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SPECIAL GRAPHITTI ANALYSIS Leadership Lessons from the On-going Ebola Virus Disease Outbreak

Critical Reflections and Timeline Analysis of West African Leadership Response during the Ebola Outbreak in Guinea, Liberia, and Sierra Leone

By Kenneth Nwabudike Okafor

From a West African perspective, it is really difficult to refrain from finger pointing in the face of a diseased and proliferating tragedy which is now firmly classified as world's worst Ebola epidemic, since the haemorrhagic disease was identified in 1976, wracking Guinea, Liberia and Sierra Leone in the sub-region. On October 23, headlines chronicled Ebola berthing in Mali via a 2 year-old girl! Dramatic reports tend to portray a region-wide affliction, but 3 out of 17 is minority. Before going any further our hearts and prayers go out to the families who have lost loved ones and in particular to orphans which have become created by the virulent Ebola virus disease (EVD). Post-mortem scrutiny (even when carried out mid-crisis as this one) are often unpleasant and unpalatable as can be; yet they may be (must be?) carried out in order that invaluable lessons and insights might be gleaned from even the worst of calamities, if not for anything else, to forestall future pitfalls. This should be norm. That said, this is a mid-catastrophe evaluation in the stead of a post-mortem and it will not be sugar-coated.

On many levels, there are invaluable lessons which can be distilled from this outbreak. The fact that West Africa and its leadership/ public institutions are wont to avoid this routine/pathway as norm is part of a wider malaise of leadership deficit, governance defects and a complete lack of accountability which disfigure and misshapen the sub-region, and the larger continent and its citizenry in every sense.

In the shambles of obviating long-term planning, there is enough evidence to conclude that no West African state has a feasible, well-conceived and adequately funded disaster preparedness and emergency management strategy/action plan and emergency operations plan for any kind of disaster/emergencies. Ordinarily, disaster preparedness and emergency management strategy/action plan should have multiple stakeholders and thorough support - government has responsibility to: develop, test, and refine emergency plans; ensure emergency responders have adequate skills and resources and provide services to protect and assist citizens. Community preparedness: roles and responsibilities: key priority in lessening the impact of disasters; critical that all community members take steps to prepare and effective when addresses unique attributes of community and engages whole community. an emergency operations plan includes: 1) assigns responsibility to organizations and individuals; 2) sets forth lines of authority; 3) describes how people and property will be protected; and 4) identifies personnel, equipment, facilities, supplies, and other resources.

Ebola Response Roadmap - WHO October 10, 2014

But then you see West Africa is such a place that if you suggest a collective plan for future disaster, someone might accuse you of negativity and wishing people bad luck. This esoteric but unreasonable point of view in the end proves precarious and fatalistic, since it kills strategic thinking and anticipatory planning which is part of the foundations of modern governance better practices. West Africa could not contain Ebola because they had not even made plans to contain endemic malaria. In Nigeria, you cannot find one single community with a standing community emergency response team and/or trained first responders. The upshot is that disease and disasters catch people unawares at every turn.

In this analysis, we would consider the West African leadership/public institutions’ aggregated response to the EVD outbreak. In this instance, leadership and leadership response is appraised from the point of view of both the individual theory and the institutional theory of leadership. The premise of this analysis considers leadership as "a process of social influence, which maximizes the efforts of others, towards the achievement of a goal. (Kruse, 2013)" Additionally, the leadership response appraised considers both the leadership and management functions; management's main function being "to produce order and consistency through processes, such as planning, budgeting, organizing, staffing, and problem solving", while leadership's main function being "to produce movement and constructive or adaptive change through processes, such as establishing direction through visioning, aligning people, motivating, and inspiring."

The one indisputable fact which stands as a veritable indictment for the failure of West African (and indeed African) leadership and public institutions is that this current EVD outbreak thrives and flourishes because of a combustible patchwork of the dearth of crisis management leadership, effective crisis management capacity/experience, infrastructure deficits, weak to non-existent instructional capacity, inadequate manpower base, technology deficits and aggravated poverty (on top of years of political upheavals, violent conflict and full-blown Civil Wars) which if not prevalent could have foreseen individual West African states coping more efficiently in the face of a rampant epidemic.

Now one cannot but wonder what Liberian President, Ellen Johnson Sirleaf would be thinking, what she would be feeling in the face of what is the most challenging crisis of her presidency. Yet whatever her thoughts are, she surely must rue being in office during a second term (which she campaigned for not minding the charges of corruption and incompetence by the opposition) which would see her country men and women become decimated by a ravaging Ebola epidemic — her spiritual advisers certainly did not see this ill-wind coming. One can equally ponder what the Presidents Alpha Condé of Guinea and Ernest Bai Koroma of Sierra Leone might be thinking as well. All of them for conscience sake may ponder at some point or the other what they should have done differently in order to have overcome this epidemic.

On Sunday, October 18, Sirleaf made what must amount to, at least to the office of a Head of State, a desperate move. In an open and direct appeal, she said Ebola has killed more than 2,000 people in her country and has brought it to "a standstill," noting that Liberia and two other badly hit countries were already weakened by years of war. Sirleaf noted that the three hard-hit countries were already in bad shape when the first-ever outbreak of Ebola in West Africa began. Appealing for more international help, Sirleaf described the devastating effects of Ebola in a "Letter to the World" that was broadcast Sunday by the BBC.  "Across West Africa, a generation of young people risk being lost to an economic catastrophe as harvests are missed, markets are shut and borders are closed," the Nobel Peace Prize laureate said. "The virus has been able to spread so rapidly because of the insufficient strength of the emergency, medical and military services that remain under-resourced. There is no coincidence Ebola has taken hold in three fragile states — Liberia, Sierra Leone and Guinea — all battling to overcome the effects of interconnected wars," Liberia's leader said, adding that Liberia once had 3,000 medical doctors but by the end of its civil war, which ended 11 years ago, the country had just 36. …This fight requires a commitment from every nation that has the capacity to help, whether that is with emergency funds, medical supplies or clinical expertise ... It is the duty of all of us, as global citizens, to send a message that we will not leave millions of West Africans to fend for themselves against an enemy that they do not know, and against whom they have little defence," Sirleaf said.

If Sirleaf had intended her "Letter to the World" broadcast to be a rallying battle cry for mobilizing an international Calvary for dire need, the thunder was stolen away from her intentions by subsequent media revelations that Sirleaf’s own medical doctor son, Dr James Adama Sirleaf, would rather stay back in the United States than return to Liberia to assist in the Ebola fight. Surely, someone would think this is rank hypocrisy.

But Dr. Sirleaf himself has his reasons for his decision. He told news reporters, "The symbolism of me going there [Liberia] and potentially getting Ebola when I have a nine and a seven-year-old at home isn’t worth it just to appease people. I’ve made a commitment not to live in Liberia for many reasons, and I think my contribution means more [from outside the country]." And it is not as if Dr Sirleaf is not lending a hand, he is, only on his own terms. In 2007, Dr. Sirleaf co-founded the Health Education and Relief Through Teaching (HEARTT) Foundation to recruit medical specialists and residents to spend a month practising in Liberia and teach at its only medical school. HEARTT sent 70 doctors in 2009 alone to Liberia to train students. But HEARTT’s last team of four doctors left Liberia in March, just as cases of Ebola were surging. "I’ve lost friends to Ebola," he said. "I can’t see the wisdom in sending unspecialized American volunteers to face that risk."

One commentator had this to say of Dr. Sirleaf’s action, "Dr. Sirleaf’s decision speaks to the challenge of not only containing this epidemic but also of preventing the next one. Although Liberia, Guinea and Sierra Leone have sent scores of doctors abroad over the years, they depend on foreign doctors and public health ­experts to halt Ebola’s spread."

Before we get ahead of ourselves, let us step back and begin the analysis in earnest. There are six keys to unlocking the overall response to the EVD and the subsequent leadership stitch-up in this disheartening episode.

