At Ebola's last mile, community engagement is key

The Ebola epidemic in West Africa that has claimed thousands of lives and wreaked havoc on the fragile economies of Sierra Leone, Guinea and Liberia is no longer front page news. But despite significant progress in tackling the epidemic, the virus remains, and international as well as local health workers are still working day and night to get to zero cases.

Last week there were 24 confirmed cases of Ebola in Sierra Leone and Guinea according to the World Health Organization’s latest numbers — a modest improvement compared with the previous week’s 27 cases, and yet a discouraging step backwards from the nine cases reported the week of May 10.

So what is needed to stamp out the virus? What’s the one thing global health and development professionals should do to reach the long-sought goal of zero Ebola cases?

Better community engagement is the key, according to Dr. Christopher Braden, deputy incident manager for Ebola response at the U.S. Centers for Disease Control and Prevention.

“I do think this community engagement is something we haven’t quite got to where we need to be,” Braden told Devex Thursday, after speaking on Capitol Hill in Washington, D.C. “If people want to hide a loved one who’s ill, they’re probably going to be able to do that.”

Braden told a group of global health experts, private sector representatives and policymakers at the U.S. Senate office building Thursday that when patients sick with Ebola are discovered who aren’t part of a “known chain of transmission,” that means the Ebola responders are not aware of what is happening in their communities. It can also mean those communities are hiding the sick, a “red flag” for Ebola eradication efforts, Braden said.

Rural villages in Guinea — parts of which were previously sheltered from the epidemic — are especially in danger of harboring knowledge gaps if and when Ebola does present itself, according to Gabrielle Fitzgerald, director of the Ebola program at the Paul G. Allen Family Foundation, who recently returned from Ebola-affected West Africa.

Fitzgerald told Devex that health workers and educators in Guinea and Sierra Leone are engaged in a slow and tedious process to educate local community leaders about the virus.

“You have to go in and you have to sit down with the village chief and you have to explain what the situation is, and then maybe they don’t want to hear it the first time so you have to give it a couple days and go back the second time,” Fitzgerald said, adding that it’s all about patience and “continuous education.”

Fitzgerald, who also spoke to the multisector audience, emphasized other critical challenges that are presenting themselves in the current last-mile fight against the epidemic.

One is the return of the rainy season, which muddies roads and limits travel and access to care. Another is the onset of Ramadan — a month of fasting observed by Muslims around the world — which brings families and communities together, and could facilitate the spread of Ebola if the virus is present in those communities.

Still, amid current challenges, both Fitzgerald and Braden emphasized that progress has been made. Liberia — one of the hardest-hit countries — was declared Ebola-free last month. And Fitzgerald told Devex she is “impressed” with how hard health responders on the ground are working.

But the reality is more work needs to be done. As Braden put it, “We need to keep our foot on the gas pedal.”

To read additional content on global health, go to Focus On: Global Health in partnership with Johnson & Johnson.