In West African countries affected by the Ebola outbreak, Rotarians step up to help — and take a page out of the PolioPlus playbook.
Among the loved ones Elizabeth Mulbah has lost to Ebola: her foster daughter, Isatu Bayon, a nurse who caught the virus while caring for an Ebola-positive mother and infant; Bayon’s 20-year-old daughter, who was named after Mulbah and nicknamed “Diamond”; Mulbah’s sister-in-law, Jenneh Siabu; several nieces; and a heartbreaking number of colleagues. Mulbah is a former dean of a nursing school in Liberia, and as of November, 170 of the country’s health workers had died. Her brother, Molley Sowoi, contracted the virus but survived. “There are so many of these stories,” says Mulbah, a member of the Rotary Club of Sinkor, Liberia, one of the countries hit hardest by the outbreak. “We are brushing against death every day.”
Grieving is complicated. In a place where physical contact is discouraged to halt the spread of the disease, there are no embraces, no handshakes. When Bayon died, the family buried her photograph in a casket; her body had been taken away to be cremated. “We blow kisses, cross arms in greeting, wave, bow our heads toward each other, shake our feet, sing, cry, and pray together,” Mulbah says. “Telephones and text and email messages help a lot.”
Mulbah explains that although she can’t bring her loved ones back, she can honor them by working to stop the virus. “We need more hands to face the challenges after Ebola, so we must save as many people as we can, God being our helper,” she says. She helps train health professionals on how to stay safe as board chair of the Christian Health Association of Liberia, and she works with a women’s organization, a school, and the national government. She also collaborates with other members of her Rotary club to educate people in Sinkor, a residential neighborhood of Monrovia, about Ebola. “It becomes very personal at times,” Mulbah says, “but we cannot give up.”
“We are brushing against death every day.”
West of Sinkor, in an office near the waterfront in Monrovia’s Mamba Point neighborhood, Victoria Cooper-Enchia and David Frankfort discuss the Ebola relief work of the Rotary Club of Monrovia. Cooper-Enchia is club president, and Frankfort is Ebola committee chair. Paper-clipped to each of their shirts is a piece of paper with a number on it – their temperature, which they had to take before entering the building to prove they didn’t have a fever, one of the symptoms of the disease. Such tags are standard at many hotels, banks, supermarkets, and other public facilities. (Their club, in partnership with the Rotary Club of Marlow, England, is helping to provide non-contact thermometers to local establishments. Ebola is spread through direct contact with blood or bodily fluids such as saliva, sweat, urine, or vomit.) When the two arrived, they had to wash their hands in buckets filled with chlorinated water, another necessity the club is distributing; many buildings also have chlorinated sponges for people to step on so they don’t track germs on the bottoms of their shoes. A curfew is in place, the first since Liberia’s civil war ended, to minimize public gatherings. “This is what we’re living with every day,” Cooper-Enchia says. “We’re not sure how it will affect us when it’s over.”
She launched the club’s Ebola relief effort the day she was inducted as president. It is Rotary’s 50th year in Liberia, and Rotarians here are accustomed to serving in challenging situations, especially following the country’s brutal civil war, which killed 250,000 people between 1990 and 2003. In early July, after the virus seemed to have been contained, cases began to reappear. So she appealed to club members, who pitched in $1,000, which they used to donate 10,000 pairs of gloves to the Ministry of Health. By the end of the month, Ebola cases in the country had started to snowball. The club redoubled its efforts.
By October, it had donated 100 plastic buckets with spouts for handwashing, 120 pairs of rubber boots for health care workers, 80 mattresses, fuel coupons for Ebola response vehicles, and books for children so they could study at home while schools are shut down. When the club realized the hospital had no photocopier for patient records, it donated one, and when a Rotarian saw patients’ family members standing in the rain waiting for word about their loved ones, the club brought tarps and rope to create a shelter. When the club heard about a group of families who were quarantined and needed food, it helped out. “Our value is that we can fill those holes,” Cooper-Enchia says. “Big donors are bringing doctors and building centers. We’re responding locally.”