The first key to understanding the lamentable leadership response from West African political leadership and public/emergency services institutions lies in the fractured relational constraints between West African states/actors exacerbated by the complexities of the Anglophone-Francophone dichotomy which colonial purveyors foisted on West Africa. By the very nature of the Guinean society, to take one instance, its subtle social / political estrangement from its immediate neighbours and Guinea even from a muddled African prism is at best an opaque society, simmering with protracted political tensions, constantly on edge of eruptions and social upheavals, crippled with distorted governance priorities. When you throw the effects of political corruption, drugs, trafficking and organized crime into the mix, you have tinder-dry socially explosive milieu awaiting a trigger. Even France cannot claim to understand the psychology of their erstwhile colony. Like Nigeria, Guinea has no business being poor and ranked among lowest income country category (LIC) with all of its potential. Guinea has abundant natural resources including 25 percent or more of the world's known bauxite reserves and has diamonds, gold, and other metals. Bauxite and alumina are currently the only major exports. Other industries include processing plants for beer, juices, soft drinks and tobacco. Agriculture employs 80percent of the nation's labour force. Under French rule, and at the beginning of independence, Guinea was a major exporter of bananas, pineapples, coffee, peanuts, and palm oil. Diamonds and gold also are mined and exported on a large scale. Guinea has large reserves of the steel-making raw material, iron ore. The country has great potential for hydroelectric power. All these notwithstanding, Guinea’s Global Competitiveness Index (CGI) for 2013/14 was 142 out of 147 countries with a score of 2.91 while it only marginally improved by one step from the 2012/13 ranking of 141st position.

The second key to understanding the weak leadership response to a fearsome viral enemy is the faulty understanding of the interconnectedness of nations in spite of national borders and regardless of language difference. Ebola did not respect French or English or any of the many local dialects in between these three countries, it simply assaulted human beings whatever their colour, language or creed. If Guinea had understood this simple truth, the initial failings of the public institutions as well as the political leadership of that country would have been nipped in the bud.

The third key to unlocking the failings and the turpitude of this EVD imbroglio is the ominous sense of entitlement which it appears as if the West African countries seemed to exhibit in their asking for help from the international community. It would appear as if the leadership feel they are at liberty to misgovern their country but ask for international assistance when overcome by challenging circumstance. So the question should be asked how come the same countries do not take counsel on how to run their internal affairs so readily are quick to ask for international assistance? Liberia and Sierra Leone despite their lack of resources and wherewithal both fought murderous albeit pointless civil wars against all common sense and decorum which lasted for years and years regardless of the intervention of the international community. Does it mean West African countries are entitled to impoverish themselves and turn their poverty to handicap for begging for international assistance? It appears this has transmuted to habit!

The fourth key is the crucial fact that Guinea had between March and early June as the EVD containment window to stop the now-spiralling Ebola outbreak but failed to curb the virus spread. Once this containment window disappeared, Guinea’s failure automatically condemned her neighbours to a nightmare which nobody could remotely have foreseen the scale of the devastation. By the time, in early August Guinea closed its borders to Sierra Leone and Liberia to help contain the spreading of the virus and the United Nation’s World Health Organization had still not yet declared Ebola an international health and security threat, it was too late even as more new cases of the disease began to be reported in Liberia and Sierra Leone than in Guinea. What would have been achieved if Guinea had immediately closed its porous borders as a key containment strategy between April/May 2014?

The fifth key is that the optimists who hope that Africa would one day reap from a sort of "reverse" brain drain which would see Africans in diaspora return en mass to lead the development and rebirth of the continent may be in for a rude awakening. Dr. Sirleaf is not alone in his voting with his feet in a crisis in his native land. Officials and physicians say far more Liberian doctors are in the US and other countries than in the country of their birth, and that their absence is complicating efforts to curb a global health crisis. Even before Ebola, there were only about 170 Liberian doctors in the country, and colleagues say many of them were not actively practising. At least four of them have since died of the virus. That shortage has prompted repeated pleas from the Liberian government for more foreign doctors to join the fight. Some Liberian doctors are making plans to assist in the ­region though. Abdullah Kiatamba, a leader in the 30,000-strong Liberian community in Minnesota, said dozens of doctors and nurses wanted to spend time in the country of their birth, though their plans were not yet finalized.

When this epidemic subsides, most of that foreign know-how will leave the region. "We Liberians need to be at the frontlines to help ourselves," said J. Soka Moses, the only doctor at an Ebola treatment unit inside a disused cholera clinic on the edge of Monrovia’s John F. Kennedy Medical Centre. "If we aren’t, our country will be wiped away."

The six, and final, key is rather tangential but still significant as the first four keys combined. World Health Organization (WHO) as the U.N.'s specialized health agency, responsible for setting global health standards and coordinating the global response to disease outbreaks and thus in position to have declared Ebola an international health emergency way back in March, did not make the move. A no less important personality as Dr Piot questioned why it took WHO five months and 1,000 deaths before the agency declared Ebola an international health emergency in August. The U.N. health agency acknowledged that, at times, even its own bureaucracy was a problem. It noted that the heads of WHO country offices in Africa are "politically motivated appointments" made by the WHO regional director for Africa who does not answer to the agency's chief in Geneva.

In a draft internal document obtained by The Associated Press, a true "smoking gun" if you will, to borrow a typical American phraseology, the agency wrote that experts should have realized that traditional infectious disease containment methods wouldn't work in a region with porous borders and broken health systems. "Nearly everyone involved in the outbreak response failed to see some fairly plain writing on the wall," the WHO was reported to have said. "A perfect storm was brewing, ready to burst open in full force." The Associated Press reported that the document — a timeline on the Ebola outbreak — was not issued publicly. WHO officials said in an email Friday that the timeline would now probably not be released. No official at the agency would comment on the draft report. In late April, during a teleconference on Ebola among infectious disease experts that included WHO officials, Médecins Sans Frontières (Doctors Without Borders) and the U.S. Centre for Disease Control and Prevention (CDC), questions were raised about the performance of WHO experts, as not all of them reportedly bothered to send Ebola reports to World Health Organization headquarters.

On October 17, Dr Peter Piot was forthright in an interview when he charged that WHO acted far too slowly, largely because of its Africa office. "It's the regional office in Africa that's the front line. And they didn't do anything. That office is really not competent. I called for a state of emergency to be declared in July and for military operations to be deployed," Piot said though he admitted that the WHO might have been scarred by its experience during the 2009 swine flu pandemic, when it was slammed for hyping the situation.

Any analysis to distil leadership lessons in this disaster transmogrifying to a catastrophe must dissect the socio-political context into which the EVD outbreak dropped, engulfing an axis which was ripe for all manner of chaotic events. The picture is equally horrifying. In the last two decades Liberia and Sierra Leone have fought a combined three Civil Wars in between themselves. Between 1981 and October 2003, that is for fourteen years, between Liberia and Sierra Leone there was three Civil Wars, 2 in Liberia and one in Sierra Leone. These wars had stripped the two countries of huge clusters of infrastructure, economic pillars and human lives. Guinea, Liberia and Sierra Leone are wracked by a miasma of upheavals stemming from political instability, poor economic performance, corruption, and maladministration so much so that there have been more coup d'états between these three than in the rest of Africa combined. When the guns finally fell silent after the Civil Wars neither Liberia nor Sierra Leone received any substantial grants for post-war rebuilding; the tatters of the wars directly helped to ensure they would be incapacitated to deal with an Ebola outbreak in this scale.

Then there is the bushmeat angle. To date governments in most African countries have not tackled the challenge of providing animal protein for the populations in a consistent and sustained manager with sound agricultural policies. The absence of large scale mechanized production of animal protein for human consumption has set the stage for the alternative of bushmeat covering the deficit. Thus the animal protein challenge in West Africa, and highlights how consuming wildlife as a source of protein threatens the ecosystem. Demand for bushmeat at home and increasingly abroad has created a vibrant trade, which is endangering the existence of wildlife and destroying forests and grasslands, as hunters employ crude hunting methods like bush burning. The trade in bush meat is already unsustainable at various local levels and appears to be increasing.  In tropical regions including the three countries impacted in West Africa, many areas are already threatened with habitat alteration (including non-selective logging, clearance of forest for oil palm, mineral extraction, etc.), causing population declines and species loss.

That Bushmeat is implicated in this particular outbreak of Ebola actually presents some public health challenge. Medical teams struggling to curb Ebola in West Africa have been discouraging bushmeat consumption, believed to have been the reservoir source of outbreak, but some rural communities, totally dependent on the bushmeat for protein, are determined to continue traditional hunting practices. Malnutrition being a major concern in Africa with lack of protein in particular a special concern, the challenge of alternative protein sources curtailed leaves predominant starchy diets. For generations, the lack of protein has stunted both physical and mental development of millions of children on the continent, damaging their overall potential. In fact, one cannot fully understand the underdevelopment of Africa's human capital without grasping the hidden, yet lifelong effects of protein deficiency. Although overall nutrition and protein consumption in Africa has improved in the past two decades, the challenge of sufficient protein consumption remains, especially among the poor.

Experts and activists say bushmeat has created a much bigger crisis in Africa as a whole. This is in addition to the international dimension of the bushmeat trade, which makes elephants' and gorillas' meat (considered a delicacy by some) to be available through illegal trade as far afield as in the United Kingdom and the United States of America.  Beyond the potential health risks, there is a very real and urgent danger – a natural catastrophe that threatens not only animals, but humans, too. In vast swathes of West Africa various peoples who have grown local tradition of bushmeat consumption resist change.

