Ebola=System Failure: Why A Grassroots Response is Necessary

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A Presentation by Simon Tsike-Sossah to:

Africana Studies, Office of International Education And The Modern Languages Department

Metropolitan State University of Denver

11th February 2015

Key Words:

Governance, Regionalism, West Africa, ECOWAS, systems, corruption, failure, Grassroots, accountability, politics, discrimination, enforcement, answerability, human rights.

Why is Ebola a system failure?

We cannot talk about a system failure without first talking about what that system is – in the view of Kant; it is “an organized set of interrelated ideas or principles”; as in the feudal system, it could be social, economic, or political organizational form.

For Talcott Parsons, it is the matter of “social order”, that is, “the nature of the forces giving rise to relatively stable forms of social interaction and organization, and promoting orderly change”. [1]

Various other sociologists such as Auguste Comte, Karl Marx, Herbert Spencer and Emile Durkheim, have all been consumed by the concept of system or order in our society.

Some have seen it as an issue of hierarchy, while others have seen it as relationships in the case of Marx[2], who saw it as class issue – a relationship between classes involved in economic and political power.

I will like to contextualise failure and in particular, system failure as ‘inability to function in or for the intended purpose’.

Health facilities – hospitals, clinics and community health centres were annexed to care for Ebola patients. Pregnant women, children and everyday people with everyday sicknesses could not access health facilities, either because they have been annex or are afraid to go there because they could catch the virus. People fear to go the one place they can get better from sickness – unless of course you had Ebola.

Government offices shut down – you could not access government offices in many towns and cities. In the capital Freetown and Monrovia, only the barest essential visits to government offices were permitted. One had to wash their hands before entering and after leaving government facilities.

Banks worked from 9am to 2pm or less; in a context where temperatures are always in the upper 20s, it was difficult not to sweat; or have that sweat not rubbing off another person. Imagine not touching people in a capital where 2.5million of the 6million live.

Public transport was a hazard even before Ebola. People rode on motorbikes, popularly called “okada”. Imagine that sometimes you had 3 or 4 people on a bike. Imagine that in Liberia, taxis took 6or7 passengers – the driver in the, and two others in the front and between 4 and 5 at the back depending on the size of the car. Now since something as normal as sweating could transmit the virus, picture the situation and imagine how many of the 20,000 or so cases could have been from public transport?

Farms and farming cooperatives shutdown as the famers died, lost farm hands or as whole cooperatives grind to a halt because of death of its members. Imagine not being able to go to the farm to harvest or plant.

As the virus raged on, tough emergency powers in Sierra Leone and executive powers in Liberia were invoked and implemented and further curtailing the rights of the people. Inter-region or district travels were banned, businesses grinded to a halt. Buying and selling – the main businesses in Liberia and Sierra Leone saw a decline and prices went up by up to 40% in the cities and even higher in the interior as less and less transportation of goods and services reached those parts of the countries.

Schools were next, from crèche to University, with little or no infrastructure to provide education beyond the classroom, the state resulted to limited broadcast of lessons via television and radio, but with no means of evaluation and testing, those services were quite useless. Of course there was the challenge of providing constant electricity with which people could watch the television or listen to the radios.

Ebola was not just a health crises; it affected transportation, health, administration of justice, finance, agriculture and anything “under the sun” for the Liberian or Sierra Leonean.

The government and people could not function. It was a failure! A system breakdown!

But why is it a failure?

After only 12 years of peace, it is understandable that Sierra Leone was in a hard place regarding its institutional preparedness; however, we cannot discount that fact that, Sierra Leone has been working on the Lassa fever since the mid-70s at the Kemema Government Hospital (KGH)[3]. The Lassa fever is transmitted, or spread, to humans by rodents through their urine and droppings. The virus is contracted though touching objects or eating food that is contaminated with these materials or through cuts or sores[4],[5]. Lassa Fever in all its manifestations is the cousin of the Ebola virus – it is also a haemorrhagic fever.

