John Galani

Liberian official speculates on how to fight ebola

An unfiltered, direct comment on how to control Ebola, from a person currently working in Sierra Leone

This comment was posted in the Financial Times this morning by John Galani. Source: steamguy


As a person working in Sierra Leone and directly impacted by it, I can say first hand the issues are both complex and varied.

First, the issue of leadership: the problem is that you are dealing with governments in West Africa that are months behind salary payments, not staffed with knowledgeable public servants in the Western sense of the way, but “bureaucratic employees” and a merry-go-round of politicians, who are untrained in the field of public services to say the least.

It does not mean there is no goodwill, just that the machinery of government is dysfunctional at the best of times; let alone in such a major crisis.  Imagine a horror movie where the actors were oblivious to the mounting threat and then belatedly the government driver is now desperately trying to start the car when the epidemic is surrounding the broken down vehicle… and you get the picture.  Giving money to such institutions, although required, will not achieve immediate results, and even less the required one, hence why so much current funding is indirect.

The second issue revolves around the wider implications of Ebola, akin to firefighters destroying a building by dosing it with water trying to put out the fire on the top floor: medical facilities where doctors and nurses are neither trained for, nor equipped to combat Ebola, and have even collapsed as some of them were infected.

The medical map is now of major hospitals with Ebola wards and minor ones closing.  The population at large does not wish to use hospitals with Ebola screening and treatment wards for obvious reasons; therefore multiple health problems go untreated.  Food in locked-down areas is hard to come by and certainly more expensive, and this in a subsidence economy which cannot afford such price rises.

Seasonal planting, schools, jobs related to all these sectors and the wider public sector whose meagre funding is now being shifted to Ebola fighting, all these conspire to a breakdown of central governance.  It is also rather unfortunate, but true, that the local population has lived through such times in the past, and can bear it better than we in Europe could, but still.

Now what does one do about all this?

The solution is actually quite simple, as it is in most major cases: you use a hammer:

The base case scenario is for Western armies to step in with the chemical and biological units. A form of martial law needs to be imposed with quarantine areas, and large scale assistance to the local population which will neither be able to feed itself nor continue normal life until this is over.  If we were to do this it would all be over in 3 to 4 months, with certain areas taking less time, and others going to the buffers, and potentially longer but only a regional basis.

Any other way, which would impeded less on the local democratic institutions and would take into account the human rights of the population, would take longer.  How much longer would be linked to the loss of efficiency versus the method described above.

It is for the local governments to decide their fate, but I would urge them to understand they are not equipped, nor could they ever be anywhere quick enough with whatever money could be thrown at them, to deal with the outbreak.  If they do not take such courageous decisions, the world will likely contain their countries rather than Ebola, as is happening now.  This should be linked to long term funding of their depleted reserves and infrastructure once this is over.

I remember conversing with a trauma surgeon who told me when they got an emergency case in their job was to save the live of the patient, nothing else, and if that meant scaring, amputating or any form of “butchering” in order to save a life, so be it…