The disease, which first erupted in Guinea’s southern Forest Region, afflicting and killing Émile Ouamouno, a two-year-old from the tiny village of Meliandou (a village in Guéckédou Prefecture, in the Nzérékoré Region) in southern Guinea, has been named as Ebola 'patient zero' and diagnosed in March as Ebola, is West Africa’s first outbreak, and the worst known to date globally with nearly 5,000 deaths. Infections continue to spread in Guinea and then crossed into neighbouring Liberia and Sierra Leone. In response, the Guinean health ministry banned the sale and consumption of bats, thought to be carriers of the disease and closed down schools indefinitely. Despite a string of measures, the virus eventually spread from rural areas to Conakry, and by late June had entered into Sierra Leone and Liberia. Once Guinea failed between March and early June to bring Ebola virus spread under control and as the containment window was lost, everything else went downhill quickly.

The other contextual consideration falls under the cultural practices including hygiene practices and funerals. It is well documented that prior and immediately during the EVD outbreak, villages across the three West African countries were openly hostile to aid groups during public education campaigns, accusing them of trying to change the local cultures and traditions. Indeed one of the cornerstone practices of social development is that if you wish to gain the confidence of project beneficiaries you do not go attacking their cultural practices. But in this particular instance the cultural practices were part of the problem.

In August, aid workers in Guinea which recorded their concerns. As soon as the Outbreak occurred in Guinea, aid agencies had been encouraging behavioural change only to meet very stiff opposition. Development news reports carried some of the stories of these challenges including the International Federation of Red Cross and Red Crescent Societies and Médecins Sans Frontières according to IRIN, a service of the UN Office for the Coordination of Humanitarian Affairs. Field officers, promoting hygienic practices to avoid contracting Ebola recorded there already was a protracted behaviour-change endeavour and urging new norms for diet was far harder. Promoters of health messages, such as Mariame Bayo in Guinea, were at a time threatened with death in villages where residents strongly oppose aid workers. "In Nongoha [in Guéckédou] we were told that if we don’t leave we would be cut into pieces and our flesh thrown into the water," Mariame Bayo recounted.

"There are those who go even as far as saying that the government and the president have invented Ebola, and that it is meant to avoid holding elections," said Health Minister Colonel Rémy Lamah (The presidential election is due in 2015). "We will die if we must, but abandoning our traditions is out of the question. It is true that we have lost many relatives. That’s fate. It is difficult to change a society’s way of life, but when it comes to saving lives I think no efforts should be spared. We didn’t say that people will no longer eat meat. [Discouraging bush meat] is just an interim measure." Because Ebola had previously never broken out in West Africa, many rural communities have been perplexed and grown wary of health workers who have been accused of introducing the virus. Some believe it is witchcraft or an evil spell. Moustapha Diallo of the International Federation of Red Cross and Red Crescent Societies, however, said that fewer villages across the three West African countries remained hostile to aid groups, following public education campaigns. "The main behaviour change needed is at funerals where a lot of cases are being contracted. That and good protective measures at health structures are the most important targets," said Stéphane Doyone, West Africa coordinator of Médecins Sans Frontières.

Like the rest of Africa, West Africa is, unfortunately, more inclined to myths and fables rather than rigour, industry, analysis and initiative. If stories which are making the rounds are proven true upon independent verification, then we have a female herbalist in Sierra Leone to thank for helping to fan a virulent disease into an out-of-control wildfire. It is alleged that the woman proclaimed she had the cure for Ebola so prospective clients thronged to her shrine. She later became ill herself and died. Thus those who went to bury her all contracted Ebola, and a Guinean palaver engulfed Sierra Leone and Liberia across porous borders. What were the authorities in Guinea and Sierra Leone doing while this female herbalist seized initiative to peddle a bogus cure to a disease with fatality rate of over 70percent? One of the sensible moves made in Nigeria was the visit of Governor of Lagos State to the Synagogue Church of All Nations to dissuade head of the church, reputedly a miracle healer, from allowing people to come to Nigeria for healing (certainly with the benefit of hindsight). The Governor was reported to have encouraged the prophet to tell prospective visitors to stay back and receive their healing at home.

There are four well established low points (or milestones) associated with this outbreak.

The first low point, and one that still subsists, is the baffling self-centredness of African states, a mixture of aloofness, separated disinterest and poor sense of the vaunted African hospitality, which has led states to shying away from contributing help, volunteering capacity or equipment, and/or resources to the assistance of neighbours’ EVD fight! What shame!

It was only midway in October that the African Union finally appealed to all leaders in the continent to contribute health workers and specialists to staff new Ebola clinics and hospitals being built in West Africa. On Thursday, October 16, Nkosazana Dlamini-Zuma, Chairperson of the African Union Commission, disclosed to news reporters, "We have written to our members' heads of state to see if each country can give us maybe up to 10 or 20 each. Even if some give us one or others give us 20, if everyone gave, we can get some hundreds of health workers. "It is not just a fight for these three countries. If we don't help them the disease will also come to everyone ... each member state cannot say it is immune."

The AU itself, hobbled by chronic finance shortages, has only managed to deploy around 100 volunteers in Liberia, where — as in Sierra Leone and Guinea — healthcare systems are collapsing. In March, the Economic Community of West African States (ECOWAS) disbursed US$250,000 to deal with the outbreak. In response to the ECOWAS Special Fund for the Fight Against Ebola, in July the Nigerian government donated US$3.5 million dollars to Liberia, Guinea, Sierra Leone, the West African Health Organization, and the ECOWAS Pool Fund, to aid in the fight against the epidemic.

The United States already has more than 350 troops on the ground in West Africa, part of a planned mission of up to 4,000 troops to support Ebola fight. They have set up headquarters in Liberia's capital, Monrovia, and hope to have a 25-bed field hospital ready this month. The U.S. military also aims to quickly build up to 17 Ebola treatment units. That is on top of the in cash and in kind contributions by US billionaires, charities, private citizens and missionaries. Britain is setting up a 200-bed hospital in Sierra Leone and the United Nations has formed a special mission to lead efforts. But aid agencies say hospitals for Ebola infections, which the World Health Organization says are doubling every 10 to 21 days, may not be built and staffed fast enough to meet demand.

Based on a Washington Post report: United States - US September 16, On Tuesday, President Obama is due to announce that up to 3,000 U.S. troops will head to West Africa to lead the fight against Ebola. Officials say the effort may cost as much as US$750 million in the next four months, which will be in addition to the US$175 million already spent. One hundred officials from the Centers for Disease Control and Prevention have been dispatched.

In a handout picture released by the British Ministry of Defence via Defence News Imagery on October 30, 2014 Royal Fleet Auxiliary (RFA) Argus is docked at the QE2 dock in Freetown in Sierra Leone on October 30, 2014 offloading equipment and stores that will aid in the fight against Ebola. (AFP Photo)