So the problem is not a poor understanding of Ebola or haemorrhagic, but rather, a lack of turning knowledge into action. There was a gap between the knowledge development process and turning that process in to real people-centred policy making.

The KGH’s research on Lassa was and is funded by the Government of the United States through the CDC from inception till date. Until August 2014 when a media speculation emerged New Orleans based Tulane University has been refused funding for the continuation of its $15milion Lassa/Ebola testing/research project at the KGH[6].

Map of Sierra Leone

Political Map of Sierra Leone

What is difficult to process is the fact that, the government of Sierra Leone has no budget lines for this important work given that people in the Kenema and its surrounding areas suffer from the Lassa fever. A few kilometres from Kenema (in Kono) are the diamond mines that could easily fund a $15million facility.

According to the website of the Viral Haemorrhagic Fever Consortium (VHFC),

“Overwhelmingly, Lassa Fever is a disease that affects the poor living in rural housing without proper sanitation and pest control resources. The cost of treatment can therefore be a huge deterrent for sick individuals seeking medical attention. The VHFC continues, patients with Lassa Fever receive treatment free of charge at KGH. Due to the highly contagious nature of the virus and its ability to spread rapidly through entire communities, the government has wanted to ensure that everyone has access to the necessary drugs and care. All medication is provided free of charge by the government and even food is made available to the inpatients of the Lassa ward.”[7] – Viral Hemorrhagic Fever Consortium

Because of the lack of accountability of the government of Sierra Leone to its own people, they have a system that they have no control over; had not protocol for accidental contamination, indeed the Ebola virus exposed the government and the line ministry – the ministry of health.

There is lack of accountability when UN and government statistics show that the first case was in Kenema following a miscarriage at the KGH by a young woman on 24th May 2014. However, while I was in Freetown in April through to May, there were reported cases (rumours) of people dying in the outskirts. Bo, Kenema, Kailahun and its environs were particularly problem areas because of their political colouration; but these areas also have huge political significance in Sierra Leone. Bo, Kenema and Kailahun are seen as the strongholds of the opposition Sierra Leone People’s Party (SLPP), and thus politically discriminated against by the All People’s Congress (APC) Party. Kailahun more particularly because that was the part of the country where the rebels launched their attack from during the assault on Freetown during the civil war.

Back in Freetown where I spent 6 weeks during the months of April and May, Ebola was discussed with political lenses, the APC led government gave the impression the problem was limited to Guinea and the places along the borders. From monitoring the media landscape, the impression was that, “this will not reach Freetown and will be limited to the regions that are opposition areas.

In the meantime, there were on going rifts in the ruling APC. President Koroma, just two years into his second term was exploring elongating his tenure by tinkling a third term agenda. The party was therefore divided among three lines – the supporters of the President, the second group supporting the Vice President who has been stripped of all of his powers and the third group led by Dr. Richard Conteh, then the chief of staff and later relieved of his position. So while the people died in the interior, the chess game was rife in the capital on who takes control of the party.

By end of April, the popular slogan in Freetown was “After U, Na U”, to wit, “the next President after President Koroma will be himself.”

After U Na U

The 3rd Term Agenda Paraphernalia

The opposition’s response to that rhetoric was “After Gbagbo Na U” to refer to the demise of the former President of Ivory Coast – Laurent Gbagbo who tried to elongate his presidency in 2011. Mr. Gbagbo is currently facing trial in The Hague at the ICC for crimes against humanity following the violence that followed the 2011 elections in that country.

The Economic Community of West African States – ECOWAS

The ECOWAS is a 15 member[8] economic and political regional organisation founded in 1975 with the mission “…to promote economic integration in all fields of economic activity, particularly industry, transport, telecommunications, energy, agriculture, natural resources, commerce, monetary and financial questions, social and cultural matters …..”

