For future reference – lessons learnt

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The Washington Post reports that people fighting Ebola are coming up with lists of lessons learned – not only for the current battle, but also for future outbreaks of deadly contagions.

Many of the lessons are surprising and specific – the colour of body bags turns out to be important, as does the design of Ebola clinics. The most common-sense lesson is that all Ebola is local; solutions can’t be dictated from Geneva or New York.

The broader and more ominous lesson is that global health organisations aren’t ready for a pandemic. There are countless conferences, reports and carefully wrought strategies for stopping epidemics, but this terrible year has demonstrated how hard it is to get resources – even something as simple as bars of soap and buckets of bleach – to vulnerable people on the front line of an explosive disease outbreak.

“You can’t just blast into a place and expect people to drop everything and do what you tell them to do,” says David Nabarro, the UN special envoy on Ebola. “They have to be utterly convinced your motives are good. They have to be able to share their view with you.” Archie C Gbessay, a Liberian who is coordinator of the Active Case Finders and Awareness Team in Monrovia, said recently that if foreign intervention and billions of dollars in contributions were all it took to stop the disease, “we should already be celebrating the eradication of Ebola from my country.”

This same lesson was hammered home by Monique Nagel­kerke, who recently wrapped up two months as the head of mission in Sierra Leone for Doctors Without Borders. “It’s the experts that get interviewed, but it’s people from the region themselves that come to work day after day,” Nagelkerke said. “They are the real heroes.”

Julienne Anoko, an anthropologist working on the Ebola response in Guinea, said, “the people suffering through this epidemic have something to say, and it’s important to listen to them first, instead of building solutions elsewhere and saying to the community, ‘We know your problem; this is the solution.’”

Many lessons were learned on the fly, in crisis mode, and they amounted to slight adjustments in tactics based on feedback from locals. Nancy Lindborg, a top official at the US Agency for International Development said: “You can get a strategy and it becomes an immovable constraint.” As the epidemic has evolved, she said, the US has decided to shift to “a rapid-response strategy” aimed at smothering Ebola wherever it pops up. “You have to be adaptable to the course of the disease.”

In an increasingly interconnected world, affluent countries have to be aware of — and care about — what’s happening in the poorest. “This is the poster child for why we should pay attention to fragile states,” Lindborg said. “This is a wake-up call. Thank God it was Ebola and not something airborne.”

Full report in The Washington Post

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