Here's some of the publicly announced plans from other nations: China - China will expand its medical staff in Sierra Leone, one of the countries worst hit by Ebola, to 174, the United Nations announced Tuesday. Earlier this week, the Chinese government announced that it would send a further US$32 million in aid to African nations and international organizations fighting Ebola, in addition to US$4.8 million it had sent in August. India - Last week, India announced that it would be donating US$500,000 to help augment WHO's fight against Ebola. The country has almost 45,000 citizens living in Guinea, Liberia, Sierra Leone and Nigeria, and has been proactive in preparing for an outbreak within India. Britain - Britain recently announced that it would be sending its own troops and humanitarian experts to Sierra Leone to help fight the outbreak. While the exact number of troops was not revealed, it was said that they would help set up a 62-bed medical treatment facility in the country. The British government has committed US$40 million to fighting Ebola so far, the U.K. Department for International Development announced last week. France - At the beginning of September, France announced that it would be sending 20 specialists in biological disasters to help fight Ebola.  As of Aug. 28, the French foreign ministry had donated almost US$200,000 to the "French Red Cross" to support the fight against Ebola in Guinea. Medical supplies were also being delivered to the affected countries, and the French embassy has been working with local authorities. France has supported the European humanitarian agency's work against Ebola with more than US$1 million in donations. French development secretary Annick Girardin is also set to become the first European minister to visit the region since the outbreak began when she travels to Guinea to tour Ebola treatment units this weekend. Germany - The German Foreign Ministry has established an action committee on Ebola and donated US$1.81 million by Sept. 8. The country’s development ministry has also supported related World Health Organization projects with US$1.29 million. Public funding supports the work of Germany’s Bernard-Nocht-Institute in Guinea, which helps to diagnose and fight Ebola. The European Union - The supranational European body has pledged almost US$200,000 to help fight Ebola, and announced this week that Liberia and Sierra Leone will receive further financial assistance. The E.U. has also reportedly deployed mobile labs to the countries worst affected to help with diagnosis and training. Russia - In August, Russia announced that it would be sending a team of several dozen scientists to create a mobile laboratory in Guinea. At the time, the head of the immunology and virology laboratory at St. Petersburg’s Pasteur Scientific Research Institute, Alexander Semyonov, told reporters that Russian scientists had developed a vaccine for Ebola. Last week, Moscow agreed to work with Sierra Leone to fight the virus. Canada - Canada announced that it would be sending more than US$2 million worth of medical equipment to West Africa on Tuesday. Canada had previously announced more than US$3 million in donations to Médecins Sans Frontières and WHO, followed by a further US$1 million Aug. 18. The Public Health Agency of Canada (PHAC) also has a team of experts operating a mobile lab in Sierra Leone. Israel - In September, Israel announced that it would be sending two doctors to Cameroon to help fight Ebola. Cuba - Cuba announced this week that it would be sending 165 doctors and nurses to Sierra Leone to battle Ebola. Turkey - On Sept. 10, Turkey announced that it would be sending unspecified amounts of medical equipment to Gambia, which has yet to have a reported case of Ebola. Earlier in the year, Ankara had announced that it would send US$50,000 to the country to help its fight against Ebola, and help with training medical staff in the country. Brazil - In August, Brazil announced that it would be sending enough drugs to treat Ebola victims to affected countries. The drugs sent would treat 7,000 people for three months, Brazil's government said in a statement. The country later held Ebola readiness drills in Rio de Janeiro and donated approximately US$450,000 for the WHO aiming to strengthen actions against the transmission of Ebola virus. (Data source: The Washington Post. See acknowledgement.)

A timeline and details of how various organizations and countries have responded to the Ebola crisis reads thus: Organizations from around the world have responded to help stop the 2014 Ebola virus epidemic in West Africa. In July, the World Health Organization convened an emergency meeting with health ministers from eleven countries and announced collaboration on a strategy to co-ordinate technical support to combat the epidemic. In August, they declared the outbreak an international public health emergency and published a roadmap to guide and coordinate the international response to the outbreak, aiming to stop on-going Ebola transmission worldwide within 6–9 months. In September, the United Nations Security Council declared the Ebola virus outbreak in West Africa a "threat to international peace and security" and unanimously adopted a resolution urging UN member states to provide more resources to fight the outbreak; the WHO stated that the cost for combating the epidemic will be a minimum of US$1 billion. ECOWAS and the World Bank Group have pledged aid money and the World Food Programme announced plans to mobilize food assistance for an estimated 1 million people living in restricted access areas. Several Non-Governmental Organizations have provided assistance in the efforts to control the spread of the disease.

As of September, a massive international response to the crisis is under way. The United Nations Mission for Ebola Emergency Response (UNMEER) has the task of overall planning and coordination, directing the efforts of the UN agencies, national governments, and other humanitarian actors to the areas where they are most needed. On September 18, the United Nations Security Council declared the Ebola virus outbreak in West Africa a "threat to international peace and security". The Security Council unanimously adopted United Nations Security Council Resolution 2177, which urged UN member states to provide more resources to fight the outbreak. The resolution was the first in the history of the Security Council to deal with a public health crisis. It was sponsored by 131 countries, which – according to U.S. Ambassador to the United Nations Samantha Power – makes it the most broadly supported of the 2,176 Security Council resolutions since 1945. Therefore the UN Security Council has created the first ever UN mission for a public health emergency, UNMEER with the primary task of coordinating the UN agencies' vast resources to combat the epidemic under the leadership of the WHO.

United Nations Mission for Ebola Emergency Response has been tasked to coordinate all relevant United Nations actors in order to ensure a rapid, effective, efficient and coherent response to the Ebola crisis. UNMEER's objective is to work with others to stop the Ebola outbreak. UNMEER will work closely with governments, regional and international actors, such as the African Union (AU) and the Economic Community of West African States (ECOWAS), and with UN Member States, the private sector and civil society. Accra, in Ghana, will serve as a base for UNMEER, with teams in Guinea, Liberia and Sierra Leone. A United Nations General Assembly document, the Report of the Secretary-General on UNMEER and the Office of the Special Envoy on Ebola (A/69/404), issued on September 24 details UNMEER's proposed mission, budget, and structure.

One organization that must be singled out for commendation is Médecins Sans Frontières (Doctors Without Borders, or MSF). Up until the end of September, the organization was the leading organization responding to the crisis, with several treatment centres in the area. Samaritan's Purse has also provided direct patient care and medical support in Liberia. Many nations and charitable organizations, foundations, and individuals have also pledged assistance to control the epidemic. A WHO report released on September 18, has documented and acknowledged its contributions as leading organization responding to the crisis. Currently, it has five treatment centres in the area with two in Guinea, two in Liberia and one in Sierra Leone. The centres are staffed by 210 international workers in collaboration with 1,650 staff from the affected regions. MSF has collaborated since March 2014 with CartONG and the Humanitarian OpenStreetMap Team (HOT) to map the areas impacted by the Ebola outbreak, especially roads, buildings, and place names. These efforts started in Guinea, and then were extended to Sierra Leone and Liberia. The data and maps are also being used by the Red Cross.

MSF has campaigned since the beginning of the epidemic for a better response from governments and international agencies. Speaking at a United Nations (UN) briefing on 2 September, Joanne Liu, international president of Médecins Sans Frontières criticized the lack of assistance from UN member countries. "Six months into the worst Ebola epidemic in history, the world is losing the battle to contain it. In West Africa, cases and deaths continue to surge. Riots are breaking out. Isolation centres are overwhelmed. Health workers on the front lines are becoming infected and are dying in shocking numbers. Others have fled in fear, leaving people without care for even the most common illnesses. Entire health systems have crumbled. Ebola treatment centres are reduced to places where people go to die alone, where little more than palliative care is offered. It is impossible to keep up with the sheer number of infected people pouring into facilities. In Sierra Leone, infectious bodies are rotting in the streets." Later, Vickie Hawkins, executive director of Médecins Sans Frontières said national and global health systems had "failed" and the task of tackling the epidemic remained "very large and difficult". She said: "At MSF we are frustrated and angry that the global response to this outbreak has been so slow and inadequate. We have been amazed that for months the burden of the response could be carried by one single, private medical organization, whilst pleading for more help and watching the situation get worse and worse. When the outbreak is under control, we must reflect on how national and global health systems can have failed quite so badly. But the priority for now must remain the urgent fight against Ebola — the job ahead is very large and difficult but we simply cannot afford to fail."

Yet as Dr David Nabarro, the UN Secretary General’s Senior Coordinator has acknowledged that more needs to be done quickly when said that "This unprecedented outbreak requires an unprecedented response. The number of cases has doubled in these countries in the last three weeks. To get in front of this, the response must be increased 20-fold from where it is today."

Now what emerged from all of this as imperceptible as it might first appear to be is the truth of genuine inter-African cooperation, brotherhood and good faith is more rhetoric than reality. Now this is not being judgemental on a distressed country which has enough of a plateful of its own headache, but it must be elucidated as the pathway for African relationships not to tow, not to evolve. At the minimum, it is well known that Congo, Democratic Republic, Uganda, and Republic of Congo have been down the EVD outbreak road a number of times (with the minimum three incidents) dating back from 1976 yet interestingly there was simply only an appallingly loud silence from that quarter at the onset of the West African outbreak; Congo, Democratic Republic, Uganda, and Republic of Congo which have all received tonnes of sympathy and more tonnes of actual and verifiable technical/material assistance from others did not think it useful and even necessary to offer help, however symbolic, to West Africa. (Tongue-in-cheek, we must review what our political leaders discuss at African Union gatherings!) Remarkably, there is no evidence to indicate that any of the West African protagonists approached any one of Congo, Democratic Republic or Uganda or Republic of Congo experts for assistance at any point in the crisis timeline so far. Just for the records, using data from the United States Centre for Disease Control, these three countries Congo, Democratic Republic (outbreaks occurred here in 1976; 1977; 1995; 2007; December 2008-February 2009; and June-November 2012), Uganda (November 2012-January 2013; June-October 2012; May 2011; December 2007-January 2008; and 2000-2001), and Republic of Congo (outbreaks occurred here in October 2001-March 2002; December 2002-April 2003; and November-December 2003) have had Ebola outbreaks a combined total of 14 times.  Or do we put it down to the fact that, perhaps, they did not learn enough to share, because as the crisis rages in West Africa, A separate Ebola outbreak has killed 41 people in Congo, Democratic Republic where 68 cases were reported as at September 18.

