The Ebola situation has improved in Lofa County and Doctors Without Borders/Médecins Sans Frontières (MSF) has decided to withdraw from the area. New actors have arrived to help and since October 30 there have been no more Ebola patients in the Ebola Management Center (EMC) in Foya. The success of MSF’s intervention in northern Liberia can be considered a model of response, benefitting from a comprehensive approach and constant community involvement.
When MSF took over the management of the EMC in Foya in August 2014, the teams were not only faced with an overflowing patient load of up to 130 people a day but also had to deal with the population’s fear, denial, and misinformation, as they had never experienced an Ebola outbreak before. Soon it became clear that the intervention could not only focus on isolating patients, but that MSF needed to take a comprehensive and transparent approach if the virus was to be contained. Hence, the teams started to work on all six pillars of Ebola management, including isolation, outreach, safe burials, health promotion, psychosocial support, and contact tracing. Ebola deeply affects family and community structures, forcing people to avoid the most natural gestures like caring for their sick relatives or paying their last respects to the deceased.
“We are convinced that our all-encompassing approach, including open and transparent cooperation with communities, local authorities, and partners, has led to this impressive reduction in the number of cases in Lofa County,” says Ettore Mazzanti, project coordinator for MSF in Foya. “Trust and the understanding of the communities have been very important for the acceptance of our medical activities and, ultimately, in successfully containing the virus. Without understanding and adapted coping behaviors, it is impossible to reach zero cases.”
As no new Ebola patients had been reported at the EMC since October 30 and new actors had arrived in the area ready to take over remaining activities and surveillance, MSF decided to withdraw from Lofa County and redirect its efforts to areas with greater unmet needs. In the last few months, in preparation for departure, the team started reorganizing the EMC by gradually decreasing bed capacity from 85 to 10 beds and by reducing the number of national and international staff.
Supporting the Health Centers So They Can Reopen Safely
To support the local health system, MSF donated Ebola protection kits to health structures and focused on training health staff in the districts of Foya, Kolahun, and Vahun in Ebola patient care, including case definition, isolation, and supportive care, as well as on protective measures and infection control. In Lofa County, as in the rest of Liberia, the entire health system has collapsed as a result of the epidemic. Many health workers have died, most hospitals and clinics remain closed, and the safe reopening of essential health services is one of the most urgent needs at the moment.
“Health workers have been decimated by the epidemic and we must ensure that the remaining staff can return to work with confidence,” says Mazzanti.
Health promotion and mental health activities were slowly reduced as well, as more and more local NGOs became active in the area. By December 10, all MSF activities in these areas had ceased, as they had been completed and handed over to the Ministry of Health and its partners.
“It is great to see that life has almost returned to normal around here, but there are definitely mixed feelings in the Lofa community,” observes Mazzanti. “On the one hand, with MSF moving out, people are confident that the situation has improved. But on the other hand, people are concerned about the situation in bordering Guinea and Sierra Leone, where the outbreak is still ongoing. Also, with Christmas coming, people will be traveling a lot and there will be more gatherings, meaning that the risks of contamination will increase. We must definitely not lower our guard and we must remain vigilant.”
In Liberia, MSF is running a 240-bed Ebola management center known as ELWA 3 in Monrovia, as well as a 10-bed transit unit close to Redemption hospital. The organization has deployed emergency mobile teams in River Cess and Grand Bassa counties. Health promotion, outreach activities, and the distribution of malaria treatments are also taking place in these areas.
MSF began its Ebola intervention in West Africa in March 2014 and is now operating in Guinea, Liberia, Sierra Leone, and Mali. The organization runs six Ebola case management centers with a total capacity of more than 600 beds. Since March, MSF has admitted more than 6,500 people, of whom approximately 4,134 tested positive for Ebola and 1,796 have recovered. MSF currently has some 300 international staff working in the region and employs 3,125 locally hired staff.