Skip to 0 minutes and 1 second [PROMOTIONAL MUSIC]
Skip to 0 minutes and 14 seconds YASMIN JUSU-SHERIFF: I know that pretty early on, after the beginning of March, young people in Kailahun District were already very much interested in finding ways in which they could get involved with the hand washing. And they understood that chlorine– they may not have understood how exactly it worked. They felt that the hand washing, keeping clean could protect them against Ebola. And from the community level, young people were saying, let’s do something about it. I understand that in Bo District– the communities working with the local council very early on, in the process, set about trying to build their own isolation units and treatment centres.
Skip to 1 minute and 8 seconds Because the districts in the east– especially Kenema and Kailahun– are opposition strongholds, the people felt that they didn’t expect much from the government. And there were a lot of complaints that the government was not providing the PPE to the nurses who worked in the district. They were not providing the funds for the sensitisation in those districts. So those people felt, very much, that they were on their own. And there was a lot of, a very positive response from Diaspora in Kenema and Kailahun District in terms of providing food and helping people through the quarantine period. Right from the beginning, from July, we issued a press release asking the government to provide personal protective equipment to women in their homes.
Skip to 2 minutes and 6 seconds Because we knew that women were going to be the first responders. We know that some of the messages that they put out, are messages that the women cannot comply with. You can’t be at home with your children, and you say, if your child is sick, don’t touch. If you’re an old person in your house is sick, don’t touch. The idea is around that, somehow, it is the experts, the authorities who are going to solve the Ebola problem. But it isn’t. It’s the communities. And it’s the women in the communities who have to be at the forefront of the fight against Ebola.
Skip to 2 minutes and 46 seconds They’re the ones who are dealing with health care, carrying the bulk of the provision of health care in our communities anyway.
Skip to 2 minutes and 52 seconds REGINA BASH-TAQI: But in the NGO that I work, for instance, because we’re very grassroots, one of the things that we noticed instantly, months and months ago– and we started doing– was training traditional healers. We went round finding traditional healers and saying to them, here’s this new virus. We know that there are a number of things that, rightly, you can cure. And indeed, a lot of traditional healers do know what herbs and things to use to cure basic illnesses like malaria. But actually, they’d never, they don’t know about Ebola themselves, and risked being infected, and also spreading it. So we worked a lot with traditional healers. And I wasn’t surprised that they were very receptive.
Skip to 3 minutes and 32 seconds Because they understood that this was about their protection. Out of that came the call, for instance, to actually make more links with the actual formal health system. So our organisation was actually able to help those traditional healers to make links, with their local health centres, so the referral pathway could be better. But I’m sure that when we go back in a few months time or in a few weeks time to check about how they’re doing, they’re not going to stop doing what they do all the time. Because that’s their livelihood.
Skip to 4 minutes and 4 seconds So if we wanted them to stop, what can we put in place, in this short term, that would make it possible for them to stop practicing and absolutely send everyone to the health centre? And even that has it’s own problems. Because if you send everyone to the health centre, then that means an influx into an already weak system that’s not able to deal with what’s happening right now. So it’s a really complex situation. There are many things that people are doing for themselves. So I can look at the number of local NGOs that we work with.
Skip to 4 minutes and 32 seconds Say, there’s an organisation called Health Forward Coalition, for instance, a local grassroot organisation who, on their own back, took to monitor quarantines and to see how effective they are. I can look at another organisation, wonderful organisation, that works with women and children called FAWE. And FAWE have been working so hard to try and see how girls can get education during this time. It’s so hard that so many children are out of school in a country where the education system is already so weak. And this is almost the whole academic year that children are going to be out of school.
Skip to 5 minutes and 10 seconds So that and I go back to the organisation that I work in where, for instance, we’ve done a keep safe at home toolkit to try and help our staff stay safe, especially over Christmas, as that comes up. And one of the things that just an ordinary member of staff has done, he’s– in doing it– he’s gone to his local mosque. And he’s set up a hand washing station at his local mosque. So people are doing a lot of things. They’re not just sitting there and waiting.
Skip to 5 minutes and 37 seconds PEARLYN MAMULU: My home church, back in Liberia– Zion Grove Baptist Church– actually puts together these home kits of, its water, bleach, and other household things that people can use. My brother recently, he’s back in the States, he did a fundraising event where he, all the proceeds went to my church so that they can buy more materials to give to the households within our cities and the community. Within our city, it’s called Broville. And so they’re going house to house delivering these packages. People don’t have to pay for them. But they just have to buy all of the materials that go into these packages. So that’s one that I know of.