Note that…

The West African Health Organisation (WAHO) was formed in 1987 when the Heads of State and Government from all fifteen countries in the Economic Community of West African States (ECOWAS) adopted the Protocol creating the organisation. The Protocol, which was subsequently ratified by each government in the sub-region, grants WAHO status as a Specialised Agency of ECOWAS and describes the organisation’s mission as follows: “The objective of the West African Health Organisation shall be the attainment of the highest possible standard and protection of health of the peoples in the sub-region through the harmonisation of the policies of the Member States, pooling of resources, and cooperation with one another and with others for a collective and strategic combat against the health problems of the sub-region.” Article III, Paragraph I 1987 Protocol of WAHO (in French)

The driving force behind WAHO’s creation was the incongruence of the agendas that were being pursued by the two existing inter-governmental health organisations in the sub-region, the Francophone Organisation de Coordination et de Cooperation pour la Lutte Contre les Grandes Endemies (OCCGE) and the Anglophone West African Health Community (WAHC). It was determined that, as matters of health are not bound by linguistic difference, it would benefit the organisations to synchronise their efforts and combine resources to enhance the impact of their programmes in West Africa. Thus, the OCCGE and WAHC merged to form WAHO, an organisation committed to transcending linguistic borders in the sub-region to serve all fifteen ECOWAS Member States. In October of 1998, the ECOWAS Heads of State and Government established Bobo-Dioulasso, Burkina Faso as the site of WAHO Headquarters and appointed the Organisation’s Director and Deputy Director. In March of 2000, WAHO began active operations as a leading health authority in the sub-region, serving ECOWAS Member States[9].

The visions and strategies are captured as:

WAHO is a proactive instrument of regional health integration that enables high-impact and cost-effective interventions and programmes by:

  • Maintaining sustainable partnerships
  • Strengthening capacity building
  • Collecting, interpreting and disseminating information
  • Promoting cooperation and ensuring coordination and advocacy
  • Exploiting information communication technologies

During all the Ebola crises, there were three key moments for ECOWAS: first was a March 25 ministerial meeting where the ministers of Mediation and security council[10] “authorised” the Commission “to take appropriate action in collaboration with the relevant health institutions in the region to mobilize stakeholders and resources to stem the spread of epidemic.”[11] The second was on August 1 when the President of the ECOWAS Commission His Excellency Kadré Desire Ouédraogo said at a meeting of the ECOWAS: “We consider it (the outbreak) as a regional security threat and under the directive by our Heads of State and Government to the Commission and the West African Health Organization (WAHO), an Ebola Solidarity Fund has been set up to ensure that all affected countries are supported to rid our region of the disease…”[12].

The third and real effort to do something about Ebola that had hit 3 of 15 members with real treat to the other countries only happened on August 26th in Accra during the Health Minister Conference[13] after 3,069 cases and 1,552 deaths had been recorded. Again, the Ebola solidarity fund was mentioned, but till date there is no record of how much was raised, made available or spent. A part from some obscure publication[14] stating that Nigeria made a pledge of $3million to the fund and earmarked thus: Guinea ($500,000), Liberia ($500,000), Sierra Leon ($500,000), WAHO ($500,000) and ECOWAS Pool Fund for Ebola ($1 million). There is no documentation of that pledge being redeemed or if the funds were ever released, neither was this highlighted on the ECOWAS website.

The scenario is not different from the AU and other regional organisations on the Continent.

The Change in the lexicon of Ebola Affected Countries

The lexicon of the countries affected by Ebola have seen dramatic changes; new words and phrases have emerged:

  1. Partial Lock-down
  2. Lock-down
  3. ETC – Ebola Treatment Centre
  4. ETU – Ebola Treatment Unit
  5. ABC – Avoid Body Contact – think of the many other ABC’s of public health discourse
  6. APC – Avoid Peoples’ Compound
  7. Ebola Corruption

It is this last one I want to talk about – corruption related to Ebola. In the news, from our networks and donors, the issue of fund misuse is well documented.

Dr. Oyewale Tomori, president of the Nigerian Academy of Science is extensively quoted in a Journal of Science in Berlin, charging West Africa was “swimming in an ocean of national apathy, denial, and unpreparedness”[15].

