On December 5, 2014, The New England International Donors (NEID) a donor learning forum supported by TPI and John Snow Inc. (JSI) co-hosted a panel titled “The Role of International NGOs: Medical and Public Health Institutions in Responding to the Ebola Crisis.” This was the second panel hosted as part of an ongoing educational series hosted by NEID on the topic, and the donors network has also launched the Beyond Ebola Fund to respond to the current crisis while strengthening the health systems in Liberia for the long run.
While the first panel focused on the role of smaller, grassroots organizations—this panel looked at larger international organizations and the role they have been playing in the response to the Ebola Crisis. We were fortunate to have panelists from UNICEF, Save the Children, JSI, and Massachusetts General Hospital Global Disaster Response at the Center for Global Health. The panel was thoughtfully moderated by Dr. Rebecca Weintraub of the Global Health Delivery Project.
Two things struck me as important messages from this panel: First, after attending both of the NEID Ebola panels, it is clear that there is a complementary and important role for different types and sizes of organizations in responding to the Ebola crisis. Second, there appears to be a “domino effect” of consequences that has unfolded that equally needs our attention.
With regard to the first message, reflections by several audience members reminded us how central the smaller, community-based aspect of the response is. Liberian Bill Massaquoi, President and CEO of Rebuild Africa, reported that in many communities trust is a huge issue and communities feel they have been abandoned by international NGOs. Lynn Black of Last Mile Health added that communities are not always responsive to expats swooping in with supplies and “help,” especially when the help arrives in the form of someone in a HAZMAT suit who comes and takes your family member away. Working with small grassroots groups to serve their own communities and establish trust in recognized protocols is essential to halting the epidemic.
A comment by Liberian audience member Marvin Tarawally underscored the way in which larger organizations also fill an essential role made possible by their size and access to resources. He reported that his student group at Babson College has been tirelessly fundraising to purchase PPE (Personal Protective Equipment) kits to send to families in Liberia. Panelist Dr. Hilarie Cranmer from MGH applauded this effort, but cautioned that such small groups would not alone be able to provide and distribute the sheer volume of kits needed- many thousands. In addition, with roads in disrepair or non-existent, helicopters are often the only means to transport staff and supplies in many areas. Larger, well-resourced organizations with access to such transportation would be needed for this distribution effort.
Further, added Jesse Hartness of Save the Children, getting the kits to households is just the first step. Caregivers must receive rigorous training in something as simple as how to remove latex gloves; even trained clinicians have inadvertently become infected while removing their PPEs. Panel member Kumkum Amin reported that JSI has been central to establishing such Standard Operating Procedures across Liberia so that health care workers from facilities to communities have a standardized training on how to protect themselves.
In thinking about small organizations (like Last Mile Health) that are in the trenches with remote communities that trust them, and large organizations such as Doctors Without Borders (MSF) that run multi-country efforts to treat Ebola patients, the vital and complementary role of each is evident. A community-based response in tandem with efforts of larger INGOs (and National Ministries) is necessary to achieve the scale, reach, and implementation of procedures required to halt the epidemic.
Second, I had not fully appreciated the existence of a domino effect of consequences in the wake of the epidemic. We have all likely heard about non-Ebola health centers shutting down and children dying from malaria, pneumonia or diarrhea and women dying in childbirth as a result. All profoundly tragic, but not surprising. But the ripple effect has unfortunately expanded beyond the health sector. I was unaware that in Sierra Leone for example, children have been out of school since last Spring and some will be missing an entire year of classes.Dr. Imran Mizra described how UNICEF has been remarkably creative, broadcasting school classes on the radio. Still, teachers have not been employed or paid, which is having a drastic impact on their household incomes and food security. Even if Ebola is under control enough so that schools can resume classes, vaccine campaigns have been halted, making schools vulnerable to measles outbreaks. Food security is another major issue—seeds have not arrived at their destinations, labor practices have been disrupted and many farmers have been unable to plant. Thus, a major food crisis could be on the horizon. To make matter worse, we have a population who has been emotionally traumatized, with many people losing multiple family members in a violent, sudden way where they cannot even say goodbye, hold or wash the body according to important cultural rituals. None of these issues can be resolved quickly. These countries will need support for many years to come both to get back on track and especially to avoid sliding back into a civil war.
So, as we read the daily updates and feel a huge sense of relief that the CDC projections for new cases have not materialized, we should also worry that the world will (want to) assume that Ebola is “over” and turn their attention to something else. The emergency response organizations will have to move on to the next emergency—and thank God they do what they do. But will there be enough support for the “Beyond Ebola” phase and sufficient investment in the organizations who are trying to rebuild health systems and address the myriad social and economic consequences that will need support over the long-term?
As Dr. Weintraub concluded, with the level of collegiality and humility seen on the panel we have every reason to believe that in partnership small and large organizations can continue to work together in harmony to strengthen health systems in Ebola-affected countries. With respect to keeping the attention of the world on both the current epidemic and its aftermath, organizations like NEID and other donors are working to keep Ebola in the public eye so that we won’t move on to the next issue while this one still urgently and unambiguously needs our attention.
S. Eliza Petrow is a member of New England International Donors (NEID) and she is also the Director of International Programs at the JC Flowers Foundation in New York, where she directs the foundation’s global health work, particularly in the area of community based malaria programs in sub-Saharan Africa.
This blog is reposted from the NEID website.