“It is better to fix the roof than to mop the floor”

Ralph Wetoh

It was thanks to my mother that I became a physician. She was illiterate but had a gift for treating children with herbs. In the village where I grew up, many children had to rely on herbalists because hospital treatment was far from what people could afford. It happened to me later, that teenaged women greeted me in the street, grateful to my mother healing their various ailments. From this moment on, I knew that I would expand on her knowledge and study medicine. I was working in a hospital in the capital, Monrovia. The days resembled each other: in the mornings and evenings, the physicians met to discuss the conditions of the various patients; we adapted the therapies if necessary, and spread out through the ward

to treat. But then came Ebola, and it changed my life.

Framing a response

On 25 March 2014, six people from neighbouring Guinea had crossed the border into Liberia in search of treatment for Ebola; five of them died. One week later, the Ebola cases were officially confirmed. Being highly infectious, the deadly virus spread quickly across the country. In the first weeks after the outbreak, Liberia’s response to the threat was uncoordinated. The country’s health care system was still in the early stages of recovery following a 14-year civil war. Laboratories lacked the capacity to properly diagnose new cases, and hospitals were unable to isolate Ebola patients. The country’s president, Ellen Johnson Sirleaf, described

the situation as one of confusion, chaos, and disbelief. On 26 July, she declared a national state of emergency and announced that she would personally chair a new Ebola National Task Force. The government’s commitment to tackle the disease was vital to controlling the outbreak. At the suggestion of the Center for Disease Control and Prevention (CDC) and other partners, our government established an Incident Management System (IMS), which brought surveillance, contact tracing, case management, logistics, dead body management and communications under one umbrella. Led by Tolbert Nyenswah, the proposal placed Liberian government officials in the leadership roles.

Deadly rites

We knew that to successfully overcome the epidemic, we had to work together with rural communities. Changing behaviour was key because the virus is transmitted through direct contact with infected bodily fluids. In many parts of the country, washing dead bodies was a widespread custom and a major source of transmission. By then, I was working with the Rapid Isolation for the Treatment of Ebola (RITE). I supervised the RITE team in Bong County where we were responsible for reaching out to suspected cases in the communities. We moved to the villages, offered psychosocial care, and organised the isolation and transport of the dead

bodies. Convincing people to abandon their cultural practices sometimes posed wrenching human dilemmas because they countermanded universal human instincts like comforting a relative with a hug or greeting someone with a handshake. And there was this constant fear of getting infected myself. It was traumatising.

Fixing roofs

The virus took away many close friends and opened my eyes. Tolbert Nyenswah suggested that I should participate in a Public Health Emergency Management Fellowship Program offered by CDC in Atlanta, USA. I realised that it would be more beneficial to prevent public health crises like Ebola than just working in a hospital and treating patients. It is better to fix the roof than to mop the floor. This conviction also reached decision makers at the highest levels. Liberia has just recently established its first public health institute, based in Monrovia. And they asked me if I wanted to join the team. Since then, I have been eagerly trying to acquire the best knowledge to face this new challenge. That is the reason why I ended up at the “Health Care and Management” course in Basel. Here I am learning to take the right decisions at the right time. Since Ebola, I know that is exactly what saves lives.