Liberia

Ebola: No one is coming to save us

Reposted from Marc Maxmeister on ChewyChunks

Katie Meyler has been telling stories of how the people of West Point slum in Monrovia, Liberia overcame Ebola:

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This little girl and her brother and sister lost their parents. The auntie is asking me to help her by taking the kids. I asked her, “If someone helped you support and empower her, would you could feel happy raising your sister’s children?”

“Of course!” She said.

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Rebecca tells me she has symptoms and is scared. I took my gloves off and let my hair down because I was leaving for the day. I wasn’t scared, because she looked strong. We are bringing her meds and will keep a close eye on her. Obviously this is agonizing but we are doing all we can. Please pray for Rebecca with me.

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I talked to local medical staff about serving West Point. Everyone I met was really lovely. There were 20 or 30 body bags with deceased people inside. I was scared but also at peace. This place has things under control.

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Community leaders made the rounds in West Point and found 45 sick people in the areas they were able to check. Unfortunately, all of the clinics are at capacity and not able to receive people.

These are stories of people trying to be resilient in the absence of any real government help. These slum dwellers had only two options if they wanted to survive: wait for the Powers to come save them, or become self-reliant. Resilience won, because they were used to being ignored. And while the medicine, supplies, and training were delivered by non-governmental groups like MoreThanMe, the people running the ambulances, screening citizens, and handing out the food were community members. The community saved itself. It illustrates a larger truism that we keep denying: Only the Poor can end poverty. Allow me to explain why.

First, a little more of my backstory. My job for the past few years was figuring out how to give Voice to the Poor. I ran an East African storytelling project with GlobalGiving from 2010 to 2013. It showed that the Poor clearly were the “experts” on what they needed, and knew how their governments could solve big problems. But my straightforward approach – collect their first-hand testimony and present it to those in power – wasn’t enough. Why? Because governments and international agencies are not built for listening. They have no effective mechanisms to redress complaints. They don’t give local leaders and local solutions a fair hearing.

Most people are eager to speak up at first, but experience teaches them that Power doesn’t care about the Poor. If they complain about a program, the donors too-often go elsewhere and start over, leaving those people with nothing. Spurned and punished for their participation, they don’t speak out.

It is not just organizations. Governments and business have also taught the Poor to merely accept what is offered. Business offers the Poor jobs that sacrifice wages or safety through the unregulated markets of Globalization. Governments are “representative democracies” at best, not direct democracies. Few representatives really listen to the Poor. Power listens to Power. The Poor survive on what they get, and only take to the streets and assert their rights when hardship becomes unbearable.

But sometimes a community does come together and builds something. Ebola’s demise in 2015 is the story of local leaders rising out of the chaos and helping neighbors choose resilience over fatalistic resignation, as I profile in my book.

Their stories are often untold, because telling their story to outsiders doesn’t help them along the path of self-reliance or survival. A reporter swooping in to get the story gives the storyteller fresh hope that someone will save him. There are millions of international do-gooders in the world spending their lives in an effort to help the Poor. We live among the Poor. We listen to them. We share their stories with a broader audience. Sometime we raise awareness about an issue. Occasionally we inspire the Poor. But mostly we offer a twisted hope that keeps them off the path of self-reliance. We cannot end poverty for the Poor, only enable to Poor to lift themselves up.

In a famous letter from a law professor to his student, Bill Quigley writes:

“Many come to law school because they want to help the elderly, children, people with disabilities, victims of genocide, victims of racism, economic injustice, or religious persecution. Unfortunately, the experience of law school and the legal profession often dilute that commitment.”

It is a harsh lesson I keep learning over and over. Regardless of my tactic, Peace Corps, science, banking, or medicine, the end result only moves the Poor a few feet from where they once stood. No mix of skills or tools or toys may ever work if I am the one holding the chalk, the shovel, or the smart phone.

Singing “No one is coming to save us!”

Katie Meyler once said that things started getting better when the people of West Point slum starting singing “No one is coming to save us!” It was a turning point. They understood that local leaders were their best hope for survival. The people were finally taking charge of their own future. The narrative changed from being about the failure of outsiders to the success of the community. And when West Point slum’s death toll fell far short of projections in the months that followed, locals could look at each other and say with pride, “We did this ourselves!

This isn’t about outsiders abandoning the Poor, but about truly Serving the Poor.

But in our world, when stories like these are told by outsiders, the people who supply the materials take the credit. The bags of rice are stamped ‘US AID from the American People’.

CENTRAFRICA-UNREST-US-AIDThe medicines and the trucks and the soldiers all have branding. But the people remain anonymous because they are the community being helped. It is a false narrative to separate the helpers from the helped. Serving the Poor means being in the community, without identity.

Instead, the locals are given supporting roles, first in the narrative, and later in the power restructuring following success (during the elusive “project replication” phase that funders seek). The meeting rooms usually look like this (a bunch of acronyms working together):

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Newsmakers and storytellers and politicians must unlearn bad habits. Every success story is, at its core, about people helping themselves. We outsiders are mere bystanders. But with hard work we can become true servants.

