From all that we’ve heard so far from our health workers, politicians across West Africa and the UN World Health Organisation, we have to accept that Sierra Leone is firmly in the claws of the Ebola epidemic and it will take a struggle of herculean proportions to free ourselves.
We have lost and will lose many more of our people probably before I finish writing this piece. Victory against Ebola is not in sight. Without doubt, this is the most serious catastrophe Sierra Leone has had to confront since Foday Sankoh brought a band of wicked killers across from Liberia. We have a few more weeks, even months to go, assuming we intensify the fight and are more honest and transparent with ourselves on this issue.
Inevitably, questions abound as to how come that unlike Uganda, we have been unable to isolate, attack and defeat Ebola after so many weeks with all the international goodwill. In fact the latest figures released by the ministry of health clearly tell us the disease is spreading.
Like in the fight against HIV/AIDS, the leadership of president Yoweri Museveni in his nation’s struggle against Ebola, was internationally acclaimed. Leadership styles are different but I think we are missing that vital convincing spark that this was a national emergency. In just a few weeks we have lost more than one hundred innocent souls. What does it really have to take to drum the message home that merely making speeches, throwing money at the problem and engaging in mindless spin are totally counter-productive?
There are a few things we have to admit as a nation: the attitude of our leaders to people living in the kinds of communities now under Ebola attack is very negative. It’s almost as if it’s the rebel war mentality all over again. Until the rebels came to Freetown, many people dismissed the war as a matter for the uncivilised rural poor.
Since independence, we have allowed many of our rural communities to be isolated and remote – even cut off from the rest of the country – to the extent that a study done by one international agency in the days of the NPRC of Valentine Strasser, recorded people in some parts of Koinadugu district as saying that Siaka Stevens was still the president of Sierra Leone. The people are physically and emotionally cut off from whatever we are doing in Freetown. All they know is that every five years politicians would go around, make promises to get them to vote for them. That’s all.
People living in border communities of Sierra Leone are heavily influenced by their interaction with people on the other side. My village lies just a few miles from Sierra Leone’s border with Liberia. The whole chiefdom uses Liberian money, they talk in Liberian accent and send their children to school in Liberia.
I am not comfortable with that but I can understand why it’s happening. It’s about the proximity of Monrovia to that border, it’s about trade, travel, inter-marriage and all that.
But why is it that Sierra Leonean influence is not seriously felt even in Cape Mount county where many Sierra Leoneans now live in the same way Liberians are influencing us on the other side. The truth is, our leaders have made no serious effort to instil Sierra Leonean-ness in the people. Come another election there will be big intellectual arguments in Freetown about who can vote in Gendema as an ORDINARY RESIDENT. If all those people had simply gone to their farms that day, the whole charade called elections would have been for the farce that it was.
Let’s confront this other issue head on: our health care system is just not robust and sophisticated to withstand the challenges of a modern health system. Yes, the free health care project achieved certain important results, just the fact that for once many pregnant and lactating women who would otherwise have never seen a doctor are now able to visit health centres is a great achievement. Apart from all the unbridled corruption and stealing of drugs that the project has suffered from, the government can still claim some credit there. But it appears as if while we were busy celebrating free health gains in Freetown, other areas of the health sector were experiencing a chronic lack of investment leading to decay. So when Ebola attacked, the system in those abandoned parts of the country collapsed like a pack of cards.
The other lesson from the Ebola campaign is that the Ministry of Health and their civil society partners have to come clean and say that they got the communication aspect of their fight totally wrong in the beginning – and even now. Well, it has improved a bit but the approach is still fundamentally flawed.
The first health workers who went to Kailahun came back to report that on seeing them the people either fled with their sick relatives or actually attacked health facilities. I make no excuses for those who behaved like that to the health workers. But I have to say that had the communication strategy around the Ebola issue been professionally handled, the chances of a violent incident like what is happening would have been zero.
When I read that story in some papers, I was reminded of some NGO workers who went to a remote village with the aim of bringing relief to the people. After a week of driving around the place they decided to construct a well in the middle of the village thinking they were saving the women the trouble of walking for half a mile many times a day to fetch watch. They found out that a month after the well had been commissioned for use, very few women used it. The women ignored the well and continued going to the stream. Later an evaluation team held meetings with the people who told them that they were not consulted before the well was constructed and that they would have proposed other projects. One of the women actually stood up in the public to explain the value to them of that walk to the stream. She said they needed that period to exchange some village gossip. How come the NGO flunked so badly?
So when a group of health workers suddenly turned up in some very remote village with the sound of an ambulance blaring and bright lights blinking on top of those vehicles, it’s easy to understand why those people fled or attacked the vehicles especially after confusing messages had reached them about Ebola.
In Freetown, our politicians and other authorities are used to a kind of communication we call awareness-raising. There’s nothing wrong with that but it’s normally too sporadic, completely not targeted at any audience hence its results cannot be measured. Facing an Ebola epidemic of the kind this nation is fighting, awareness-raising should be only a small part of the general communication effort. But we understand what happens when politicians and civil society groups embark on “sensitisation”.
Beyond raising of awareness about Ebola, the type of communication required was supposed to get the people to change long-held livelihood habits like a man heading off into the bush at night to hunt animals for food, like the people congregating once a week to sell and exchange goods and like people caring for their sick relatives with traditional medicine because there is usually no hospital.
And sometimes the people just don’t trust the Whiteman’s medicine. Compounding the problem was the fact that the first half a dozen or so people who were taken into hospital, died. The people just couldn’t understand how it was that their relatives were being taken away by men dressed as if they had just descended from space and even why they died, they were not allowed to bury them in their traditional way. That’s too complex a matter to explain at a press conference at Youyi building in Freetown by a minister.
When communicating for behavioural change, it must be strategically done. A key component of that would be the channels through which clearly defined target audiences are reached with clear and concise messages. To assume from air-conditioned offices in Freetown that a one-size-fits-all press conference approach or a tempestuous radio interview would be enough, is a big blunder.
Like the war, Ebola too shall pass. But there are important lessons to learn now.
By Isaac Massaquoi:Politico