* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.
"Hand shaking when you meet someone is out of the question. You put your hand over your heart. I've seen good friends just rub elbows."
I arrived at Roberts Field, Monrovia's International Airport, January 12 of this year on a UN Humanitarian Air Service flight from Dakar.
The only people at the airport were those that came on the UN-HAS flight. The only airplane on the tarmac besides our flight was a cargo carrier. In the fall of 2014, many countries banned anyone from Liberia or other Ebola-affected areas from entering (a debate which also raged in the US). Commercial air traffic in and out of the country slowed to almost a standstill. Last fall, the world walled off Liberia, Sierra Leone, and Guinea - the countries in the West African "Ebola belt.” The virtually empty airport was a stark reflection of the terrible toll the Ebola epidemic extracted from a country just recovering from over a decade of violent civil war.
The medical dimension of the epidemic is well-known. By the end of 2014, Liberia had reported over 8,000 cases of Ebola virus disease (EVD), and nearly 3,500 deaths. In order to stop the spread drastic measures were taken. Schools never opened in September of 2014. Movement of goods and people across counties and market activities were restricted. This helped slow down the transmission chain. But at a price.
A recent set of mobile phone surveys, conducted by the World Bank, and designed to track the economic costs of Ebola, sheds some light on the magnitude of the negative socio-economic impact of the outbreak.
Nearly half of Liberian household heads remain out of work despite response-related jobs being created in the construction and health fields (building and manning Ebola Treatment Units and Community Care Centers to treat those with symptoms or confirmed EVD, for example).
The World Bank study shows that women have been particularly vulnerable because they work disproportionately in the very hard-hit non-farm self-employment sector.
In the agricultural sector, the survey raises fresh concerns about farmers’ ability to organize work teams. Those farmers that did harvest (already just 80 percent of those that could have harvested) reported smaller harvests as a result. And because of smaller harvests, reduced incomes and restricted movement of goods and services, food insecurity is a real problem. Three out of the four households surveyed indicated that they were worried about having enough to eat.
As 2015 starts, the outlook in terms of EVD transmission is looking much better. Reuters reported that there were only 10 confirmed cases by the 12th of January (down from 25 in November 2014). This same week the Government of Liberia (GoL) announced that schools would be reopening in February.
Improvement did not come by accident or good luck. It's the result of one of the most remarkable efforts to change behavior I've ever seen. Upon deplaning and before you can even get into the airport for passport control, you are asked to wash your hands and your temperature is taken. Whenever we arrive in any office, hotel, or restaurant, the drill is the same. You are washing your hands dozens of times a day. Your temperature is being monitored publicly on a fairly constant basis (I've never seen so many thermal thermometers).
This is not an expat thing. Hand-washing and strict observance of hygiene protocols has become part of the daily routine for hundreds of thousands of Liberians in the cities and the countryside. You see water dispensers for hand-washing at the entrance of little shops along the road. And hand shaking when you meet someone, even a good friend, is out of the question. You put your hand over your heart. I've seen good friends just rub elbows. But hand shaking is out. This is really hard culturally for Liberians. But it is being observed and being enforced and reinforced by the population itself, not just by the health authorities or the police. And this behavior change is making a difference.
Plan International has been very much at the forefront of providing information, education, and communication on hygiene and sanitation behaviors as part of its efforts in this epidemic.
I had an opportunity to watch these sessions in one of our communities in Bomi county, one of the areas hardest hit by the epidemic. Plan leveraged long standing relationships in the county with County Health Teams, local organizations, community leaders and youth groups to carry the hygiene and sanitation messages forward to every household. This is, like much of what Plan does, slow work, one village, one community and one household at a time. But it is paying off dividends.
Hygiene behaviors at the village level will become that much more important in the weeks ahead when children go back to school. The fear is that schools, some of which are overcrowded, and many of which lack access to water (essential for hand-washing behavior), could quickly become a hotbed for Ebola transmission.
The government of Liberia is working closely with its partners, including Plan, to adapt existing hand-washing and surveillance protocols for a school environment. There are many questions that will need to be addressed in the weeks ahead: when and how often should kids be hand-washing? With what soap solution? Where will the water come from (if access to water is lacking) and how will the work to build or rehabilitate water access points be best organized? What type of temperature surveillance will be done? What should be the role of the teachers in this process? What type of training will they need?
There is much to work out and a few weeks to do it. Resources will be needed for the hand-washing equipment, for training the trainers, for monitoring, for surveillance - all necessary elements to keep children safe as they return to schools.
While incredible progress has been made, much work lies ahead as the country slowly gets back to "normal." The fact that the number of confirmed cases is down to 10 doesn't mean the effort to control the EVD epidemic is coming to an end. It just means a new phase of the work is starting, bringing many new and daunting challenges.
--Tessie San Martin is president and CEO of Plan International USA,
