This post originally appeared on Ebola Deeply.
As 2015 dawned, Ebola Deeply spoke with a cross-section of voices engaged in the fight against Ebola. We talked about lessons learned, hopes for the new year, questions of accountability and trust. And most importantly, we asked: What can the world do now?
When Ebola first began in Guinea more than a year ago, few suspected that the earliest cases might spark an epidemic that would spin out of control.
And yet it did – slowly, at first, with 86 cases in southeastern Guinea in March. It soon burned south toward the capital, Conakry, and, undetected, snuck into Liberia and Sierra Leone, carried in the blood, bodily fluids and baskets of market traders and business owners.
By May, almost 200 people had died, but outside of the affected communities, few took notice. Samaritan’s Purse was one of the first international organizations to respond in Liberia, even before the Liberian government declared a state of emergency. MSF (Doctors Without Borders) and International Medical Corps (IMC) soon followed. But it wasn’t until late July, when Patrick Sawyer, a Liberian, died from Ebola in Lagos, Nigeria, that the World Health Organization (WHO), governments and the wider international community began to act.
A year on, Ebola Deeply spoke with health workers, authorities, community members, survivors and international organizations. We asked what went wrong; why so many missed the early-warning signs? We talked about courage in the face of danger. We discussed the weakened health systems and entrenched trust issues that opened the door to the outbreak. We questioned accountability, social systems and experimental treatments. And most importantly, we asked: What have we learned, and what can the world do now?
The Health Workers
Dr. Rashida Kamara is one of Sierra Leone’s few female senior doctors. She heads the Waterloo Ebola treatment center in Freetown.
Her biggest lesson learned in 2014: “The Ebola outbreak exposed our country’s rotten health system to the rest of the world. With such a terrible health system, there was no way we could have stopped the epidemic. As a country, we have now learned to always be prepared for the unforeseen.”
In 2015, the Ebola outbreak needs: “We hope that 2015 will be a different story for our country’s health system. I’d be very pleased to see an Ebola-free Sierra Leone within the first quarter of 2015.”
Dr. J. Soka Moses runs Liberia’s Ministry of Defense Ebola Treatment Center, one of the largest such centers in Liberia. He is the former head of the John F. Kennedy Medical Center Ebola Treatment Center.
His biggest lesson learned in 2014: “Courage in the face of danger. Imagine being a medical doctor working in a hospital where people are dying from a disease that no one knows how to cure. Imagine senior doctors running away from the hospital, fearing their own death. Now imagine that you want to help. The one thing that will keep you there is courage.”
In 2015, the Ebola response needs: “Health system strengthening. Our health service needs to be able to better respond to any medical disaster. We need to empower health workers, pay higher salaries and offer more training. We need to go back into the communities and help people start their lives again. We must also set up an early-warning system to detect emergencies before they get out of control.
“I’d like for us to honor those who died from Ebola with a proper monument that lists their names. It’s important for us to know the total number of deaths. One hundred years from now, people should remember those who died. It will allow them to take better measures for their own future.”
O.B. Sisay is the director of the situation room at Sierra Leone’s government-run National Ebola Response Center (NERC).
His biggest lesson learned in 2014: “Ebola is a twin epidemic. One kills bodies and the other paralyzes minds – with fear and ignorance.”
In 2015, we need: “More acceptance of the disease and changes in social attitudes to help complement the progress we are making in providing testing, care and treatment facilities to our people.”
Anita A.B. Koroma is the patient care manager at Save the Children’s Kerry Town Ebola treatment center in Sierra Leone, where she is responsible for coordinating patient admissions, discharging survivors and arranging burials. She is also the founding director of the Girl Child Network Sierra Leone.
Her biggest lesson learned in 2014: “Ebola is real. It’s not a myth. Ebola knows no boundaries and can affect anyone at any time. It can kill within days if symptoms are ignored, or treated at home as if it were malaria. Ebola can eliminate an entire family, an entire community. Proper preventative measures must be in place. I want every man, every woman and every young person in Sierra Leone to know this. I want community stakeholders and media personalities to keep talking about it. I want to see continued action.
“When you act on the symptoms of Ebola and report it on time, survival rates are more favorable. At Kerry Town I’ve seen patients who weren’t treated until neurological problems set in. I’ve seen physical disability and brain damage. Acting early is key.”