The second low point came at two disparate times when, separately, Sawyer and Duncan escaping abroad, spreading Ebola in their wake. What Liberia exhibited in mishandling potential high-risk persons, firstly, Patrick Sawyer, clearly infected by Ebola and fully aware of his infection status, to board an international flight because of administrative and procedural failings between state ministries, to spread Ebola, deliberately it appears, in Nigeria and secondly, Thomas Eric Duncan, again based on dodgy premise, to board a flight to the United States, is unconscionable incompetence with strong suspicions of criminal negligence.

The third low point is the fact that both West African leaders (along with the larger international community) allowed frontline health workers with vast experiences, who were on the case of attempting to contain the formidable virus, to die. In the September 28, 2014 edition of the Washington Post Op Ed, Karen Attiah, the Washington Post's Opinions Deputy Digital Editor, wrote a poignant article titled Leaving Ebola Fighters Behind To Die. She wrote, "Almost every world leader noted the bravery of first responders to the Ebola crisis, calling them ‘heroes’. Despite all of the rhetoric seemingly laced with care and concern for the victims, the fact remains that no African doctors or health workers have been evacuated as of yet to Western facilities for treatment.  No Western leaders announced specific frameworks to evacuate African doctors or other health personnel who contract Ebola, which, at this stage of the outbreak, is indefensible. Very recently, Dr Olivet Buck, a Sierra Leonean doctor, died after the World Health Organization denied a request that she be transported to Germany for treatment. In July, Dr Sheik Umar Khan, an eminent physician that headed up Sierra Leone’s Ebola response, died after negotiations for his evacuation. On Sunday, health officials reported that Liberia’s chief medical officer, Dr Bernice T. Dahn, has been placed under quarantine after her assistant died from Ebola on Thursday. Sierra Leone officials have criticized the WHO for its sluggishness on decisions to evacuate their country’s infected doctors."

Millions of people would probably completely agree with Karen, but the bigger question should be thrown to the country leaders first and foremost. Can anyone provide full details of proof  effort made beyond official channels up to and including use of personal contacts when it became necessary seeing that there was general tardiness to request at the country level to get help for those who have risked their lives for their countrymen?

This question must be asked in Sierra Leone just to clear the air that nobody was engaged in helpless handwringing and waiting on the international community until Dr. Sheik Umar Khan and Dr. Olivet Buck, both excellent patriots and top doctors, succumbed to Ebola. Far from it, this analysis would never suggest that the authorities stood by and did nothing. Of course, they did not do that.

You see Dr. Khan was a Sierra Leonean national hero: he was the virologist in charge of the Lassa Fever Ward and Research Programme based in Kenema Government Hospital, 300km (186 miles) east of the capital city of Freetown, in an area with the highest rates of Lassa fever in the world. During his time at the Kenema Hospital, Dr. Khan additionally served as a physician and a consultant for the United Nations Mission in Sierra Leone (UNAMSIL), specializing in Lassa fever. He later turned to head up Sierra Leone’s Ebola (a Level 4 pathogen like Lassa fever) response, died after negotiations for his evacuation. Dr. Khan was a specialist in viral haemorrhagic diseases and one of the world’s leading experts in Lassa fever, and people described him as voluble and intense; virus experts from a number of American research institutions had developed close friendships with him and his staff. The virologist was credited with treating more than 100 patients at the hospital in Kenema - one of the world’s leading Ebola diagnosis facilities.

An article in The New Yorker by Richard Preston, Reporter-at-Large, captures poignant details which would otherwise not have been known. He wrote:

The government of Sierra Leone regarded Umar Khan’s plight as a national crisis. As soon as Khan became ill, a government official sent out an e-mail to Ebola experts around the world, asking for information about any drug or vaccine that might help him. In a series of international conference calls, officials from the World Health Organization, the U.S. Centres for Disease Control and Prevention, the government of Sierra Leone, the Public Health Agency of Canada, scientists from the United States Army, and health workers from Doctors Without Borders, which was running the Kailahun Ebola centre, debated how to treat Khan. Many of the people on the phone knew him, and this was a matter of life and death.

The debate quickly centred on ZMapp, which seemed to show more promise than other drugs. Why should Khan, and not other patients, get any experimental drug? What if he died? ZMapp had been tested in some monkeys a few months earlier, but what was the significance of that? It was made from mouse-human antibodies that had been grown in tobacco plants. If such substances enter the bloodstream, a person might have a severe allergic reaction. If something went wrong with the drug, there was no intensive-care unit in Kailahun. The population of Sierra Leone would be furious if the West was seen to have killed Khan, an African scientist and a national hero, with an experimental drug. But if he wasn’t given the ZMapp, and he died, people might say that the West had withheld a miracle drug from him. “I was making sure my tone of voice stayed neutral,” Kobinger recalled. The debate and the calls went on for three days.

…On July 25th, the international groups finally came to a decision about Umar Khan. ZMapp was too risky and would not be given to him. Khan was informed; it is not clear that he was brought in to the decision. That same day, his brother Sahid, in Philadelphia, began frantically calling Kailahun in an effort to speak to him. Sahid had been calling Umar’s cell phone for days but had got no answer. Sahid got somebody at Kailahun on the phone and demanded to speak with his brother. “It is not possible to speak to Umar,” he was told. Sahid blew up. “Then I want a picture of him to prove he is still alive!” he shouted. Soon afterward, somebody texted him a photo of his brother. In the image, Umar is sitting on a plastic chair, slumped, and his eyes are heavy-lidded. He appears to be exhausted and turned inward, though a slight smile flickers on his face. Sahid believes that the smile was for the sake of their mother, an attempt to tell her not to worry.

…On July 28th, Gary Kobinger, of the Public Health Agency of Canada, received an e-mail from Lance Plyler asking for ZMapp to be sent toELWA as quickly as possible. Kobinger told him that the nearest course of the drug was sitting in a freezer in Kailahun, in Sierra Leone, across an international border. By now, Umar Khan was close to death. Hensley had not taken part in the debate over whether to give ZMapp to Khan, but she knew about the decision.

The drug would have to be flown from Kailahun, but there was no airfield there; the nearest was in a town called Foya. A few days earlier, a team from the Sierra Leone Ministry of Health had been attacked in Foya, and a ministry vehicle was burned; residents were fleeing the area. The U.S. Embassy in Monrovia asked Lisa Hensley to pick up the drug and arranged a helicopter for her.

The chopper was an old gray Russian Mi-8, flown by two Ukrainian pilots. A colonel in the U.S. Marine Corps accompanied her—to provide peace of mind, he told her. A heavy rain was falling, and Hensley and the colonel sat in the helicopter for hours on the tarmac. During those hours, in Kailahun, Umar Khan died. Finally, during a break in the weather, the helicopter took off and headed north. Hensley, wearing ear protectors, sat buckled on a bench facing the colonel. She could see almost nothing out the window except moisture whipping across the glass, but now and then she caught a glimpse of a ridge covered in jungle slipping by below. She grew anxious, especially when the colonel remarked, “We’ve been flying in periods of zero visibility.”

If you learned the story of how Dr. Khan had come to become valuable to the Lassa fever programme, you will agree Sierra Leone should have moved the world literaly to save Dr. Khan’s life. Because leadership is also anticipation of the unforeseen – like Dr. Khan in the course of dangerous exposure to a formidable virus contracting EVD and his chances of survival being slim to nil in Sierra Leone and that without evacuation, it was absolutely up in the air. Effective leadership should have anticipated that contingencies for overseas evacuation be made ahead for whichever top doctor came down with Ebola, since there were so few such experienced staff in the first place!

In diplomatic speak, there is a principle which termed as "extraordinary measures". You achieve results by extraordinary measures outside conventional, bureaucratic channels, a kind of thinking "outside the box" strategy; pursuing legitimate objectives outside the regular channel without infringing the law. When countries with clout require certain favours they regularly lend weight to this principle to get results outside bureaucratic official channels. In matters that some countries in the Northern hemisphere perceive a clear and present danger to their national security, they do not take no for an answer based on the principle of "extraordinary measures"; they call in favours to obtain result outside of normal routes. Why could African countries not do the same in this case where Ebola has shown its hand so to speak as clear threat to national and regional security?

Although Attiah in The Washington Post article referred to above quoted the Liberian president as complaining that "Partners and friends, based on understandable fears, have ostracized us; shipping and airline services have sanctioned us; and the world has taken some time to fully appreciate and adequately respond to the enormity of our tragedy." President Ellen Johnson Sirleaf made this statement during high level emergency meeting at the United Nations on the Ebola outbreak on Thursday, September 25. It was still a big let-down to have failed to do more to prevent the deaths of these frontline fighters. This then leads to the conclusion that it behoves political office seekers to weight their known and unknown demands of the office they seek before they put themselves forward, and then to seek subsequent terms.