Take another example, this time from the 1960s US Civil Rights movement. One witness tells the story of the political parade that was the funeral for Rev. James Reeb, who was brutally murdered in Selma in 1965:

From the balcony I saw a sea of dignitaries clearly unrelated to the events in Selma. Many faiths had come to pay tribute in this memorial to James Reeb. Until Dr. Martin Luther King himself spoke, it is hard to imagine a more jumbled collection of prepared prayers and speeches rattled off in a patronizing way. It was ecclesiasticism at its worst. James Reeb’s death was described as the most monstrous example of brutality, when in fact it was one more instance in a long series. Men who had not taken the time to meet any young people praised them for their courage. The men and women who had come “thousands of miles” for the memorial were extolled. I thought that it was not too difficult to come and go in 24 hours and have the vicarious experience of heroism through singing a few freedom songs.

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When King began to speak, however, it suddenly seemed right that we should all be there. Everyone moved a bit in his or her seat when King asked rhetorically,

“Who killed Jim Reeb?”

He answered: A few ignorant men. He then asked,

“What killed Jim Reeb?”

and answered: An irrelevant church, an indifferent clergy, an irresponsible political system, a corrupt law enforcement hierarchy, a timid federal government, and an uncommitted Negro population. He exhorted us to storm the bastions of segregation and see to it that the work Jim Reeb had started be continued so that the white South might come to terms with its conscience.

This account captures the movement as well as a pan-out to illustrate the circus around the movement. Power lives a circus life. I too had that experience and blogged about it.

So if local efforts do succeed, outsiders swoop in and take all the credit, and the Poor are pushed out of the limelight. Outsiders get promotions and the Poor find themselves only a few feet from where they began. Though nothing is won entirely without cooperation – and everything is at least partly enabled by those in Power – the distortion of who deserves credit is so large in the International Aid world that we’ve forgotten why it ever works at all. Everything starts because a community buys-in, and ultimately survives because a community takes ownership. We are just drifters and gamblers in their story.

Only the Poor can end poverty. But the rest of us can make that journey lighter. 

One way is by emulating organizations like MoreThenMe.

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It was no accident we find them in the slum at the center of a strong network of relationships. Katie spent 9 years there working for the community as a humble servant. Then in December of 2014, Time Magazine anointed her “Person of the year.” Now she’s brunching with billionaires instead of begging for books. But it is the same Katie, doing the same work. Serving Pearlina and Rebecca and other girls who deserve to go to school. She is part of the community. She was amazing and unknown before; now she amazes a bigger audience with grace:

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They did not invent the process of community-building. It has been known for thousands of years. It is explained in Sun Tzu’s The Art of War:

“Come among the people.

Live among them.

Work with that they have.

Build on what they know.

And when the work is finished, they will say,

‘we have done this ourselves!'”

There has never been a better credo for fighting poverty, nor a better description of resilience. There are many technical ways to stop Ebola, but underneath every successful strategy is an appetite to empower resilient communities in precisely the way that Katie has. She didn’t know much about Ebola, but she knew a whole lot about inspiring people and organizing groups.

This is the most important lesson in my Ebola book for how we deal with the next crisis. Local leaders exist in every community, but too often our international systems co-opt their power and authority, replacing them in a state of emergency instead of empowering them. The sooner we can get a community singing, “No one is coming to save us,” the sooner that community can come together to save itself. Only then – and only through pre-existing local relationships – can international help be effective. No one from the Red Cross, WHO, CDC, and US army can live Sun Tzu’s credo in every town that might face a disaster in the future, and so these institutions need thousands of local allies. Only local voices can sing the melody in the resilience song.

A pro-Poor environment

If we want to hear the Poor speaking up, we must give them space to lead. We can create mechanisms to connect local voices with better performance in foundations and government (Keystone Accountability’s mission). We can reign in our proxy-democracy and make it more direct through functional citizen feedback loops (FeedbackLabs’s mission). We can listen to the Poor and let them speak in their own words (GlobalGiving’s Storytelling Project). These are all steps on the path to prosperity, but they are not the whole path.

I offer a deeper dive into these issues in my book, Ebola: Local Voices, hard facts on Amazon.

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Time person of the year: Racing to end ebola

NEW JERSEY – Katie Meyler, Founder of More Than Me, joins the Ebola Fighters named  TIME’s Persons of the Year with her work highlighted in the Ebola Caregivers list. Meyler and the Ebola Fighters group join a list that in the past has recognized Winston Churchill, Ghandi, Pope Francis, and President Obama.

“The past few months have been filled with some of the most intense moments of my life, but they’ve also been some of the proudest. I’m honored to be listed next to these truly inspiring people and want to take this time to recognize everyone, on this list or not, who has helped fight Ebola on the front lines,” Meyler said.

This recognition comes out of great tragedy, but is a reminder of the need to continue the fight against Ebola until there are no new cases – and to move forward and rebuild as the epidemic ends. The mission of More Than Me has always been to expand educational opportunities for the most vulnerable girls from the West Point slum in Monrovia; but unable to stand by while their students were at risk, the organization shifted to rapid Ebola response programs in August. As Meyler puts it, “We don’t have an organization if we don’t have students who are alive.”

