As the Ebola epidemic escalated in Liberia last fall, the nation's ministries and international public health agencies asked The Carter Center to help mobilize communities to identify cases of the disease and prevent its spread.
Fearing quarantine if they were found to have Ebola, people resisted being tested for it. Health education was not reaching everyone. Many were offended by instructions to suspend burial practices that might spread the active virus. There was a growing need to help individuals and communities deal with the trauma and stigma of Ebola. Compounding all of this was a general distrust in rural areas of central authorities.
Having worked in Liberia for 25 years to help resolve conflict, establish a post-war rural justice system, improve access to information, and create a cadre of mental health clinicians, the Center brought to the table established networks of grassroots partners and longstanding relationships at all levels of government.
Hear from people working in the field how The Carter Center leveraged well-developed networks to mobilize Liberia's chiefs against the Ebola virus.
"Health agencies were under enormous strain, and it became clear that community leaders not only were an underused resource in this fight, but also were critical to identifying cases and spreading accurate information," said Tom Crick, associate director of the Carter Center Conflict Resolution Program.
The Government asked The Carter Center to mobilize its rural network of community justice providers and the National Council of Chiefs and Elders to help educate citizens about Ebola. Because they had worked with the Center since 2006 to establish a community justice system, these groups were uniquely positioned to engage the network of respected local traditional leaders, who had influence at the grass roots. Other partners in the effort were the Ministries of Internal Affairs and Health, the Centers for Disease Control and Prevention, and UNICEF.
In the outbreak's initial months, The Carter Center brought together 118 chiefs and elders for Ebola training and to explain the challenges facing health authorities.
"The Carter Center played an important role by bringing the chiefs together," said C. Linda Campbell, national health promoter in the Liberian Ministry of Health. "The chiefs have power in the various districts and towns, but they would not allow health teams to trace the person-to-person contacts spreading the disease or other mobilization activities in their districts because they felt they were not being respected. This all changed after the chiefs were brought together. They even planned how they would work with the community health volunteers, and some drafted laws or regulations to ensure compliance."
Emmanuel Kwenah, leader of the Bong Youth Association, greets villagers in rural Leleh, located near Gbarnga in 2006. Over the years, The Carter Center has partnered with community-based organizations to provide education programs on the rule of law and freedom of information. (Photo: The Carter Center/ C. Nelson)
From November 2014 through January 2015, over 4,000 clan-level chiefs and 10,000 community-level volunteers, including elders, youth, women, and religious leaders, were trained through this partnership to perform a door-to-door Ebola information campaign and search for active cases in 88 health districts. With training from public health professionals, citizens began reporting deaths and suspected cases to the town chief, who took the information up the leadership chain.
"By focusing on health education for the elders and chiefs and having them lead and organize the community outreach, resistance quickly changed to assistance," said Pewee Flomoku, chief of party for The Carter Center in Liberia.
Another prong of the Center's Ebola response in Liberia was to help the government develop and implement a strategy for disseminating timely, accurate information about the epidemic, including use of funds, case detection, and food distribution as imports dwindled.
"As the crisis intensified and with inadequate resources to deal with it, there was a lack of certainty and even distrust about what the government was doing," said Laura Neuman, director of the Center's Global Access to Information Initiative. "The Ministry of Information asked us to help because we had been working with them for several years to maximize transparency and accountability and increase citizens' access to all types of government information."
The Carter Center helped coordinate over 50 government briefings and their radio broadcast. The Center also leveraged freedom-of-information networks in seven counties to reach people at community events with Ebola information, encourage use of the freedom of information law, and help collect on-the-ground realities to share with local and national authorities.
The devastating toll on life and fear of the contagion also created the need for widespread psychological first aid. Mental health clinicians trained by The Carter Center since 2010 shifted their focus to citizens' psychosocial needs in the face of the epidemic, and Center staff in Liberia worked closely with the Ministry of Health on emergency response.
"Communities had a hard time dealing with anger toward those who got infected and infected others. There was a lot of discord around survivors and whether they continued to be infectious. In general, there was just a lot of loss very quickly for individuals and a strain on community dynamics," said Dr. Janice Cooper, the Carter Center's country lead for its mental health work in Liberia. The Carter Center sponsored community dialogues to foster healing and gave Ebola-specific training to more than 200 mental health clinicians and other health workers.
The Center will respond to psychosocial needs in Liberia for the next three years, well after the epidemic is over, with counseling, community dialogues, anti-stigma campaigns, further training for mental health providers, and the creation of a cadre of child mental health clinicians to be deployed to schools.
"Taking care of orphans and vulnerable children and seeing that survivors get resources available to them will be a priority for a long time," Dr. Cooper said.
Published March 17, 2015.
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