The only action with yet-to-be-ascertained origins which has emerged in this crisis but firmly underpins the principle of "extraordinary measures" despite the cloud of ethical issues which hung over the practice but which clearly was not at the instance of leadership structures/figures was the use of blood of Ebola survivors to treat EVD patients. Sadly, this is now driven forward by black market forces. Again for the simple reason that official channels have neither being flexible and adaptable enough to lead from the front on this account. The World Health Organization had to step in to rush out an agreed position on the medical ethics of this practice after a meeting of a panel of experts.

This issue is however closely tied to what must be, at least from the research point of view, the greatest lost opportunity for West African countries in this instance: the loss of the opportunity to gather primary data on the progression of the EVD. What a huge waste of a very opportune moment! What are we thinking as African people. All the countries actually helping and pledging to help why can we not imagine that they would gather data and vital statistics. They would get material which they would convert to better prepare just in case there is a future occurrence directly or indirectly.

The fourth, and final, low point surely is the cold-blooded slaughter of health workers, local officials and journalists in the Guinean village of Wome! Already the Ebola outbreak as a whole has hit hard on health workers with 236 of them have lost their lives to the disease as at Friday, October 17, 2014.

In September, eight members of a delegation on a mission to raise awareness in a remote village in Guinea about the Ebola outbreak were killed by an angry mob who thought they came to spread the disease, a government spokesperson disclosed. The delegation comprising government officials, health workers, journalists and a pastor left for the remote village on Tuesday, September 16, the New York Times reports and subsequently vanished before Thursday. Several officials who escaped said an angry crowd in the village began hurling rocks at them. Three days later, on September 19, international news reports carried the story that eight members of a team trying to raise awareness about Ebola have been killed by villagers using machetes and clubs in Guinea, officials say. A journalist who managed to escape revealed how she could hear villagers looking for them while she was hiding. Much later, some of the bodies - of health workers, local officials and journalists — were found in a septic tank in a village school near the city of Nzérékoré, one of the eight administrative regions which are then further subdivided into thirty-three prefectures. Correspondents claimed many villagers were suspicious of official attempts to combat the disease. The team disappeared after being pelted with stones by residents when they arrived in the village of Wome — in southern Guinea, where the Ebola outbreak was first recorded.

The government delegation, led by the health minister, which had been dispatched to the region were unable to reach the village by road because a main bridge had been blocked.  On Thursday night, government spokesman Albert Damantang Camara confirmed the victims had been "killed in cold blood by the villagers" as the bodies showed signs of being attacked with machetes and clubs. This led to the arrest of six people and the village became reportedly deserted. The motive for the killings has not been confirmed, but the British Broadcasting Corporation's Makeme Bamba in Guinea's capital, Conakry, says many villagers accuse the health workers of spreading the disease. Others still do not believe that the disease exists.

A plausible explanation boiled down to a catastrophic failure along the channels of communication as a result of lack of full public disclosure of intent as well as failure of intelligence from a poor reading of the local situation. With the benefit of over two decades in project planning and development, it is straightforward to point out that one of the trickiest phase of needs assessment/project implementation is community entry. Of course, once you exposed to Conflict-sensitive Development then you realize that intelligence about security/atmosphere of a prospective study area/project location must never be taken for granted. Next is the vital step of recruiting/selecting appropriate Key Informants/Community Facilitators who usually must be persons/indigenes from the target community and must be person of unimpeachable character and good standing amongst the people. A project can rise or fall based on the personality of the Community Facilities. Of course all the above steps may have been adhered to, and matters still go awfully awry.

But one thing that is certain, until the report of full scale inquiry is made public, the health workers, local officials and journalists walked into a "minefield", a metaphorical warzone, where the rules of engagement were not distinct. It is possible the health workers, local officials and journalists were collateral damage. Noteworthy is the fact that local officials also got killed which smacks of mistrust and deep seated anger between government and villagers. Of course, with the pervasive smell of death and deprivation, rumour, uncertainty and long-standing neglect swirling, the villagers were on edge and tetchy with the feeling of complete disenfranchisement, fed up with the corruption in Conakry, they merely took out their frustration, having lost all sense of civility and rational judgement. They pounced on the health workers to embarrass the government. Well, no matter the level of frustration, no person should kill another human being to make a point; this is the lesson Conakry should now cause the villagers imbibe by letting the full extent of the law take its course.  

In the aftermath of the horrific slayings, what further measures aside the arrests have the Guinean authorities taken in connection with the killings? The picture is not clear so we have no clue. Perhaps government is waiting for the outbreak to ebb before they proceed with investigations and consequent prosecutions. We should not hold our breadth though, worse has happened in Guinea and nothing happened. What is wrong with the African mentality? Why the thoughtless recourse to mindless violence, to jungle justice? Of course, you cannot separate the bloodlust from a deep distrust of the justice systems which many deem as utterly corrupt? Did President Alpha Condé declare the incidence a national tragedy? Those health workers died just like the Nigerians that were killed and nothing changed.

But it is not only in Guinea that there were sceptical populations. Another instance was in Liberia where looters invaded a treatment centre and chased out in-patients while looting bed sheets and mattresses. In an orgy of thievery, one can only imagine how many more people got adversely exposed. On August 17, Liberian officials feared Ebola could soon spread throughout the capital's largest slum after residents raided a quarantine centre for suspected patients and absconded with items including bloodied sheets and mattresses. The violence in the West Point slum occurred late Saturday and was led by residents angry that patients were brought to the holding centre from other parts of Monrovia, Tolbert Nyenswah, assistant health minister, said Sunday. Local witnesses told Agence France Presse (AFP) that there were armed men among the group that attacked the clinic. "They broke down the doors and looted the place. The patients all fled," said Rebecca Wesseh, who witnessed the attack and whose report was confirmed by residents and the head of Health Workers Association of Liberian, George Williams. Up to 30 patients were staying at the centre and many of them fled at the time of the raid, confirmed Nyenswah. Once they are located they will be transferred to the Ebola centre at Monrovia's largest hospital, he said. The attack comes just one day after a report of a crowd of several hundred local residents, chanting, 'No Ebola in West Point,' drove away a burial team and their police escort that had come to collect the bodies of suspected Ebola victims in the slum in the capital, Reuters reports. West Point residents went on a "looting spree," stealing items from the clinic that were likely infected, said a senior police official, who insisted on anonymity because he was not authorized to brief the press. The residents took medical equipment and mattresses and sheets that had bloodstains, he said. Ebola is spread through bodily fluids including blood, vomit, faeces and sweat. "All between the houses you could see people fleeing with items looted from the patients," the official said, adding that he now feared "the whole of West Point will be infected." Some of the looted items were visibly stained with blood, vomit and excrement, confirmed a resident, Richard Kieh. Later however the Liberian police restored order to the West Point neighbourhood. Sitting on land between the Montserrado River and the Atlantic Ocean, West Point is home to at least 50,000 people, according to a 2012 survey.

On August 2, The Economist carried an article vividly portraying the depth of this disbelief titled Ebola in West Africa: Death and disbelievers, which stated, "When Ebola came to the Kailahun district of eastern Sierra Leone in late May, the government put out a series of messages telling people how to recognize and avoid the disease—among other things by avoiding exposure to victims’ blood, sweat, saliva or to dead bodies. Few villagers took any notice. Instead, a string of wild theories is circulating, including suggestions that the government and aid agencies are intentionally spreading the disease. The outbreak highlights a chronic lack of trust between ordinary Sierra Leoneans, their government and the aid-giving Western world. When a burial team including people from foreign charities recently arrived at a village in Kailahun, women and children fled at the sight of their branded vehicles. The men denied they had any bodies to be buried—and chased the team away. Events like these are common."

Then there are the academics and internet Ebola skeptics fuelling the disbelief. Notable is Dr. Cyril Broderick, a Liberian-born faculty member, who is listed as an associate professor in the Department of Agriculture and Natural Resources at Delaware State University. On September 9, Dr. Cyril Broderick wrote, in what may plant further seeds of mistrust and suspicion, an article in a major Liberian newspaper, the Daily Observer, titled: Ebola, AIDS Manufactured by Western Pharmaceuticals, US DoD? implying the epidemic is the result of bioterrorism experiments conducted by the United States Department of Defence, among others. Dr. Broderick later defended his article in a brief interview with The Washington Post.