Hundreds of Rotary clubs worldwide have assisted the Monrovia Rotarians in their dedicated efforts, which they publicized on Rotary Ideas, Rotary’s new crowdfunding platform at ideas.rotary.org. The Rotary Board of Directors and Foundation Trustees discussed the crisis at their October meetings; watch for updates on Rotary.org.
Through PolioPlus, Rotary has laid the groundwork for the response to a disease such as Ebola. Emergency operations centers serve as the central command for polio eradication activities in northern Nigeria, providing locations for the government, Rotary, and its partner agencies in the Global Polio Eradication Initiative to pool resources and coordinate activities to prevent and respond to polio outbreaks. Staff members include 100 Nigerian doctors trained in epidemiology to assist in the polio eradication campaign. After a Liberian American lawyer collapsed in an airport in Lagos, bringing the Ebola virus to Nigeria, a team including 40 of these doctors was reassigned to establish a similar command center to tackle Ebola. Through diligent tracking of people who may have come in contact with the virus – including 18,500 in-person follow-up visits to 898 identified contacts – the country limited its total cases to 20 and deaths to eight.
“That’s what the ‘plus’ in PolioPlus has always entailed,” says World Health Organization spokesman Oliver Rosenbauer. “Whether it’s Ebola now, or the drought in the Horn of Africa or the earthquake in Pakistan or the tsunami in Southeast Asia, often it was the polio infrastructure that was front and center for the emergency response. They know how to work with local institutions, they know what’s available locally, they’re based at the grassroots level. That’s always been the case. Ebola is another example of that.”
The challenges of the Ebola outbreak are similar to those that have confronted the polio eradication campaign: fragile political environments, weak health care systems and, in some places, denial, says Heidi Larson, a senior lecturer at the London School of Hygiene and Tropical Medicine, where she leads the Vaccine Confidence Project. Techniques that have been effective in polio eradication can also be used to fight Ebola, such as working with trusted local partners, she explains. “Some of the community mobilization work that Rotary has contributed so much to is essential in this,” Larson says. And, after the outbreak is over, Rotary’s grassroots nature will help with rebuilding. “Rotary can play a valuable role in getting countries back on their feet.”
In Abuja, Nigeria’s capital, members of the Rotary Club of Abuja-Gwarinpa built on their experiences with polio immunization and awareness efforts to educate the community about the Ebola virus. Within weeks, club members had traveled in a mobile health van to pass out information to area residents and talked about prevention measures on the local radio station. Ama Umoren, a past president of the club, recalls that people were hungry for facts about the disease; they’d heard of Ebola and were afraid. Though the virus never made it that far north, it brought the need for hygiene education – and Rotary’s role in it – to the forefront, she says: “Thank God this is one of Rotary’s areas of service.”
The countries most affected by the Ebola outbreak already have fragile infrastructures and will need to rebuild extensively once this is over. In Liberia and Sierra Leone, the International Monetary Fund estimates that economic growth could decline by 3.5 percent because of crumbled mining, agriculture, and service sectors. “It’s going to be extremely difficult for business, for ordinary citizens, for the health system,” says Sam Mitchell, president of the Sinkor club. “The system needs a complete overhaul. Rotary can help with sustainable programs on these issues.” The Monrovia club is exploring how it can provide scholarships to train nurses, paramedics, and social workers.
Then there’s the toll on individuals: The minority who recover from the virus are often shunned by their communities, unable to find work. Orphans are ostracized for fear of contamination – some children too young to know the names of their next of kin are left to fend for themselves. In early October, UNICEF put the number of Ebola orphans at about 3,700 – a number that is likely an underestimate, and that is certain to grow.
Cooper-Enchia recalls an anecdote that she heard from a burial team member, who was going to pick up the body of a woman and found a six-month-old infant trying to nurse. The baby was crying, but because of the fear of catching the virus, no one had gone in to help. It’s contrary to human nature, Cooper-Enchia and Frankfort say, to be unable to help someone who is hurting. “What has happened to that child?” she asks, choking up. “This is the new reality. This is the new situation. It’s difficult when you think about all the orphans in our everyday life now. We just don’t touch.” — Diana Schoberg