Ebola’s Legacy Can Be a Thriving Community Health System

With war or a disease like Ebola, fear is natural. It seems like people all around you are dying. People you love, people you take care of, people who take care of you.

In such a context of enormous grief, it is human to imagine that these deaths are the result of a “curse” or conspiracy.

Much has been said of the local beliefs thwarting efforts to stop the spread of Ebola and to care for those who are already infected. Yet, such beliefs are eerily similar to hesitance in the United States around vaccination, and are a natural product of fear, distrust, and a lack of accurate information.

So how do we stop the spread of misinformation and ensure people go to Ebola Treatment Units or seek other forms of supportive care?

We start by letting it be known that Ebola can be a survival story.

To enable survival, we need to ensure consistent access to medicines, labs, and supportive care. Through this improved quality of care—one that focuses on support rather than quarantine—we can combat fear and stigma.

In fact, the best way to stop superstition and fear is actually to provide the best possible care for people.

Supplies alone are not enough to enable the best care. Most importantly, we need local community health workers who can build relationships with community members based on trust. We know that community members want to help. My colleague, Paul Farmer, indicated that 300 people showed up to an Ebola Treatment Unit to work. This demonstrates how we may exaggerate the stigma and underestimate the willingness of people to get involved in fighting this disease.

By recruiting, training, and mentoring local village residents to become professional community health workers, those falling sick in remote villages are able to access care for the very first time. Through building relationships across the community, we will ensure villagers are turning to the primary health center for treatment, rather than turning away from it. Not only will we continue to treat patients for malaria, pneumonia, and diarrhea, but we will be more likely to have villagers infected with Ebola seek care, and go on to survive.

Indeed, Ebola survivors could be a new frontline of response. Ebola survivors, including mothers and sisters who are often community caregivers, can be a key component of Ebola response. Not only do those who recover have an intimate stake in curbing the epidemic, but they also show us it is possible to have Ebola, and survive. A survivors’ network makes it clear that Ebola doesn’t have to be a fatal disease.

Ebola has spread fiercely because in countries such as Liberia, where 51 doctors were left to care for a country of 4 million after the war, villagers have been left without access to care. The public health system had been shattered. As we fight Ebola, we need not only to address the current challenge but also envision and build a new infrastructure for community health.

Ultimately strengthening health systems will not only end the current epidemic, but it will prevent future epidemics from recurring. We can do this by deploying professional community health workers, who are providing consistent quality of care and are linked to local health centers.

At the age of nine, I fled Liberia as it was gripped by war. I returned to support my community because I believe that no lives matter more than others. Access to health care should not only be a basic right—it can also be a building block for community.

Let’s use this crisis to create long-lasting change—a community health system where every person, even those living in last mile villages, has an equal chance at health and survival.

If we do so, we will not only have fought Ebola, we will have made possible a new future based on access to care, strengthened health systems, and resilient communities.

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innovation often comes from those with the least resiurces - Liberia and the training of health workers who are survivors can serve as an international model in community health and patient centered care

Organizations such as OSF should identify strategic synergies with other organizations working in comparable thematic areas to identify long-term initiatives (systems work is not a short-term fixable) with pooled funding. Working in isolation can only put bandages on large, open wounds, irrespective of good intentions.

I've been watching the impending health care crisis in Ebola Zaire since 1976. It appears to be endemic to our species that we respond when life presents us with a perfect storm. This is a potential global storm, and we will succeed in stopping it's devastation.
I'm confident, that this extraordinary country will take on the potential pandemic and transform the broken health care system. It's who we are as a nation. We have the resources, money, and know how.
Polio, Tuberculosis, Malaria, ....know how, willingness, and compassion..We've done it before, we'll do it again.

Thank you for this excellent video. One thing that also is missing from the effort, in my view, is mental health care for the victims, the families, and the affected communities, also given on a long-term basis. This is even more important because most of the people involved have been affected by wars, and the traumas have not been dealt with. The Coalition for Work for Psychotrauma and Peace has developed a program of educating "lay therapists" that we believe could increase the capacity in such areas. If anyone is interested, and would like to set up a cooperative arrangement, they can write to us at [email protected]

I pray for you and the team every day. God Bless you every day. Spreading the truth about Ebola.

Please ensure that to enable survival, we need to ensure consistent access to medicines, labs, and supportive care. Through this improved quality of care—one that focuses on support rather than quarantine—we can combat fear and stigma. Please act now!

As of July 2014, the ongoing Ebola virus epidemic in West Africa holds the record for being the worst outbreak in the recorded history of the virus. The outbreak – which has affected the countries of Guinea, Liberia, and Sierra Leone – now has more than a thousand cases, in which more than half of those are confirmed.

Infections of Ebola virus cause a viral hemorrhagic (bleeding) fever officially known as Ebola hemorrhagic fever or Ebola virus disease, a deadly disease with a fatality rate of up to 90%
Therefore; if a network is form and funded the NGO will be re cute right for rural area and fight this disease as they do to HIV and AIDs.


I fully agree with Dr. Panjabi. Let us remember our first approach with people with HIV / AIDS. It took a dose of global solidarity and finding appropriate strategies to make change happen.
That's the same way we can fight Ebola. The approach must be global and inclusive.

The survivor trajectory is a novel and hopeful approach to the Ebola crisis. Fear and mistrust have proven to be ineffective thus far.. Thanks for sharing this hopeful trajectory ..