Skip to 6 minutes and 18 seconds And they’re also spreading messages about how to keep yourself healthy, how to keep yourself clean, keep your surroundings clean, and what to do when you do come into contact with someone that has the virus.
Grassroots responses to the epidemic
Local people have often taken measures into their own hands as governments and agencies fail to respond swiftly enough or to reach remote communities. The video and case studies give some examples of community responses initiated by individuals or local organisations to try to mitigate the effects of Ebola.
Yasmin Jusu-Sheriff, a lawyer and women’s rights activist from Sierra Leone, provides some context as to why grassroots action has been required and discusses how young people and women have been involved in the response. Regina Bash-Taqi, country representative for the non-governmental organisation (NGO) Health Poverty Action in Sierra Leone, explains how traditional healers have been trained to support Ebola prevention and care activities, and other local initiatives. Pearlyn Mamulu gives an example of work being done by her church in Liberia. Both in Sierra Leone and Liberia, financial support from the diaspora (people from the area who are living abroad) has been important.
Case Study: Liberian nursing student treats her own family members at home1
In August, Fatu Kekula, a 22-year-old Liberian nursing student, arrived home to find her father, mother, sister and 14-year-old cousin all desperately ill. Fatu feared they were suffering from Ebola and repeatedly called for an ambulance but none came. When her father’s condition worsened he was taken by taxi to Monrovia but no Ebola treatment unit could take him. Realising she was alone, Fatu had to put her basic knowledge of medicine to use and was determined to treat her relatives.
With a few items she was able to source locally she recalled that she ‘put on socks, plastic bags donned like waders, rain boots, four sets of gloves, a coat, a mask and a plastic bag over her hair.’ She was able to insert an intravenous drip for her father and administer rehydration liquids as well as blood pressure medicine, antibiotics and analgesics. A week later, just as he was beginning to show signs of improvement, Fatu’s mother, sister and cousin began to decline. Fatu then had to care around the clock for all of them. But she maintained precautions saying ‘every time I would go into a dangerous room, I would dress up.’ She carefully removed her protective layers and sprayed copiously with chlorinated water and burned all waste. She reported that she used ‘four boxes of surgical gloves, and bags of raincoats.’ The supplies cost her US$600.
After two and a half weeks her cousin Alfred declined sharply and an ambulance finally arrived. The ambulance took all the family members to John F. Kennedy Medical Center in Monrovia, where Alfred collapsed on arrival. He and the other family members were tested and all were positive for Ebola. Although Alfred died, all of Fatu’s other family members survived.
Fatu is now passing her knowledge on to other families and has addressed workshops organized by the Ministry of Health, teaching people how to use plastic bags to protect themselves when there is nothing else.
Other examples of community driven initiatives
Photo credit: CDC, Public Health Image Library
In a campaign initiated by a Liberian NGO, the People Empowerment Program, a local community troop of the Liberian Scout Association from outside the Liberian capital Monrovia, embarked on a month-long anti-Ebola sensitization and awareness campaign in August 2014. They aimed to reach over 5,000 people within their locality. Scouts spread several key messages about reducing Ebola transmission through the sensitisation campaign and held gatherings where they dramatised the issues. ‘The exercise galvanized community members into taking preventive measures and alerting each other for signs and symptoms of the virus’2.
The governments of Guinea, Liberia and Sierra Leone have imposed cordons sanitaires to isolate entire regions in an attempt to contain the Ebola outbreak. Community members have also attempted to stop the flow of infected individuals into their areas. The UN Mission for Ebola Emergency Response (UNMEER) reports that ‘there are reports of locals mounting checkpoints and roadblocks in [and] out of their communities, a highly visible tactic. Although this is re‐activating practices adopted during the wars, use of roadblocks and checkpoints [predate] the recent conflicts and are a respected strategy for preventing the arrival of unwanted strangers.’3
Grassroots prevention efforts signify an important contribution by local residents who are most affected by the outbreak. As Regina Bash-Taqi expressed4, ‘people are not just sitting there and waiting.’ Synergy between grassroots, NGO, and institutional responses may ultimately facilitate the best way forward to stop the epidemic.
© London School of Hygiene & Tropical Medicine