Fighting Ebola, Liberia’s ‘Invisible Rebel’

//Fighting Ebola, Liberia’s ‘Invisible Rebel’

Fighting Ebola, Liberia’s ‘Invisible Rebel’

By | 2014-08-30T11:40:33+00:00 August 30th, 2014|Health|0 Comments

Women pray for an end of the Ebola epidemic on Aug. 14, 2014, in Monrovia, Liberia. (John Moore/Getty Images)

The following is a guest post featuring field notes from Liberia’s Ebola outbreak by Leah Breen. Breen is a senior at Colby College majoring in Global Studies and Government.

Monrovians call Ebola the “Invisible Rebel.” The ongoing public health crisis, now in its sixth month, evokes memories of Liberia’s 14-year civil war that ended in 2003. “When war was here, you could see the soldiers coming, you could see the bullets flying and striking. You could run and protect yourself. But now, there’s no way to know where Ebola is or whom it will hit,” a Liberian tells me. I’m standing with a group of Liberians next to a hand-washing station. Still, people note that hands washed in bleach solution aren’t enough to resist Ebola. They joke saying, “Liberians don’t need to buy [skin-lightening] bleach lotion anymore! My hands will soon look like a white man’s!” Liberians have begun to greet each other with “foot-shakes” instead of handshakes.

In late July, I walked past the James Spriggs Payne airfield and noticed a group of women in white T-shirts sitting in the grass along the side of the road. They gathered for two weeks until the government prohibited crowds from amassing. The scene mirrored images from documentary film footage of the 2003 women’s peace movement. Then, activist Leymah Gbowee organized thousands of Liberian women to pray and protest for peace. They wore white and gathered at the James Spriggs Payne airfield. Leymah Gbowee and her Women of Liberia Mass Action for Peace are often credited with ending the war: her movement’s organizers held rebel leaders hostage at peace talks in Ghana and all but forced them to sign the Accra Comprehensive Peace Agreement.

That was 2003. Eleven years later, women again came together to fight the Invisible Rebel. This time, however, the women didn’t hold political signs that read, “Wake up women, our nation needs peace.” This time, the women sang, danced, prayed, and fasted for Liberia to overcome Ebola. They directed their appeals not toward politicians, but to God.

“In Liberia, there’s not a democratic situation…even if there was, people would never reelect Madame Sirleaf,” a Liberian business owner says. “If the government had responded to Ebola in March, we wouldn’t have this problem today. Instead, Ma Ellen did what she always does—she waited until the situation got so bad the international community had to send aid. Financially, Liberia is not independent.”

At Monrovia’s only Western-style coffee shop, a U.N. staff member observes, “Ellen Johnson Sirleaf’s decision to close the borders was just to appease the international community. It barely means anything to close the border between Guinea and Liberia or Sierra Leone and Liberia. One can easily cross through the bush.”

In late July, the government announced a new travel policy at Roberts International Airport: required fever testing for all passengers. There was just one issue, as a traveler points out in an e-mail, “The thermometer read 32 degrees Celsius (87 degrees Fahrenheit) for every person…When the issue was pointed out by a traveling public health worker, [the screener] responded by stating that the thermometer was supposed to read lower than normal.” When I boarded a flight three days later, it was no surprise that my temperature read the same: 87 degrees. The government may appear to outsiders to be implementing effective preventive measures to hold the virus in check, but their containment strategies are dubious and the impacts are potentially harmful.

The World Bank just upped its pledge of assistance to $490 million to fight Ebola in West Africa. When I ask why the women and others weren’t demanding a stronger response from the Liberian government, a Liberian says, “Then the AFL (Armed Forces of Liberia) would say you’re disrupting the peace and they would give you 50 lashes!” He laughs as he says this but then explains, “Most people don’t want to organize and protest because we don’t want to scare away international health workers and volunteers. There’d be more chaos if international funding were cut. During the end of the war, it was the international community that brought peace to Liberia, not the Liberian government.”

Not everyone is wary of civil unrest. On a beach outside of Monrovia, I met an ex-combatant who fought as a captain under Charles Taylor in the Armed Forces of Liberia. His father was a former governor who was hanged for overseeing the ritualistic killings of 14 people.

He argues, “There’s no such thing as Ebola. The government ordered doctors to inject sick people with a disease that makes them very weak, and then the doctors remove the patients’ kidneys to sell for the government. Why do you think the hospital never returns the bodies to the families and buries them wrapped in plastic? So that no one will see that the body’s kidneys had been removed.”

