Ebola deaths and it is clear that the authorities lack the capacity to respond with immediacy.

Importantly, the ultimate priority should be directed at efforts to contain and stem the further spread to unaffected regions in Liberia, and other high risk areas where people live in congested conditions: prison and detention centres, orphanages and welfare centres. The State and its relevant arm should exercise serious duty of care, where individuals such as prisoners and detainees are under direct State care. These should include special preventative measures for orphanages and welfare institutions, and those quarantined for other communal diseases such as Tubercolusis.

It is now clear, that at the highest level of the Liberian Government the seriousness of the Ebola epidemic is unquestioned.  Schools have been closed, non-essential public servants ordered to stay home. A state of emergency declared.

The messages and the measures should aim to avoid panic and hysteria. These measures should aim to assure people that authorities have a full understanding and a better grip of the situation.

The efforts by the authorities to re-open hospitals that have been close are welcome. These hospitals and health centres are needed to respond to this health emergency. More importantly, the capacity of the health care system should be strengthened to respond to other endemic diseases. In additional, measures in the term of mobile health care delivery should be considered to take into account activities such as routine vaccination for children under five; and supportive care for pregnant and lactating mothers.

Perhaps non-essential servants asked to remain home can assist in community mobilization and awareness, in terms of Ebola preventive measures.

Minus war, never, has a single issue dominated the discourse for too long in Liberia. Ebola is the bug that has succeeded in doing so.

The Lull

During this period, a sense of assurance that the threat had come under control was provided by an upbeat message from the Health authority. Here the message was that measures were adequate, all contact traced cases monitored and no new case was reported within a certain timeframe. Many had their guard down. Senior officials in the government of Liberia mocked the very existence of Ebola. There were doubts in public circle, fueled by talk show hosts on some radio stations.

During this period of lull, there was one voice, ignored, the MSF warning that the disease was getting out of control.

A man monitored by the health authority boarded a flight to Nigeria where he was later diagnosed with the Ebola virus. The man was under surveillance by the Liberia Ministry of Health. In the US, a wife and a mother mourned their lost. In Liberia, a President angered, charged the deceased with indiscipline.

Yet this is not a time to deal with the counterfactual, since it must be left for the Ebola aftermath, the period when the Ebola is completely eradicated. Then the question about coordination between the different arms of the State can be addressed, about poor enforcement of already existing public health law that made it possible for a person under surveillance to board a plane.

The Storm

The WHO has declared the Ebola epidemic a global health emergency. Hopefully this is expected to trigger a number of measures, among them, the mobilization of needed medical support and expertise to help the worst effected countries stem the further spread and contain the virus.

Liberia has declared a State of Emergency, and ‘quarantined’ some of the most affected regions, with the deployment of the military.

Some governments have issued travel adversary against non-essential travel to Liberia. Some airlines have suspended their flights to Liberia.

A number of international experts and advisors are among the first on the plane out, concern about the risks of the spread of the Ebola Virus Disease and the weak capacity of the Liberian State to respond. These will be the first with the loudest voice in terms of advice on various government policies and strategies, hopefully, in the not too distant post-Ebola future.

The MSF announce the establishment of additional treatment facility for persons infected with the Ebola Virus Disease.

These measures cannot afford to be too little and too late.

The Aftermath

In the aftermath of the Ebola, that period of time when Ebola is completely eradicated from Liberia, there will be plenty of lessons to be learnt.

At the centre may be the importance of a people’s trust in their government. Where this trust has been broken, the people seem to ignore messages from the government and listen to messages of their own, a failure to listen to well- intended messages that can have dangerous consequences. It will be how trust can be rebuilt, and how central this trust is to enforce government authority and actions that may be a defining lesson.

Trust building can better be enhanced by accountability chain at all levels of actions and inaction in society…where failure may lead to personal responsibility. Trust cannot be enhanced by a system of patronage that shields individuals from responsibility.

There may be a question about the international community understanding about the situation in these poor post-conflict regions of the world. International response may need to be escalated and should come more rapidly in regions where fragility means weakened systems in health care that can offer little resistance to severe external shock, such as posed by Ebola.

The robustness of the systems for basic social services should not be replaced by topical and fancy top down ‘state-building’ measures and reforms: New Deal, decentralization, public financial management, to name a few. A big hole has been dealt in this theory of change that put basic needs as secondary consequence.

In concluding, it is important to leave with few messages from the Centre for Disease Control regarding Ebola prevention: ‘You can’t get Ebola through water; You can’t get through food; you can only get Ebola from touching bodily fluids of a person who is sick with or has died from Ebola, or from exposure to contaminated objects, such as needles’.

Charles Lawrence holds a Master of Arts in Human Rights and Conflict Management from the Scuola Superiore Sant’Anna in Pisa Italy, and works as National Programme Officer for Democratic Governance and Human Rights at the Embassy of Sweden in Liberia.

DISCLAIMER: The views expressed represent those of the writer and not any entity of which he is associated.

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