In 2015, we need: “To support organizations that can deliver services to families and communities affected by Ebola, especially those that target women and girls. We need to reunite communities broken by Ebola and help people access psychosocial support and counseling services. We must reclaim our education system and find ways to create national financial security in Sierra Leone.”
Dr. Dan Kelly is an infectious disease specialist in Koidu Town, Sierra Leone. He oversees an infection prevention and control program at the district’s main Ebola treatment center, working together with UCSF Global Health Sciences, Wellbody Alliance, Partners in Health and Last Mile Health.
His biggest lesson learned in 2014: “Ebola kills health systems. Patients and healthcare workers alike would prefer to suffer from malaria, HIV and every illness at home than risk the chance interaction with Ebola. Ending Ebola means restoring hope and health.”
In 2015, we need: “We need to be more proactive in our response. Diagnostic and treatment facilities need to be as decentralized as imaginable. The number of Ebola cases in an area should not constrain our imagination [in terms of] the systems needed to care for patients and save lives. In the meantime, we need to vaccinate everyone possible.”
Julia Duncan-Cassell is Liberia’s Minister for Gender and Development. She previously served as Superintendent of Grand Bassa county, Liberia, for six years.
Her biggest lesson learned in 2014: “The lack of a national emergency response strategy, irrespective of the type and scope, affected the country’s ability to take control of the Ebola epidemic. Various beliefs caused it to widen its grip and toll, but the involvement of communities and the establishment of task forces and contact tracing teams may have contributed to reducing the spread of the virus.”
In 2015, we need: “A more robust and integrated approach to prevention and response that comprises planning, coordination, funding allocation, interventions and human resources. It’s also important to put in place a well-designed psychosocial framework.
“Liberia needs a post-Ebola national strategic framework with indicators to support a holistic recovery that embraces economic, social and political processes. On a wider level, we need a regional, West African policy founded on mutual support that will improve prevention, response and recovery. It should consider cross-border trade, marriages between nationals of different countries, and other socioeconomic and cultural practices.”
Mayor Sahr Emerson is the Mayor of Kono District Local Council in Sierra Leone.
His biggest lesson learned in 2014: “We would have stopped the current spread of Ebola while itwas still in my district where it all started, if only the central government would have heeded myadvice to quarantine Kono back then. On several occasions, I personally advised the government to seal off Kono from the rest of the country. But my advice fell on deaf ears.
In 2015, the Ebola response needs: “We are hoping that the outbreak can be curtailed within the first quarter of 2015. This fight now needs the collective coordination and cooperation of all, not just the government alone.”
Mohamed Kamarainba Mansaray is the leader of one of Sierra Leone’s political opposition parties, the Alliance Democratic Movement (ADM). He is running for president in 2018.
His biggest lesson learned in 2014: “Ebola has taught Sierra Leoneans that we must not politicize every issue, especially those of national concern and security. When the outbreak first struck our country, some politicians used it as a political weapon against their opponents. The ruling party wanted to do all the fighting by itself, while some opposition parties tried to use it as a tool with which to campaign.
In 2015, the Ebola response needs: “I am looking forward to seeing continued apolitical cooperation and national coordination. That will ensure that the virus is wiped out of our country.”
Captain Issa Turay is a senior military officer in Sierra Leone’s national army.
His biggest lesson learned in 2014: “We can’t stop Ebola in Sierra Leone unless stringent measures are taken against those violating community bylaws on Ebola. I suggest the military should be put in charge of operations and strategy mapping in the fight against Ebola in Sierra Leone.”
In 2015, we need: “To focus on instituting disciplinary measures, and to fight against Ebola strategically.”
The International Organizations
Sean Casey is the Regional Director for International Medical Corps’ (IMC) Ebola Response in West Africa. IMC was one of the first responders to the outbreak, and now operates Ebola treatment centers in Liberia and Sierra Leone. It also has an emergency team on the ground in Guinea.
His biggest lesson learned in 2014: “Ebola isn’t as scary as we all thought. Back in July and August, everyone was panicking. Epidemiological projections painted a doomsday scenario. Humanitarian organizations that usually rush in to crises initially refused to engage, and health workers, watching their colleagues die around them, refused to work. Bodies were piling up. The prevailing discourse was one of fear and paranoia.
