By Sherman C. Seequeh
It would be folly for the people of Liberia and those helping to repel the galloping spread of Ebola to concentrate on the virus alone and leave out the ill-fated measures employed by Government purportedly intended to curb the spread of the virus. The Government’s communication, preventive and other operational measures to remedy Ebola are as vicious, unmerciful and deadly as the virus itself. I am personally that surprised by reports that Liberia is topping the Ebola death rate. At least that is the general assumption of everyone. But I know for sure, unlike many others, that at the end of it all—when the Ebola stampede shall have been announced over whenever that time will be—the final number of fatalities including the present death rate would be equally shared between, and equally blamable on, the virus on the one hand and the intended and unintended excesses of Government’s professed panacea on the other. That is why I think that except there is an organized, visible response to Government’s professed policy measures against the pandemic as there is against Ebola, we are settled down for a long and costly fight. Why?
Deadly communication regime
A cousin of mine, who cut short his visit to Liberia and returned to the United States mid July, the accelerated point of Ebola in Liberia, voluntarily quarantined himself for more than 21 days before arriving home. He tells me that during that period spent in a hotel, he fought the onslaught of trauma and fear and is still fighting them even more than 30 days since. Each time there is a voluntary muscular movement in his body—whether it is in his head, leg or stomach—he feels it is a popping up of early signs monstrous Ebola. He says why in his self-imposed quarantine he felt he was sick; but that was just artificial fever which the fear and trauma he incurred during the Monrovia. The bad feelings went away when he paced idly up and down in the hotel, offered short prayers and words of self-assurance. “In fact when while in Monrovia, after listening to official statements of the Ebola situation, I felt the virus was walking on me every moment,” he tells me. “Even back in the States over a month now, the trauma and fear still haunt me.”
The trauma, fear—voluntary muscular movements and odd feelings, perhaps “artificial fevers”—haunt a short-time visitor here, and perhaps many more also thousands of miles away from Liberia. Consider the case of people living the situation and even now able to recite official pronouncements of Ebola without looking on paper. The fact of the matter is communicators and communicated messages from the administration create more panic and mental unrest amongst the population and, while I not a health expert, it is claiming unknown fatalities.
I understand that whenever one is diagnosed with HIV, the victim is caressed with counseling—with psychological doses—with the news is ever broken. In under there is a pretesting counseling, testing counseling and post-testing counseling. Though I am not a medical practitioner, I understand this is done because study shows that subsequent heartbreak from news of the diagnoses hastens the infected person to his death than the virus would do. If that is the case with HIV, then what about Ebola, which is perhaps ten times more deadly than HIV.
But in the case of Ebola, the message of infection comes direct, strict and blunt not only to the public, but also just as raw to the infected person. What would be the mental or psychological response of anyone told of attracting the deadly disease? How much additional health risk such a person carries before the first dose is ever administered?
I know someone will shout at me at this point and say, “You idiot, shut your month! Where has this been done since 1976 when Ebola was discovered? What makes you think communicators of Ebola must be euphemistic about a deadly virus? Don’t you know that this will leave people more vulnerable and at risk?”
Granted! To say there is no precedence for “euphemistic” communication, say pampering of victims and potential victims, during Ebola crisis doesn’t mean it is insensible to do it Liberia. Furthermore, what sense does it make declaring every sick person automatically Ebola infested as is generally being done right now? That is exactly what our communicators are telling people in the country. Every death is now a result of Ebola, and sadly some journalist colleagues are amused and copycatting official communicators on the pandemic. When a body is found in the street, in the community and at homes, it is automatically an Ebola dead. There is no delineation even between confirmed Ebola infection and Ebola dead on the one hand, and “probable” and “suspected” Ebola infection and dead on the other. In fact, I even understand that when major referral hospitals were temporarily closed and subjected to fumigation, all the dead collected from mortuaries of these public facilities were branded and reported “Ebola dead”.
The blurring of the line between Ebola infection or Ebola dead and suspected or probable Ebola infection as well as non-Ebola related death and sicknesses--whether or not it is deliberate to artificially increase stats to attract external donor money or whether it is inadvertent--is leading too many people to their early graves. Firstly as stigmatizing as Ebola has become, the public communication regime on Ebola drives many shy persons away from early treatment—whether that illness is actually Ebola or not and these people resort to self-treatment, quasi nurses or prayer mothers.
As far as we know, the Liberian health system had remained ineffective long before Ebola and the national mortality rate was high, with many more stricken with various illnesses. Today, in fact, the fate of those who were bedridden at the time Ebola struck is unknown following the military-styled closure and fumigation of major health facilities. For instance, according to the Annual Review Report National Health and Social Welfare Plan Implementation, 2011–2012, over 1.4 million citizens were logged and treated for malaria; 17,348 for HIV and STDs, 4,265 tuberculosis, 10,525 for Epilepsy, amongst others. And these were the feared killer deceases in the country before now. How many of these are being targeted as Ebola is and how are awareness messages creating the environment for infected people of these traditional ailments to come out.
