Around the Institute

On Ebola: Finding Leaders Where We Need Them

November 3, 2014  • Andrew Quinn, Guest Blogger

Above, watch the full conversation “Who Will Solve the Ebola Crisis?”

In a complex global health emergency like the West African Ebola outbreak, the focus turns quickly to leadership.

And leadership has been in short supply as institutions ranging from the World Health Organization (WHO) in Geneva, Switzerland, to Texas Presbyterian Hospital in Dallas, Texas, found themselves wrong-footed by a deadly virus which has already killed more than 5,000 people in Liberia, Guinea, and Sierra Leone.

At a recent panel hosted by the Aspen Institute Global Health and Development and Health, Medicine, and Society Program, three global health experts said the solution may lie in part in giving Africa a larger leadership role in managing its own battle against Ebola, which causes a viral hemorrhagic fever and for which there is no vaccine.

“The focus should be on getting the communities themselves to own responsibility for stopping the epidemic,” said Dr. Francis Omaswa, executive director of the African Centre for Global Health and Social Transformation.

As a senior health ministry official, Omaswa helped direct Uganda’s response to a serious Ebola outbreak in 2000 to 2001 that killed 425 people — at the time the deadliest outbreak since the Ebola virus was discovered in 1976.

Omaswa said the swift response by Ugandan health officials was buttressed by immediate outreach to community leaders, who helped to organize grassroots efforts to keep the virus in check.

“The WHO came in about two weeks later, but by the time they came they actually found that a system was in place,” Omaswa said. “The message is that there was an early, robust response. We ended up with a mechanism which was led by communities (and) leaders who were trusted by the people themselves.”

The three West African countries at the center of the current Ebola crisis today all face an array of challenges, including lack of basic health infrastructure, shortages of medical staff, and widespread mistrust of political leadership in a region riven by coups and civil wars — helping to fuel perceptions that Ebola is a distinctly African problem.

But West Africa also has dedicated local leaders and medical experts who are tackling Ebola from the ground up and who should be playing a larger public role, said Dr. Margaret Mungherera, immediate past president of the World Medical Association.

“A leader without followers is just taking a walk,” Mungherera said, citing an African proverb. “The world needs to do a bit more to listen to what we think should happen. We are not being consulted, not by anyone really, and decisions are being made on where the resources should go.”

One African approach would be to do more to involve traditional healers, who are the first point of care for many people on the continent. While operating outside of traditional Western medical principles, traditional healers have strong bonds with local communities and could become important allies if they begin instructing people on ways to fight Ebola and to discard traditional practices which might help the virus spread. Though traditional healers have often been cited as part of the problem, if the situation is handled differently, they might be part of the solution.

“Traditional medicine is the conventional medicine of Africa,” Mungherera said. “In countries where you are trying to deal with an epidemic and you are not engaging with the communities, then of course the traditional belief systems, you’re not going to get to those.”

In many ways, Africa is already helping to lead on Ebola. Several African nations including Nigeria, which was recently declared Ebola-free after effectively containing its own outbreak of the disease, have pledged to send medical reinforcements to the affected countries. But with the broader global response to the crisis lagging and infections on the upswing, local leadership will remain crucial.

In Liberia, Last Mile Health is a locally-led organization taking on Ebola by training community leaders to become frontline health workers, showing that when given knowledge on basic infection control, local communities can act to trap the virus before it spreads.

“If we can make this transition from the community health center to the primary health center to the major hospitals or Ebola treatment units, we can get this under control,” said Dr. Lynn Black, who recently returned from the country and is the chair of Last Mile Health’s board. “It just has to reach all the way into the communities.”

“Yes, this is frightening; yes, this is serious; and yes, we can take control of it,” Black said. “We can absolutely control this,” she continued, saying her Liberian medical colleagues were the true heroes of the epidemic. “If you want to hear about role models, and people that will inspire you and will just bring you to your knees with the work they’re doing — that’s what really gives me hope.”

Andrew Quinn is director of the New Voices Fellowship at the Aspen Institute.