I am in Liberia, where shaking hands is taboo but washing hands and temperature checks are routine. Dark clouds hover above the wettest capital in the world as I land, but my Liberian colleague who greets me at the airport with a warm, welcoming smile says that they are finally beginning to see the light. It is early November 2014.
Communities at the forefront
A few days after I arrive, I join a team of UNDP consultants going to Banjor, one of the worst-hit communities, to talk about ways to fight stigma, help orphans and find food and income for affected families. We sit with survivors and their families and neighbours. We learn about innovative ways they are coping together. We learn that if early on they had information and some basic support, Ebola would not have claimed half the lives it did here. Once they got this help, they practically eradicated the disease from their community.
I visit a house where 13 people died. In this small community outside Monrovia, Ebola killed 111 people in just over four months, 31 of them children. Survivors and orphans are singing to the water spirits, “Mamiwater (mermaid), take Ebola away to the sea.” Despite the tragic circumstances, I cannot help being inspired by the courage and resilience of these kids as we sing and clap and smile in the rain.
People’s voices make the difference
To say that I am not afraid to go to the slums and the villages where people are still in quarantine and dead bodies are being removed by people in masks and “moon suits” would be a lie. But, I learn that safe interaction with affected communities is not only possible, it is essential to an effective response. “People walk on the other side of the road when they pass our community,” says one local leader. “We are grateful that the UN team came to hear our stories instead of making them up at their computers.”
A few days later, I am with a young team of UNICEF volunteers in one of the largest slums in West Africa. An 80-year old pastor welcomes their presence. “Some people used to come here and drop off medicine boxes, but never told us how to use them. I am so happy that these youngsters come and talk to us and answer our questions,” he says.
Ebola is not only a health issue
Ebola was unheard of in Liberia. People know Malaria, Cholera, Typhoid and Measles. Early symptoms of Ebola are not that different and so most people simply did not believe that they were infected or could infect others of a deadly disease they did not think existed. To stop the spread of the disease, people need to believe first and then consciously change their behaviour. Sometimes this means changing deep-rooted social and cultural norms. Sometimes it means asking people to stop doing the most natural and human of things like not holding a sick child or washing the body of a dead parent.
A young local NGO worker tells me how you communicate counts. “Some people used to go in cars with loudspeakers saying Ebola is real. But it’s only when we started to take the risks and go house to house explaining, answering questions that people started to believe, to change,” he says.
A few days later, I am in West Point, the largest slum in West Africa, where more than 75,000 impoverished people live in squalid conditions, packed into a small peninsula that juts out into the Atlantic Ocean. The UN estimates there are only four public toilets here. The lack of clean water and sanitation has allowed cholera and tuberculosis among other diseases to run rampant for a long time.
This year, Ebola joined the deadly list. A team in full protective gear is removing the body of a middle-aged man who died the night before while I try to comfort his distraught relatives outside his house. They don’t want the “safe burial team” to take the body away because according to existing protocols it will be cremated and according to their custom and religion this is a serious transgression.
I am in West Point with young UNDP volunteers hired from the community. They go house to house looking for Ebola throughout the week, sometimes at great personal risk from both Ebola as well as the families who may be hiding their sick or dead relatives. Two months earlier armed soldiers surrounded the slums and tried to enforce a collective quarantine. Angry residents resisted and in the ensuing violence, a 16-year old boy was shot and killed. By the time I visit the number of Ebola cases has dropped dramatically because instead of enforcing mass quarantine, the response strategy has changed to engaging with the community one household at a time.
When you hear the voices of those truly affected, you know Ebola is not only a health issue requiring a medical response from doctors and nurses. It is so much more than that and it starts with building trust between vulnerable populations and responders, between the governed and those who govern. No amount of top-down policy-making, distant messaging and law enforcement can substitute for human interaction and conversations based on mutual respect, trust and confidence.
When people believe in change, they become agents of change
The following week I am with a group of colleagues from the UN Population Fund and the UN Mission for Ebola Emergency Response on the border of Sierra Leone. When we forget to wash our hands, the villagers remind us to use the chlorine water buckets that the UN gave them before they will even sit and talk to us. The message is clear: when people believe in change, not only is transformation possible, but they become agents of change. This is true even in the face of strong social, cultural and religious practices; even when it is heartbreaking, highly personal and acutely painful.
In early December, a colleague declares, “If we can get one day without a single new infection before Christmas it would be a good day.” We are eager to achieve a goal set by Liberia’s President: “Zero new cases by Christmas.” By December 19th, it happens. There are zero new confirmed cases of Ebola two days running in Liberia. Finally, the Christmas lights can be turned on. Staff from UN offices in Liberia, New York, Belarus and Turkey join hands to help bring a little Christmas joy to more than 2,400 children affected by Ebola in and around Monrovia. Some are survivors, some are orphans, and some are both. But, on Christmas day in Monrovia they are all just kids like anywhere else in the world – with the most infectious of smiles and the most contagious demonstration of courage and hope.
Looking over the horizon – together
Poverty, distrust and capacity deficits over time allowed a disease to turn into an epidemic. However, now the country is looking to the future. I am fortunate enough for a short time to be part of a coordination and decision-making body called the Incident Management System (IMS). While not perfect, I can see it works. Government leadership, collaborative support from the UN family and the international community, and responsive decision-making characterizes much of the work of the IMS. If we can turn this model into not just crisis response but into development cooperation, perhaps Liberia will not only succeed in zero new Ebola cases, but will begin to eradicate malaria and measles, malnutrition and illiteracy, gender-based violence and extreme poverty.
As I write this, the Ebola virus has killed more than 8,500, many of those in Liberia. However, the number of new daily cases has dropped dramatically. The UN is instrumental in this success. We are seeing downward trends in other countries, too. But a single new case anywhere can ignite an outbreak everywhere. The challenge now is not only to bring it down to zero – but also to keep it there – everywhere! If we work together, we can. As Ban Ki Moon says, “Ebola will not be gone from any country, until it is gone from every country.”
