As health officials in Liberia, Guinea and Sierra Leone struggle to eliminate the final cases of Ebola, a new report said some hard lessons have been learned. The group International Alert says a lack of trust between the Liberian people and their government made the outbreak worse
The report’s author, Ashoka Mukpo, said that “many people mistrust official institutions and even feel threatened by them.”
Mukpo, an American, is an Ebola survivor himself. He contracted the disease last year in Monrovia.
“It was a bad couple of weeks. I was very, very sick. I’ve never been that sick in my life and I was quite scared.”
After being treated for five days in Liberia, he was airlifted to a medical facility in the U.S. state of Nebraska.
The International Alert report is entitled Surviving Ebola: Public Perceptions of Governance and the Outbreak Response in Liberia.
“International Alert is an organization that looks at underlying dynamics to maintain peace in fragile states. And one of the things we’re really curious about with the Ebola outbreak in Liberia is how much did people’s perceptions toward government contribute to the outbreak? And what we found when we talked to people is that there were very high levels of mistrust and suspicion towards the government’s motives. And this was really what underpinned people’s initial refusal to take their warning seriously about how deadly Ebola was,” said Mukpo.
The mistrust, he said, stemmed from history and unfulfilled expectations.
“On one hand, Liberia has quite a history of tension between citizens and government. It had a civil war about 15 years ago. But I think right now what people felt is that there is this tremendous sense of hope. That with President Johnson Sirleaf’s election this would mean development and accountability for corruption and these kinds of things. And the results actually have been quite disappointing. So, people are savvy enough to see that what they were hoping would happen hasn’t actually happened.”
Mukpo said Liberians had expected more from the healthcare system when the Ebola outbreak took hold.
“People felt like so many millions of dollars have gone into aid and development over the past 10 years. With the health sector that completely collapsed so quickly, there was this perception that, well, there must have been some kind of corruption – that people were taking money and not putting it into places it was supposed to go. So, fair or not, if you look at the record of this government in battling corruption, it’s been so poor that even if there were much bigger issues, you know, with how hard it is to fight an Ebola outbreak people’s perceptions automatically went to corruption.”
He said, however, perceptions were not the same for the international community.
“You know, actually, I was really surprised by this. As someone who lived in Liberia for a few years I really expected that the levels of trust in the international community would have been equally as low as the government. Because, you know, I’ve heard people say, well, these are the folks who support this government [in] the way that they act. But actually the levels of trust that were given to the international community were much higher than the government. In fact, most of the remarks in most of the reports on the international community’s performance during Ebola, and just, in general, its concern for Liberians, was very high,” said Mukpo.
He said that “one of the critical and under reported narratives” of Liberia’s Ebola crisis involved community leaders.
“Initially, there was this really authoritative effort to quarantine communities and force them to do things differently. And it kind of didn’t work. And what really worked is once you sat down with communities – and once the government actually got to community leaders and said, look, what can we do to assist you in fighting this outbreak? What do you need from us and what can you do to help? Then once that kind of collaborative effort started, then that’s really when you started to see cases reduce,” he said.
Mukpo said community trust played a major role in the safe burial of Ebola victims. Touching and washing dead bodies helped spread the disease, despite government warnings against the traditional practice.
“Really, when you’ve got community volunteers involved, these are the people whose neighbors doing these secret burials – whose neighbors were hiding the sick. So, it’s much easier to hide somebody from an official who doesn’t live in your neighborhood than from someone who grew up 30 yards away. They come and knock on your door and say, you know, look, I hear your sister is sick. We need to take her to the clinic. And I really think that was the tipping point – that once it was people that folks trusted and that knew had their best interests in mind, that that’s really when people started to be more cooperative and change their behavior,” he said.
The International Alert report said, “Post-Ebola policy-making and aid delivery must take into account the need to repair the bonds between Liberians and their government, in order to strengthen good governance and accountability.” It added that “projects that seek to strengthen health services, promote good governance and rebuild service delivery must incorporate civil society and…communities into planning and decision-making.”
It also recommended that security forces exercise restraint during demonstrations and protests, that anti-corruption agencies be strengthened, and that the Liberian government support a free press and civil society.