The tremendous efforts of Iris Martor, More Than Me’s school nurse turned Ebola Fighter, are also mentioned. While working in the community leading trainings to keep staff safe and coaching nurses, Martor’s 8-month-old girl became ill and she feared it was Ebola. When her daughter tested negative and recovered, Martor momentarily questioned the risk she was taking, but ultimately thought, “If someone from America comes to help my people, and someone from Uganda, then why can’t I? This is my country. I should take the first step.”

More Than Me is committed to caring for Monrovia communities that have been deeply affected by this outbreak. More Than Me’s team hopes to reopen their school and resume regular programming in early 2015, but is also committed to long-term support of survivors and the families of those affected by Ebola in their students’ communities. Next year, Meyler hopes to open a boarding school to offer a greater number of children an education including many Ebola orphans. Donations to support More Than Me’s work are matched until December 25th. Learn more here.

The TIME editors’ selection is based on “who best represents the news of the year,” spotlighting leaders who showcase “both a snapshot of where the world is and a picture of where it’s going.”

You can follow Katie’s daily experience at racingheartblog.tumblr.com and donate to MoreThanMe at GlobalGiving.

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Science Magazine: How many Ebola cases are there really?

Every couple of days, the World Health Organization (WHO) issues a “situation update” on the Ebola epidemic, with new numbers of cases and deaths for each of the affected countries. These numbers―9216 and 4555 respectively, according to Friday’s update―are instantly reported and tweeted around the world. They’re also quickly translated into ever-more frightening graphics by people who follow the epidemic closely, such as virologist Ian Mackay of the University of Queenslandin Brisbane, Australia, and Maia Majumder, a Ph.D. student at the Massachusetts Institute of Technology in Cambridge who visualizes the data on her website and publishes projections on HealthMap, an online information system for outbreaks.

But it’s widely known that the real situation is much worse than the numbers show because many cases don’t make it into the official statistics. Underreporting occurs in every disease outbreak anywhere, but keeping track of Ebola in Guinea, Liberia, and Sierra Leone has been particularly difficult. And the epidemic unfolds, underreporting appears to be getting worse. (“It’s a mess,” Mackay says.)

So what do the WHO numbers really mean—and how can researchers estimate the actual number of victims? Here are answers to some key questions.

Does WHO acknowledge that the numbers are too low?

Absolutely. In August, it said that the reported numbers “vastly underestimate” the epidemic’s magnitude. WHO’s situation updates frequently point out gaps in the data. The 8 October update, for instance, noted that there had been a fall in cases in Liberia the previous 3 weeks, but this was “unlikely to be genuine,” the report said. “Rather, it reflects a deterioration in the ability of overwhelmed responders to record accurate epidemiological data. It is clear from field reports and first responders that [Ebola] cases are being under-reported from several key locations, and laboratory data that have not yet been integrated into official estimates indicate an increase in the number of new cases in Liberia.”

Where do the reported numbers come from, and why are they always too low?

Officially, the governments of Guinea, Sierra Leone, and Liberia transmit the numbers to WHO, which then passes them on to the world. But WHO is also closely involved in helping determine the numbers. The data come from several sources, says WHO epidemiologist Christopher Dye; the three main ones are clinics and treatment centers, laboratories doing Ebola tests, and burial teams.

Getting the numbers right is hard for many reasons. Many patients don’t seek medical care, for instance, because they don’t trust the medical system or because they live too far away. Of those who do, some die along the way, and some are turned away because treatment centers are overloaded. Of Ebola people who die at home, some are buried without ever coming to officials’ attention. It can also take time for recorded information to be passed on and entered into data reporting systems.

Testing is a big problem as well. The reports break down the numbers into suspected cases, based mostly on symptoms; probable cases, in which someone had symptoms and a link to a known Ebola case; and confirmed cases, in which a patient sample tested positive in the lab. In an ideal world, all suspected and probable cases would eventually be tested, but testing capacity is lacking. In WHO’s 15 October report, only 56% of the cases in the three countries was confirmed; in Liberia, where testing is huge problem, it was just 22%. (Friday’s report did not break down Liberia’s cases and said the data were “temporarily unavailable.”)

Dye says WHO and other groups are trying hard to improve the reporting on the ground. Among other things, they are trying to set up a system that would provide every patient with a unique identification number. Now, Dye says, patients who enter an Ebola clinic and then have a sample tested in the lab may enter the reports twice, because there is no way to know that the lab and the clinic were recording the same patient.

Are there ways to estimate the extent of the underreporting?

There are. For instance, In a technique called capture-recapture, epidemiologists visit one area or district and determine what percentage of the Ebola cases and deaths there has found its way into official records. “You throw out the net twice, and you compare,” says Martin Meltzer of the Centers for Disease Control and Prevention (CDC) in Atlanta, who is modeling the Ebola epidemic. (The term capture-recapture was borrowed from researchers who study the size of wildlife populations using two rounds of trapping.) But this method is logistically challenging and possibly dangerous, given the hostilities that some Ebola response teams have met, Meltzer says: “I’m not going to ask people to risk their lives to collect some data.”

