THe Blog

April 28, 2020

When Liberia forsook its Hand-shake


The Liberian handshake is elaborate. It starts with a regular handshake, followed by gripping, finger snapping and fist-pumping. In 2016, as Ebola gripped the nation, this handshake nearly went extinct. India’s namaste may give us some fleeting comfort in the midst of the COVID-19 crisis, but dealing with a pandemic requires more serious cultural shifts, as West African countries like Liberia can illustrate.The countries that were worst hit by Ebola had fragile governments and health systems, but their consolidated response to Ebola was ultimately successful. West Africa, like India, has several community-based cultural practices; tackling Ebola required mobilising community/faith leaders (including secret societies) and local youth. These often informal, local leaders helped with sensitisation, combating misinformation and encouraging testing/treatment. The establishment of Ebola-specific community-based care centers was another novel model that proved successful in some contexts. 


A second lesson from West Africa is that there has to be an active effort to find temporary alternatives for infrastructural gaps. For instance, most government offices in Monrovia, including mine, did not have running water. But each table in a government building had a sanitiser dispenser as part of its office supplies. Making temporary sanitation provisions for slums, relief camps and other densely populated informal housing without running water is essential to prevent cluster outbreaks.  


(Rain clouds loom over Monrovia, Liberia’s capital city, PC : author) 


Another much written about lesson from Ebola is the need to protect frontline workers. According to the World Health Organization (WHO), during Ebola, frontline health workers were up to 32 times more likely to contract the disease. It is important to understand that the transmissions and deaths among health workers are completely preventable. However this requires going beyond the provision of Personal Protective Equipment (PPE) and also creating barriers at health centres and ritualising correct donning and doffing of the equipment. Health workers may also be non-care workers who require adequate training. It is also important to provide for their post-traumatic care. The use of drones and other technological solutions for doing basic tasks is another protective strategy adopted during Ebola. 


In addition to the humanitarian response through WHO (US$ 459 million) and the United Nations (US$ 165 million), West African countries engaged in fund-raising through international charities, business communities and their diaspora. This is something state governments can and should replicate in the Indian context. 


Sub-regional centres for disease control were set up in order to allow multiple african states to pool resources and have common measures and guidelines, a model worth replicating at a regional level in India.


Finally, despite India's own experience with outbreaks of swine flu, dengue etc. state readiness to tackle epidemics is low. Health disaster preparedness is now a regular assessment for West African countries, to the extent that simulations of government response in Sierra Leone nearly triggered an actual response in Liberia. Even though India is still officially in the local transmission stage, drills for the community transmission stage must begin immediately.



(Water-side, one of the densest markets in the city, now cleared out for containing spread, PC : Nikhil Nair) 


While there is much to learn from what worked during Ebola, there are also useful lessons in West African countries’s failings. Ebola-hit countries often lacked diagnostic capacity which consequently led to severe under-testing upon outbreak. This is also because the onset of Ebola had non-specific symptoms, like COVID-19. 


Inadequate border control was another failing, exacerbated by the high human mobility across countries' land borders (guaranteed by right to free passage under the Economic Community of West African States agreement). While the Indian lockdown and cancellation of public transport across state borders has helped curb COVID-19 spread to some extent, little has been done to incentivise migrants to stay in their cities of residence, leading them to walk  to their villages


Government messaging in this period is also a sensitive consideration; some Ebola-struck countries erred here. States must clearly communicate the risks of the infection without inducing panic. As India sees an upsurge in panic-purchasing and exaggerated police response to e-commerce agents, governments must issue regular clarifications and actively engage its citizens. 


Conversations with large business owners, often expatriates, about their experiences during Ebola always brought up a counter-intuitive insight that their profit margins were highest then as they often won large contracts for building hospitals and managing supplies. It is therefore necessary for governments at this critical juncture to engage in responsible contracting. If well planned, matching SMEs and daily wage earners with the construction and supply needs of Corona-specific facilities could give them much-needed economic respite. Indeed, better economic relief and compensation for Ebola-struck industries and communities could have mitigated, to some extent, the $2.8 billion economic impact of the pandemic in the sub-region which continues until today


Citizens of West African countries also faced serious social costs of being identified as nationals of Ebola-hit countries, such as stigma and stereotyping -- something that even comedian Trevor Noah alludes to in his set on Ebola. This is all much too familiar now with migrant returnees and quarantined individuals, fearing and facing abuse. Mitigating these harms and social consequences is as much a need of the hour, as the economic consequences of the pandemic. 

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