Whistleblower Liberia

Whistleblower Liberia

Editorial: Treat Ebola Resurgence As National Emergency

Neighboring Guinea has moved swiftly to declare that an Ebola epidemic has resurfaced after three people died and four others became ill in the southeastern part of the country.

Meanwhile, in the wake of reports of the resurgence of the deadly Ebola virus disease in neighboring Guinea, President George Weah has put the country’s health authorities on alert by mandating them and related stakeholders in the sector to heighten surveillance and preventative activities.

President Weah’s instruction is intended to ensure that Liberia acts proactively to avoid any epidemic situation following the outbreak in 2014.

Elsewhere, DR Congo has faced several outbreaks of the illness, with the World Health Organization (WHO) confirming a resurgence of Ebola, three months after authorities declared the end of the country’s latest outbreak.

At the start of the Ebola outbreak in 2014, many people did not know about Ebola because the national public awareness campaign did not share information in formats they could understand.

Following the first official case of Ebola in Guinea in December 2013, the disease spread unchecked throughout the country and neighboring Liberia and Sierra Leone. Very little was known about the disease or how it is transmitted as there had never been an Ebola outbreak in this part of Africa.

It was only after Ebola began rampaging that Liberians wished they knew about the virus sooner. Before authorities could educate the populace about how to prevent the disease, the country lost many lives.

As the epidemic grew, health authorities launched a national awareness campaign to educate the public about how to prevent the spread of the disease. However, not everyone got the message.

The resurgence of Ebola and deaths in Guinea now makes clear the urgent need for practical messaging and engagement of individuals, families and key stakeholders. These messages should inform individuals, families and communities, in clear practical terms, of the ways in which they can minimize their risk of catching the disease, and help them to support their family and community members safely and humanely.

The messages are a resource that national and local communication and social mobilization teams can work with and adapt to address different aspects and contexts of the Ebola outbreak, and respond in a way which does not stigmatize or marginalize anyone.

There is a need to have over-aching messages, supporting messages, information for those who have recovered from Ebola, information for those who have had close contact with a person with Ebola, information for those handling a person with Ebola who has died and what one can do to stop Ebola in a community.

On May 9, 2015, WHO declared Liberia free of Ebola virus transmission after 42 days passed since the last laboratory-confirmed case was buried on March 28, 2015. Therefore, outbreak of Ebola virus disease in Liberia was over.

Interruption of transmission was a monumental achievement for a country that reported the highest number of deaths in the largest, longest, and most complex outbreak since Ebola first emerged in 1976. At the peak of transmission, which occurred during August and September 2014, the country was reporting from 300 to 400 new cases every week.

During those two months, Monrovia was the setting for some of the most tragic scenes from with gates locked at overflowing treatment centers, patients dying on the hospital grounds, and bodies that were sometimes not collected for days. Flights were cancelled. Fuel and food ran low. Schools, businesses, borders, markets and most health facilities were closed. Fear and uncertainty about the future, for families, communities, and the country and its economy, dominated the national mood.

Though Monrovia was hardest hit, every one of Liberia’s 15 counties eventually reported cases. At one point, virtually no treatment beds for Ebola patients were available anywhere in the country. With infectious cases and corpses remaining in homes and communities, almost guaranteeing further infections, some expressed concern that the virus might become endemic in Liberia, adding another and especially severe permanent threat to health.

It is now a caveat to the current government and people of Liberia that determination to defeat Ebola should never be wavered and that courage should never falter.

Local volunteers, who worked in treatment centers, on burial teams, or as ambulance drivers, were driven by a sense of community responsibility and patriotic duty to end Ebola and bring hope back to the country’s people. As the number of cases grew exponentially, international assistance began to pour in. All these efforts helped push the number of cases down to zero.

Now, health officials ought to maintain a high level of vigilance for any spread into Liberia as the outbreak in neighboring Guinea is creating a high risk that infected people may cross into Liberia over the region’s exceptionally porous borders.

The government of Liberia should be fully aware of the need to remain on high alert with the experience, capacity, and support from international partners to do so. WHO must deploy an enhanced staff presence in Liberia without delay as the response transitions from outbreak control, to vigilance for imported cases, to the recovery of essential health services.

Health authorities and their partners should be quick to recognize the importance of community engagement. Health teams should understood that community leadership brings with it well-defined social structures, with clear lines of credible authority. Teams should work hard to win support from village chiefs, religious leaders, women’s associations, and youth groups.

One of the first signs that the outbreak might be turned around appeared in September 2014, when cases in Lofa County, Ebola’s initial epicenter, began to decline after a peak of more than 150 cases a week in mid-August. Epidemiologists would later link that decline to a package of interventions, with community engagement playing a critical role.

In Lofa, staff from the WHO country office moved from village to village, challenging chiefs and religious leaders to take charge of the response. Community task forces were formed to create house-to-house awareness, report suspected cases, call health teams for support, and conduct contact tracing.

See-through walls around the treatment center replaced opaque ones, thus allowing families and friends to watch what was happening inside, thus dispelling many rumors. Calls for transportation to treatment facilities or for burial teams were answered quickly, building confidence that teams were there to help.

Finally, strong coordination of the international and national response will be essential to prevent a spread. International support was slow to start, but abundant when it arrived. Innovations such as the Presidential Advisory Committee on Ebola and introduction of a incident management system have in the past helped ensure that resources and capacities were placed where needed.

Many of these lessons and experiences were reflected in WHO’s response plan, which aimed to identify all remaining cases in West Africa by June 2015.

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