Looking Past Quarantine to Community Health

In between trips to Liberia, Paul Farmer of Partners In Health visited Open Society’s offices to discuss his work on Ebola. Paul talked about the need to ensure sustainable health systems for people in nations where the virus has spread. If there had been strong health-care systems in Guinea, Liberia, and Sierra Leone, Ebola would not be the epidemic it is, particularly in terms of the rampant death rate.

The current focus on quarantine presents a danger not only in the short run, but in the long run as well. Quarantine forces farmers to leave their fields, freezes air travel in African cities, and slows the flow of food and labor. These interruptions can touch off longer, more complex health crises in the countries where Ebola is already weakening systems.

Instead, the coalition that includes Partners In Health is training and equipping community-based health workers, with local partners such as Last Mile Health taking the lead. Community health workers are trusted neighbors who provide care while connected to a formal health system. This kind of community-based health response not only challenges the spread of Ebola and its fatality but also enables a new economic base and public health infrastructure.

As the spread of Ebola continues to unfold, new health and economic challenges will emerge. If we stay nimble and flexible, we can use this experience as an opportunity to develop a responsive health system rooted in communities. This would be a victory for vulnerable economies, sustainability, and long-term health outcomes.



Hey, from what I red, it's true the communities need to be part of this ebola fright. Because many denier stail come from, I saw a accident that toke place shortly. A ebola affected person(not comming down with the signs yet) was sealling bread, he had protective water but foce people to wash their hands before handing the money over, after holding the money he serve the bread. Not knowning who this man is I went to buy, then he apply the above statement. Then I said as I wash to pay you, you must wash to serve me too, he said no because he is not moving up and down, beside, the varus do not spraid through money.

I am a civil society activist with a local initiative that is a community based organization called Children's Network and Family Welfare Organization-Sierra Leone(CNaFWO-SL) currently working in the district of Kai;ahun where the Ebola virus outbreak started in Sierra Leone. I am very impressive of Dr. Farmer's expression on the effects of the Ebola outbreak on the world. Realistically all what he said are visible in our country Sierra Leone especially where we work as there has weak health systems in the district which infact has created the spraed of the Ebola virus in other part of Sierra Leone. Most farmers have left farming and this is a serious threats on the living of the people and the economic. We would be very greatful to humanitairian organizations to come to the aid of our health worker and structures in terms of trainings and the like.

The Society For the Advancement of Humanity Inc.(SAHI) stated awareness in four community with a massages (a) do not get in direct contact with body fluids of a sick Ebola person. (2), dead Ebola person, blood, vomit, urine, faces sweat, and spit, infected animals by contact with blood. The awareness is done in District #6 ELWA community, Monsterrado County Liberia. The activities is door- to door and face to face with family head and their depended. As of Sept. 19, 2014 to Oct. 3, 2014, the massages has reach 185 family head and 1,284 depended with total family reach 1,469. With this total family 1,469, 701 are washing their hand because they have plastic bucket before their houses. While 768 not washing their hand reason, no plastic bucket..

This is SAHI activities report.

Mr. Togbah
SAHI Liberia

I think of our people fight together we can stop the virus

From the Dr. Discussion, he is 100% right. In Liberia, Sierra Leone and Guinea the health system is very much deplorable and the Government needs to improve these facilities. It is true every community should help in the fight against this epidemic, even individual family head should help in sensitizing their family member on how to handle their love one who is sick. The Government should also encourage the health workers because they are the front line forces in this fight.

We observed that with the outbreak of the Deadly Ebola Virus, its has exposed the three countries (LIBERIA, GUINEA AND SIERRIA LEONE) poor health facilities and limited access to research made by health workers and other health patricians. Dr. Farmer, is correct 100%.. and with regard to the information provided by him, the Government of these three countries have to put mechanism into place that will help save the life of their citizens.

To quarataine people or community is not consider the best way to keepthem safe.I'll recommand that all partners in ebola activities empower the community health volunteers to in turn cary out the necessary awareness,contact tracing and referral of all sick persons to the nearest health facility.They should be given PPE for their prectaction.
I'm working with Liberian Red Cross MNHC Project in Grand Gedeh,Liberia

Dr. Farmer we agree with you and will like to know how we can partner with your organization. We are in Liberia.

The government should take all the health workers to take part in the fight of Ebola there are people who have the ex prince of different sickness in our country in Verious areas the have to be on board to help the govt has to cooperate this train medical old people they have the exprince thanks

Ebola is real and kills, the health workers are making lots of sacrifices as they are the front line fighters with this deadly virus therefore they should be the first to be prevented from contracting the virus, including vaccinations and more incentives including a trust fund for every health worker in the most effected countries as a means of encouraging. Sooner or later this epidemic will be history.