For a paper published last month, Meltzer and his colleagues used a different technique. CDC has a computer model that, among other things, calculates how many hospital beds should be in use at any given time based on the cumulative number of cases at that moment. For 28 August, the time the paper was written, that number was 143 beds for Liberia; but people in the field told Meltzer that the actual number of beds in use was 320, a factor of 2.24 higher. (These numbers can be found in an annex to the paper.) “We had heard some other numbers that were higher, so we rounded that up to a correction factor of 2.5,” Meltzer says. But it’s a very rough approximation. Also, underreporting is likely to vary greatly from one place to another and over time, he says.

The CDC team’s widely reported worst case projection of 1.4 million cases by 20 Januarywas based on the correction factor of 2.5, and assuming control efforts didn’t improve. It included only Liberia and Sierra Leone; in Guinea, the reported numbers of cases have fluctuated too much to make a reasonable projection, Meltzer says, which could also could be partly due to underreporting.

What does WHO think is a reasonable correction factor?

WHO hasn’t published an estimate. “It’s a point that has been greatly discussed but there is a tremendous amount of uncertainty,” Dye says. For its internal planning purposes, however, WHO uses a correction factor of 2.0. When WHO’s Bruce Aylward said at a press conference last week that the agency is expecting to see between 5000 and 10,000 cases per week by early December, “the difference between the 5000 and the 10,000 is that factor of two,” Dye says. A correction factor of 2.0 would mean that the total number of cases has now crossed 18,000 and the number of deaths 9000.

If the numbers are that far off, should they be published at all?

Even if many cases are missed, the trends in the numbers are still very meaningful. They clearly show that the number of cases has roughly doubled every 3 to 4 weeks and that this trend is continuing. If underreporting  gets worse, however, it may be even more difficult to discern such trends.

Is there any good news in the recent numbers?

There is. The number of new cases in some areas at the epicenter of the outbreak—Kenema and Kailahun districts in Sierra Leone and Liberia’s Lofa County—has been dropping, and that’s not a result of underreporting, Dye says. “It has happened for a sufficiently large number of weeks now that we are confident that it’s a real reduction in incidence on the ground, probably related to control measures,” he says. “Our colleagues working on the ground believe it is, too.”

One important factor has been the increase in safe burials, Dye says. (The bodies of Ebola victims are very infectious.) People in the affected areas have resisted abandoning traditional burial practices that carry a high risk of infection, but in these three areas, local leaders, supported by WHO and others, have come to advocate a change. If that happens elsewhere, Dye says, “we expect to be able to cut out a substantial amount of infection in the community.”

*The Ebola Files: Given the current Ebola outbreak, unprecedented in terms of number of people killed and rapid geographic spread, Science and Science Translational Medicinehave made a collection of research and news articles on the viral disease freely available to researchers and the general public.

Delaware Liberians rally to send food, supplies overseas

by Jen Rini, The News Journal 9:16 p.m. EDT October 23, 2014

Source: Local Liberians rally to send food, supplies overseas

Sei Boayue’s uncle was just trying to do the right thing.

His uncle had seen how Ebola had seeped into his beloved Ganta, a town nestled on the border of Liberia and Guinea.

The market there was teeming with people forced to purchase food every day because of a lack of refrigeration. But in the market, there is no way to tell who is infected.

So his uncle made the decision to travel there every day alone, and keep his wife, son, daughter-in-law and grandchild at home away from the risk.

It didn’t work.

“They all passed from the virus. No one survived it. The unfortunate thing is this is now becoming a commonplace thing,” Boayue, 57, of Townsend, said. “After my uncle died, you sit here and everything seems to be so daunting. You wonder: is there anything I can do?”

Boayue didn’t sit for long. Just weeks after the deaths of his relatives, Boayue and other Liberians living in Delaware are fueling an effort to send as much food and supplies as they can to their remaining family and friends trying to survive in Liberia.

To date, 4,555 people in West Africa have died from the virus, 2,705 in Liberia. And those numbers continue to grow.

Boayue is working with the Delaware Community Foundation to start a charity dedicated to sending nonperishable foods abroad, a luxury for those living in the heart of the Ebola crisis.

He still has nine siblings who are living in the affected areas. He hasn’t heard from one sister in over a month. There’s no communication to say where she is, or even if she is alive, he said.

In Liberia, the tragedy is there is no such thing as “local” food. Traditionally, most of the food ending up on Liberians’ plates has been imported, he said. After a string of civil wars over 14 years, and now the Ebola disaster, food prices have doubled and tripled.

Even if he raises enough money to buy food, copious amounts of red tape stands between his group and getting those goods on the ground to the people that need it most.

“How many kids will die within that time period,” he said.

“The situation in Liberia is such that cultural attitudes also had a big part to play in the out-of-control nature of this crisis. What would help most people is food security.”

Jarso Jallah Saygbe, a Liberian living and working in Dover, agreed that sanitizer and Clorox are not enough.

“The approach needs to be holistic,” Jarso said. Her family living in Liberia takes each day at a time. Jarso talks to her sister almost every day and tries to send as much money and supplies as she can.

“You never know when the phone rings what’s going to happen,” she said.

