Combating the Spread of Ebola

More than one year ago, during the height of the 2014 Ebola epidemic, a small group of staff from Global Communities Liberia identified a plot of land approximately 30 miles outside of Monrovia, overgrown with vegetation, known simply as “Disco Hill.” In response to Montserrado County’s controversial cremation policy that had been instituted at the time, Global Communities, along with traditional community leaders, had been searching for a site that could provide an alternative to cremation.

“The site perfectly met our criteria,” said Josh Balser, Global Communities’ Acting Country Director. “It was a large space and it was very accessible to the road. Most importantly the community was accepting and welcoming of our idea to use it as a burial site.”

Negotiations between community leaders and the Government of Liberia soon ensued and construction rapidly began at the site. In just two months, Disco Hill opened its doors and thus began a pivotal time of the response as the practice of cremation ceased. Since its opening in late 2014, more than 2,200 deceased – both Ebola and non-Ebola cases – have received safe, dignified burials at Disco Hill.

On November 22, Disco Hill staff organized a ceremony to honor all team leaders at the site, namely Site Manager Matt Ward. Ward joined Global Communities in the fall of 2014 and has been instrumental in leading the development, management and operations of the site.

Balser added that initially, Matt was supposed to come to Liberia to do health messaging and promotion. “He was going to travel around teaching communities about Ebola transmission and prevention. I called him one night and said ‘Matt, there’s been a change of plans. We need you to come out here and build a burial site.’ Matt’s immediate response was ‘When is the next plane?’ Matt has been an extremely dedicated member of the team, working weekends and late nights. He deserves to be congratulated,” said Balser.

Chief Zanzan Kawar, head of the National Council of Chiefs and Elders of Liberia, attended the celebration and expressed his gratitude and satisfaction with the site and what Global Communities has helped the Government of Liberia achieve through the USAID OFDA-funded Assisting Liberians with Education to Reduce Transmission (ALERT) Program.

When asked about his thoughts looking back on the site and his experiences in Liberia, Ward responded, “I have a lot of memories of this place but the most rewarding times were when families would personally thank my team and me for providing their loved ones with a burial. I will always be proud to have been part of an operation that allowed victims of this virus to be laid to rest safely and with dignity. I also would add that my team has been amazing here. I am proud that now the Disco Hill team has taken full ownership of the site and can successfully run it without my supervision.”

After nearly one year of intensive support for construction and burials at Disco Hill, Global Communities is now working to hand over the site, as well as the management and operations responsibilities, to the Government of Liberia by the end of January, 2016. Chief Zanzan Kawar ended the ceremony with a statement to Global Communities: “We have greatly appreciated Global Communities’ work and collaboration with us. We wish you could stay and work with us forever. During the fight against Ebola, this place [Disco Hill] brought us together and gave us strength. This is something we cannot forget and the Traditional Leadership looks forward to continued work with Global Communities in the future.”

For four years, we were busy creating access to safe sanitation for communities in Liberia. And if not for an unprecedented epidemic of what is now one of the world’s most feared diseases—Ebola—almost no one outside of the country would have known about it.

That wouldn’t have been surprising. We were making making solid, consistent progress with Community-Led Total Sanitation, but it was one of those projects unlikely to generate much excitement outside the development community. We began this work through the USAID-funded Improved Water, Sanitation and Hygiene (IWASH) program in 2010 in the three Liberian counties of Nimba, Lofa, and Bong. Our program gained the support of the national government, and we worked with them to develop their sanitation strategy to improve the health of rural communities across the country. By early 2014, we had helped 284 communities become “open defecation-free,” and were working on more.

All that changed with Ebola.

Suddenly, Global Communities and our partners in the Liberian County Health Teams and the Ministry of Health found ourselves at the center of a maelstrom. We scaled up our community engagement work, and then, at the request of the Ministry of Health, began supporting burial teams. This was crucial, since unsafe burial practices were widely identified as the source of 50–70 percent of infections. By October of last year, we were training, equipping and compensating more than 500 volunteers who were dedicated to the emotionally and physically demanding job of ensuring safe and dignified burials. The teams were able to bury 98 percent of bodies within one day of death, and not one of our burial team members was infected with Ebola.

It was at that same time that we received reports of an astonishing statistic. All 284 open defecation-free communities were reporting that they were also Ebola-free—despite being surrounded by Ebola hotspots.

Was there a link between being open defecation-free and Ebola-free? Or between our program’s process and Ebola resistance?

Earlier this year, we employed two independent public health consultants to conduct research into the informal reports we had received, they came back with extraordinary findings. Focusing their research on 551 households in Lofa County, they established with a representative sample that the communities that had reached open defecation-free status were indeed Ebola-free.

Amazingly, they also found that communities that had even begun the Community-Led Total Sanitation process—but not reached full open defecation-free status—were 17 times less likely to experience a single case of Ebola. This suggests a statistically significant correlation between our work to become open defecation-free and being Ebola-free.

Still, we would be remiss in assuming that these findings mean that simply becoming open defecation-free stops Ebola. Rather, they suggest that people who had been exposed to the program’s education were far more likely to develop healthier behaviors and practices that lead to Ebola resistance—especially when led by a member of their own community.

Small investments in the community-led approach were able to save thousands of lives and millions of dollars in curative and humanitarian interventions. Such methods are inexpensive; in Liberia, incentives of only $130 per community can result in far better sanitation practices. Make household latrines, hand washing facilities, garbage pits, and dish racks available, and you have a safe, hygienic, and resilient community.

The resulting behavior changes don’t only defend against Ebola, they help prevent water, insect-borne, and diarrheal diseases, some of the other biggest killers in the developing world today.

While the recent news of a vaccine for Ebola is certainly encouraging, strengthening health systems across Africa and other vulnerable countries will be vital in helping to prevent future outbreaks. In the aftermath of the the crisis, it is essential to improve hospital access and clinical infrastructure, but Ebola—like many other diseases—spreads at the community level.

We must focus our efforts on curbing infections by empowering those at risk to make wise decisions that prevent disease in the first place.

Links:

• The Cost-effective Way to Protect against Future Ebola Outbreaks
• West African Response to the Ebola Crisis
• Global Communities Homepage