What happens after Ebola?

March 31, 2015

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  • By working with local organizations in Liberia, trained community educators have been able to reach 2 million people with lifesaving information in the fight against Ebola. Photo: Sean Sheridan for Mercy Corps

Twenty-six year-old Malike Dulleh lives in Lofa county — the same county where Liberia’s first two cases of Ebola were confirmed one year ago. The disease that has killed thousands in Liberia came for him, too.

The first of his family to succumb to the disease was the uncle who raised Malike. “A lot of people didn’t believe the virus was real at that time, but Mama called me to tell me that my uncle was sick,” he says. “I came back to Lofa to take care of Uncle. But he didn’t survive; he died.”

After that, things only got worse. The family conducted a traditional burial for Malike’s uncle, which involved bathing and burying him by hand. Soon after, Malike’s mother fell sick with Ebola. When the transport came to take her to the local Ebola Treatment Unit (ETU), the family faced a risky dilemma.

Malike (in red) lost 19 members of his family to Ebola. Photo: Crusaders for Peace for Mercy Corps

“No one could put her in the car,” says Malike. “So I sacrificed myself. I put Mama in the car and they drove her off to the ETU. But after three days, she died.” Three of Malike’s siblings went with their mother in that car, and they died, too. The decision Malike made changed his life. “I believe that’s how I got the virus,” he says.

In total, Malike lost 19 members of his family to Ebola. Even though he and his sister survived, their suffering wasn’t over.

Like so many others in Liberia, Malike and his remaining family are desperately trying to recover from the personal, emotional and economic catastrophe that Ebola brought to West Africa. It’s for Malike and so many like him that our Ebola Community Action Platform (ECAP) program exists.

Fighting Ebola with community action

One year after the first case of Ebola appeared in Liberia, the country is on the road to recovery — but it hasn’t been easy. As the epidemic spread quickly through Liberia and neighboring affected countries Guinea and Sierra Leone, much of the chaos and tragedy was fueled by a serious lack of information about the deadly disease.

In October of last year, we worked with Population Services International (PSI) to launch the massive ECAP response to Ebola in Liberia. With funding from USAID and in coordination with the Liberian government, our goal was to equip 2 million people with the lifesaving information they needed to protect themselves and their families from the disease.

When the disease first began to spread quickly, there were as many Ebola myths as there were truths in the streets of Liberia. Mercy Corps recognized that getting accurate information about the disease to all corners of the country was key.

A community educator gets young people involved during social mobilization activities in Robertsport, Liberia. Photo: Sean Sheridan for Mercy Corps

To do that, we gathered local organizations, leaders and citizens — people who are seen as trusted sources — to go into communities and spread lifesaving information.

The community educators have gone to all 15 counties, including some of the most isolated and remote areas — teaching people how to limit transmission and effective hygiene protocols for dealing with those who are sick or have died.

It’s because of their hard work and determination that we were able to reach 2 million people — almost half the population of Liberia.

How we reached 2 million people

To reach so many people, we worked with 76 local organizations to train 830 public health trainers. Those trainers then mentored 15,000 community educators, who worked in groups to bring critical information to communities.

The groups of community educators addressed each community’s needs and questions in different ways that were impactful and culturally-relevant.

Some groups handed out flyers and put up posters in public places. Others went door-to-door to have lengthy conversations with skeptics about Ebola. Some groups even used song and dance to relay their messages and get young people involved.

While their approaches were sometimes different, their messages were always the same: Ebola is real, and it is deadly, but it can be prevented.

In the first phase of the program, messages were focused on hygiene practices, preventing transmission, and how to deal with someone who is sick with Ebola. Now, we must remain vigilant, but those messages are shifting to help survivors of the disease re-integrate into their communities.

Mercy Corps partner Crusaders for Peace uses song to help educate communities about Ebola. Photo: Laura Keenan/Mercy Corps

While the fight against Ebola and its effects in Liberia is far from over, we’ve met our goal of reaching 2 million people, and we credit this success to our broad network of partners and community educators in Liberia.

