Pandemics happen. They’ve killed major percentages of the human population in the past and might again. How might communities respond to such a pandemic? One indicator is the epidemic response of communities who have been under the shadow of such a killer disease.
This story is a report from Dr. Odell Wannie Kumeh, who in 2014 was the health officer of Maryland County, Liberia. (Maryland County…not like Liberia was founded by Americans trying to start a homeland for freed slaves, Right?) It’s a story of the epidemic response as she saw it unfold in her own county. Is Maryland County, Liberia just like your community? No … but people are people, and fear is fear.
Maryland County, Liberia
I got this story from a MOOC (free online course) from Harvard in which I’m currently enrolled. It’s called Lessons From Ebola: Preventing the Next Pandemic.
The situation
Liberia was being hit by the 2013-2015 Ebola epidemic that killed well over 10,000 people in West Africa. Maryland County was not a disease center. It wasn’t a center of much of anything in fact. It’s an isolated place, with very poor infrastructure. How poor? At the start of the epidemic, there wasn’t even any personal protection equipment available for the county hospital — not even gloves.
This, except the lack of gloves, is what a well-dressed Ebola caretaker wears. What Maryland County carers had was … the lack of gloves.
What they did have was scattered bits of news, and all of it was pretty darned scary. Everyone knew the disease had no cure. It was pretty well known that the disease was spread by personal contact with the sick. It was absolutely well known that many many people had died of it.
How can you have an epidemic response when you’ve nothing to respond with?
The health officials had one weapon: Information. They started a strong push, to teach the people how to protect themselves and keep Ebola out of the community. Some of what they taught was hygiene. Wash your hands with bleached water. Do not shake hands. (That last was a big ask; shaking hands is just what you Do whenever you meet a stranger or a friend in Liberia.)
They also pushed the message about how the people of Maryland County must not let sick people, even their family members, come into the community from places where the epidemic raged.
When the epidemic response is to decide that “Health is everyone’s business”
The people heard the message. Ebola is scary enough here, where we have plenty of information, good health care, and thousands of miles between us and anyone likely to be infected. It was terrifying to people in the midst of a society in turmoil; ‘isolation units’ that were essentially prisons for the sick, people dying by the thousands, international travel halted. Oh yes, they heard the message about not letting strangers in.
In some communities, if a stranger showed up the community members would demand the person stay in their residence until cleared of the possibility of illness. In one case they literally locked a man inside a home and would not let him out. Then they called the health officials.
The health officials would come and interview the strangers. Where had they come from? Why had they left there? Why had they come here? Did they know anyone who was sick where they’d come from?
If the answers did not satisfy, the strangers were held in detention for the 21 days it can take Ebola to manifest.
If a stranger had become sick, he would have been transferred to an isolation unit. There wasn’t much care there, but there was plenty of isolation.
How did this epidemic response end for the suspected?
Once a detainee cleared the 21 day interval and was still healthy, he was not simply set free. There was a ceremony, almost like a graduation. A leader of Maryland County would come; and so would a leader from the community the person would go to next. They would shake his hand and (presumably) congratulate him on being disease free.
Why the ceremony? Otherwise, the community the man was going to would not accept him. They too feared the disease. The people of Maryland County were trying to protect the healthy man from the suspicions of others … once they themselves were satisfied he posed no threat.
Takeaways to learn from the epidemic response of the Liberian communities
You take your own lessons of course, but a couple struck me:
1) When they in fear of a deadly disease, people will be ruthless to outsiders. The rights of the outsiders are as nothing.
2) Travel may be extremely problematic during an epidemic. The more populous the route, the more potential problems.
3) It’s no good pretending this story is just about some Other people in some Other place. American communities did very similar things during the Spanish Flu outbreak of 1917-1919, going so far as to prevent even the postal deliverymen from entering their communities. The Liberians were not evil people (as shown by their care to get those proven free to be accepted on down the road). They were afraid, and protecting themselves as best they know how. It’s what people do.
Reference
Jha, Ashish. 2015. Lessons from Ebola: Preventing the next pandemic. Harvard Global Health Institute course, as distributed by EdX.
There is a lot of truth to this. It’s always the known to the unknown in bad times. In good times it’s the opposite. We take our kids to unknown McDonald’s playgrounds, we go into work and deal with new people and we hop on transportation filled with who and what.
The good thing for us is that our people don’t dance with infected corpses as the Africans do nor rape everything above 5yrs of age as is common practice in some areas of Africa but the bad thing is our sexual freedoms are wide open as is physical contact such as hand shaking. Those little things lead to quick spread.
The most common method of spread of Ebola in this epidemic was *caregiving*. People who cared for sick relatives (or strangers; the toll was high among health care workers) and people who cared for the dead were most likely to catch the disease. The custom in the regions the speakers were from is to *bathe and dress* their dead for the funeral, not “dance with infected corpses”. We do the same; except we farm the job out to the workers in the funeral business. In an emergency, that route may well not be available.
I understand the tendency is to try to create mental separation between Those People who are having an epidemic and ourselves; but other than the lack of a decent health care system the disease-relevant behaviors of the Africans in the midst of the epidemic are not different from our own. Nor is it only the sexually free who are at risk. It’s not just Them that can have such problems; it’s us too.
There is a separation. It’s why they haven’t gotten a handle on it since the late 80s when we had to cancel my first mission outside of CONUS.
It’s probably been going on longer but that’s when I personally became aware of it.
I’m agreeing with you but I’m pointing out downfalls of both them and us that have led specifically to the spread that many want to avoid because it’s an uncomfortable topic.
The washing of the body will have to be forgone and burial or incineration will still need to be conducted. Many cultures used to do it successfully before our modern laws.