The ongoing Ebola crisis in West Africa cannot be solved through health interventions alone.
The international community is bent on stopping the spread of the virus and bringing the crisis to a peaceful, well-ordered resolution soon. But recently, this public health disaster has shown itself also to have roots in the mistrust between citizens and their government and in the misinformation that can accompany imposed public health decisions and actions.
To avoid further social turmoil and unnecessary fear, civil society leaders must be more purposefully included in the response and containment effort, according to groups working on the ground to combat bad information and poor communication in quarantined communities.
Health worker safety, quarantine and containment, and experimental treatments have dominated the Ebola-related headlines since the virus reappeared in West Africa in late March, before growing into the worst outbreak ever, with over 1,500 dead and thousands more cut off from critical public services like health care and basic supplies as of late August.
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International aid and health agencies have scrambled to deploy health workers to combat the spread of the disease, and struggled to ensure responders have enough training to combat a virus with a 50-90 percent mortality rate. Roughly 200 health workers had contracted Ebola, and many others had willingly put themselves at risk as of late August.
But doctors cannot be the only heroes of a successful response and containment effort, Bill Burke, IREX chief of party for a U.S. Agency for International Development-funded civil society and media leadership program in Liberia, told Devex.
“There is another side to this story,” Burke said.
Crisis of public trust
In the latter part of August, sporadic clashes erupted between citizens and law enforcement personnel in the quarantined West Point community in Monrovia, Liberia.
Those limited disturbances raised concerns that the public health emergency could spiral out of control and create widespread civil unrest. They also revealed a crisis of public trust, which has complicated the crisis of disease response and containment.
“If this distrust is there, people are not going to respond kindly when their communities are quarantined,” Burke said.
The outbreak of the deadly disease has demanded resolute, emergency measures, including the establishment of Ebola treatment centers and the decision to quarantine some communities. But in a country still struggling to overcome 14 years of brutal civil war, measures like restricting people’s movements or forcing clinics to be established in affected communities are met with suspicion.
Those measures, Burke said, have to occur always in close consultation and collaboration with civil society leaders, who can augment the flow of accurate information to communities that remain largely wary of public institutions and their decisions.
“Community leaders can be brought into this picture,” Burke said. “They in turn can understand what’s happening, and they will be able to get to the communities to explain to the constituents why certain actions are being taken by government.”
Engage community leaders
The USAID official who is coordinating the U.S. government’s response likewise noted that inaccurate information has been a key challenge.
“There’s always, in these events, a lot of rumors,” Tim Callaghan, the agency’s disaster assistance response team leader now based in Monrovia, told Devex.
Callaghan noted that Liberian President Ellen Johnson Sirleaf has gone on television to provide accurate “messaging,” and that the Liberian government has set up a call center to answer questions about the causes and treatment of the disease.
But given the historic legacy of distrust and current misinformation surrounding Ebola, public broadcasting and call centers are not enough — especially in communities like West Point, where few have regular access to television, radio and phones, according to Burke.
“To get people in those communities to understand what is really happening, we need to go beyond the usual,” he told Devex. “We need to go beyond just the radio messages, beyond just an address from the president or some government leader. We need to be able to engage the leaders of those different communities so they can be able to speak to the people in the language the people are familiar with.”
One of the central challenges to delivering information to large numbers of people — and to soliciting communities’ concerns — is that governments in Ebola-affected countries have mandated that large groups of people not assemble in the same place for fear of spreading the virus.
That concern underscores the importance of identifying and collaborating with a few key representatives, who can speak on behalf of communities and deliver accurate information to them.
“People need to understand that bringing a treatment center to your community doesn’t mean we’re bringing Ebola to your community,” Burke said. “Civil society must be the buffer, must be the medium through which these policies, these measures can be explained to the people to avoid any semblance of what we saw [in August] in Monrovia.”
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