“As some of the first responders to this outbreak, what we quickly learned was that Ebola can be defeated, patients can survive, and health workers can stay safe with the right resources, the right protocols and with the right dose of political will. Our first Ebola treatment unit, in Bong county, Liberia, has a survival rate of nearly 50 percent, we’ve had zero staff infections after serving over 500 patients in 2014, and we think we have the happiest Ebola treatment unit in West Africa – complete with a karaoke machine in the confirmed ward, movie screenings every night and regular dance parties with patients, staff and survivors. Responding to Ebola is by no means easy, but we learned in 2014 that we shouldn’t cower from it – we can beat it by fighting it head on.”
In 2015, we need: “Adaptability. The dynamics of this outbreak are changing weekly. We see caseloads rise and fall, new localized outbreaks, changing trends in behaviors, and we’re learning a lot about improving clinical care. We need to be agile, open to changing our approaches and willing to move beyond strategies that are no longer appropriate.”
Erin Hohlfelder is the Global Health Policy Director for The ONE Campaign.
Her biggest lesson learned in 2014: When crises like the Ebola outbreak hit, we shouldn’t expect that donors will automatically step up to the plate, or that systems will be in place to track their commitments and ensure accountability for when, where, and how those resources are disbursed. Many donors arrived late to the Ebola response, only when prodded by calls from African leaders, advocates, and first-hand accounts of just how bad things were. And once they did step up, there was no one centralized place where all commitments were being consistently tracked, which further added to the confusion.
In 2015, we need: sustained commitment. As this Ebola outbreak (hopefully) tapers out in the months to come and fades from the headlines, we must remind donors that the effects of this crisis are long-lasting and far-reaching, illuminating many systematic weaknesses we have collectively ignored for too long. Governments must dig deep to provide political and financial investments for the region, particularly in support of a new generation of locally-trained health workers, without neglecting other development priorities.
Tiffany Persons is the founder and director of Shine On Sierra Leone. The organization is partnering with the Wellbody Alliance, training community health workers, distributing risk-reduction kits and low-literacy educational materials and providing basic supplies.
Her biggest lesson learned in 2014: “Ebola has illuminated just how powerful a community can be when they work together. It has been an honor to work alongside the heroes within our community and make a powerful, sustainable impact against Ebola. We are a global village. And even though Ebola is a human rights tragedy, in many ways it is slowly but surely bringing the importance of the village to the forefront.
“I also learned the importance of connecting at root level with community members in a time of crisis. It’s not just communication that’s key, but the type of communication. Fear kills even faster than Ebola.”
In 2015, we need: “My greatest wish is for the negative stigma to be released, and for donors of all levels to feel confident that their funds are truly saving lives – because they truly are.”
Blair Glencorse is the Executive Director of the Accountability Lab in Liberia, an organization that builds civil society and co-creates innovative solutions to accountability problems in the developing world.
His biggest lesson learned in 2014: “Ebola is about all of us individually taking responsibility for our actions and collectively working together to make sure people stay aware and stay safe.”
In 2015, we need: “To make sure that the entire process of development – including the healthcare system – is inclusive and fair. It is only when Liberians can expect and trust their government to deliver essential services that we can ensure Ebola will be beaten once and for all.”
The Religious and Community Leaders
Sheikh Uthman Faruk Umarr Sawaneh is a chief imam in Freetown, Sierra Leone.
His biggest lesson learned in 2014: “Religious bodies and institutions in Sierra Leone were initially neglected and pushed out of the conversation about Ebola. The entire process was largely political; the government concentrated on engaging politicians and social leaders, leaving out the religious leaders. We were only included beginning in December 2014, but the impact has been huge; partly thanks to engaging with our congregations on a regular basis, there has been a drop in daily caseloads.
In 2015, the Ebola response needs: “We are hoping that the government will continue to engage religious leaders.”
Evangelist Peter Israel Sesay is a Christian Leader in Freetown, Sierra Leone.
His biggest lesson learned in 2014: “It was unfortunate that we, the religious leaders, were the last to be included in the fight against Ebola. If we could have been included long before now, God could have saved Sierra Leone from the agony we now face.
In 2015, the Ebola response needs: “We appreciate the fact that we’ve now been fully incorporated in the Ebola war so with God’s intervention, we have faith that this Ebola virus will be erased from our country as soon as possible.”
