The Ebola outbreak in the DRC is escalating. The Ebola Research Group reflects in a new article on lessons from Sierra Leone and how frontline workers and communities can be brought in more centrally into the design and implementation of the response.
A review and critique of current dynamics by Prof. Paul Richards, Ebola Gbalo Research Group
The Ebola outbreak in north-eastern Democratic Republic of Congo is dramatically worsening. It began in August 2018, and there was a prompt and forceful international response. Treatment centres were rapidly put in place. Vehicles and equipment are available. An effective vaccine to protect front-line health workers has been deployed. And yet things are going from bad to worse.
The major voices in the international community explain this reverse by reference to the complex and chaotic war raging in the region. Ebola centres are attacked. Convoys are at risk. Health workers have been killed.
Voices on the ground, however, talk about another issue. People are dying in their communities, meaning that they either do not understand the disease, or they have not been mobilized to play a key role in the response.
The West African epidemic was considered a wake-up call and the international agencies heeded the warning. Could it be, however, that the wrong lessons were learnt?
Members of the Ebola Gbalo Research Group Prof Susannah Mayhew and Esther Mokuwa reported on their findings and engaged senior WHO and IFRC health and emergency response leaders on lessons to be learnt for the DRC outbreak at an event hosted by Dr Michaela Told at the Graduate Institute Geneva / Global Health Centre on 13 May 2019.
The Ebola Virus Disease outbreak in West Africa in 2014 shook the world and dramatically highlighted the need for new approaches in responses to disease outbreaks, including strengthening resilient health systems. While much has been learnt from the 2014 crisis, the current outbreak in DRC has underlined again the challenges of operating in a fragile context.
The event discussed the lessons learnt from the West Africa outbreak and their relevance for the current crisis in DRC. It was be informed by findings of a three-year ethnographic study entitled “Ebola Gbalo” undertaken by the LSHTM and Njala University and aimed to define pathways on how we can better support communities in responding to an Ebola outbreak in a challenged context & the role of policy-making in this.
Ahmed Vandi and Lawrence Babawo of Njala University presented research of the Ebola Gbalo Research Group on the role of the Districts in responding to the Ebola crisis at the 2018 Liverpool Global Health System Research Symposium.
Against widespread assumptions about rapid and early collapse of the health system, the authors find that before the arrival of international actors, local involvements at district and community levels can be of great help in initial epidemic interventions.
However, overall many District health systems are fragile and benefit from continued central support including for training of middle level health workers to recognise and investigate eminent disease outbreaks at the lower levels of the health system.
It is unclear how public authorities shaped responses to Ebola in Sierra Leone. Focusing on one village, we analyze what happened when “staff, stuff, space, and systems” were absent. Mutuality between neighbors, linked to secret societies, necessitated collective care for infected loved ones, irrespective of the risks. Practical learning was quick. Numbers recovering were reported to be higher among people treated in hidden locations, compared to those taken to Ebola Treatment Centres. Our findings challenge positive post-Ebola narratives about international aid and military deployment. A morally appropriate people’s science emerged under the radar of external scrutiny, including that of a paramount chief.
We have posted key project presentations from Antwerp, Liverpool, Bo/Freetown and London https://responding-to-ebola.org/presentations/