The former captain is the chairman of the Unconstitutionally Disbanded Armed Forces of Liberia. Recently, these ex-AFL soldiers signed a document to remove Johnson Sirleaf from the presidency. His conspiracy theory may or may not be based in poor knowledge about how Ebola spreads, but it is definitely politically motivated. He appears to be capitalizing on the opportunity Ebola presents to help foster further widespread distrust of the government.

Liberia’s civil war raged from 1989 to 2003. Many citizens felt that the numerous rebel groups existed simply as conduits for greed. Today, citizens complain of corruption throughout their government. Many are upset that Johnson Sirleaf won a Nobel Peace Prize in 2011 even though the Truth and Reconciliation Commission of Liberia recommended that she not hold public office for 30 years because of her support for former president and warlord Charles Taylor.

According to the World Food Program, 64 percent of Liberians live in poverty. Infrastructure is poor—buildings in Monrovia that were looted during the war remain abandoned. Only 14 percent of Liberians attend secondary school. Liberians have good reason to believe that their government is not doing enough to increase quality of life in the country. Hospitals are often long distances from towns and villages, and the ones that do exist aren’t properly equipped. Citizens know that government officials often leave Liberia for the United States or Europe to seek medical attention. Since there are few clinics or hospitals outside of the capital, most Liberians have had little experience with the formal health system. When health workers appeared in communities to combat Ebola, citizens were skeptical of why the government was suddenly paying attention to them. In Lofa County, a rural region on the border with Guinea, citizens attacked health workers. In West Point, a Monrovia slum that the government consistently ignores in development projects, citizens looted an Ebola clinic.

Ebola is beginning to cripple the country’s already weak economy. The government restricted travel between counties, so citizens outside of the Monrovia area cannot travel to the city to purchase groceries. Food prices, especially the price of rice, a staple food, have spiked. The Ebola crisis has caused businesses to shut down or slow, international investments have come to a halt, and with the costs of food rising, many families are struggling to eat.

Illness and injuries are common in the West African country, but with each day that hospitals remain closed, more non-Ebola patients grapple with medical issues on their own. A Liberian friend writes, “My brother was hit by a bike and sustained multiple fracture to his leg and head. Because of the Ebola virus, most medical facilities are closed to the public. I’ve been trying to get a bone specialist or any doctor at all to give him some antibiotics or pain killer or to set the bone back to no avail. My brother stayed indoors bleeding for 18 hours. Yesterday I finally got a gynecologist to have a look at him and he prescribed some medication for him. My brother leg is going bad. I am still hoping to find someone to help him. I’ve been all over the city looking for help.” In this crisis, state services for citizens have evaporated. Another Liberian says, “This is worse than the war, at least during the war, the rebel soldiers understood the importance of hospitals and they kept them open so if you got sick or hurt, you could go. Now, there’s no hospital to go to.”

On Aug. 19, Johnson Sirleaf ordered a city-wide curfew from 9 p.m. to  6 a.m. and quarantine for West Point, Liberia’s largest and most densely populated slum of 50,000 people. Citizens immediately began protesting, and on Aug. 20, soldiers fired live rounds at the crowd when residents attempted to overthrow a barricade. The quarantine sends the message to West Point’s residents, all of whom live in extreme poverty, that the government is attacking them, not the virus. A Liberian friend says, “West Point is home to many ex-combatants. I fear that they may organize and grab arms from the AFL and violence may erupt. Already a boy died from bullet wounds from the shots the soldiers fired.”

Michael Goldfarb, spokesman for Médecins Sans Frontières, wrote in an e-mail, “There is no indication that confining whole communities to their villages or neighborhoods is an efficient approach to containing the epidemic at such an advanced stage of the outbreak. Quarantines and curfews tend to instill fear and distrust towards the whole of an outbreak response, including health structures.”

In order for a government to manage a health crisis, citizens must believe that their government will work to protect to them. Citizens must be able to trust that the government is acting in their best interest. Liberia’s 14-year war, its widespread corruption, its questionable legitimacy, and limited presence outside the capital has hindered the development of citizens’ trust. When citizens do not view their government as accountable, they are not likely to trust the government in return. Perhaps that is why mobs of angry citizens have chased health workers, why an Ebola victim’s relative burned down the second floor of the Ministry of Health, and why citizens create roadblocks to prevent ambulances from collecting the bodies of Ebola victims. Only when citizen-government trust and accountability is embedded into the political culture will Liberia’s government and its people be able to work together to properly fight this Invisible Rebel – and future crises.