Would it therefore be a euphemistic approach in remedying Ebola if the public communications regime on virus highlighted the delineation in their messages—also focusing other sicknesses that were raging before Ebola? By doing this—by ensuring that the public awareness on the virus is not stigma-laden and fear-fanning—everyone would freely lineup for checkup and testing, knowing that they are also going for checks on traditional illnesses, even if it meant some were later found to be Ebola patients. But as it is, communication on Ebola has increased trauma and hypertension amongst the populace, driving citizens away from early test and treatment, and leading lives lost and at times mistaken with Ebola statistics.
It thus makes sense to dispute reported mass deaths and bodies in the streets and homes being attributed to Ebola or to Ebola alone.
Killer Quarantine Order
Before I ever knew how to read and write, I had heard in my remote Bestman Town village in Sinoe County that Leprosy was regarded a misery disease and the infected persons were kept a mile or two away in the jungle from town. Leprosy, like Ebola, is not an airborne infectious disease, at least that’s what health experts say. And for Ebola, it is not transmitted unless the post-incubation infected person comes into close contact with and shares body fluids with potential victims. In Asia, the United States and Europe where deadly airborne diseases, such as SARS, H1N1, amongst others have killed thousands of people, there is no record that the epidemic-ridden countries quarantined entire communities and provinces as a solution.
This is why I agree with the New York Times’ opinion that Liberia and other West Africa countries were using primitive tactics to combat Ebola. This is how the respected newspaper put it in an article published recently: “The Ebola outbreak in West Africa is so out of control that governments there have revived a disease-fighting tactic not used in nearly a century: the ‘cordon sanitaria,’ in which a line is drawn around the infected area and no one is allowed out. Cordons, common in the medieval era of the Black Death, have not been seen since the border between Poland and Russia was closed in 1918 to stop typhus from spreading west. They have the potential to become brutal and inhumane. Centuries ago, in their most extreme form, everyone within the boundaries was left to die or survive, until the outbreak ended.” That is exactly what the Quarantine Order of Government is doing and will continue to do before and at the expiry of Ebola from Liberia, whether this is a deliberate or inadvertent objective of Government: “left to die or survive, until the outbreak ended”.
Dolo Town and West Point in addition to Western Liberian provinces, perhaps many others to soon follow, are quarantined and left on their own to forage at the mercy the national armed guards notorious in their military-civilian relations. I don’t know the population of Dolo Town—and while population may not really matter in this debate—West Point hosts for nearly 100,000 persons, not to mention Tubmanburg and its likes in the West. There was no report that Government had properly prepared the communities psychologically and nutritionally before cutting them off from the country. Within a day or two of the quarantine order, calls came from West Point, Dolo Town other quarantined communities that hardship, hunger and their accompanying nemeses were set in.
The policing of checkpoints to ward off infiltrations to and from quarantined communities has now taken over or overshadowed person-to-person, door-to-door and village-to-village awareness, testing and collection of suspected cases and responding to other traditional ailments in those communities which one expects would have been the priority after all. Worse still, little or nothing is done to address the nutritional concerns of the quarantined populaces in a country of a largely subsistence economy—eat all to go hustle—which has been the order of the day. In the case of over 70,000 people in West Point, the first publicity-studded intervention took 300 25kg or 150 50kg) bags of rice for distribution. Besides the fact the distribution was reportedly highly infinitesimal, it was disorderly and chaotic; and if West Point is truly an epic center of Ebola then the distribution, as far as it was done, had the potential to increase the rate of infection on that day.
So what is the purpose of the quarantine that does little or nothing as a remedy or doesn’t focus person-to-person contact but only waits at checkpoints to prevent movements to and from those communities? Why was the quarantine order imposed without prior awareness and mobilization of the people? Why tons of food—rice, oil, beans, etc,--now been sought from international donors not mobilized before effecting the quarantine order? Does the Government have the capacity to respond to the multiplicity of health and other vexing conditions of the quarantined populations and communities? Said in another way, can the government pickup three to five persons from each community ever day in response to health and nutritional and other emergencies (for instance, hypertension, cardiac complications, diabetes, natal, prenatal conditions, etc.) not related to Ebola?
We need not be deceived; the Government can’t answer those questions in the positive. Even in pre-Ebola times, it couldn’t; what much more when the health sector is in complete tatters right now! Does it therefore make any sense to lockup already hunger-embattled and disease-vulnerable populations for no substantial reason whatsoever? And so, what does it all lead to if you place clusters of towns and houses and huge populations in an open air prison without the commensurate response capacity? Mass death!
Killer Curfew and State of Emergency
The State of Emergency is all that crowns the deadly appellation of Government’s anti-Ebola measures. The Armed Forces of Liberia and its counterpart, the Police Response Unit (PSU), long eyed with suspicion and fear by citizens and foreign investors for the uncouth traits of their forebears are let loose like wild spices in the streets, highways and communities of Liberia. The presence of these armed units in the streets and communities of Liberia has raised temperatures of the population and investors. Their presence invokes the nightmares of the civil conflict years, more so because though professedly reformed and re-oriented, these armed units have hardly demonstrated a break from the traits of trigger-happiness, banditry and mayhem of their prewar and wartime ancestors.
