Avoiding Ebola – how this Chiefdom in Sierra Leone did it

Mike and colleagues,

This article's discussion of the critical importance of community leadership and culture in establishing and maintaining Ebola resistance and persistent Ebola-free zones in West Africa is, in my opinion, the crucial factor in not only ending this current Ebola epidemic in West Africa, but also in managing future epidemics, while securing the road to recovery and development. Unfortunately, the heroics of setting up Ebola Treatment Centers, vaccine trials, and western doctors risking their lives to save Ebola patients under horrendous conditions has gained the most attention from the world press, as well as almost all of the resources from governments, international organizations, and foundations. The community's role in preventing Ebola, responding to emerging cases and deaths, and holding the lion's share of the responsibility for recovery -- as well as getting to zero cases -- has been largely overlooked and continues to be dramatically underfunded.

We have seen a tremendous, rapid suppression of Ebola cases with essentially no contribution from curative medicine or vaccines in West Africa beyond improvements in early detection, infection control, and early rehydration. These improvements arguably have more to do with public health, operational biosecurity, and supportive nursing care than medicine as we know it in the developed world. The great success during the response phase in Liberia, Sierra Leone, and Guinea has been largely from establishing behavioral and social immunity. Medical isolation, case and contact tracing, health education, effective use of disinfection and personal protective gear, logistics, improved communication, increased collaboration and project management all contributed significantly to the successful flattening of the epidemic curve through establishing Ebola-resistant areas and Ebola-free zones that suppressed transmission and translocation of EVD.

The unity of effort provided by UNMEER and host government leadership was critically important. Members of the Global Ebola Response Coalition played very important roles. No question clinicians, both international and West African were essential. Far too many lost their lives and became a part of the chain of infection. We should not underestimate the personal sacrifices that have been made by these clinicians as well as the burial team members, along with the family members of Ebola patients.

So how will epidemic management be differently going forward in West Africa, Haiti, and other places challenged by deadly diseases knowing what we know now?

How will we act differently and with different partners than in the failed cholera epidemic management in Haiti that continues to claim an increasing number of lives almost five years after its unfortunate introduction to the Western hemisphere through Haiti?

How will we act differently than during the first nine months of Ebola cases in West Africa?

Will we start empowering community members and set up resilience infrastructure now at the community level at far less cost in lives and economic impact to reduce the conditions that contribute most significantly to disease emergence, transmission, and translocation?

Will we replay the massive slow intervention from the outside with foreign governments, militaries and physicians in the lead?

If we were thinking about what is best for West Africans, based upon the evidence emerging from the Ebola epidemic so far, we would be focusing far more of our resources and innovative capacities on empowering West African communities to gain situational awareness, prevent disease, identify disease early, care for the sick at the community level, and ensure integrated water, sanitation, and hygiene. In this time of rapid global change with increasingly dense and mobile populations in close proximity to water-borne disease and animal reservoirs of Ebola and other deadly diseases, we should be building a network of Resilience Capacity Zones down to the neighborhood and village levels that are establishing viable local and regional indigenous value chains for ongoing management of health, human security, and sustainability at the local level. With these capacities in place, the building of hospitals, transportation systems, electrical infrastructure, and the long road ahead of training sufficient numbers of doctors and nurses to staff them will eventually become strategically important.

Let's start with what will improve health status the most first, in a way that reduces dependency aid and debt, while increasing resilience. For now, we need to address the mission critical functions at the community level that will end the current Ebola epidemic, kickstart recovery and sustainable development with Guineans, Sierra Leoneans, and Liberians in the lead. The African Union, the UN, NGOs, foreign governments will continue to play important supportive roles understanding more about West African Resilience Networks and the One Health realities of Ebola and the many other diseases and social conditions that are growing in importance in relation to the health and human security of West Africans at this point in time.

Mike

Michael D. McDonald, Dr.P.H.

Coordinator
Global Health Response and Resilience Alliance

Chairman
Oviar Global Resilience Systems, Inc.

Executive Director
Health Initiatives Foundation, Inc.

Cell: 202-468-7899
Michael.D.McDonald@mac.com <mailto:Michael.D.McDonald@mac.com>

http://resiliencesystem.org

> On Apr 16, 2015, at 11:11 AM, Mike Kraft via admin <admin@m.resiliencesystem.org> wrote:
>
> UNICEF CONNECT
> blogs.unicef.org
> April 15, 2015
>
> by Margaret James, a Health Officer with UNICEF, Sierre Leone
>
> When I first heard in February that Lugbu chiefdom was one of the few in Bo
> District, Sierra Leone, that had not recorded a single case of Ebola, my
> interest was immediately triggered. On 2 March 2015 we got to visit the
> chiefdom’s main town, Sumbuya, for several hours of meetings with
> local leaders, youth, a traditional healer and business people to find out
> more.
>
> /Lugbu chiefdom has several entry points and can be accessed by both land and
> water. (c)UNICEF Sierra Leone/
>
> In our quest for answers, we got permission from the local Paramount Chief,
> (PC) Mohamed Allie Nallo, who gave his blessing and got in touch with key
> people to help us in our research. We held group meetings, one-on-one
> interviews and even carried out spot visits.
>
> It is important to understand these community success stories to see the
> sorts of indigenous responses to Ebola that are being developed. You can
> build as many Ebola Treatment Centres as you want, but if communities
> aren’t engaged in the fight little progress will be made.
> ....In my notebook, I wrote downthree important responses:
>
> * Early acceptance by the chiefdom population of the reality of Ebola
> * Strict enforcement of the chiefdom by-laws
> * Good/strict neighbourhood watch
>
> To ensure the involvement of all, the traditional leadership developed their
> own form of a ‘cluster’ approach. They set up five main chiefdom
> committees: a Chiefdom Taskforce and then groups for sensitization,
> oversight, surveillance, and discipline....
>
> Read complete blog.
>
> /http://blogs.unicef.org/2015/04/15/avoiding-ebola-how-this-chiefdom-in-sierra-leone-did-it/
> [1]/
>
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> [1] http://blogs.unicef.org/2015/04/15/avoiding-ebola-how-this-chiefdom-in-sierra-leone-did-it/