Jarso’s brother-in-law, Moses Ndama, pastor of the Freedom Christian Fellowship in Dover, held an informal meeting Wednesday evening to jump start planning for an organized donation effort for children in need abroad.

Food, clothes, rain boots and school supplies are all needed, said her husband, Moses Saygbe, who is Ndama’s brother. The church is hosting a meeting Saturday at 10 a.m. to gather Delawareans from all walks of life, from West Africa to Seaford, to mobilize against the Ebola crisis.

As the planning takes off to send aid abroad, Moses said it is important for the local Liberian community to work with the state to preemptively prepare for an Ebola case in Delaware.

He’d like to see the state institute special residential centers in Delaware used to screen and house West Africans traveling into the state from the affected areas. Efforts like this would erase the stigma that every Liberian is living with Ebola, he said.

“We need to end prejudice. We are not the virus,” Ndama added.

For now, the Freedom Christian Fellowship is working to send goods directly to a sister organization in the Brewerville community in Liberia.

Last weekend, the community received Clorox, hand sanitizers and soap, Ndama said. It still took a month for the goods to get there, but it’s better than nothing.

They hear stories every day that are heartbreaking, but the kids are the hardest hit, Ndama said. Schools have been closed since late July. Children, many orphaned, are forced to beg on the streets and scrounge for money.

The future of Liberia rests with nurturing these children, he said.

“If we don’t invest in the kids, we will lose the future generation,” Ndama said.

“We can defeat Ebola, but can we survive after?”

Jen Rini can be reached at 302-324-2386 or jrini@delawareonline.com. Follow @JenRini.

CHURCH OUTREACH

What: A statewide meeting hosted by the Freedom Christian Fellowship to discuss donations, plans for more community outreach.

Where: Freedom Christian Fellowship, Dover, 4164 North DuPont Hwy. (North Dover Shopping Center)

When: Saturday, 10 a.m.

The stories still hard to find: The local responses to Ebola

Reposted from How-Matters.com

This morning when I googled “local response” + “ebola”, here’s some of the headlines I found:

Nurse’s visit spurs Ohio Ebola fears 

Florida: County and hospitals prepare for Ebola

As KU Hospital tests patient with Ebola-like symptoms, Lawrence agencies coordinate response

Denton City Council to be briefed on virus response

Ohio residents fear Ebola precautions could prompt panic (What’s up Ohio?)

Patrick Poopel holds his certificate that informs the world he is Ebola free in Monrovia in September. Photo: Morgana Wingard / MSF

Not exactly what I was looking for. With all this drummed-up fear and stereotypes and prejudice flying around, I guess it’s easy for Americans to miss that Nigeria has been declared ebola-free, as was Senegal on Friday. And it’s easy to miss stories of people fighting the disease, like survivor Alhassan Kemokai in Sierra Leone who caught it while caring for his ailing mother, independentambulance workers in Monrovia, or 6-year-old Patrick Poopel (pictured) whose smile who the only thing left that is infectious. Nursing student Fatu Kekula saved her father, mother and sister by inventing her own protective gear from trash bags. Apparently international aid workers heard are now teaching her ”trash bag method” and to others who can’t get into hospitals.

This is more of what I was looking for, but these stories are unfortunately often hard to find. So I thought I’d share a few others on the local response to Ebola that I’ve been collecting since the outbreak hit the international media – please share any others in the comments:

  1. The Hidden Heroes Of Liberia’s Ebola Crisis, by Jina Moore
  2. Ebola must be fought from the grassroots, by David Norman and Saran Kaba Jones
  3. The Rain after the Drought: Ebola, International Assistance and Community Initiatives in Liberia, by Charles Lawrence
  4. The West ignores the stories of Africans in the middle of the Ebola outbreak, by Ishmael Beah
  5. Liberian Ebola Survivors Return to Help the Sick, by Heidi Vogt
  6. Ebola: the story of the Sierra Leone diaspora response that no one is telling, by Katherine Purvis

Is Ebola in West Africa a “crisis of governance” or “the ugly face of a global aid system that is broken“? These questions are an abstraction to those who are facing sickness and suffering this very day.

Malonga Miatudila, MD, who was part of the first team that dealt with Ebola first in 1976, describes how they contained the disease without the knowledge we have today: “Engage with communities. Give them the leadership of the fight…International experts are there to support local communities, and not to substitute.”

If you want to give to local efforts, see GlobalGiving and the Ebola Survival Fund. Unfortunately this Indiegogo campaign by 5 grassroots organizations in Sierra Leone didn’t meet their goal, but you can still be in contact with them directly via email. Diaspora, share how you’re responding to ebola here.

When I was a boy and I would see scary things in the news, my mother would say to me, “Look for the helpers. You will always find people who are helping.” ~Fred Rogers

Look for the helpers. Reach out. Invest in those that are there for their communities, whether funding is available or not.

Seattle Nurse Trains Health Workers In Liberia

  &  on KUOW’s blog

Story audio (MP3) 

A mural in Liberia warns of Ebola.
Credit Courtesy Karin Huster

There is no shaking of hands in Liberia.

Instead, people elbow their hellos.

