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  • I supported the Ebola emergency response in West Africa at the peak of the crisis.

  • After a few months on the ground, I realized Ebola gets too much attention.

  • Ebola tested the world's ability to respond to a crisis, and we failed.

  • We failed on several fronts.

  • Over 11,000 people have died.

  • Over 16,000 Children are orphaned villages, communities, families wiped out, economies destroyed.

  • Off course.

  • We need new capabilities, better systems, better tools.

  • We need to do more.

  • Be better, move faster.

  • But there's something else we need.

  • We need to think differently.

  • Our current approach focuses on Ebola, the virus, the disease.

  • I call it the virus centric approach.

  • We search for the virus and people.

  • We've isolate the virus infected person.

  • We try to treat the virus affected patient, and if we fail, we look to bury that virus ridden body.

  • The virus centric approach gets us to important answers.

  • It helps us understand what the disease is, how to deal with an infected patient, but it misses something.

  • The virus doesn't spread.

  • Ebola.

  • People spread Ebola, and people are far more complex than viruses.

  • People are part of families.

  • They're part of communities.

  • There part of religious groups and ethnic groups.

  • People want to take care of their sick.

  • They want to embrace their dying people, spread Ebola.

  • So if we want to stop the spread of this outbreak, we need to move from a virus centric approach to a people centric approach.

  • Why change your strategy?

  • Because despite our success is we had numerous mistakes, fumbles, course corrections, and again and again it was when we did not fully understand the people aspect, and every mistake is lost lives.

  • The problem of burials is a great example of why we need a new strategy.

  • The dead body is the most infectious point in the life cycle of an Ebola virus in West Africa.

  • There are traditions around washing and cleaning this body and embracing the dead during a ritual burial, so burials were becoming a major source of infection.

  • We knew our response had no chance of success unless burials became safe.

  • When I was supporting the operational planning in Liberia, I thought the burial strategy looked great.

  • We had an excellent plan, great implementing partners, radio announcements, social mobilize, er's even early success.

  • All set or so we thought.

  • Several communities resisted you see burials are based in deep held beliefs that a traditional hands on ritual is needed for the spirit to pass on peacefully.

  • In many communities in West Africa, people save their entire lives to afford an appropriate burial.

  • They sometimes spend more on it than a wedding, so people continue to bury bodies themselves.

  • Or they would wash and clean the bodies quickly before the burial team showed up.

  • Or in some cases, the resistance wasn't even that secret.

  • The burial teams were attacked as soon as they got in your village.

  • It's not that people didn't understand one man.

  • After he and seven others of his family got infected from burying, his father said.

  • Of course, I know I might die, but how can I live if I don't bury my father property?

  • Our strategy was based on scientific logic.

  • People operate on emotion, traditions, beliefs.

  • It became clear that are safe and dignified.

  • Burial strategy was not going to be fully successful unless people were willing to partner with us and we were learning where we took a people centric approach.

  • We had success where we had the trust of people.

  • They let responders in.

  • They called hotlines, told us where there was a death or someone was sick in the community where we were willing to listen.

  • People gave us solutions.

  • They said.

  • You know, if there was someone from our own community, one of one of our boys who was part of this burial team, that would make us feel better and trust this more.

  • They said if the body bags were white instead of black, that would respect our customs More.

  • Where we observed people showed us the way, like in Harmon Field in Liberia, which, despite being surrounded by areas of high infection, remained Ebola free.

  • This is because the community leaders off Harmon Field created their own people centric approach.

  • They set up handwashing stations.

  • They created a self monitoring program program for the households.

  • And so the question for the response, then, is how do we build on these solutions?

  • How do we add to what they've already developed?

  • Partnership with the community is not always easy.

  • In the crowded slums of West Point in Liberia, cases were increasing rapidly.

  • The response was not able to turn around the long held mistrust in government or quell the rumors that Ebola was some sort of foreign or government conspiracy to kill them.

  • The quarantine center, which was a converted schoolhouse where cases from all over was being brought in, was run over by an angry mob.

  • The military was brought out in full force that were curfews and barricades and barbed wire.

  • The resistance only became stronger.

  • The shouts of There is no Ebola just got louder.

  • No medical solution was going to be sufficient.

  • But community leaders persisted.

  • They brought survivors back in who could share their stories.

  • The quarantine center, which had become the flash point in the riots after it was closed the U.

  • N International NGOs and local NGOs partnered with the community to refurbish renovated back into a community school.

  • This persistence with the community is willingness to listen to them to win.

  • Their trust is the reason why West Point is Ebola free.

  • Today, this people Century Cole lead model will have its critics not because it doesn't make sense, but because none over strategies and our institutions are set up for this.

  • So I've heard push back one of them is this all sounds great, but we need to move fast.

  • In a response yes, but can we actually move fast if we don't have the support of the people in the affected communities in Guinea, where this crisis actually started over a year and 1/2 ago, cases continue to fester because of community mistrust in Liberia, which had the most cases.

  • At some point they were able to turn this around and become able of free for a good period of time.

  • And it's universally acknowledged amongst those in the response that this is a large part due to the efforts of the community.

  • The other pushback I hear is you are highly overestimating the capacity of these poverty ridden communities to come up with answers.

  • Two.

  • They may not have all the answers, but neither do we.

  • And when has that ever stopped us?

  • This is a new way of thinking, not just for this Ebola crisis or the next one, but for any crisis, because we know the next time this could be much worse.

  • The next virus could affect a much more populated city in Africa.

  • In India, in China, the next virus could be airborne and spread faster.

  • So what does a people centric model look like?

  • The next time we in the international community and the national response need to think, act and respond differently.

  • We need to go into communities not just to inform them, but to listen to them, to hear their questions, their concerns.

  • We need to bring their community leaders into our planning meetings, understand what solutions, what resource is they already have in place and build on those we have to reorganize.

  • Our response protocols are processes are teams are institutions.

  • Community engagement is not just some parallel work stream.

  • We need to bring this people centric approach into our core strategy, one that is jointly developed by epidemiologists and anthropologists.

  • We have to invest not just in drugs and diagnostics and vaccines, all of which are critical but still only addressed the virus centric part of the problem.

  • We need to invest in understanding traditions and beliefs in mapping local networks, identifying influencers, figuring out community structures that can be quickly activated in the next crisis.

  • The next time we cannot wait for a mistake.

  • We need to go to the people and the communities first to create solutions not just for them, but with them.

I supported the Ebola emergency response in West Africa at the peak of the crisis.

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B1 ebola burial response people approach crisis

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    林宜悉 posted on 2020/03/21
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