Isatu Gbassay Munu is the chairlady of the Vegetable and Perishable Goods Traders’ Association in Sierra Leone.
Her biggest lesson learned in 2014: “Early actions should have saved the precious lives of our dead loved ones. If our leaders in positions of authority would have put politics aside, and braced themselves long before now, especially when the outbreak was still just in Guinea, we would not have suffered so much.”
In 2015, we need: “Authorities coming together devoid of political, social, religious and ethnical affiliations, to fight the virus out of the country. And Sierra Leone needs to return to normality.”
Ade Daramy is the chairman of the Sierra Leone UK Diaspora Ebola Response Taskforce (SLUKDERT), which is pooling resources and responding to the outbreak from afar.
His biggest lesson learned in 2014: “The outbreak took the world by surprise and no one has come out of it with much credit; the affected governments were too slow to realize the danger, and the international community was too slow to respond. Sierra Leone’s health service provision, which has been inadequate almost since independence, needs a complete overhaul.”
In 2015, we need: “Regular, formal meetings between NGOs, agencies, governments and diaspora organizations. Planning for a post-Ebola future should not have to wait until the virus is eradicated. We need to start thinking of ways to establish funds to address other areas that are similarly lacking: education, agriculture, proper tax revenue gathering, to name but a few.”
Abdul Karim Kafoir is the administrator of The Forum, a group for young professionals in Sierra Leone.
His biggest lesson in 2014: “Ebola has taught us to be patriotic. We learned a lot about politics; one factor that made Ebola go viral is that of political bickering. As is common with most other issues in Sierra Leone, a lot of people initially politicized the outbreak. We must all learn to be patriotic by putting our country first above anything else. We should know when to play the political game, and when to come together as a nation to fight a common cause.”
In 2015, we need: “To unite as one people. I am hopeful about 2015, because people are now adhering to messages designed to combat the spread of the virus. In 2015 we need to continue to work with authorities to eradicate this dangerous disease that has caused us all so much pain.”
The Survivors and Family Members
Saah L. Blackie is an Ebola survivor. He runs a car-parking business in Gblowin Community on Bushrod Island, Monrovia. He believes he may have contracted the disease while parking the car of a man infected with Ebola; the virus can survive for at least several hours outside the body.
His biggest lesson learned in 2014: “I learned how it feels to be rejected. I felt the shame of being a survivor. People do not want to come around you. I used to sit with friends, freely, but after I came back from the treatment center, friends started drawing back from me. Right now my parking lot is almost empty and most of my customers are not coming back. I’ve joined an association for survivors of Ebola.”
In 2015, we need: “Efforts to stop Ebola should be doubled. I want to see Liberia and its international partners step up until the last case is gone. If we reach zero cases, the focus should shift to looking after those of us who survived. Life is very bad for us. We need training opportunities. Orphans need to be looked after; so many kids lost their parents to Ebola, and some are just hanging around in the streets. They badly need support.”
Kadijatu Turay is at secondary school in Freetown. She lost her uncle to Ebola in 2014, and is waiting for the day when Sierra Leone’s schools reopen.
Her biggest lesson learned in 2014: “It’s very unfortunate and disheartening to have lost a whole academic year, especially when students in other countries are moving forward. What will become of our future, especially when we are living in a country with a very poor educational record?”
In 2015, we need: “Schools and colleges to reopen, and teachers to return to their classrooms. We look forward to returning to school and taking our examinations.”
Evangeline Kamara caught Ebola from her husband, Abdou, in Conakry, Guinea, in August 2014. The couple had been married for two months when Abdou called into work sick with a high fever. They both survived.
Her biggest lesson learned in 2014: “We don’t know everything. I went to university and I grew up in a supportive family where we were encouraged to learn and study. But still, I didn’t believe that Ebola was real. They say that Ebola is a crisis of trust. But me, I trusted myself and my family too much. Ebola has taught me that we must question everything, including what we believe. Even the best scientists don’t know much about Ebola. We are all younger than we think.”
In 2015, we need: “To share information better. We need more trusted channels of information – not just rumors or sensationalism, but facts and truths. We need this in Guinea, but we also need it everywhere in the world. We should condense our information and find better ways of sharing what is important – by phone, radio, text message, internet – so we can all benefit.”