Since the spread of the deadly Ebola virus to two Americans, the death of an American Liberian in Nigeria, and the death of prominent doctors in Sierra Leone and Liberia, the words, "catastrophic," and even "apocalyptic" have been used to describe the situation in the three affected countries -- Liberia, Sierra Leone, and Guinea. It is true that the Liberian President Ellen Johnson Sirleaf has called the Liberian situation a national crisis and that according to the Ministry of Health and Social Welfare in Liberia, as of Wednesday (July 30), the rate of infection was estimated at 22 new cases per day in Liberia (in the three countries, there has been an estimated 1,200 people infected and over 826 have died). The infection rate could easily climb higher, and there has also been sporadic violence associated with quarantining communities, disposal of bodies, and government (non) response.
On the ground in Monrovia, however, the scene is hardly like the movie Outbreak. People have been and continue to be out, traveling in the yellow taxis to get around the city. People are selling on the streets and the restaurants and shops are still full. The general attitude has been Liberian, "this too will pass." In a country ravished by decades of civil war, the general complacency should not be astonishing, nor a sign that the country is not concerned about the problem. But, individual behavior has changed in recent days, for the better.
For the first time, shops and even households have buckets of chlorine water outside for people to wash their hands before entering. Almost every single shop is outfitted with such buckets and security guards are quick to make sure everyone uses them before entering. Sanitation has improved immensely and the general cleanliness of the city has reached an all time high. People have stopped the cultural custom of shaking hands and snapping, now resorting to fist bumps or shoulder taps. Most importantly, in recent days, everyone is talking about Ebola, and behind this talk is talk about general hygiene. This is all unprecedented in Liberia.
If anything, the government declaration of national emergency and the international media attention has started a larger discussion about doing something and has raised much needed awareness about Ebola. I arrived in Monrovia a month ago and at that point, most people I spoke with did not believe that Ebola was real (in the one month that I have been here, signs saying "Ebola is Real" have become ubiquitous). And those that I talked to were not the stereotypical "ignorant, highly uneducated Africans," but many of them were highly educated, with multiple master's degrees. Social and economic class did not play a role in the denial that existed just a month ago. That is why the recent hype has helped to make people truly believe that Ebola is real. This has been a crucial first step in combating the virus and something that should have happened months ago. Now that international attention has basically forced the government to react, steps are being taken to curb the spread of the virus and for the first time more Liberians are starting to get on board.
One of the biggest problems presently and in the future could be that other medical emergencies are being ignored. Multiple people have already died because health care workers have refused to treat people for fear that they have Ebola. Much of this fear stems from the fact that this is the first time that the Ebola has reached West Africa. Health care workers are simply not trained to detect the symptoms, so the worst-case scenario is assumed for all medical emergencies. This fear combined with the already stretched-thin resources being used to fight Ebola could exacerbate the situation further, as people without Ebola are denied basic healthcare. This has already turned into a source of frustration for many Liberians.
At the headquarters of the Liberian National Police (LNP), the police are working together with the UN Mission in Liberia (UNMIL) to prevent the security situation associated with Ebola from escalating. There is now a LNP officer directly stationed in UNMIL headquarters to serve as a liaison so that response can be quicker. So far the security incidents have been isolated: an individual attempt to set the Ministry of Health and Social Welfare on fire, few riots in rural counties over lack of respect of burial rituals, attacking hospitals for not providing care to individuals and not releasing dead bodies for family burials, demonstrations against constructing isolation centers in different communities, and criminals taking advantage of citizen fear to commit burglaries (one common trick has been to fake vomiting so that people run away and leave the place open to burglarize). The response has been well coordinated between the LNP and UNMIL, perhaps because the incidents have been small and isolated. The LNP are also working to establish community patrols to raise awareness about Ebola in rural counties. The hope is that by working with traditional leaders, prevention can be more effective.
In fact, one of the better suggestions for containment has been to engage community leaders (village elders) in prevention efforts. Taking an enforcement-only approach may only serve to alienate and worsen the security situation, whereas working with traditional leaders to educate their communities and villages about Ebola may serve to be more effective, as most people respect and listen to their community and traditional leaders over government authority. Indeed, engaging and including traditional leaders and embedding explanations through cultural messages may be the only way to completely curb the epidemic, as was done in Uganda.
The situation in Liberia is undoubtedly grave, but the city is not in widespread panic as the international media has suggested. However, the international media attentions has definitely helped ensure that Liberians take Ebola seriously and has spurred a number of good practices such as having a national discussion on health, hygiene, and security. Maybe some of these trends will continue after the Ebola crisis comes to an end.