Recently my non-blogging life has experienced a set of interesting, but time-consuming convergences. As a result my engagement at HLSWatch will be constrained for several weeks, potentially a few months.
In my judgment the task of this blog is to amplify, aggregate, analyze and occasionally advocate. Until more time emerges from the convergence, I will mostly use this Thursday post to amplify a situation someone else has written about, but that has not gotten much mainstream attention.
The Ebola threat continues to be deadly in West Africa and despite considerable progress still presents a potential threat to global health. Here is the December 3 WHO Situation Update.
Local (whether Dallas or Monrovia) and global engagement of this threat has also been an interesting case-study in prevention, preparedness, mitigation, response, and — we hope — recovery. It has been fascinating, at least to me, how crucial “whole community” engagement has been to bending the transmission curve.
For reasons that are not yet entirely clear, Liberia and Guinea have made much more progress on changing population behaviors than has Sierra Leone. This is despite considerable efforts by the Freetown government for a period of several months. On Black Friday the New York Times ran a related story on its front page. The following is from Tuesday’s Concord Times, a leading newspaper in Sierra Leone. It was written by Mohamed Massaquoi.
The Disaster Management Department in the Office of National Security, with support from UNDP, will be embarking on a door-to-door campaign in new Ebola epicentres across the country, targeting 100,000 households in the next two weeks in Waterloo, Port Loko and Moyamba with specific life-saving information.
The campaign, which is expected to reach one million people, has commenced following the recruitment and training of 300 community disaster management volunteers in Moyamba last week.
The volunteers, drawn from localities in new Ebola epicentres, will disseminate information ranging from the importance of early treatment, keeping families safe from infection while waiting for help, to welcoming survivors back into the community as a way of reducing stigma associated with Ebola.
The UNDP-supported campaign is part of national efforts to engender behaviour change in order to stem the spread of the Ebola virus disease in Sierra Leone.
In the past 21 days, Sierra Leone has recorded an exponential rise in the number of Ebola infections. Latest WHO figures show that while reported case incidence is stable in Guinea with 148 confirmed cases reported in the week to 23 November, stable or declining in Liberia – 67 new confirmed cases in the week to 23 November, Sierra Leone recorded 385 new confirmed cases in the week to 23 November.
In addition to the continued rise of cases of Ebola in Sierra Leone, the epicentre of the outbreak has shifted from the east of the country (Kailahun and Kenema) to the north-west, including Bombali, iron ore mining district of Port Loko and the Western Area, especially Waterloo and Freetown.
The Western Area continues to have the highest rate of infection, with 280 cumulative cases in the past week. Port Loko is also a major area of concern, with 120 cases in the past 7 days, according to WHO figures.
Chief Alimamy Bethembeng II of Waterloo, himself a volunteer in the door-to-door campaign in his community, enthused that with the right information, using face-to-face methods and using people who are part of the community, things would hopefully change. “We have to defend our communities from Ebola,” he said as he moved from house-to-house in the Faya-Mambo neighbourhood in Waterloo, one of the worst hit areas in the Western Area.
During one of the training sessions in Port Loko, Director of Disaster Management Department, Mary Mye-Kamara, said that the face-to-face campaign has proved very successful in slums across Freetown, and that it is the preferred method for effective awareness-raising on Ebola.
She said: “People in some of these communities are still suspicious of outsiders coming into their neighbourhoods and villages telling them about Ebola. Some of them think that these outsiders are the ones spreading the virus. This is why we are engaging the local people, training them so that they will do the awareness raising themselves. That is the only way forward now.”
She added: “Without community ownership this is difficult, even impossible to make any meaningful headway. The imams need to understand and accept that they cannot be doing the same burial rites like before…otherwise the virus will spread.”
Mye-Kamara noted further that denial is still very high, as is distrust and reticence in communities, thus urging everyone to get involved in the campaign.
“People said to us why should they be bothered to take their sick relatives to the hospital and treatment centres when the ones who had been taken before did not return? ‘They are going to die anyway’. But now we are saying to our compatriots that, with early treatment, there is a huge chance of survival. We are showing them evidence of people who have recovered from the virus. They are seeing it and we continue to hope things will change. Ebola will go,” she said.
Denial, suspicion about the spread of the disease, low level of knowledge and information are still very much prevalent especially among the poor in urban and rural areas. The face-to-face campaign hopes to target the hard-to-reach villages and communities with the right information in Port Loko, Moyamba and Waterloo in particularly, where the virus is spreading.
UNDP Programme Manager Saskia Marijnissen says, “Stopping the Ebola outbreak will not only depend on improved knowledge, but also on a change in attitude and practices. Our approach actively engages community members in a dialogue to motivate behaviour change.”