A Grim Anniversary for Liberia

Anniversaries. We use them to commemorate the best of times and the worst of times. In Liberia, this is a grim anniversary -- one year of fighting Ebola. As I look back on my past year, I think of where we all were in the beginning of April, 2014, before the world faced one of the greatest public health emergencies in a generation, and I think of where we need to go.

In the early days of the epidemic, only a few cases of Ebola were identified, and by May, life returned to normal with no new cases. Sadly, that didn't last.

Nobody was prepared when Ebola flared up again in the summer. The President of Liberia declared a state of emergency in early August, health centers closed, and communities panicked. We learned that no one was immune from this disease as health workers, including foreign doctors and nurses, became infected while providing care to patients. Religious leaders residing over funerals became infected. High-ranking government officials were lost to the disease.

Liberia sounded the alarm as they tried desperately to respond to the perfect storm of transient populations, porous international borders, and unprepared health systems. International assistance poured in, providing the resources for essential training and bringing Ebola Treatment Units and Community Care Centers online. This proved effective, silencing the early, terrifying projections of millions infected and thousands dead.

Factual information was hard to come by, and action at the local level became critical. We utilized our community groups of Parent Teachers Associations (PTA), farmer associations, and water committees to broadcast messages on how to stop the spread of Ebola. It is ironic that the same way Ebola initially spread was our main tool against it. Strong cultural and religious traditions such as burial practices or even hugging were altered, which proved to be the most successful behavior changes to stop the spread of Ebola.

Because we were on the ground and able to respond immediately, the 700 communities we worked with received early training in infection prevention and control. They also received the supplies necessary to protect themselves, including hand washing buckets, bleach, and education -- supplies they did not have access to because of poor roads and far distances. Those 700 communities remained 90 percent Ebola free

While history has drawn political boundaries in West Africa, Ebola has shown us that these boundaries can often help the spread of a virus, rather than halt it. With porous borders, there is the need for a coordinated response throughout the region to ensure suspected cases of Ebola are treated at the closest centers, regardless of which country they are in.

In the end, Liberia and the world were simply not prepared. Ebola, or something potentially worse, will return if we do not have a strong community structures, functioning health system and education in place. The question is how do we move forward using the current response to build a stronger nation and region?

Liberia is beginning that recovery, but has a long way to go. As I started this reflection, we were 21 days with no new cases. But disease outbreaks have a way of ebbing and flowing and we now have a new case. In order to get to zero cases, and remain there, we must build community resilience. This means having adequate funding, training, and facilities to treat not only the emergency health situations, but also the everyday health ailments that affect us all.

Building resilience takes time, but it's an investment we cannot afford to miss. We must take to heart the lessons learned throughout this crisis and remember that our global health system is only as strong as its weakest link.

Jolene Mullins is the Liberia country representative for PCI (Project Concern International). You can learn more here.