“I have never washed my hands so much as I did in Liberia,” said Karin Huster, a former intensive care unit nurse at Harborview. Huster recently returned from five weeks in Liberia, where she trained health workers on Ebola.

The Ebola outbreak was immediately obvious in Monrovia, she said.

When her plane touched down, an announcement came over the intercom:

“Welcome to Liberia. This is the last Delta flight into Monrovia. God bless you all.”

An Ebola task force vehicle in Liberia.
Credit Courtesy Karin Huster

Land Cruisers fashioned as ambulances would wail through the streets.

“You see the driver in all the equipment, with their goggles and their mask, and you know they are either on their way to get somebody or carrying someone to the treatment unit,” she said.

Freshly painted murals warned of Ebola symptoms. Markets, too, looked like a Petri dish of potential infection.

“You can be walking in Monrovia in a market, and people are sweating,” she said. “All of a sudden, I realized that going to a market might not even be a smart thing to do.”

Huster didn’t come in contact with anyone with Ebola – that she knows of.

A market in Liberia. Karin Huster, a former Harborview nurse, said she realized walking through the market might not be a smart idea in this country ravaged by a recent Ebola outbreak.
Credit Courtesy Karin Huster

The closest she came to a possibly infected person was at a rural clinic where she worked, 300 miles outside Monrovia. There, a man was admitted for Ebola-like symptoms.

She never learned whether the man had Ebola, as he died the next day. A blood sample was sent back to Monrovia by a county health team’s car, but it never made it to a lab. (They tried to give the sample to Huster’s team, but they all refused.) The car ended up stuck on the roads – “red, sticky mud pits,” she called them – for three days.

Karin Huster outside a car on one of the roads she described as red, sticky mud pits. It took her three days to travel 300 miles.
Credit Courtesy Karin Huster
Karin Huster’s room during her five-week stay in Liberia. Huster returns on Nov. 10.
Credit Courtesy Karin Huster

Upon return to Seattle, Huster, a mother of two teenagers, was heartened by the media frenzy that had exploded in her wake.

“This is a huge humanitarian catastrophe. The media frenzy means more attention toward fighting the epidemic,” she said.

She said that if the U.S. wants to protect itself from Ebola, it needs to send health workers.

Ebola isolation rooms in Liberia.
Credit Courtesy Karin Huster

“You cannot just fight this crisis and try to block your border,” Huster said. “People are so mobile nowadays. It’s going to be impossible to pretend it’s not happening.”

There are about 50 doctors in Liberia total, she said – that’s about one doctor to every 100,000 people. The Liberian health workers are overworked, underpaid and exhausted.

A clinic in southeast Liberia.
Credit Courtesy Karin Huster

Huster returns to Liberia around Nov. 10. Before she heads there, she’ll train with an NGO and in an Ebola simulation lab at the Centers for Disease Control and Prevention.

She calls these trips to Africa an extension of Harborview’s mission – to treat the underserved.

“These countries need health care workers,” Huster said. “We are the ones who can make a difference.”

Look back on how leaders reacted to ebola in Liberia

Grassroots organizations fighting ebola in Liberia

 

Fighting Ebola from the grassroots | By David Norman and Saran Kaba Jones of FACE Africa | Oct 9 2014

Image: A health worker checks the temperature of a man at a roadside health checkpoint outside Ganta October 7, 2014. REUTERS/Daniel Flynn

As a global community, our ability to respond to the Ebola crisis gripping West Africa and to future crises will depend on how much we effectively learn from past interventions, and how best we adapt our practices to improve on coordination, mobilization, impact and long-term outcomes.

When responding to crises and disasters of this magnitude, we can benefit tremendously from local, grassroots organizations and their ability to operate in complex environments, to aid in more timely assessments, and to quickly disseminate information and critical services in the wake of a global crisis. Due to the very nature of their proximity to a potential disaster, community-based organizations become the de facto first responders, witnessing the situation as it begins to emerge. Their knowledge on the ground can play a critical role in assessing the severity of the problem and more accurately projecting its impact.

The first cases of Ebola in West Africa were reported back in September of 2013 and went through a lull before finally resurfacing in early 2014. We can ask ourselves what if, during that period, we had made use of on-the-ground reports by local organizations? Could we have come to learn earlier what we now know about the disease? Would epidemiologists have been able to better predict the capacity of health systems in the region to cope with this new Ebola virus? Could local groups have been able to warn others that the lack of local containment of the disease could pose a serious threat to attempts at intervention?

Unfortunately, as has happened far too often in the past, by the time the world acknowledged the potential consequences of the current epidemic, it was already too late to avoid a completely overwhelmed and unprepared response lagging far behind the spread of the disease.

However, even at the current phase (with a recent CDC estimate suggesting that the virus could infect anywhere from 500,000 to 1.4 million people across the region over the coming months), identifying and empowering local groups as the foundation of intervention could have a significant impact on efforts to contain the spread of the Ebola virus.

