The End of Epidemics by Jonathan D. Quick

Author:Jonathan D. Quick
Language: eng
Format: epub
Tags: SCI000000, MED022000, MED078000, MED076000, MED028000, MED039000
Publisher: Scribe Publications
Published: 2018-03-07T16:00:00+00:00

Messengers, Messages, and Local Hands on Deck: Lessons from Sierra Leone

The Ebola outbreak reinforced the basic epidemic communication principle that top-down, government-issued disease prevention too readily glances off its target audience. Messages delivered from on high didn’t engender the community’s trust in this case; people overwhelmingly refused to adopt sound, official health advice. The good news is this: when government works together with local efforts, everything changes.37

An example comes from Sierra Leone, one of the poorest places in the world.38 The country suffered more than 14,000 Ebola cases—more than any other affected nation.39 “Ebola . . . attacked us with a ferocity that stunned the world,” 40 said President Ernest Bai Koroma. The country’s first Ebola case was reported in May 2014. Over the next several months, the disease spread throughout the country. Every week the number of new cases rose, despite early public-health efforts.

Finally, in October, in a brilliant move to achieve zero new Ebola cases while treating the sick, President Koroma established the National Ebola Response Centre (NERC) as the command and operations hub for the battle against Ebola. NERC officials created core teams, called “pillars,” at the national and district level. These teams were responsible for social mobilization, surveillance, case management, burials, logistics, psychosocial support, child protection, and food security.41

One of the people deeply involved in NERC’s social mobilization effort was Mohammad B. Jalloh, a public-health leader who had spent 37 years working with both the Sierra Leone government and UNICEF. Under his watch, national immunization coverage in Sierra Leone skyrocketed from 6 percent in 1986 to 80 percent in 1990, and he guided similar campaigns in 30 countries.42 A passionate, animated social scientist, Jalloh has led Focus 1000, his own local public-health nonprofit, from a modest office near the ministry of health in the capital Freetown since 2012.

When the Ebola crisis hit, Focus 1000 helped lead a social mobilization group called the Social Mobilization Action Consortium (SMAC) to engage Sierra Leoneans from every corner of the country in ending the crisis.43 At first, people flatly denied the reality of the frightening new disease. When a local driver chauffeured a viral emergency specialist through Freetown, the driver insisted, “There is no such thing as Ebola,” 44 even as people throughout his country clearly were in its throes. Barely a month after Sierra Leone’s first Ebola case, Focus 1000 conducted the first of four community surveys to understand the prevalence of denial and to assess changes in knowledge, beliefs, and practices. To gather the data, Jalloh put coordinators on bicycles and sent them to meet with households, village chiefs, and religious leaders to understand why people were continuing to engage in risky behaviors like hand-washing corpses and hiding the sick.45

Jalloh did his work quickly, and Focus 1000’s efficiency paid off with both rapid data collection and real-time learning. The information enabled SMAC to continuously create, test, and revise messages that resonated with local communities. The aim was to correct misinformation and to provide comprehensive knowledge. They learned that some messages—such as “Ebola is real”—were finally penetrating deeply.

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