I supported the Ebola emergency response
in West Africa at the peak of the crisis
after a few months on the ground I
realized he bola gets too much attention
Ebola tested the world's ability to
respond to a crisis and we failed we
failed on several fronts over 11,000
people have died over 16,000 children
are orphaned villages communities
families wiped out economies destroyed
of course we need new capabilities
better systems better tools we need to
do more be better and move faster but
there's something else we need we need
to think differently our current
approach focuses on Ebola the virus the
disease I call it the virus centric
approach we search for the virus in
people we've isolate the virus infected
person we try to treat the virus
affected patient and if we fail we look
to bury that virus ridden body the virus
centric approach gets us to important
answers it helps us understand what the
disease is how to deal with an infected
patient but it misses something the
virus doesn't spread Ebola people spread
Ebola and people are far more complex
than viruses people are part of families
they're part of communities they're part
of religious groups and ethnic groups
people want to take care of their sick
they want to embrace their dying people
spread Ebola so if we want to stop the
spread of this outbreak we need to move
from a virus centric approach to a
people centric approach why change your
strategy because despite our successes
we had numerous mistakes fumbles course
corrections and again and again it was
when we did not fully understand the
people aspect and every mistake is lost
lives
the problem of burials is a great
example of why we need a new strategy
the dead body is the most infectious
point in the lifecycle of an Ebola virus
in West Africa there are traditions
around washing and cleaning this body
and embracing the dead during a ritual
burial
so burials were becoming a major source
of infection we knew our response had no
chance of success unless burials became
safe when I was supporting the
operational planning in Liberia I
thought the burial strategy looked great
we had an excellent plan great
implementing partners radio
announcements social mobilizers even
early success all set or so we thought
several communities resisted you see
burials are based in deep held beliefs
that a traditional hands on ritual is
needed for the spirit to pass on
peacefully in many communities in West
Africa people save their entire lives to
afford an appropriate burial they
sometimes spend more on it than a
wedding so people continue to bury
bodies themselves or they would wash and
clean the bodies quickly before the
burial team showed up or in some cases
the resistance wasn't even that secret
the burial teams were attacked as soon
as they got near a village it's not that
people didn't understand one man after
he and seven others of his family got
infected from burying his father said of
course I know I might die but how can I
live if I don't bury my father properly
our strategy was based on scientific
logic people operate on emotion
traditions beliefs it became clear that
our safe and dignified burial strategy
was not going to be fully successful
unless people were willing to partner
with us and we were learning where we
took a people-centric approach we had
success where we had the trust of people
they let responders in they called
hotlines told us where there was a death
or someone was sick in the
where we were willing to listen people
gave us solutions they said you know if
there was someone from our own community
why don't one of our boys who was part
of this burial team that would make us
feel better and trust us more they said
if the body bags were white instead of
black
that would respect our customs more
where we observed people showed us the
way like in Harmon field in Liberia
which despite being surrounded by areas
of high infection remained Ebola free
this is because the community leaders of
Harmon field created their own people
centric approach they set up
hand-washing stations they created a
self monitoring program program for the
households and so the question for the
response then is how do we build on
these solutions how do we add to what
they've already developed partnership
with the community is not always easy in
the crowded slums of West Point in
Liberia cases were increasing rapidly
the response was not able to turn around
the long-held mistrust in government or
quell the rumors that Ebola was some
sort of foreign or government conspiracy
to kill them the quarantine center which
was a converted schoolhouse where cases
from all over was being brought in was
run over by an angry mob the military
was brought out in full force there were
curfews and barricades and barbed wire
the resistance only became stronger the
shouts of there is no Ebola just got
louder no medical solution was going to
be sufficient but community leaders
persisted
they brought survivors back in who could
share their stories the quarantine
Center which had become the flashpoint
in the riots after it was closed the UN
international NGOs and local NGOs
partnered with the community to
refurbish renovate it back into a
community school this persistence with
the community his willingness to listen
to them to win
Trust is the reason why West Point is a
bowl of free today
this people-centric oled model will have
its critics not because it doesn't make
sense but because none of our strategies
and our institutions are set up for this
so I've heard pushback one of them is
this all sounds great but we need to
move fast in a response yes but can we
actually move fast if we don't have the
support of the people in the affected
communities in Guinea where this crisis
actually started over a year and a half
ago cases continue to fester because of
community mistrust in Liberia which had
the most cases at some point they were
able to turn this around and become
Ebola free for a good period of time and
it's universally acknowledged amongst
those in the response that this is in
large part due to the efforts of the
community the other pushback I hear is
you are highly overestimating the
capacity of these poverty ridden
communities to come up with answers true
they may not have all the answers but
neither do we and when has that ever
stopped us this is a new way of thinking
not just for this Ebola crisis or the
next one but for any crisis because we
know the next time this could be much
worse the next virus could affect a much
more populated city in Africa in India
in China the next virus could be
airborne and spread faster so what does
a people-centric model look like the
next time we in the international
community and the National Response need
to think act and respond differently we
need to go into communities not just to
inform them but to listen to them to
hear their questions their concerns we
need to bring their community leaders
into our planning meetings understand
what solutions what resources they
already have in place and build on those
we have to reorganize our response
calls our processes our teams our
institutions community engagement is not
just some parallel work stream we need
to bring this people centric approach
into our core strategy one that is
jointly developed by epidemiologists and
anthropologists we have to invest not
just in drugs and diagnostics and
vaccines all of which are critical but
still only address the virus centric
part of the problem we need to invest in
understanding traditions and beliefs in
mapping local networks identifying
influencers figuring out community
structures that can be quickly activated
in the next crisis the next time we
cannot wait for a mistake we need to go
to the people and the communities first
to create solutions not just for them
but with them thank you