21 January 2015: I have just returned from Liberia and Sierra Leone after spending a week there. To my surprise, I found that most aspects of life in the two countries worst-affected by Ebola continue as normal.
This is somewhat contrary to the impression one gets from the outside. People are going about their lives in most respects as usual and the streets are bustling.
Obviously there are some changes, such as the check points for health and hand-washing outside most buildings and on major roads, lots of posters about Ebola on the streets, the Ebola care and treatment units that have sprung-up, and the almost deserted airports.
This is a unique emergency, the likes of which has not been experienced anywhere in the world in recent times - a major outbreak of a highly dangerous and contagious disease such as Ebola in countries with particularly weak infrastructure and health systems. The situation has required a highly complex and sophisticated response. Just the setting-up and daily management of Ebola treatment centres alone is complicated and requires high levels of expertise, not to mention everything else, including border controls, managing the air corridors, front-line tracing of potential infected, dead-body disposal, community outreach, awareness raising, and community relations, logistics/supply chain, recruitment of personnel, dealing with high levels of stigma and fear both within and outside affected countries.
Real heroes
Front-line responders are real heroes, in particular the health workers, contact tracers and burial teams. During our brief visit, the most moving part was to the Plan supported community care centre in Foredugu, Port Loko, in Sierra Leone. There, we met the nurses and staff hired by the government, some of whom had been working non-stop for four months in a highly risky environment, and in regular contact with infected people.
The head nurse told us how she had managed the centre every day for four months and how she had been unable to see her own children and family during this entire time because of her family’s fear about her work with Ebola. We were also introduced to two small boys, and their mother, who were survivors of Ebola and who had lost their father and brotherand the head nurse talked about how the nurses had taken the surviving family members in and loved them.
We also heard stories of contact tracers who had to search for potential infected and then deal with highly emotional and resistant communities and families to get them to go to community care centres for diagnosis and treatment. And, we met a doctor in Liberia who told us of how he had led the initial response in his county with minimal outside help and who had seen many of his colleagues become infected and die.
New cases declining
The commitment and work done by front-line staff, most of whom are local and have minimal support, as well as those coming in from outside, and in the midst of such danger, is simply incredible and hopefully will be recognised by the governments and agencies involved.
The commitment and work done by front-line staff, most of whom are local and have minimal support, as well as those coming in from outside, and in the midst of such danger, is simply incredible and hopefully will be recognised by the governments and agencies involved.
The combined response is working. The number of new cases is now declining in all three countries: Guinea, Liberia and Sierra Leone. It would appear that this is due to the combined work of all agencies involved, and all interventions, including the community care and treatment facilities, tracing of cases, body disposal, hygiene measures and community awareness raising.
For example, we visited a Plan supported community hygiene training session in Bomi, Liberia, and it was clear that it was well run, effective and community members highly engaged. Agencies are working very well together overall and an example is the effective collaboration between Plan and Partners in Health at the treatment centre in Port Loko, in Sierra Leone. Here, Partners in Health does all the front line clinical work in the centre, while Plan provides management and logistics support, including providing supplies and meals to staff and patients every day. While the work is not yet done and everyone needs to remain vigilant until there are no more cases, the indications are that we could soon see an end to the outbreak in these countries.
Moving forward
Plan is playing a substantial role in the response. The organisation stayed in the affected countries and quickly established relevant roles and scaled-up and managed a significant response. Our existing presence and capacity in-country was a great advantage. We have raised $40 million, reassigned existing staff, hired many new staff, and we are directly impacting over 2.5 million peopledirectly. The response has been difficult, has stretched our capacities, and we have made mistakes, yet we have continued to address challenges and move forward. Our efforts have been recognised by governments, donors and peers as contributing significantly to the response.
Assuming the trend of declining cases continues, all agencies need to begin planning for early recovery and transition. We also should try to change the narrative of the media, some of whom have criticised emptying facilities as a waste of money.It was prudent of organisations to build centres based on responding to a potential worst case.The fact that collectively the response has prevented a worst case and the situation is now improving quickly should be seen as a success.
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