* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.
In our response to any future new outbreak, we need to become serious about engaging with communities
When English novelist Graham Greene travelled to Sierra Leone and Liberia in 1935 for what became his travelogue ‘Journey Without Maps’, he arrived fearful of tropical diseases, and aware of the critical shortage of medical doctors. Eighty years on, things have clearly improved, but with the official end of the Ebola outbreak in Sierra Leone this weekend, we need to make sure the health crisis doesn’t undo decades of work.
The outbreak hit Sierra Leone’s children hard - almost half the more than six million population are children. According to government figures 1,459 children were infected by Ebola, and 8,624 children lost at least one parent. Thousands more went through quarantine. Many more were deeply traumatized by the death and suffering they saw all around them. 1.8 million enrolled school children had to wait eight months for classrooms to reopen, and we fear some will never return.
What Sierra Leone has seen over the last year and a half is an unprecedented effort by Sierra Leoneans, supported by the international community, to first stop the spread of the virus, and then to search out every last case no matter how remote the location. It was a unique crisis - perhaps the first time a humanitarian emergency anywhere in the world has entered the psyche and fears of everyone everywhere.
Above all, it’s been a fight that’s involved the whole population of this country, including many Ebola survivors. Heroes who beat the virus in their own bodies and then served others in their community like Kadiatu Konteh delivering water to families in quarantine, and Alfred Pujeh, running an Observational Interim Care Centre, which provided a safe monitoring area for children without caregivers who may have come into contact with Ebola.
We rightly celebrate the medical professionals working in their protective suits in infectious ‘red’ zones. But this was a victory won by communities because this was a battle that first needed to be won in people’s homes. As painful as it was, centuries-old practices around burials, and the most natural human instincts of caring for sick family members had to be altered. Even the warm hearty Sierra Leone handshake was set aside for the cause – I’ve yet to shake hands with any of the people I work with every day in the UNICEF Freetown office.
A recent study by the London School of Hygiene and Tropical Medicine calculated that the global response in Sierra Leone saved an estimated 40,000 deaths (while recognising that a faster response would have saved even more lives). The country’s very last Ebola case highlighted how the response has improved. When we got the alert that a recently-deceased 16 year old girl had tested positive for the virus in Bombali district, it triggered an immediate and comprehensive response from the National Ebola Response Centre, supported by partners like WHO, UNICEF, DFID, the Sierra Leone Red Cross, and a host of other actors working in partnership. Quarantine and isolation were quickly set up around the village, contacts were identified and traced, and a massive logistical operation got underway to make sure those in quarantine were well looked after, regularly checked, and were able to learn and discuss with responders. It worked, and there were no further infections.
We’ve learned the hard way, that we need quick coordinated responses. But we’ve also learned an equally important point - the importance of working with communities. In a little over 12 months we have gone from a situation where ambulances and medical centres were being attacked and denial of Ebola’s very existence was common, to one in which knowledge of safe practices and how people get infected are now widespread. A survey in July 2015 showed 69 percent of responders had a ‘comprehensive knowledge’ of Ebola, up from 30 percent in August 2014.
The change in behaviour required an unprecedented mobilisation campaign – less eye-catching than the health specialists in space suits, but just as vital to the Ebola response. At UNICEF we shipped in more than half a million of those protective suits, pushing suppliers around the world to massively scale-up production. We worked with DFID to set-up more than forty 8-bed community care centres in rural communities to isolate Ebola cases. But we also supported Sierra Leoneans going door-to-door to reach every home, community and village with safety messages and to have a face-to-face engagement.
In her 2013 novel set in Sierra Leone, ‘The Memory of Love’, Aminatta Forna wrote: “War had the effect of encouraging people to try to stay alive. Poverty, too. Survival was simply too hard-won to be given up lightly.” Beating Ebola has been a hard-won victory. We need to secure this victory by accompanying Sierra Leone’s recovery.
As in Liberia, we need to be ready should other isolated cases of Ebola crop up in the coming months. The occasional but repeated outbreaks in places like DR Congo, Sudan and Uganda show that there can be no room for complacency. And the outbreak is still not over in neighbouring Guinea, making high levels of surveillance and preparedness vital.
The world needs to be on constant stand-by, and have the mechanisms and resources to react quickly. In our response to any future new outbreak, we need to become serious about engaging with communities – investing in understanding their concerns and beliefs, and then working together to find solutions. Far beyond Ebola, that’s not a bad reminder for everyone in the aid industry.
Geoff Wiffin is the UNICEF Representative in Sierra Leone
