Interview with Fayiah Tamba Secretary General, Liberia National Red Cross Society

Publié: 14 novembre 2014 11:15 CET

Can you give a brief history of Ebola in Liberia?

Ebola came to Liberia in late March when the first case was reported in Lofa county. By April, the Liberia National Red Cross Society, together with other partners, had sent a team from Monrovia to start the process of raising awareness of Ebola in communities. Thanks to that effort, the outbreak quietened a little and I remember, by May, it had reduced so greatly that I think we only had one case reported. Unfortunately, I think people also scaled back their response mechanisms, and in late June, the whole thing burst open. Since then, we continue to see the number of cases increasing.

The outbreak started in one place, in Lofa county, and has now spread into Montserrado county, Margibi, Bong and Nimba. It has escalated so much that all of Liberia's 15 counties are now reporting positive cases and all are considered response counties. Today, Ebola is still on the rise, there are increasing deaths, and we have not reached a point where we have been able to contain the situation. Before the war in Liberia, there were already issues related to our health care delivery system. It was quite poor. It was not a strong health care system. When Ebola came, it hit the health care system hard.

Today the situation in Liberia is still alarming. Cases are increasing on a daily basis. This means we have not been able to contain the sickness or break the transmission. This is largely a result of the low capacity that exists in the country. Every day we are seeing more deaths. We are taking care of safe and dignified dead body management in Montserrado county where it is densely populated. When we started this in June, we were managing an average of 10-15 bodies per day. After a few weeks, that went up to 20-25 bodies per day. Today, on average, we are collecting 40-45 bodies on a daily basis. The number of sick people increases, deaths increase, contacts and infections increase, and so on. So looking at all of this, you realize that, today, the situation in Liberia is quite grave.

What has been the nature of the Red Cross response to the Ebola outbreak?

The Liberia National Red Cross Society, with support from our international partners, IFRC and ICRC and partner National Societies, is responding in five major areas. We initially started with just one, social mobilization and awareness raising. But as the situation escalated, as the virus moved from Lofa into Montserrado and into greater Monrovia where it is so densely populated, the need arose for us to expand the scope of our operations. We have since moved into contact tracing, providing psychosocial support, and safe and dignified dead body management. Recently, where communities have been quarantined by the government of Liberia, we started collaborating with the World Food Programme to distribute food in Montserrado and Margibi, so today we are working in these five major areas.

What are the secondary, knock-on effects of this Ebola crisis with regards to the health of the people?

Today, most of the health facilities that were running prior to the Ebola outbreak are not operating at full capacity. Some of them are still closed to the public. The reason is that Ebola is a new phenomenon in our environment, in West Africa and in Liberia. So when it came, there was this huge denial. People did not want to believe that Ebola really exists. At a certain point, people even began to attribute it to a government strategy to raise some money from international partners. But when the disease started to show its own true weight and impact on the population, it was frightening because many of the health workers who were engaged in providing health services got infected and died. Because health workers got infected, some of their colleagues  abandoned the health care facilities.

In Liberia, before Ebola, we had serious situations with malaria, diarrhoea, acute respiratory infections and, in the midst of having a country where the health system has completely closed up, many people are dying, not only because of Ebola but because there are not the health care facilities or staff to help.

If you look at the mother and childbirth situation in Liberia, it is also not good. The Ebola situation has further compounded that because women are still getting pregnant and they need medical attention. But they cannot access health care because health workers have left the facilities due to fear of Ebola.

How would you characterize the long term effects of Ebola on Liberia?

The Ebola situation today will have a significant impact on our long-term development goals as a country. Liberia has been struggling to improve its performance when it comes to deaths due to malaria, maternal deaths in childbirth, etc. But because of the situation today, all of the advances that the government has been making are stalling. There will be additional gaps.

If you look at food security today in Liberia, if you check all around this country in terms of the farming situation, it has been brought to a complete standstill. The whole nation is now concentrating on how to fight Ebola. Even if you go into communities, everybody is sitting down and discussing strategies on how we can end Ebola. People are not farming. In the long term, we will run out of food as a nation. We are already dependent on others, so that situation will get worse. Maternal deaths will increase. Even access to safe drinking water is a problem. Many organizations and partners including the Liberia National Red Cross Society have been in the business of helping rural communities get access to safe drinking water, but because of the Ebola situation we will have to draw a curtain across these programmes and focus more on the fight against Ebola. In the long run, these communities that should have had access to safe drinking water will not have it during this period, so waterborne diseases will increase too.

Why is the Community-Based Protection programme, which was recently launched, so important?

There are two reasons for this. One, this is one of the core competencies of the Liberia National Red Cross Society because we are a community-based organization. If you talk about the fight against Ebola, we think it should be fought from the bottom up, and starting from the bottom means that the communities themselves should get involved.

If you look at the track record of how Ebola has been spreading in Liberia, it has gone from person to person. Family members are not aware of how to care for sick people in these communities, so they end up contaminating an entire family and sometimes the whole family loses their lives. But this community-based protection service will ensure that at the community level, people are trained and, if there is a sick person, they are able to provide care in a safe way until assistance can come. But more significantly, family members will also be protected from infection. The person taking care of the sick person will also be aware as to how not to become contaminated until they can get the person to an Ebola treatment unit or isolation unit.

Why is the community-based protection programme only being launched now?

