Filed in by Olando Testimony Zeongar – 0776819983/0880-361116/life2short4some@yahoo.com
Monrovia – Liberian scientist and Deputy Director General of the National Public Health Institute of Liberia Masoka Fallah, has been outlining lessons learnt by his country during the deadly outbreak of the Ebola Virus Disease (EVD) that claimed 4,810 lives in the tiny West African country.
On 30 March 2014, Liberia confirmed its first two cases of the EVD in Foyah, Lofa County. By 23 April thirty-four cases and six deaths from Ebola in the country were recorded, and by 17 June 16 people had succumbed to the disease in Liberia.
The first EVD deaths occurred in Monrovia when seven patients died from the disease by 17 June. Among them were a nurse along with other members of her household. The EVD infected nurse was treated at the state-run Redemption Hospital, at the time when there were about 16 cases reported in the whole of the country in total.
On 2 July the head surgeon of Redemption Hospital died from the disease. He was treated at the JFK Medical Centre in Monrovia. Following his death Redemption Hospital was shut down, and patients were either transferred or referred to other facilities.
By 21 July four nurses at Phebe Hospital in Liberia’s central region of Bong County contracted the disease. On 27 July Dr. Samuel Brisbane, one of Liberia’s top doctors, succumbed to Ebola. A doctor from Uganda also died from the disease. Two U.S. health care workers, one a doctor (Dr. Kent Brandy) and the other a nurse were also infected with the disease. Both of them missionaries, were later medically evacuated from Liberia to the USA for treatment where they made a full recovery.
By 28 July most border crossings had been closed, with medical checkpoints set up at the remaining ports and quarantines in some areas. All flights between Nigeria and Liberia were suspended, and on 30 July, Liberia shut down its schools in an attempt to prevent the outbreak from spreading.
Howbeit, the man who headed case detection during Liberia’s EVD outbreak in 2014 and 2015, in a recent chat with the independent source of news and views from the academic and research community, The Conversation Africa, Masoka Fallah, shared his experience and what lessons can be learnt by DR Congo that is currently struggling to fight off the resurgence of the Ebola scourge.
‘Spread of Ebola in the DR Congo’
Giving his expert opinion on the rapid spread of the epidemic in DR Congo, where the situation is very serious, with some 458 cases being recorded so far, including 271 deaths, in two of the country’s provinces, and things looking to get much worse, Masoka warned that it could be a matter of days before DRC’s epidemic spreads to more urban centres or spills over into neighbouring countries.
“I say this because of how the outbreak is unfolding,” said Masoka, who noted that “First, health care workers are being infected. In our experience in Liberia, and in most outbreaks, infected health care workers can be super spreaders. They can infect the people they treat or those taking care of the sick.”
He continued: “Second, there are now cases (live and dead) reported in communities that were not on the contact list. This is a list of people that may have come into contact with an infected person. If there are people that are infected who weren’t on the list, it means that proper tracking isn’t happening. It also implies that people don’t trust, or are afraid, of the ebola response and are turning to home treatments, including traditional remedies or prayers. These could expose a larger population to infection.”
He pointed out that to contain an Ebola outbreak, it’s crucial that 100% of the contact list is documented and tracked, saying. “If this is broken, then a spread should be expected.”
‘Why has DR Congo not been able to contain the EVD second round spread?’
Masoka opines that the DRC’s inability to contain the second round spread of the virus in the country is due to a variety of factors, stating that “Because of the civil war and with huge numbers of people living in abject poverty – as was the case in Liberia – there is widespread distrust in the government and its institutions. This means it will be hard for people to trust the Ebola response team.”
“Since 2014 the Ebola outbreak in Liberia killed over 4,800 people. This is a major problem because Ebola containment is based on trust. Response workers can’t be in every house and so they rely on individuals in communities to alert them. But if they’re not trusted, cases won’t be reported. Mistrust can also lead to violence – as we’ve seen in the frequent attacks against response workers in the DRC. These attacks delay response when speed is critical,” he maintained.
He explained that these reactions are because Ebola response goes against the normal tendency for families and friends to take care of their sick, stating that “instead they are isolated and kept away.”
“To help people accept this requires them to trust the health workers. People who are very poor, and have been neglected by the state, don’t trust the authorities. And they aren’t likely to accept the radical changes required. This, in turn, results in resistance and violence,” Masoka further said..
‘What steps DRC needs to take immediately?’
To remedied DRC Ebola woes, Masoka recommends that the first steps must be to address some of the fundamental needs of the people, stating that “For example, at risk communities should be provided with food and useful tools and services – like water pumps and functional clinics. But these must be distributed through locally trusted leaders.”
“Second, Masoka said, “some of the Ebola response must go to the local community. The first step would be to identify key, trusted leaders who can lead the response. They can also be invited to propose solutions, and be supported in getting these implemented. In addition, local youths and religious and traditional leaders need to drawn in and paid to do active surveillance and community sensitisation.”
Masoka added: “They must share the resources (financial and logistics) in the Ebola response.”
‘Sharing Liberia’s Ebola lessons’
Sharing Liberia’s EVD lessons learnt with CRC, Masoka intoned that “the one big difference is that there’s an active war on in the DRC. Apart from that, however, there are some clear parallels between the outbreak in Liberia and this one.”
He recalls: “The first case of Ebola in Liberia was reported in March 2014. Five months later, we accounted for 51% of all cases in West Africa – it had spread across Liberia, Guinea and Sierra Leone. But we shifted the epidemic curve and, in September 2015, became the first country in the region to be declared Ebola free.”
Hear scientist Masoka: “This was because of our work with the community. I confounded the community-based initiative with support from the Ministry of Health, the United Nations Development Fund and the World Health Organisation. We were advocates for the communities and got support to them quickly and efficiently. We held daily meetings with national response workers and international partners organised under the national emergency operation centre.”
Revealing exactly what Liberia did to combat the fast-killing EVD that claimed thousands of lives in his homeland in 2014 and 2015, Masoka said “These are the steps we took,” stating, “We engaged local communities in meetings to allow them to express their concerns and propose solutions.”
“We then asked them to map out all the households in their communities and recruited members of the community to cover 40 households. They would need to pass on messages, search for the sick, the dead and visitors. This information would then be passed on to us.”
“Local community chairs were given visitor log books. This allowed us to see where visitors came from and if they were at risk.”
“Precautionary observation was encouraged. Here those who could be infected stayed home and restricted their movement for 21 days. During this time they were provided with food and comforts – like electricity.”
“A mobile app was deployed on the phones of community members who reported cases of infection or death to us. This allowed us to analyse and respond quickly.”
“Culturally sensitive burial teams – for example observing Muslim traditions – were developed and rolled out.”
“We recruited over 5700 community members. By the end of the response they had earned nearly $3million for their daily work.”
Having shared with DRC steps Liberia took to beat back Ebola from a country ravaged by war, Masoka made it clear that many of the steps taken by his country to defeat Ebola could be replicated by Congo DR, but warned that time is of the essence.