He went on to say: “GAVI [a public-private partnership that funds vaccines for low-income countries] just sanctioned Nigeria after a critical audit report. GAVI gave us money to do certain things, and we could not account for $2 million or $3 million of it. GAVI insisted that Nigeria must pay back that money, and the government agreed. But our government should not just agree to pay back the money, the government should find out who misused the money, get the money back from those persons and not from public coffers. And those people should be brought before the courts to answer for the deaths of the children who did not receive the vaccines that the GAVI money would have provided.”[16]

In Sierra Leone, the Minister for Tourism and Cultural Affairs, Mr. Peter Bayuku Konteh (now resigned) was accused of scamming Italian organisations to the tune of over €25,000[17]. Mr. Konteh resigned his position and has not been investigated. His resignation was on health grounds.

There were social media photos of staff of NGOs and UN agencies stealing food supplies to sell on the black market in both Sierra Leone and Liberia.

Accountability (in) Governance and Answerability

According to Rick Stapenhurst and Mitchell O’Brien, “Accountability ensures actions and decisions taken by public officials are subject to oversight so as to guarantee that government initiatives meet their stated objectives and respond to the needs of the community they are meant to be benefiting, thereby contributing to better governance and poverty reduction.”[18]

With “accountability” comes with the concept of “Answerability” or “Blame” as is reflected by Angela M. Smith (2012) in her work: “Attributability, Answerability, and Accountability: In Defense of a Unified Account”. But unlike Smith, there is no opportunity for the heads of government (in Liberia, Guinea and Sierra Leone) to justify themselves. All heads of states in the three countries swore oaths to protect and defend their citizens and yet failed to do so. The structures that were to guarantee their oaths; these structures that they oversee did not work when the demand was made of them. As an external agent, and for the citizens of Sierra Leone, Liberia and Guinea, there is no need for moral evaluations and are therefore excused of “evaluative judgments.”[19]

The essence then of answerability is to understand; where there is a “relationship where an individual or body, and the performance of tasks or functions by that individual or body, are subject to another’s oversight, direction or request that they provide information or justification for their actions” – Stapenhurst and O’Brien (undated).

How Communities Helped Worsen the Transmission

Certain traditional practices such as washing dead bodies, traditional birthing, etc have helped spread the virus.

Communities have also prevented agencies and aid workers access to sick relatives because the misconception that the agencies and their staff made things worse for the sick. In Guinea, we have heard how some aid workers were killed[20] because of the suspicion that they help spread the virus.

Communities Mobilizing for Themselves

Dr. Peter Clement is quoted telling Chiefs and People of Lofa county in Liberia: “In many years, you have not fought with these people,” he told them. “Now you attack them. They are not the enemy, Ebola is the enemy. If we don’t chase Ebola, it will kill us. You have to know Ebola to fight Ebola. Mobilize your people. Let’s get to know Ebola.”[21] This was in October, in that time, DERSWA was in its final formation. Agreements were being reached with partners on how to work, etc. And we felt the best way to overcome Ebola was to work with the communities. So it is exciting for us to hear that our call for community involvement was not only being advocated by the local organisations, but the UN and its systems were seeing the light too.

Our partner, Shalom[22], was already providing home care to suspected patients and helping secure their homes and getting external help.

Since then, the trajectory changed; people were themselves organising, policing their own communities and supporting each other.

Grassroots organisations found their ground again and have helped to bring the numbers to where they are now.

While many organisations were looking at providing education via television and radio, DERSWA/ACIPP were asking different questions: “how to you measure the effectiveness of the teaching and learning that was happening over airwaves”? It turned out there was not systems to understand if the children understood what was happening. Classes were short and too fast. Very few families had televisions or radios so we shipped 120 pieces of radio to Freetown. This month, we will be buying in-country another 200 or so to further distribute. This radio distribution is a part of 500 pieces we secured from Ears to Our World. We estimate that this project will reach 2,000 people; letting children in different levels to access education and entertainment while parents and adults can access public health education related to Ebola.

But this is not enough – we are obsessed with measurement; testing so we have found a US based organisation we are working with to help send 500 preloaded tablets to help bridge the gap of what the children get over television and radio to actually measure what they are learning.