I do not think the siuation in Africa was helped, by the likes of the UK, encouraging health workers from Africa to emmigrate to the UK. This was to fills vacant postions in the UK's National Health service, brought about poor pay and working conditions. Leaving African nations short of trained and experienced health workers.

Brain Drain is definitely a huge problem for Africa, and has indeed contributed to the Ebola situation getting much more complicated, but I feel as though you have simplified the problem a little in your comment. There have been significant push factors that have all but forced African professionals to relocate to more advanced economies, one of which is a long drawn, chronic and severe systemic failure. Doctors in Kenya for example have been on strike numerous times due to poor pay and work conditions; both of which happen because central government is not very strong on allocation of funds to support healthcare and healthworkers. The UK and other countries present a very good and viable alternative to professionals who yearn to see their work making a difference to both the society and themselves. It is like the doctors have all said, systemic failures.

The fight against Ebola should be a collective one. Should not be left to only countries affected for now, since we belong to a society that is in constant touch with one another (moving from one place to the other) for business, visits and what have you. You or I may be the next victim. Together let's help fight Ebola and all other contegeous diseases from the continent.

Dr. Raj Panjabi is to be applauded for the intelligent comments concerning Ebola. Ebola given for the destruction of the world or ending of life as known to humanity. It is a disease that by human concentration, research and intentional treatment, we, the people in the world shall defeat. A matter beyond the emergent response to Ebola is the lack of care in underdeveloped areas/communities. Without being repetitive, the Ebola Virus is one of many reasons for humanity to seek equality in fair treatment of life, including human lives.

Empowering the community (CHW) to provide care to affected people in the village is the best approach to minimizing the epidermic and this will build the trust among people. Those who survived are important if taken in to give testimony so that the people will know that one can get well even after getting the virus.

The fastest and most efficient way to organize and maintain effective health care is with a user-friendly intuitive electronic health record system, which can be used in the remotest of villages -- needing only cell phone coverage. Inexpensive, effective -- and blocked by politics.

Dr. Raj Panjabi's personal story of fleeing Liberia is touching, true and authentic. That experience has clearly given him the drive to address Ebola -- to serve patients in Liberia. Good luck and our thoughts are with you, Dr. Raj.

Thank you for this hopeful message. So much to be done, but YES to health workers EVERYWHERE, in the most remote villages!!!
I am currently in Liberia and this article / video gives me hope.

The fight against Ebola should be a collaboration fight, should not be left with the only countries affected, as far as we belong to a society that is in constant touch with one another (moving from one country to the other) for business, visits and what have you. You or I may be the next victim. Together let's help fight Ebola and all other contegeous diseases from the continent.

Dr.Raj,i highly commend you for those insertful medical words . i think Africa need to institute long turn healthsystem, n do away with temporary responses to issue of like kind.


Let me applaude Dr. Panjabi for his far sighted comment on this deadly Ebola outbreak in the sub-region. For my country(Liberia) nearly all of our health facilities have been poorly operating due to neglects by the national government. Before the outbreak, most of our health workers have gone on go- slow actions due to the unwillingness on the part of the Health authorities to increase their allowances. So like the battlefield, the Virus infetrated into Liberia unnoticed, spreading like wide fire. If Dr. Panjabi's recommendations are taken seriously, this community approach could the best legacy.

It very essential to begin with the bottom to top approach for the eradication of the epidemic. what matter most now after the debris of the Ebola virus, there are many children that both or entire family taken by the virus, the outcome of these children future is something International Partners need to be carefully look at. If nothing is done to care for these children, these countries affected by the Virus will have lot of street kids without future.

Another thing I am not seeing in this fight is, what is working for the survivors and how we can leverage that - what medicines, etc., we can use for others so we can raise the number of survivors. There must be lessons learnt in here somewhere that we can replicate to save more lives.

Thanks for highlighting the social component to medicine and how epidemics are tied to resources and inequality.

Your article and video needs to be posted everywhere and seen by everyone!

Well said Dr. Panjabi, Community based initiatives are key in effectively enagaging the epidemic. This is while AIFO, an Italian International NGO has stepped up efforts to utilize its CBR network which involves community based rehabilitation workers, mental health clinicians, and other local and INGOs at county level to effectively mobilize our communities in the fight
against Ebola. To be specific, this intervention will be held in theCBR project communities of Bong County as follows; Kpakolokoyata community, Marshansue, community, Wreputa community, Salala community, SKT, Suacoco Leprosy Colony, Wainsue, Iron Gate and Gbarnga city. Activities will be, amongst others training, awareness, mobilization, contact tracing, proper burial procedures, hygienic kits distribution etc. in line and in coordination with the activities the Ebola Task Force have already planned for Bong County. We have developed a proposal in said light and is seeking funding. If anyone is interested in knowing more about our intervention, please contact Luther Mendin on email:luthermendin at gmail dot com.

To help those who need it.

the Ebola with its "policies" has come in changing effect causing differences in its manifestation where the communities are left crippled due to lack of skills to fight the stigma. these deserves massive effort to build capacities of the individuals with inclusion of sensitization events to reduce the repelling disease that seam not be curbed. this drives me back to the recent out break of Ebola in west Africa and shortly' a thriving out break of malaria in eastern Uganda where most communities were reporting bloody diarrhea and vomiting of blood. the scary part of it was when communities had brought in issues of witchcraft and hence using traditional medicines to treat. sorry for the moral families of this nation.

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