The first principle of Ebola care is isolation. Isolation provided by trained health workers is still the gold standard, but nothing about this outbreak is standard. The overwhelming case numbers and geographical spread means that new innovation is needed to provide care where it is needed. And that is not always where there is an available isolation unit. When we saw such large numbers of inter-household transmission, in areas with poor access to care, we needed to do something.

It is a risky programme to do. But what we can say to those involved is that you must be conscious of yourself. You have a responsibility in as much as you want to help the sick person, but self-protection is paramount. So we provide the kit and we provide the training to the person who will use the kit and make sure they use it appropriately.

It is important to remember that the community protection programme is not a treatment unit. And the reason for this is that we do not want our people to have the idea that once they have some protective equipment to provide care to somebody in the family, they can provide treatment for that person. It is not for that purpose. The purpose is that you can take care of somebody immediately until they can be taken to an Ebola treatment unit where they can have advanced medical attention and proper isolation.

We need to stress this clearly: community home-based protection is not an Ebola treatment unit. It is not meant for treating. It is meant to provide basic care until the person can be brought to an Ebola treatment unit where they have access to proper services. It fills an important gap in terms of protect families, and assisting individuals in areas with limited services.

The focus remains on effective transfer. Basic treatment for other illness is provided, such as for malaria and dehydration, to limit negative effects from not going to health centres for normal illnesses. This programme allows us to assist at the grassroots, find individual cases, limit transmission and ensuring we stop second-generation transmission.

What will it take for Liberia and the Red Cross to win this battle against Ebola?

We, as Liberians, need to take on the commitment ourselves. Yes, there is a need for international support, but there is also a need internally for Liberians to believe that we can play a significant role in the situation at hand. If there is a sick person, we have to believe that we should not hide this person. We should alert the relevant agencies that somebody is sick or that there is a dead person and, once we all can contribute, then we can – as a nation – help to end the outbreak.

For the Red Cross and other partners, this is an alarming situation. The Ebola outbreak is overwhelming the nation and the Red Cross. It takes a concerted effort, which we have started with our international partners.

We started on a very small scale. Today, if you look at our own emergency appeal and how much we require, we are talking about somewhere in the region of 8.9 million US dollars, to do those basic things that we have set up to achieve own contribution in the fight against Ebola in this country. If this support is forthcoming, it will be a further buttress to help us to contribute significantly in supporting the efforts of the government to contain this disease.

Today, there is a lot of good news out there. The United States has made a commitment to Liberia and the sub-region. But we also think that there is still more needed. There is still a need for international partners, for other donor countries, to provide support in other areas to help. For example, the United States government support is very clear; they are coming to help put up treatment units, they are going to train people, but there are still some other areas that require attention. There is the issue of safe and dignified body management, which we as the Red Cross are very much involved in and which is quite an expensive venture. Even trying to bring back the health system in this country into full operation. If we are going to be able to contain this disease, these facilities should also come into play to help the process.

What message do you have for the international community?

The message I have is that the situation in Liberia is overwhelming; it is beyond our national capacity, and that there is the need for international support if this situation is to be brought under control. We think this is urgent because the more we delay, the worse the situation in Liberia will get and the longer it will take to contain the disease. So we need international support and we need it urgently.

What can you say about the role of the Red Cross volunteers?

I consider the work of our volunteers and staff who are involved in the communities as a tremendous gift to this country and a selfless service to our nation. This is a disease against which not many people are willing to offer their services. It takes the love of humanity to move somebody to take on these kind of responsibilities. And this is exactly what our volunteers are out there doing.

Take, for example, the teams in charge of safe and dignified burials. These are young people who, on a daily basis, move in communities where there are dead bodies, sometimes for up to two or three days, and they go to pick up these bodies. In some instances, they meet resistance from the communities – people do not understand the risks that are involved and do not want to release the bodies. To get this done requires a kind of selfless service to humanity and that is exactly what our volunteers are doing.

If you look at areas like psychosocial support, today in this country it is altogether a new phenomenon. In Liberia, when our people die, they have traditional ceremonies to bury the dead in a befitting manner. But because of this disease, people are not getting that opportunity. If somebody dies and the team goes to pick up the body for cremation and the family is left often without the breadwinner, the family feels that all is gone from them. Our volunteers, who are providing psychosocial support, are filling in these gaps, sitting with these families, talking to them, discussing what other opportunities are there, where they can find some help, life can still go on.

I think it's a tremendous contribution from our volunteers out there in the field. When I meet with them and have the opportunity to sit with them and talk with them, this is what I usually tell them: that this is a sure contribution to our own country; this is selfless; it is not because of what they are getting, but it is purely driven out of the passion of humanity to serve somebody who is in need.

Are you optimistic about the future?

I am quite optimistic. If you look at the history of Liberia, we have been through a series of very traumatic situations and events and the resilience of Liberians gives me that optimism. While it is true that today the situation is appalling and overwhelming, I feel strongly that we will surely come out of this and, considering the resilience that Liberians have, we will say it again, we will write it in our history books and say: "Once upon a time we had this situation, but we came out of it."

We had a civil war that was devastating for the country, but we came out of it. And for the last ten years, Liberians, in my own mind, have enjoyed a reasonable semblance of peace. Yes, today we have Ebola, but I am also very optimistic that we will defeat Ebola and rise up as a nation.