This post, written by Sulaiman Sesay, Action Against Hunger's Country Director in South Sudan, was originally published on EcoWatch on June 19, 2020.
I lost five family members to Ebola within two weeks when the virus ravaged Liberia in 2014. First my uncle became sick. I called an ambulance to take him to the treatment center, but he died before they came. Everyone who attended to him became infected and passed away.
At the time, I was the Logistics Manager for a humanitarian organization, and we were determining how to best respond. Our mandate was maternal health, child protection and education, but Ebola was quickly becoming West Africa's number one concern. There was fear that anyone on the front lines would be in harm's way. We were losing many colleagues, including doctors and nurses, to the virus. In the early days of the outbreak, many were afraid for us to directly intervene, but I insisted that we do so before Ebola consumed us all.
I lived in a small apartment with my wife and two children. For six months, I didn't see them as I tried to protect them from contracting anything I might pick up in the field. I came home after working late into the night only to eat, rest, change my clothes, and go back out before they woke up. I wanted to make sure that even if something happened to me, they would survive.
Fortunately, our efforts paid off. We reduced the cases of Ebola down to zero in Liberia. But it wasn't easy. Our primary challenge was getting people to change fundamental behaviors.
For example, it is considered very disrespectful in Liberia to not shake another's hand. It wasn't until people were dying in the streets that people realized this important custom needed to be put on hold for the virus to subside. As more and more bodies were carried off, people awoke to the need not only to avoid hand-shaking, but to regularly wash hands with soap and avoid contact with strangers.
Fast forward to 2020 in South Sudan, where I work to prevent childhood deaths from malnutrition. Now we are faced with COVID-19, which officially has infected nearly 1,700 people, with 27 reported deaths in the country — though we know actual numbers are significantly higher. Health infrastructure is very weak here, and testing is slow where facilities exist.
As with the early phases of Ebola, people are receiving mixed messages, not knowing what to believe. They are being told not to go anywhere, but daily visits to the marketplace are essential for survival, because people don't have refrigerators or the funds to stockpile food. If you wear a mask, you are viewed with suspicion. And again, many frontline workers are becoming infected and paralyzed with fear.
While COVID-19 doesn't have an exact corollary, elements of what we now face remind me of the successful — though newly resurgent — fight against Ebola in West Africa. Here are a few key lessons for the current pandemic:
- Deliver Strong & Consistent Messages: As with the beginning of Ebola, there are significant misconceptions about COVID-19. To counter this, there needs to be clear and consistent public education that this virus is serious — and preventable — coming from top government officials to state politicians, religious leaders, elders, women's groups and young people. To raise awareness, we are coordinating with these influencers to promote social distancing, mask-wearing and hand-washing in a range of creative ways, from radio ads to community theater, and from word-of-mouth to text messages.
- Establish Community Care Centers: Isolating people who were infected with Ebola was crucial in preventing its spread, especially in hard-to-reach, remote areas. In South Sudan, where as many as 20 family members live together, quarantining from family is challenging and home-based care will not work. Health care in facilities is also extremely limited. In this context, the best approach to prevent the spread of COVID-19 is to set up "Community Care Centers," essentially single-room huts with a hand-washing facility. Anyone experiencing symptoms can be isolated in these centers for 14 days so the virus doesn't spread within their family and beyond. They also must be given daily food and water to avoid having to go into marketplaces, where they could infect others. All construction materials can be found locally, but still require funds to develop.
- Keep Treating Malnutrition: People in South Sudan will die from hunger before they die from COVID-19 if we stop vital nutrition and health services. During the Ebola outbreak in West Africa, people didn't seek basic health care because of the disease, resulting in a significant loss of life. This "indirect mortality" resulted in as many deaths as the crisis itself. We must continue to serve the most vulnerable in South Sudan so that they can become healthy and strong. To this end, we are placing utmost importance on protecting our staff so that they will feel empowered to keep doing this work safely. We also need to continue our plans to help communities better access water, soap and sanitation to build local resilience for whatever might lie ahead.
It's not only important to apply these lessons, but to apply them consistently, over the long haul. It takes time, patience, and constant monitoring until cases reach zero.
Leaders in South Sudan and throughout sub-Saharan Africa need to demonstrate that we can be safe and still work to defeat deadly threats, whether it's COVID-19, Ebola, malnutrition or otherwise. When it comes to contagious disease, we will not run away from the communities we serve, because none of us is safe until all of us are.