Through West Africa and in particular Liberia is exposing the yet still fragile nature of states, state structures and national institutions. The particular nature of health systems and responses to health epidemic is found wanting.
In Liberia recently, the government’s late night pronouncement to quarantine West Point on Tuesday, August 19th rippled and sent an eerie feeling of an imminent return to looting and vandalism across downtown Monrovia on Wednesday 20th. The quarantine and curfew were amongst adhoc measures announced in response to an epidemic of untold proportions with no known cure.
Within 48 hours Westpoint and Liberia dominated the news at home and worldwide social media for the sad and wrong reason again. The face of the 15 year old boy with blood streaming down his feet is strewn across and a day later his death gave rise to speculation as to cause of death. A medical report, the most reliable and simple instrument of the state is yet to be made available to the family, the community, the country, yea the world.
This article does not suggest that because the kid is from West Point that is why a certificate of death showing cause of death is yet to be made available. Neither is it because of the anger, nor in spite of the anger that we do not know or have sufficient reason to believe the plausible reasons given for the deep lacerations which the bloody photograph shows.
West Point is a slum community which harbors a microcosm of the economically deprived strata of society. Like slum communities locally, sub regionally or regionally they create rules written and unwritten. Within their communities and amongst themselves, they respect law and order. Compared to other slums on the fringes of society, West Point is a very peaceful place to be. To enter West Point anytime, day or night, the one simple rule is to know where you are going. No one bothers you.
If this is a known fact, how then did this dot on the island bring all the problems associated with Ebola in one crucible called government with the lid off? And if one may ask further just how did life in the city state come so close to artificial or real tensions at the edge of the political cleft?
At the height of the storm, the health issue took backstage to security issue…that community leaders in the six zones or quarters of the township felt alienated by the local government structure is very much a center piece to the missing puzzle. And now, the people of West Point are now treated as objects rather than the subjects of the Ebola virus evading their province is still taking the matter lightly as a dangerous health issue
That there is now an uneasy calm under the canopy of curfew and quarantine rightly or wrongly, for which West Point and its holding center captured every form of attention and imagination remains still lingering. The simple health questions remain: how do we identify and report cases of Ebola on the one hand and how to communicate with the family and the community to cut transmission on the other. Attending consequences to consider and plan for, if there is death how to respond to the death and communicate with the living family or social network in which this person or households are geographically located.
Over the last 6 months since Liberia and in particular Montserrado became the epicenter of the disease, information available suggests that the strain of the Ebola virus (Zaire strain) while potently deadly is significantly lower in fatality ratio 50 to 60 percent compared to Ebola (Zaire) 90% fatality. Questions for researchers and other health scientist abound, but critical to this is what appears to be a disease that is not airborne but require contacts with liquefy or solid excrements from an infected or dead person. Incubation period- signs and symptoms largely known, yet the mode of human to human transmission appears difficult to break. The seemingly uncontrollable manifestations and spread have many theories at work to explain our way of life, social and traditional beliefs of disease and dead persons, our distrust or mistrust or absolute lack of trust in government by large parts of society, educated and uneducated.. As a government, what are its plan and response mechanisms and as a person what message needs to be communicated to know that Ebola can kill.
The Liberian populace has been informed about the deadly nature of the virus and how it tends to spread. Awareness is high. Then the next question would be- is the public education sufficient or effective? Further queries should help explain what accounts for the fear and the denial or the flight when there is a report of a new case or suspected cases? The public will look to the Ministry of Health disease control and prevention specialist called epidemiologists for the possible and plausible explanations for containment and end of transmission. They as local experts are in the position to lead with mechanisms to contain. They will work with their public health communication team. If this is a fact then what explains the chaos surrounding coordinating mechanism to provide finance and other logistics to support and bring this health matter under complete control.
The public health communication, team studies develop and design messages using a multi prong approach to the various publics. In Liberia, we have communities that are affected as one public and communities that are yet to be affected or are unaffected communities as another public. To the two publics, messages are crafted to adjust attitudes and in some parts temporary behavioral changes with the individual in or out of a family or social structure as the basic unit of society. Precisely because it is an epidemic, the communities in which affected and unaffected people or persons live remain the center of all activities. This is where state structure is necessary, needed, relevant but perhaps woefully lacking or inadequate in urban, peril-urban and rural sectors of the comity or geographic entity, we call Liberia, the only place those who are true Liberians call home, Communities, Communities, Communities across the socioeconomic strata of the geographic space called Liberia.
As the mantra of all politics is local, all disease control in an epidemic is community, community, community. In every community, there are youth, women, children, men, women, old men, old ladies, pastors, imams, leaders, social workers etc. Plan nationally and work locally in communities, Map out areas and let the public know those that have reported cases. Inform the public of what processes and procedures and in place to respond inform the public of the various kinds of teams that will appear if a person is sick. Inform them about what happens to affected people associated with the sick persons. Inform them about what mechanisms are in place to handle. Inform if they need to be self quarantine for observation or if they need to owe to isolation. Inform what to expect when someone dies. Information education and communication process will go in tandem
The point needs to be made clear firstly that this is a health issue and remains a health issue. A fact that needs to be drummed home to all and sundry who have a mandate to control and to those who must help to bring this disease under control.