You want to prove me wrong? Walk down Waterside and join the queues of citizens struggling to send food supplies to relatives caught in quarantine-paralyzed West Point. Or attempt travelling to Clay Junction and make an attempt to seek means to contact someone in Bo-Waterside. The countenances of armed are grim and warlike, their embarkation and disembark from vehicles is rebel-styled, their conversion or verbal exchanges crude, not to mention their militia-style law enforcement moves in communities.
The panic, trepidation and insurgency unrest-style environment created by the declaration of state of emergency and curfew not only make more cardiac patients, the number predictably rising amongst the population, creating another de facto health emergency situation, but also sends out messages having incalculable toll on the economy. In addition to the disruption of petit trade, as armed personnel chase and whip marketers and yana boys and girls, serious investors fearing the militarized environment and panic-ridden situation than Ebola got no intention to do normal business. Many have since fled. The economists will tell us what that means for the country.
Still prove me wrong with the coldblooded murder of a teenager, the live-bulleting of two to three others and the deliberate indiscriminate discharge of firearms on unarmed demonstrators that precipitated the showdown in West Point. And come to think about what could have happened if the demonstrators were well-intentioned was predicated when the curfew and state of emergency were declared. Indeed, it is those thuggish showdowns prevailing in the country that have underpinned the fear leading to the flight of investors and partial operations of several other concessionaries.
Clearly consequently, the imposition of both the state of emergency and curfew has turned the Ellen Johnson Sirleaf administration a rule of fear if not a rule of banditry. Fear is the order of the day, and our social scientists must be prepared to settle the biological osr medical impact and implications of this in the near future if not now. Who likes to exist, eat, move and speak in a state of fear if not under the rule of banditry? Which Liberian or friend of Liberia wants to hear about curfew again, about state of emergency and wants to see mistrusted trigger-happy armed Liberian folks? Not particularly investors and businesspeople. And pundits continue to dig out, without success, is just one cogent reason for, and tangible gain of, the declaration of these measures; I mean an achievement or progress made that would otherwise not be the case if the state of emergency and curfew were not imposed.
Think about this: Families having the burden of taking the sick to hospital during the night hours fear state of emergency, curfew and in some specific cases the prevailing quarantine orders. Don’t these measures prone to cause the death of people? Think about this also: Citizens who live on what we call here “hand to mouth” economy. How can they fend out for themselves under a state of fear and intimation—intended or unintended?
And finally, and think about this also iron: I heard and read that a Liberia’s Foreign Affairs official alarming about the “disproportionate and exaggerated” reactions of other African countries to the West African Ebola crisis. When I read this statement, I knew the Liberian senior diplomat was picking fuss with colleagues because the “disproportionate and exaggerated reaction” to Ebola is manufactured here right in his front-yard. It is the Liberian Government which has created a fear kingdom and employed killer measures via its “disproportionate and exaggerated” reactions to Ebola. Why don’t this Foreign Ministry official and his government know that the “land, sea and travel restrictions” they fear from other African countries are being imposed right here by them in the form of state of emergency, curfew and quarantine policies to fight Ebola. If it is wrong for Africa countries to punish Liberia in the way they are doing, which has drawn the attention the Ministry of Foreign affairs, then it is knowingly—and don’t want to unknowingly—wrong and sinful for the very government to impose exaggerated and disproportionate sanctions on Liberian citizens.
There is no doubt that Ebola exists in Liberia now and it kills and I have no doubt that Government may have intention to repel its spread and ultimately its defeat. What I also know is that the measures employed by Government are worsening the situation even to the level of driving citizens and non-citizens to their early death. Such policy measures by the Government may not be intentional but may be an outcome of the fact the pandemic is in its maiden attack on Liberia and there is no immediate lesson to learn from. It could also be a result ill advice, the instinct to prove though or just simply the dismissal of non-governmental advice and counsel.
I therefore call for the evaluation and possible reconsideration and reversal of Government’s communication regime, the abandonment of any instinct that the higher the stats of death blamed on Ebola the better for pecuniary gains and the mentality that suggestions from left are outright rubbish. Furthermore, the state of emergency, curfew and community quarantine must be stopped and more focus directed at the substantial, workable remedial actions—including one-on-one, door-to-door awareness and testing; clarion calls for anyone feeling the symptom of other illnesses to feel free to come for testing; perhaps special referral centers for non-Ebola related ailments; supplying households personal protection equipment (gloves, spraying detergents, etc) in case the temptation of temporarily caring for loved ones (children in particularly by mothers) is an imperative while awaiting; etc.
The zeal to overcome must calm down. Let the zeal clam down so that it reduces the natural impulses beating inside Liberians. Let all our people see this Ebola fight as a medical war, not a military insurrection on hand. In fact I wonder what this government would do if it had had a military insurrection on hand as was the case with Samuel Doe and Charles Taylor. What would it do when we see what is now transpiring in the case of Ebola?It is only when this Ebola fight is declared a war of all Liberians, and the people are not caged like domestic animals and militarized, the better and sooner victory will come. Otherwise, we reckon with a killer disease just as we reckon with killer policy measures.