Organisations with strong local ties have long understood the importance of engaging with communities in a meaningful, equitable way. Liberians teaching Liberians. Guineans treating Guineans. Sierra Leoneans empowering Sierra Leoneans. In the case of our organisation, FACE Africa, our track record of community engagement in Rivercess County, Liberia allowed us to launch an Ebola awareness campaign far more quickly than a major international player would have been able to. The effectiveness of our campaign was enhanced by the local ties and level of deep-rooted trust we already had within communities. An international team parachuted in would likely not have received the same level of receptiveness from local communities (indeed, there have been numerous cases where health workers and response teams have been met with outright hostility).

Engagement is the pathway to empowerment and when communities are empowered to take control of a situation for themselves, you see meaningful change. They may not have all the expertise, but they have the ability to learn, take charge and even put in place their own solutions. Ian Smillie in the book Patronage or Partnership states that, “supporting the work and strengthening the capacity of local organizations can not only be instrumental in dealing with the situation at hand, but also increase resilience to future humanitarian emergencies. Sending in international emergency teams can help, but is not enough. It is important for the international response to move from a culture of patronage to a culture of partnership.”

We only have to look at the catastrophic 7.0 magnitude earthquake that devastated Haiti in 2010 to understand the importance of local response and long-term planning. As the world’s attention was focused on Haiti after the earthquake, billions of dollars of emergency relief flooded into the country from international donors, supplies were mobilized and doctors and nurses were parachuted in to perform lifesaving medical procedures and care. UN soldiers were deployed to coordinate efforts and governments pledged billions to reconstruct the country so that it was “stronger and more prosperous than ever before”. Four years on, and Haiti is still reeling with nearly a million homeless, the worst cholera outbreak in recent history and an insecure future.

We cannot allow the mistakes in Haiti to happen in Liberia, Sierra Leone and Guinea. As the world rushes in to help eradicate Ebola in West Africa, now is the time to start thinking beyond the current crisis. Now is the time to focus on ways to sustain our efforts and build infrastructure that will last long after the current crisis has subsided. Because in strengthening the infrastructure and capacity of these countries well into the future, we are not only limiting a potential recurrence, but we are tackling the myriad of other health problems from malaria, to diarrhea, to cholera and typhoid that continue to kill far more people every day.

But any efforts at sustainable development cannot be achieved in the absence of local organisations and community groups. These groups must be at the forefront and lead any long-term development efforts. They must be recognized and supported because they represent the long-term health and strength of African communities; they have been on the ground, are currently on the ground and will still be there when everyone else has left.

Authors: Saran Kaba Jones is the Founder & CEO of FACE Africa and a World Economic Forum Young Global Leader. David Norman is the Business Development Officer at FACE Africa.

How Liberian children orphaned by ebola are stigmatized

Liberia children orphaned, ostracized by Ebola | BY KRISTA LARSON | OCT. 9, 2014

First 16-year-old Promise Cooper’s mother complained of a hurting head and raging fever, and she died days later on the way to the hospital.

The following month, her father developed the same headache and fever. Her baby brother grew listless and sick too, and refused to take a bottle.

That’s when Promise knew this was not malaria.

She had heard about Ebola on the radio. When she tended to her father, she washed her hands immediately afterward. Desperate to keep her three younger siblings safe, she urged them to play outside their one-room home. Yet she was powerless before an invisible enemy, as her family of seven disintegrated around her.

In the meantime, neighbors and relatives were starting to become suspicious. No one came by to check on the kids, not even their grandparents.

Word, like the virus, was spreading through Liberia’s capital:The Coopers had Ebola.

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In Liberia’s large, deeply religious families, there is usually an aunty somewhere willing to take in a child who has lost a parent. But Ebola, and the fear of contagion and death, is now unraveling bonds that have lasted for generations.

At least 3,700 children across Liberia, Guinea and Sierra Leone have lost one or more parents to Ebola, according to the U.N. children’s agency, and that figure is expected to double by mid-October. Many of these children are left to fend for themselves, and continue to live inside infected houses.

Promise was used to looking after her younger siblings, and often carried a baby cousin on her hip around the neighborhood. When her mother was alive, they would alternate weeks of cooking. She knew how to make porridge for breakfast, rice with potato greens for dinner.

When her father fell sick, she took over all the things her mother used to do. There was no school because of the Ebola epidemic, so she had time to wash her brothers’ soccer jerseys and jeans.

But nothing she did could help 5-month-old Success, whose name reflected his parents’ dreams. Just like their mother, the little boy died. There was nobody to help them and no ambulance to spare, so his body stayed in the house for several days.

By the time the ambulance finally came to take away her father and the tiny corpse bundled in blankets, 11-year-old Emmanuel Jr. was stricken too.

Promise watched as medics packed half her family into the back of the ambulance. She was now alone with 15-year-old Benson and 13-year-old Ruth.

She could not afford a phone call to see how their father and brother were doing, even if she could get through on the hotline for relatives that was almost always busy. A taxi to the Ebola clinic across town cost even more. An uncle stopped by to drop off some money, but left without touching the children for fear of infection.

Promise resolved to keep the family together until her father came back.

She decided to use what little cash she had to buy plastic bags of drinking water. The family had a cooler, and she planned to sell the bags she bought at $1 a piece for $2.

