After twelve hours of a bumpy car ride from Monrovia, our team finally reached Lofa county – the county where the first reported case of Ebola in Liberia occurred back in 2014. We had five days in Lofa to conduct three health advocacy meetings in three regions: Voinjama, Zor Zor and Foya. I learned so much just by listening in on the meetings but three words that really stuck with me were trust, compassion and hope. These seemingly dramatic, sentimental words were spoken with honesty throughout all the meetings. When Marietta Moore-Yekee, Deputy Director of HC3 in Liberia, asked the health workers what these words meant for them and how they were related to the work they did, their responses reflected their passionate attitude towards their community.
Ebola had a devastating impact on Liberia. It took many lives and destroyed the relationship between health care providers and the community. Fatu D. Kollie, an officer in charge (OIC) nurse from St. Johns Clinic in Montserrado County, recalled how people ran away from her because they thought she was the one who was spreading Ebola. People genuinely believed that they would get Ebola from visiting health facilities and as a result, health facilities were almost completely empty during the outbreak. Kollie explained that continuous effort by the Ministry of Health and other international organizations to educate health workers and engage the community in health activities had a great impact on rebuilding the relationship between communities and health care providers.
Similar to Kollie, Zay Zay Kovtimai, a general community health volunteer from Zor Zor, also faced a challenge earning the trust and respect of his community when he first started working. To gain trust from his community, he visited the village chief multiple times to explain his role and really tried to show he was a trained health worker and was there to serve the community.
After repeated efforts, people started listening to him.
With similar stories shared by other health workers, it was clear that the lack of trust is a major barrier to their work of keeping their communities healthy, and it was especially detrimental to their communities and the workings of the health facilities during the Ebola outbreak. But at the advocacy meetings, health workers expressed a sense of hope for overcoming the lack of trust. One OIC nurse from Voinjama region said health workers “have to trust [themselves], then have trust in their patients, and when this happens the patients will learn to trust [them].” She added that people will learn to trust health workers when people see trust and compassion go hand in hand.
Building trust by expressing care for the community and working together demonstrates how trust and compassion go hand in hand. When participants in the advocacy meetings spoke about compassion, many of them emphasized how it was through everyone working together as a community that they were able to eradicate Ebola from their region. David Zauru, a religious leader from Zor Zor explained: “Ebola was very quick to be minimized in this region because people were more vigilant to inform what needed to be done.” He recalled that all of the community leaders were trained on the protocols to follow in the case of an Ebola patient and that they did their best to spread the message to their community. Community leaders also made sure that people in their communities realized that Ebola was something that everyone needed to work together to stop.
Healthy Life in Liberia
Ebola is now gone from Liberia, but after everyone suffered during the difficult period of the outbreak, people now have a greater sense of compassion for each other and are much more aware of the importance of a healthy lifestyle. “People now know that their health is of an important concern and that they have to work as a community to keep everyone healthy,” Zauru described. Community leaders and health workers at the advocacy meetings described significant improvements in the overall health awareness in their communities, with more people sleeping under mosquito nets, cleaning their compounds and bringing their children to the hospital when they are sick.
In addition to taking care of their own health, community members are also continuing to attend health promotion activities, such as Bridges of Hope activities, and community dialogues. Zauru believes that “people are happy to participate in these workshops not only because they acquire knowledge about health but also because it makes them feel that they are part of the society,” indicating the importance of continuing to build trust, compassion and hope.
The word community empowerment seemed so important yet so vague to an undergraduate public health student who had only learned about global health through a textbook. I didn’t know what to expect but I certainly did not imagine meeting so many passionate health workers, all trying their best to work out a plan to lead their communities to a healthier future. I did not realize just how important it is to establish a relationship with the community and really care about one’s work, but my mindset changed after meeting those health workers and hearing them talk about their work in their communities.
After taking part in three health advocacy meetings and conducting interviews, I now understand how significant community empowerment and education are in maintaining a healthy society. In a real life health emergency, like Ebola, what the community needs is not a theory-based, textbook-defined public health intervention. What is more effective and important is having active, passionate health workers who really know about and care about their community, and who never stop trying their best to promote a healthy lifestyle. It is also crucial for the health workers to get out in their communities and work together with community leaders and community members to not just inform them, but also engage them in a way that builds mutual trust and a common sense of hope toward a healthy future.
I am so grateful that I had the opportunity to hear directly from health workers in Lofa and see for myself how much they care and love their community. A combination of effective encouragement from the HC3 team and the health workers’ own determination to serve their community created a very fruitful, interactive learning environment during the advocacy meetings. The cooperative environment at the advocacy meetings was illustrative of the consistent and unified efforts of communities, health workers and partners that was a major force in stopping the spread of Ebola in Liberia. After my experience attending the advocacy meetings, I am confident that the compassion, trust and hope that grew out of those difficult times will allow Liberia to reach a healthier future.