Critical Reflections and Timeline Analysis of West African
Leadership Response during the Ebola Outbreak in Guinea, Liberia, and Sierra
Leone
By Kenneth
Nwabudike Okafor
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.
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| 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 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.
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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)
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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.html2. 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-wars5. 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-dod6. 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-death7. Obadina, Tunde’s Africa’s Crisis of Governance visit: www.afbis.com/analysis/crisis.htm
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