That it is a national and international health emergency which requires additional support to the ministry whose core function it is to manage public health and bring disease and various forms of diseases under control needs to be highlighted. Logistics to include finance, human and material support to tackle this pandemic are all equally important supporting aspect in the fight. All of that which led to the clear and present danger warranting a state of emergency are in order. This is the third time in WHO’s history that it has declared a pandemic a health emergency global.
The question that is perplexing to many Liberians and professional and philanthropic friends of Liberia in and outside of the republic is- why is it taking us such a long time to put a handle on this problem? One may even ask: do we now have a handle on it to know when the disease will peak and how long it will take to eradicate? The guesstimate of time span is anywhere between 4 to 6 months on the more optimistic side,
There is a school of thought which posit that the disease in spite of its high potency of transmission and the fatality rate thrives best in poor health structures. As virologists contributing to the search for containment and cutting off transmission trail have informed that in societies with proper health care systems both for curative and preventative, the disease can be easily quarantined and brought under control. The United States of America took the partially diseased in person of Dr. Ken Brantley to CDC Atlanta. The world witnessed a healthy looking patient walk to a microphone. He lives at a known address if anything goes out of the way, he will taken to a hospital and will be quarantined.
With all due and kind courtesies to our legendary and indefatigable Minister of Health Dr. Walter Gwenegale and his team of hero and heroines of health, the question that still beg answers and lead us into governance issues is what went so deadly wrong this second coming of Ebola. The Ebola virus disease came so close to being contained between Feb through April for nearly 42 days of 45 days to declare Liberia Ebola free then. Now it has spiraled out of control demanding one form of control higher than the other at the apex of political governance.
This article is a call to action to first and foremost see Ebola as a deadly national and international emergency requiring a properly coordinated approach to disease prevention and disease control. By extension it is to draw attention to the executive to establish and propose approach structure and finance for disaster management, prevention and control mechanism and for the legislature to appropriate the requisite funding for such a serious body to plan and anticipate and when the inevitable happens be prepared. Being penny wise and pound foolish is an antiquated doctrine, not to be found in a country yearning to be counted as a middle income country by 2018 or 2030.
Let the word go round, If and where we allow the health team of epidemiologist both local and foreign, to guide us, with the local expertise leading the way, we will be able to avoid the temptation of attempting to reinvent the wheel. Further, we will be able to rely on local anthropologist and sociologist to work with professional communications persons to know how to package information, how to educate our people and what messages to effectively communicate which will help end transmission at the community level.
A diseased person and those associated or possible infected or affected person (s) lives somewhere, be it a zinc shack, a mud-house, few planks nailed together or a concrete structure. They are stratified along various socio economic structures and we must approach those who have expertise in public health and communication to assist in a coordinated manner to deliver a message or messages to deal with fear, distrust and denial. M cube that is media or medium, the message and the messenger must be credible for it to be effective.
As communication personnels, the West Point incidence more than found its way into the national psyche: that while this matter of Ebola is a health matter, the community approach which will bring several disciplines to the fore in one calabash of wisdom is the way to go.
Many wondered whether it is extreme-poverty that forced the people who stormed the temporary holding center into an act of calamitous effrontery to loot diseased or possible contagious disease materials, or is it an act of defiance to local authorities who showed no will or desire to communicate or listen or is it plain denial on its face that is deeply laden in distrust as a popular mantra states that government broke, major budget shortfall resulted in the scam to hoodwink international community.
It might be worth considering; it’s time to revisit the message.”Ebola is Real” to, for example “Ebola can kill”l… And translate that into every dialect with possible short skits to drum home the signs and symptoms to look out for. Newspapers will help if they have local pictures with victims or survivors to bring it home rather than pick photos of the internet with blood dripping or oozing. It might also be time that we see in the newspapers and on the radio or local television, updates on where a new case was reported and how it is being handled. Like we are at the war front, we must see Ebola as an enemy, know where the enemy is and its movement to track, contain and eradicate. A daily map and map coloration of hot spots need to be imprinted everywhere. Weekly bill boards of numbers and places will help in the buy in of everyone, everywhere being a part at each community. Then we have a daily scoreboard we the general public must want to read and hear about daily and nationally.
We might also want to tune down the many Ebola music as we fade in the new one. That is where it is determined that this message has outlived its usefulness. We appreciate all the good works but perhaps message in the music with so many different kinds of music and messages, these forms of communication do not appear efficient for this deadly disease and its spirally out of control nature. One thing is certain, we are not communicating to the people who matter most when the disease hits and perhaps we are not allowing the health team to do their work.
Fear, denial and distrust remain constant as roadblocks to change attitudes and halt the spread. How to communicate past, this is where the challenge is. Political scientists, sociologist, anthropologist, social psychologist, communications’ professionals and epidemiologist might need a brainstorming session to understand the postwar social dynamics that are proving difficult to communicate simple messages of a terribly deadly disease with unimaginable consequences that could alter the socioeconomic and political conundrum like a hurricane devastation after the storm.
The government structure may have been found seriously wanting and institutional collapse may be the challenge facing us as a people, but certainly to abdicate ownership of the health problem and the attending chaos associated with it and call for international organizations to come take control, is to put it mildly to those on that path to be bereft of ideas in times like these. Make no mistake that there is no applause forthcoming for the national response, it is still a work in progress, how long and at what pace is where the people of Liberia come in as to their approbation or condemnation. Certainly not abdication.
Medina A. Wesseh
Attorney At Law, International Law Group, LLC