From the Frontlines: Lessons from Ebola
As the Ebola outbreak in West Africa appears to have receded from the deadly highs of the past year, there are many lessons that we can all learn from this tragedy -- from the need to strengthen health systems, to the importance of coordinated responses at all levels, from the local to the international. But for me, from my experience spending the last year on the front lines against the disease, the lessons of the past year are far more simple. When we work directly with communities and engage with the systems they have already put in place, we have the greatest chance of success. It was through the work of traditional leaders, volunteers, concerned citizens, and the countless individuals who put their lives at risk to help fight this disease that Ebola has managed to be nearly eliminated in Liberia.
Well before the first cases of Ebola had been detected, Global Communities was on the ground in Liberia, working directly with communities to improve their sanitation and hygiene. Utilizing a Community-led Total Sanitation (CLTS) methodology the idea was simple: empower locals to take on leadership roles in preventing open defecation, educating their peers and helping encourage them to make the changes necessary to improve the health of them and their neighbors. Then, these “natural leaders” could work with other communities in their areas, helping to trigger them to become open defecation free. The result was a positive feedback loop, with more and more communities becoming open defecation free. And by utilizing locals, the program could be sustainable even after Global Communities ended its programming.
All of this changed with the outbreak of Ebola. It was then, in August of 2014, I began working directly for Global Communities, having previously worked closely with them on the CLTS program. The situation was obviously grim. The disease, which had been ravaging the countryside had reached the urban environment of Monrovia. Fear was spreading faster than disease, with many convinced that Ebola was not real, or worse some kind of foreign conspiracy. Many feared to report that loved ones had died of the disease, as strange men in white suits would show up to take the body away, never to be seen again.
We knew if Liberians were going to take the lead in fighting this outbreak, it would require public engagement and activation, similar to the CLTS program, but on a much larger, and much more time constrained scale. So we began a Community-led Ebola Response program, targeting town chiefs, religious leaders, and community health workers to help educate them on the nature of Ebola, and how best to protect yourself and loved ones. These same leaders would then help spread the word to the rest of the community, helping to dispel myths and alleviate fears so that health workers could do their jobs.
At the same time, we operated burial teams throughout Liberia, and took extensive efforts to introduce these teams to the communities they operated in. Simple changes like putting on protective clothing in the village so people could see you beforehand helped make people more comfortable turning over the loved ones they had lost. Through our efforts, more than 5,800 bodies were successfully handled, with 95% buried within 24 hours. Not a single member of the burial teams contracted Ebola.
But other barriers still remained, most importantly the fear of cremation. For most Liberians cremation went against our deeply held beliefs, yet the government had mandated that Ebola victims be cremated. The need for an alternative was apparent, so assisting the Government of Liberia, we worked with local leaders to find an appropriate location for a national cemetery for victims of Ebola. Located on Disco Hill, the plot contains sections for Muslims and Christians, and houses the remains of those who were cremated as well. In a ceremony performed by local chiefs, ashes were interned at the site, giving the families of those who were cremated a location where they could pay their respects.
Through these efforts and those of countless others, perceptions and attitudes began to change, and the spread of Ebola slowed, halted, and eventually even receded. And as Ebola began to be contained in Liberia, the focus shifted to preventing a resurgence of the disease. As Sierra Leone and Guinea had, and continue to have cases of Ebola, monitoring along border communities became increasingly important. Utilizing the same methodology, we worked to assist these communities in setting up monitoring and quarantine stations, to ensure travelers crossing the border were Ebola free. And to help communities become more resistant to the spread of Ebola and other diseases, we are expanding the CLTS program to help more communities become open-defecation free. In fact, in the 284 communities, that were certified open defecation free as part of the CLTS program, not a single case of Ebola was reported, in spite of being located in some of the hardest hit counties. The combination of community activation and better hygienic practices appears to have saved countless lives.
Like most Liberians, my life this past year has been mostly defined by the outbreak of Ebola. But in spite of the tragedy that has been visited upon Liberia, I've seen so much that makes me proud. I've seen men and women, without regards to the risk, help their communities take the lead in fighting this disease. It's this kind of work that must continue, not only to prevent a resurgence of Ebola, but to help Liberians take control of their own health and future.
This blog is by George Jordu Woryonwon, winner of InterAction's 2015 Humanitarian Award. Since August 2014, George has worked with Global Communities (GC) through the OFDA funded Assisting Liberians through Education to Reduce Transmission (ALERT)/Ebola Response program to train and supervise burial teams across Liberia. See a Devex Interview with more from George about his work combatting Ebola:
— Julie Espinosa (@DevexTV) June 23, 2015