However, Terence McCoy, a foreign affairs reporter at The Washington Post, wrote of Dr. Broderick’s article:

Broderick drew on research published in several conspiracy Web sites, including Global Research and Liberty Beacon. He discussed a 1996 book called Emerging Viruses: AIDS & Ebola — Nature, Accident or Intentional? written by a man [Dr. Leonard Horowitz] who called himself a “humanitarian, clinician, prophet, scholar and natural healer.” One of Broderick’s sources claimed Tulane University, which once worked on test kits for hemorrhagic fever in West Africa, has “been active in the African areas where Ebola is said to have broken out in 2014. …His claims represent a pervasive, pernicious and crippling problem facing the fight against Ebola: misinformation. Across Liberia and Sierra Leone, where the CDC fears Ebola could eventually infect 1.4 million people, there is such distrust of the medical community that some don’t even think Ebola exists. By drawing from conspiracy-obsessed American sources — one of which said the attacks of Sept. 11, 2001, were planned by the American elite — its author took rumors circulating in the United States and injected them squarely into the most Ebola-ravaged place on Earth. Such rumours are "commonplace" in Liberia’s capital, according to Ramen IR, an international affairs blog: “They become strengthened through mass dissemination and the credibility gained through publication. The public is then mobilized through misinformation. This tendency is especially high in post-conflict zone like Liberia, where the 14-year civil war still fills the country with memories of violence distrust.

Every reader must decide what to believe, after reading and consulting all referenced sources.

On August 21, the lone voice which spoke what many other people may be thinking but did not vocalize was Dr Joanne Liu, international president of MSF. Dr Liu surmised during an interview that efforts to curb the deadly Ebola epidemic that swept across West African states are being undermined by a lack of leadership and emergency management skills. In that particular interview, Joanne Liu also said the world’s worst ever outbreak of Ebola has caused widespread panic and the collapse of health care systems particularly in Liberia. She said Western nations must dispatch more experts in tropical medicine, especially field workers who know how to help communities prevent the often lethal virus from spreading. And the World Health Organization must fulfil its leading role in coordinating the international response to the epidemic, the president of the global, Swiss-based medical charity told Reuters by telephone. "think they are in the process of bringing more people from the World Health Organization but the reality is that this epidemic will be not be contained unless there are more players," Liu said. "We are missing everything right now. We are missing a strong leadership centrally, with core nation capacity and disease emergency management skills. It’s not happening."

It later started to happen…slowly, but mostly from outside of West Africa. In another place, a writer had opined that "The real number of those who have fallen ill could be a magnitude greater than those officially diagnosed, as the patients may be cared for at home, and buried secretly, to avoid stigma. Unsurprisingly, these cases, where proper sanitation measures have not been complied with, contribute to the further spread of the disease."

On the other hand, the international response is best summed up in the words of no less a personality than the Dr. Margaret Chan, Director General of United Nation’s World Health Organization. At some point along the timeline, a media report quoted Dr. Margaret Chan as hitting out at international bodies for failing to promptly respond to the Ebola epidemic when it first appeared months ago, admitting the disease is now "racing ahead of doctors. All international organizations underestimated the disease. The outbreak will get worse before it gets better. And it requires a well-coordinated, big surge and huge scale-up of outbreak response urgently."

It should be on record that Dr. Joanne Liu of MSF as far back as August had called for the deployment of "civilians and military assets with expertise in biohazard containment was imperative" which is now being promised by international community.

In this particular instance, Nigeria appears to have come out with commendation all round and from several quarters for the way and manner in which it handled the Ebola outbreak. On October 20, in a much-anticipated ceremony, the WHO representative declared Nigeria Ebola-free. The glee of the occasion masked the terror which had loomed months before. Clearly, the Hand of Providence is all over what actually transpired.

In summary, on July 25, the Nigerian Ministry of Health confirmed that a man (later identified as Patrick Sawyer) in Lagos, Nigeria, died from Ebola having falling down vomiting blood at the Muritala Mohammed International Airport (MMIA) after arriving on board an Asky flight. The man Sawyer had been admitted to a Lagos hospital, First Consultants Medical Centre since arriving at the Lagos airport from Liberia. A small number of Ebola cases linked to this patient were reported in Lagos including Dr Adedavoh, Dr Agonoh, nurses Justina Ejeleonu and Evelyn Uko (all staff of First Consultants Hospital) and then one of the primary contacts of Sawyer, a diplomat sneaked to Port Harcourt, Rivers States, and infected Dr Ikechuckwu Enemuo who later died after infecting his wife and another patient in the hospital where he was treated. Olu-Ibukun Koye escaped a quarantine centre in Lagos where he was sick with Ebola and came to Port-Harcourt, Rivers State for treatment. Dr. Enemuo allegedly knew that he had the illness but did not report it and he kept treating him secretly at the hotel in Port Harcourt. However, all the people in Nigeria who were sick with Ebola have now either died or recovered from the disease. The Nigerian government also monitored the health of people who had come in contact with Ebola patients in the country. Nigeria had not found any new cases since September 8 and as at September 26 all those being monitored or quarantined have completed their 21-day monitoring period and are no longer at risk for getting sick with Ebola. If no new cases emanate then Nigeria hopes the country would be certified Ebola-free on October 20, 2014 by the World Health Organization.

True, nobody in Nigeria invited Patrick Sawyer to the country and what Sawyer’s undisclosed intent was when he prevaricated and hoodwinked various groups of people to board an international flight en route to Nigeria has never been explained. If the doctors at the First Consultants Medical Centre had been less than adamant who can tell what conflagration would have been set off amongst a population of over 170 million. Albeit Nigeria is not without causality; the country went on to record a total of nineteen cases and seven fatalities. The story of Sawyer’s subterfuge and the Liberian authorities’ negligence in allowing Sawyer trick his way out of monitoring is yet to play out in full.

Here is why. There is mounting evidence that Liberia government (and somebody high up Sirleaf’s administration and the corridors of power) failed their core duty which led to Sawyer’s unrestricted (and alas irresponsible) movements.

On October 10, Dr Benjamin Ohiaeri, the Medical Director of First Consultants Medical Centre, where Sawyer was taken for treatment, indicted the Liberian Ambassador to Nigeria, Professor Al-Hassan Conteh, for complicity in the first Ebola case in Nigeria, saying the Ambassador put the hospital under pressure to release Sawyer against wish of hospital management; the Ambassador threatened to institute a lawsuit against First Consultants Medical Centre if Sawyer was not released. Briefing journalists for the first time since its reopening in Lagos, the Medical Director, Dr Ohiaeri, disclosed "The ambassador said if we continued to keep him (Sawyer), it would be tantamount to kidnap and abuse of human right. He said if we did not release him, we would be subjecting our hospital to international diplomatic row and we should not rule out the possibility of law suit."

Dr. Ohiaeri disclosed that amid pressure to discharge Sawyer, the management immediately conveyed a committee of three who concluded that although Sawyer has the right to sign against medical advice, they would not let him go for public good. Regretting the loss of four hospital staff, comprising two doctors and two nurses to Ebola, he grieved that the entire hospital was bereaved. "As if that was not bad enough for us, the Liberian Ambassador to Nigeria started to put pressure on us that Mr Sawyer had his fundamental human right that he wanted to leave the hospital and he should be allowed to leave. In other words, we have a provision within the law that allows the person to sign and leave the hospital. Meanwhile, there is a superior provision within that law which is that you can decline the patient for public good. In order to protect ourselves as an institution, we called in our lawyer who drafted for us a resolution, stating that we were not going to let Sawyer out because it will not be in the public good to let him out."

According to Ohiaeri one of their greatest challenges with Sawyer Ebola virus saga was when he insisted he must be discharged and unleashed his bio-terror on the staff. The doctor said "Within that time Mr Sawyer insisted that he wanted to exercise his right to leave the hospital and sign against medical advice and the executive committee of the hospital made up of three of us, myself, late Dr. Adadevoh and Dr. Abaniwo, Director clinical services, deliberately agreed that base on the confidence in our legendry physician, Dr. Adadevoh, we will not fall for it. Because we did not let him go, Mr Sawyer unleashed his bio-terror on the staff of the hospital. He knew he had the disease, he was angry to the extent that he released his blood to contaminate our people as they came in. We lost four of our key staff who included, Dr. Adadevoh, she worked here for 21 years, Dr. Amos Abaniwo, our Chief consultant Anaesthesiology and Director of clinical service, had been with us for 16 years. Dr Adadevoh died leaving the husband and a son, Dr. Abaniwo died leaving his wife and three kids, the third person that died was a nurse Ejeleonu, she just started working with us that day. Unknown to us she was two months pregnant and she died with the pregnancy. The fourth person that died was nurse Evelyn Uko who had been working with us for the past 31 years. She was a widow, a single parent raising four children; she died living those children with us, multiple tragedies because the four children were kicked out of the home because of the stigma. So watching her is a combination of so many burdens on First Consultants Medical Centre."