We have thought about the issues of how to charge the tablets, to what content to put up, training and evaluation among others. We hope this pilot will help us understand how to support the children further and help them be ready when the next West African Examinations are due. Note that, the UN, its agencies and the big International NGOs have no such programming while they have the largest pot of money coming to them. Their work, in the context of post Ebola strategy does not scratch the surface of the issues the local/grassroots organisations let us.

Conclusion

Ebola has deepened poverty in Sierra Leone, Guinea and Liberia. Human rights were abused; many rights were taken back by the state. The social, political, economy and the cultural spaces have been affected and changed in many ways.

With nearly 10,000 deaths, tough questions must be asked even as we fight to contain and wipe out the virus.

We must think fast and hard, of how to extract answers (not blame). The ways to find those answers are varied and many. Many authors have espoused various ways of extracting accountability and answerability, however, I believe the best way is a people-cantered, community-led storytelling and documentation process that allows history to be re-written in a way that is personal to the people and help in identifying and shaming the people with the most responsibility while at the same time, providing healing.

The best people to lead this process of healing and extracting answers are the local organisations; what they need is for us to WALK with them, support them and not usurp their roles and spaces.

Thank you.

Note:

S. Eyram Tsike-Sossah holds an Msc Political Science from the University of Amsterdam and an MA from the University of Cape Coast in Ghana. He is the author of “Youth and Local Governance: Youth Participation in Local Governance: Bringing Youth to Decision Making in Sierra Leone“. Simon works for ACIPP West Africa as its Executive Director and also leads is Consulting work in Sierra Leone and Liberia. Currently, Simon is leading the efforts of grassroots organisations in Sierra Leone and Liberia to help fundraise for them to implement Ebola related projects.
This blog is the private work of Simon Tsike-Sossah and do not represent the views of the organisations he works for.

[1] See: Shils, E., Naegele, K. D., & Pitts, J. R. (Eds.). (1965). Theories of society: Foundations of modern sociological theory. Free Press.

[2] Marx, K., & Engels, F. (1848). The communist manifesto. Karl M

[3] See: http://vhfc.org/consortium/partners/kgh

[4] See: http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/fact_sheets/lassa_fever_fact_sheet.pdf

[5] http://www.cdc.gov/vhf/lassa/

[6] See: http://www.reuters.com/article/2014/08/07/us-health-ebola-funding-exclusive-idUSKBN0G72C220140807

[7] See: http://vhfc.org/consortium/partners/kgh

[8] ECOWAS was a 16 country organisation until Mauritania left in 2000

[9] From the website of the WAHOOAS: http://www.wahooas.org/spip.php?page=rubriqueS&id_rubrique=24&lang=en

[10] see: http://news.ecowas.int/ – Release N°: 056/2014 28 March 2014 [Yamoussoukro – Cote d’Ivoire]

[11] ibid

[12] http://news.ecowas.int/ Release N°: 145/2014 1 August 2014 [Abuja-Nigeria]

[13] http://news.ecowas.int/ Release N°: 153/2014 29 August 2014 [Accra-Ghana]

[14] See: http://www.worldbulletin.net/haber/140474/ecowas-sets-up-solidarity-fund-to-fight-ebola

[15] See: http://news.sciencemag.org/africa/2014/11/nigerian-virologist-delivers-scathing-analysis-africas-response-ebola

[16] ibid

[17] See: http://news.sl/drwebsite/publish/article_200526849.shtml

[18] Rick Stapenhurst and Mitchell O’Brien http://siteresources.worldbank.org/PUBLICSECTORANDGOVERNANCE/Resources/AccountabilityGovernance.pdf

[19] Angela M. Smith: Attributability, Answerability, and Accountability: In Defense of a Unified Account, Ethics, Vol. 122, No. 3 (April 2012), pp. 575-589 (pg 578)

[20] See: http://www.cnn.com/2014/09/19/health/ebola-guinea-killing/

[21] http://www.who.int/features/2014/liberia-stopping-ebola/en/

[22] Shalom is into HIV/AIDS care and support programming including providing palliative care

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