Which lesson can we learn from this analysis?
By focusing on building Ebola treatment centres which remain mainly unused, the American intervention seems to have been misplaced. Backing the efforts of local communities in the fight against the spread of the disease has proven to be a more successful strategy.
As bodies littered the streets and the sick lay dying in front of overwhelmed clinics last year, President Obama ordered the largest American intervention ever in a global health crisis, hoping to stem the deadliest Ebola epidemic in history. But after spending hundreds of millions of dollars and deploying nearly 3,000 troops to build Ebola treatment centres, the United States ended up creating facilities that have largely sat empty: Only 28 Ebola patients have been treated at the 11 treatment units built by the United States military, American officials now say. Nine centres have never had a single Ebola patient.
Liberia could be declared free of Ebola as early as next month. But with health officials warning that it is only a matter of time before another outbreak erupts in this region, they are drawing important lessons from the successes and shortcomings of the response by international and West African leaders. Had the Americans and other donors been more flexible, critics and some officials contend, the money could have been put toward rebuilding Liberia’ shattered health care system – or backing the efforts of local communities – instead of focusing on treatment centres that would be scarcely used.
Labs were also set up to test for Ebola. Teams were deployed to rural areas to quell flare-ups before they could spread. Critical supplies were airlifted across a nation with many impassable roads. Money poured into education and awareness-raising in communities. Dr. Moses Massaquoi, the head of Ebola case management for Liberia’s health ministry, said that the American support “came too late” to have an impact at the height of the epidemic. But “what it has done for us is that it has built our capacity to sustain the gains we had,” he said, “and that’s why we are here today.”
“Communities taking responsibility for their own future – not waiting for us, not waiting for the government, not waiting for the international partners, but starting to organize themselves,” said Peter Graf, the leader of the United Nations intervention in Liberia. In the neighbourhood where the outbreak in Monrovia started in June, a 200-volunteer task force formed in July, with residents buying chlorine and buckets to put in public places and donating two vehicles so volunteers could monitor the sick. In another neighbourhood, residents collected $2 per home, buying rubber boots and megaphones so that volunteers could fan out to counter rumours that Ebola was a hoax and implore people not to hide the sick and the dead.
In a weak state like Liberia, people were used to getting by with little or no help from the government, an ability reinforced by the country’s 14-year civil war. And the government did not reach out to them as the outbreak gathered steam. Experts and officials now say that an official push should have been made to help those communities early on. “We should have seriously worked on the communities starting in July,” when cases were rising but had yet to explode, said Dr. Massaquoi of Liberia’s health ministry.
In early September, the government began a listening tour of affected communities and enlisted an epidemiologist who had earned residents’ trust. Soon, he was carrying out workshops for the countless volunteer task forces across the city, supplying them with low-tech tools to track the sick and stop Ebola’s spread: a notepad, a pen and an identity badge. As the United States and other donors increased aid, these volunteer groups assumed a more formal role. In November, thousands of volunteers began receiving training from international health workers and earning $80 a month from the United Nations.
Just as previous generations learned how to deal with the smallpox before vaccination, communities here have “learned how to deal with Ebola” – greatly decreasing the chances of another explosive outbreak, said Dr. Frank Mahoney, who had been leading the effort in Liberia for the United States Centres for Disease Control and Prevention. “Everybody knows right now that the best way to fight Ebola is to prevent it,” said Joseph Boye Cooper, a volunteer leader in one Monrovia neighbourhood. “People learned a severe lesson from Ebola.”