Day after day, though, no customers came. Nobody wanted to buy water from the girl whose mother died of Ebola, and whose father and brother were at the clinic. Promise looked healthy, but fear was overcoming compassion in the St. Paul Bridge neighborhood where they lived.

If the children sat down somewhere, people would spray bleach after they got up. When they tried to buy something with what little money they had, vendors refused to serve them.

Neighbors didn’t want the Cooper boys playing with their children. And even though health workers had disinfected the path from the well that went right past their house, women took their brightly colored plastic buckets the long way around instead.

Promise, overcome with grief and beaten down by stigma, became depressed.

“Why don’t you want to talk to me? Why God does nobody want to come around?” she sobbed. “We are human beings.”

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Finally she scraped together enough change from a cousin to take a taxi to the gates of the Ebola clinic. A security guard said he would check whether Emmanuel Cooper Sr. was on the list of the living.

Promise and Ruth paced outside the barbed-wire topped walls of the clinic for what felt like hours, waiting for an answer on when he would be coming home.

The guard came back. He said he was sorry, but their father was dead.

The girls broke down sobbing.

No one could tell them if 11-year-old Emmanuel was still alive.

___

Even as Promise lost both her parents, another man in the community was trying to document just how many children were orphaned in the St. Paul Bridge community. Kanyean Molton Farley, a human rights researcher by day, devoted all his spare time to making a list of the now 28 parentless children living alone. In most cases, teenagers like Promise are now raising their siblings amid an overwhelmed social welfare system.

“The story of the Cooper children touched my gut, and I never stopped coming back,” he said one morning, as he dropped off soap for the children.

The family’s rent was already paid through the end of the year, but they soon ran out of money to pay the electricity. Farley worried most of all that Promise could fall prey to an older man. At 16 and hungry, she was vulnerable to abuse.

Then the Cooper children caught a lucky break: Promise saw her brother’s face on television, among government photos of children who had survived Ebola at the city’s clinics but were still separated from their families.

“It’s him, it’s him!” she told Farley. Off they went to get Emmanuel — the first in the family to survive the plague sweeping their neighborhood.

Not long after Emmanuel came home, Ruth became feverish and unwell one night. How could this be happening again? A terrified Promise called their friend Farley late at night. He couldn’t come until morning because of the curfew.

So he told her to use the family’s mattresses as room dividers in the single bedroom where they all slept. Ruth would stay on one side; the healthy children would sleep on the other.

At first light, an ambulance called by Farley took Ruth to the hospital.

___

Now it is just Promise and the boys.

She insists they will never go live with strangers. Yet they no longer want to stay in the house where their parents lay dying and their brother’s body sat for days.

On a Sunday afternoon after church, there is no television to watch without electricity. The TV set sits gathering dust with a soiled stuffed unicorn on top of it.

The children sleep together in their parents’ bed at night, instead of crowding on the floor below as they did in their previous life. Some nights her brothers weep for their mother, and Promise tries to be firm but caring.

“I tell them Ma and Pa are no more, and that they shouldn’t worry about that,” she says. “We must concentrate on living our lives because they are gone.”

Just a few weeks ago, their aunt Helen came around to the house — the first family member to do so in months. She had been upcountry when the children’s parents died and wanted to see how they were doing.

It pains her to think of her brother, and what he would say about the children out of school, cooking and cleaning for themselves.

“I have to come back because everyone has abandoned them,” says Helen Kangbo, breast-feeding her 1-year-old daughter Faith after joining her nieces and nephews for a paltry dinner of rice. “I must have the courage to come.”

Of course, now that Helen is in contact with the children, she is shunned by the same extended family that fears Promise and her siblings.

Each day Promise mixes up bleach and water in bottles to keep the house and her brothers clean. “Don’t go around people. Don’t touch your friends. Anything you touch, you wash your hands,” she scolds them.

Days later, she says her prayers have been answered: After three weeks at an Ebola treatment center, 13-year-old Ruth is cured. She is still weak, so she is staying with Farley’s family. When Ruth is well enough she will return home.

Here in their house, there is little trace left of dead loved ones, because authorities have burned their parents’ clothing in a bid to stop the spread of the disease. The only photos of their parents are on their voter ID cards. And the only reminder of Success is the two bottles of baby powder, still sitting on a table in the room.

Follow Krista Larson at https://www.twitter.com/klarsonafrica

Ebola: 1,332 Nigerian Soldiers Quarantined in Liberia

The Nigerian Army has revealed that about 1332 of its peace keeping troops in Liberia have been placed under surveillance following their contact with a Sudanese who later died of the Ebola Virus Disease (EVD).

They reportedly came in contact with an infected Sudanese man who was in the soldiers’ camp to lead them in prayers during the Sallah celebration.

The development was disclosed by the Director of the Nigerian Army Medical Corps, Major-General Obashina Ogunbiyi in Abuja on Thursday October 9.

Ogunbiyi reportedly added that Nigeria is still at risk of the disease as any of the soldiers could choose to come back home at any time.

He also said that the quarantined soldiers are part of the reason “…why the military had to be totally involved in the fight against the Ebola virus.”

Nigeria has contained the Ebola outbreak and is set to be officially cleared by the World Health Organization on October 20.