April 3, 2019
Mozambique: Rebuilding After Cyclone Idai
On the last day of his field visit to Liberia, Doctors of the World’s Antoine Bogaerts sat at a table with the two DotW doctors who coordinated the ebola response, Pierre and Jules, and the 30 local staff members.
The local staff explained that they wanted to thank Pierre and Jules in front of the visitors. “People starting crying. They thanked Pierre for staying in the country with his family for 2 years to manage the response,” said Antoine. “One staff member, a DotW driver, lost 9 family members to ebola. He lost his mother, his father, his wife and 3 of his children. He said that going to work gave him a reason for living because they (Pierre and Jules) continued to work and stay throughout the crisis.”
“It was very emotional,” said Antoine, “it brought home what people have gone through.”
Liberia was devastated by the ebola crisis with ten thousand Liberians contracting ebola and 4,809 deaths. Liberia was first declared ebola-free on May 9 2015, but new cases emerged in June. WHO declared the country ebola-free again on Sept. 3, which held until a death of a teenage student in November.
At the peak of the crisis, farms, schools, business and even vital services like hospitals had been abandoned.
Does Antoine feel that the ebola free declarations have been premature? “Not really,” says Antoine. “People have gone through so much loss that to acknowledge, and to celebrate, 90 days of being ebola free is very important psychologically.”
But the danger is that people believe it is over. “People go back to normal,” Antoine says, “back to pre-ebola behavior: They shake hands. The student who died in November, the family washed her body, that’s why there were then 9 new cases: People go back to old habits.” It isn’t just resumption of old habits that has created dangerous behavior. “There is a lot of fear,” says Antoine. “People think that other people and health workers are still contagious and there are rumors that organs were stolen at hospitals during the outbreak, so some people won’t go to health centers. We hear of a lot of people dying in the bush. They don’t undergo any tests and we have no idea what they died of.”
Wracked by civil war until 2003, Liberia’s health infrastructure was already fragile at best. Today, the hospitals and health centers that have re-opened are in poor condition. A lot of reconstruction is needed. Many have had materials stolen. “People are dying from very, very simple things,” said Antoine. “Pregnant women die. People die in very basic surgeries.” This is one of the worst post-crisis situations Antoine has seen. “There are so many diseases: HIV; cholera; Rabies; Tuberculosis; all present at the same time in the same region.”
Monrovia, Liberia’s largest county with one third of the country’s population, is in a grave situation. “There is no training from the Ministry of Health. Local county health teams are counting on DOTW 100% for training staff in post-ebola management,” says Antoine. “We are ready to help, but there is a lack of funding for the operations.“
This is the other danger of a post-crisis phase: Attention shifts and people, including funders, don’t believe the need exists anymore. While this is not the emergency of the outbreak at its peak, the work required is still critical.
We cannot forget that if this post-ebola phase is not handled adequately then all the funds, all the work, and all the sacrifices will be entirely undone by future outbreaks.