The ECAP program has been celebrated in Liberia for its success as a powerful force in the fight against Ebola. Recently, the Honorable Lewis Brown, Liberia’s Minister for Information said: "No group has been able to effectively engage the nation during this crisis the way that ECAP has.”

Addressing stigma and discrimination

Malike’s personal experience with Ebola and desire to help others inspired him to join the fight against Ebola and discrimination. He is now working with one of our partner organizations as a community educator himself, teaching others about the disease and the negative impact of discriminating against survivors.

“People from YOTAN [an ECAP partner] called and they started to explain that survivors are important to the community,” Malike says. “Then I was recruited to join the program. I started going around telling people that they should not treat me or other Ebola survivors badly.”

Malike has joined the fight against Ebola and is educating people about the harmful effects of discrimination. Photo: Donnish Pewee, YOTAN for Mercy Corps

Even when people like Malike survive Ebola, they often face fierce discrimination when they return home to their communities. While information about preventing transmission of the disease has become more common and understood, there is still a great deal of confusion about survivors — many people harbor inaccurate fears about catching the disease from survivors.

“When I was discharged from the ETU, my experience was bad,” says Malike. “Nobody wanted to associate with my sister and I. She is also a survivor. People were even gossiping about us.” Unfortunately, this story is not uncommon. Many survivors, even children, have been exiled from their communities due to fears about the disease.

Posters about Ebola and its symptoms help educate people about when to reach out for help. Photo: Sean Sheridan for Mercy Corps

During the ECAP program, we are conducting surveys of the people we serve to monitor changes in attitudes and behaviors over time, including their opinions about survivors. This data helps us understand and measure the impact of the program and gather learnings for the future.

In a recent Mercy Corps survey of more than 12,000 citizens in different counties across Liberia, we found that stigma and discrimination against survivors is widespread. According to the survey:

  • 49% of survey respondents would not feel comfortable visiting the house of an Ebola survivor.
  • 64% would not be comfortable eating from same bowl as a person who works with Ebola patients.
  • 58% would not be comfortable living in the same house as a person who works with Ebola patients.

To combat this fear and support recovery, community educators are telling people:

  • To welcome survivors and anyone whose life has been touched by Ebola back into the home and community. Encourage and help them to participate in community activities.
  • Survivors and others that have been touched by Ebola can help us. Their stories can help us learn and give us hope.
  • Health care workers, burial teams, social workers, mobilizers and contact tracers are working hard to end Ebola in Liberia. Welcome them and allow them to do their work.
  • We can help survivors and others touched by Ebola when we tell others the truth about how Ebola is spread and how to protect ourselves, our families and our communities.

For Malike, the ECAP program has given him a renewed sense of hope after so much tragedy. With his work in the community, he can slowly begin to rebuild his life after surviving Ebola. “Now, I’m happy to be accepted back in the community,” he says. “I don't want to see anybody suffering from Ebola as we did before."

What happens now?

Liberia had zero cases of Ebola for a short time, but a new case reported this month brings to light the vigilance required to eliminate the disease completely. It only takes one new case to spark an outbreak, so information about stopping transmission of the disease is still crucial.

Beyond the lives it’s taken, Ebola has ravaged Liberia’s economy. People have been struggling to earn income and feed their families. The outbreak over the past year has torn apart the fabric of entire communities, and the recovery in that aspect is just beginning.

To help families that are struggling to recover economically, we will soon begin a series of unconditional cash transfers reaching 150,000 people. With cash in hand, people can purchase the food they need to feed their families, and support the recovery of their local economy at the same time.

A selection of 10,000 small farmers will also receive vouchers that they can use for seeds and tools to help restart their businesses. The outbreak has had a severe effect on Liberia’s food supply — supporting small farmers is an important step towards helping Liberia’s markets fully recover.

Thank you

When a crisis strikes unexpectedly, supporters like you enable us to get on the ground quickly and respond to help people and their families. The Ebola crisis is no different. Your support helped us react quickly and give communities in Liberia what they needed to battle the disease.

In such a difficult time, our supporters and Liberian communities came together to respond to this crisis on a massive scale. The local organizations that we partnered with have been key in bringing lifesaving information to all corners of Liberia. We thank everyone who has made the Mercy Corps response to Ebola possible.