In the face of what another Liberian’s action of travelling to the United States under similar devious atmosphere, Liberia must be made to offer Nigeria, the United States and the whole international community a convincing explanation. If they do not clear the air, that country will garner much ill-will from inscrutable faces.

Apart from Sawyer’s deadly antics toward the medical team catering to him at the First Consultants Medical Centre, there is the now truncated subplot of a daft idea nearly served up as the real McCoy when some unnamed Nigerian scientist in diaspora prodded the Nigerian health authorities into considering Nano Silver as a possible cure for Ebola even in the face of definitive American rebuttal. Yet someone in the corridors of power believed there were prospects in treatment with Nano Silver for the Nigerian Ministry of Health to have given approval for preliminary testing. Later the Ebola cure capability claims would be furtively recanted.  And we wonder why quackery is so widespread.

This EVD outbreak will cost the West African economies dearly; the jury is still out as to the full extent and scope of the impact, economically, socially, politically and psychologically. However the most certain is the impact of infrastructure and economy; Guinea’s health infrastructure just as Liberia’s and Sierra Leone’s has collapsed. Liberia is now reportedly spending its reserves according to the head of its Central Bank. Then there is the talk of impact on food security.

Financial aid and global coordination are needed to prevent the Ebola health care crisis from becoming a food emergency, agriculture ministers from West African nations at the centre of the Ebola outbreak said Wednesday. In Sierra Leone, where thousands are infected and more than 900 have died, 40 percent of the farmers have abandoned their fields, said Joseph Sam Sesay, Minister of Agriculture, forestry and food security. Coffee and cocoa beans amount to about 90 percent of the country's agricultural exports, and the region where they are grown has been struck hard by the virus. Sierra Leone's economy was expected to grow more than 11 percent this year until Ebola struck in May. Now growth is only predicted to be around 3 percent, he said. "Farms have been abandoned. Some families have been wiped away. Some villages have been wiped away. It is very serious," Sesay said. "We have to understand that agriculture is the mainstay of our economies. If agriculture is down our economies will be down." Liberia Agriculture Minister, Florence Chenoweth said billions of dollars of outside agricultural investment is gone because farming has been decimated. She went on to elaborate that Liberia expected 9 percent economic growth but has ratcheted it down twice to about 2 percent. The nation had attracted US$17.6 billion of foreign investment of which US$7 was for agricultural development but those investors have left, Chenoweth claimed, adding that a recovery plan has been developed. "We are very determined, very resilient people. We have not as ministers of agriculture put forward a recovery plan for nothing. We will implement that plan ... and rebuild our country's agricultural sector."

Speaking at forum on Wednesday, October 15, at the World Food Prize Foundation annual meeting in Des Moines, US where government, academic, corporate, non-profit agriculture and food experts gather to discuss issues of hunger and boosting agricultural productivity, Kanayo Nwanze, president of the International Fund for Agricultural Development (IFAD), a United Nations agency based in Rome, said the Ebola epidemic is strangling regional trade and could "lead to a hunger crisis of epic proportions for West Africa. International food and medical assistance is needed to stem the spread of Ebola. It is unfortunate that the international community does not look up to crises when they occur in what I call the forgotten world, the invisible world where people die in rural areas from drought or disease until it grows out of proportion or until it begins to effect the larger international community. When there's a crisis in Timbuktu it doesn't stay in Timbuktu anymore. Nowadays it reverberates in Paris, London, Berlin, and Washington."

If as Vickie Hawkins wondered that national and global health systems can have failed quite so badly, then we should wonder why the West African leadership response was so slack and effete. Will the world ever sit back one day and think – could all these have been avoided? Could a different leadership and public institution response have obviated these crippling and spiralling outcomes?

This current EVD outbreak merely further incapacitates our aspirations and wastes precious human capital. The real calamity is that nothing might change before the next outbreak whether disease or disaster. West African perennial leadership failure has to end sometime; why not now? This Ebola outbreak merely further reinforces the hubris and vacuity of West African leadership and public institutions.

In his work Africa’s Crisis of Governance published in the Africa Business Information Services (a portal which presents information and analysis on business and economics in Africa with a special emphasis on Nigeria) website, Tunde Obadina, director of Africa Business Information Services, wrote thus:

Franz Fanon in his book 'The Wretched of the Earth' published in 1961 eloquently described the character of the class that inherited power from the colonialists. It is "a sort of little greedy caste, avid and voracious, with the mind of a huckster, only too glad to accept the dividends that the former colonial powers hands out. This get-rich-quick middle class shows itself incapable of great ideas or of inventiveness. It remembers what it has read in European textbooks and imperceptibly it becomes not even the replica of Europe, but its caricature." This class, said Fanon prophetically, is not capable of building industries "it is completely canalized into activities of the intermediary type. Its innermost vocation seems to be to keep in the running and to be part of the racket. The psychology of the national bourgeoisie is that of a businessman, not that of a captain of industry." The description remains accurate for today's elite who have grown through civilian politics, military governments, business and the civil service.

As long as African political rulers and administrators are drawn from this class of predators, no amount of preaching the virtues of good governance or tuition on public administration will fundamentally alter the quality of governance. This is not to say that constitutional reforms and increasing civil society infrastructure are not important. They are. But they are not the key to solving the problem of bad governance.

Good governance is the effective exercise of power and authority by government in a manner that serves to improve the quality of life of the populous. This includes using state power to create a society in which the full development of individuals and of their capacity to control their lives is possible. …Bad governance is not a mainly problem of ignorance or lack of infrastructural capacity or even of individual dictators. States in Africa are incapacitated as instruments of development because ruling classes, including people in and outside government, are motivated by objectives that have little to do with the common good. …Africa's tragedy is not that its nations are poor. That is a condition that is a product of history. The tragedy is that it lacks ruling classes that are committed to overcoming the state of poverty.

Poor and inadequate leadership/public institutions aggregated response in the face of the world’s worst heamorrhagic disease though the first in West Africa utterly failed the general populations, Ebola victims and survivors alike in Guinea, Liberia and Sierra Leone not just because of the poor response to the EVD but because of past failure to conceive and construct systematic plans for future needs. This must stop so that a future epidemic does not reap huge harvest of human lives, again. West Africa (and Africa writ large) must re-write their leadership experiences and outcomes narrative. Unskilled, unaccountable and unresponsive leadership must not be allowed to become entrenched, perpetuating itself as self-fulfilling prophecy! People cannot wait forever for transforming leadership. We must change the perennial conceptual theory of leadership experiences and outcomes whenever Africa is the object of appraisal as being a litany of broken dreams, frustrated social contract, and unfulfilled potential considering that despite several years of political independence, Africa’s aspiration and hopes remain today largely marooned and unfulfilled. The leadership question should now be rescued from remaining the recurring issue in the discourse on the African project.

Note:

Bushmeat is a large, but largely invisible, contributor to the economies of West African countries.  Although it rarely figures in national economic statistics or nutritional estimates, estimates of the national worth of the trade suggest that it is often amongst the most economically significant trade sectors in the countries involved. The importance of bush meat most likely has been over-looked and hence marginalized in national and international circles.

Acknowledgment

This analysis draws from several current and archived news reports. All sources are gratefully acknowledged.

References

• 1.    Clark, D. R. (2004). Concepts of leadership.  Retrieved from http://nwlink.com/~donclark/leader/leadcon.html
  2.    Kruse, K. (2013). What Is Leadership? Forbes Magazine. http://www.forbes.com/sites/kevinkruse/2013/04/09/what-is-leadership/
  3.    Adam Taylor What the world is doing to stop Ebola.The Washington Post. www.washingtonpost.com/blogs/worldviews/wp/2014/09/16/what-the-world-is-doing-to-stop-ebola/. Adam Taylor writes about foreign affairs.
  4.    Richard Preston The Ebola Wars - How genomics research can help contain the outbreak. The New Yorker October 27, 2014 Issue. http://www.newyorker.com/magazine/2014/10/27/ebola-wars
  5.    Dr. Cyril Broderick Ebola, AIDS Manufactured by Western Pharmaceuticals, US DoD? September  9, 2014. http://www.liberianobserver.com/security/ebola-aids-manufactured-western-pharmaceuticals-us-dod
  6.    The Economist Ebola in West Africa: Death and disbelievers August 2, 2014.  http://www.economist.com/news/middle-east-and-africa/21610250-many-sierra-leoneans-refuse-take-advice-medical-experts-ebola-death
  7.    Obadina, Tunde’s Africa’s Crisis of Governance visit: www.afbis.com/analysis/crisis.htm