I would like to propose this idea: To effectively battle the effect of EBOLA like the shortage of local food due to the fear of this deadly disease, the establishment of microfinance business with minimum interest rate in communities of West Africa from which farmers will be in the position to borrow a long term repayment schedules of loan that borrowers will begin repayment when they shall harvested what was planted. I think this kind of empowerment will help with sustainability after EBOLA has been controlled in those affected communities.

My organization though based in Central Africa do feel so much for these countries severely stricken by the Ebola epidemic. I believe like Dr. Paul Farmer clearly states that Ebola urgently needs a community response through which he is calling on all to link information campaign to real action. this to me must be pro-active, even in communities which are Ebola free because taking preventive measures is cheaper than curing the act.

Sure Elizabeth, I agree with you that community-based interventions should be proactive and capable of addressing the root sources of the disease, especially in the West African region where trade and consumption of game meat in rampant. Communities should be educated on the dangers and health consequences of game meat and other likely causes of Ebola to avoid cyclical recurrence of the epidemic.

the outbreak of this deadly disease is weak community health education and services ,all we need now is to put our hands on disc and kick out politics and approach our people with realitity; .improving health status in sierra leone.

This disease wouldn't have spread and stay so long if only our leaders and the citizens have taken this thing seriously. Lots within my country Liberia would disagree, but it's the fact... and I can explain more in just simple form...but the leaders and the citizens wouldn't care because it's already part of them to never cares...it's a pity for this nation and it hurts so bad inside some of us as children of this soil..

Thanks you ever so much for such an advisor just like brother Fallah said. I had an experience at G T BANK yesterday at 9:00 am why we were on line a man came in with his Hammond Jeep with out washing his hands and taking his temperature the officer allowed him in.We as Liberian we must stop these thing by picking and choosing that the only way God will help us.

Thanks for this vital information about the negative impact of Ebola from Dr. Paul Farmer.
Actually the impact is not felt only in countries were there is Ebola but neighboring countries like the Gambia not yet affected by Ebola and its fatality.
Protective equipments are important will be more effective with w
Awareness creation and confidence building between the health workers and the communities.
Dr. Paul Farmer, I hope will be willing to travel to countries like the Gambia to attend a few days consultative workshop to assist in preparing Training Of Trainers for health workers for a better disaster prepared action.

We should accept the fact that Ebola is real, and that it's a very dreadful disease that can kill thousands of poeple in less than no time. So let us put politics aside and our customs and traditional beliefs aside and really come together to fight this virus and this endemic that has eaten deep into the fabric of our health care systems and destroyed our human resource base especially in the medical or health sector. It has also crippled our economy so much so that we rely only on donor funds now to fight this great battle against this common enemy, the Ebola virus. But let us remain resilient and steadfast in this fight, I'm sure victory is certain. At this point I will want us all to observe a silence moment for the souls of all those medical practitionals who died in active service whilst trying to save lives, and all those who have passed away as a result of this dreadliest disease Ebola. May their souls and the souls of the faithful departed rest in perfect peace Amen.This is the time we must pray fervently, and be united more than ever before to win this scurge, and tell the whole world that we can do it as a nation. But above all, we must remember to put God's divine intervention first so that God will curb this menace for us Remember with "God all things are possible," I am just too optimistic that soon and very very soon, Ebola will be no more in Jesus mighty name Amen. I also want to at this point, thank our international partners like WHO, MSF, UN, Red Cross and the world leaders for the humanitarin roles they played and continue to play in our strives to win this fight. I also want to thank the health sector for their relentless service in saving lives during this turbulent time in our nation. Of course, we must be thankful to all both internally and internationally who have contributed in diverse ways to win this fight. To WFP we say bravo for a work well done, because had it not being for the food that you've been providing, hunger would have been another strong enemy to contain in this difficult period. To all of us as a nation, we have gone through very difficult situations, in which we were quarantined, lockdown and even shutdown all in a bid to win this fight against the Ebola virus I thank all of us for our cooperation and understanding. To the government, I must say kudos for a work well done, amidst all the criticism, all the blames, and pull down syndrome you remained steadfast and focused to see that this battle is won, and I can assure you that we're not there now, but we're almost there. And by the special grace of God, the fight against Ebola has been won.

I 100% agree with Dr. Farmer. How the suggested sustainable health system can be put in place wherein no or little pressure is force on government by the civil society organisations and the public for substantial budget allocation in the health sectors of these countries. I believe this time around our civil society organisations in my country Sierra Leone would step up now to see that the government allocate more fund in the Health section as well as the Education section than any other sector for the next twenty years if we want to progress in fighting such epidemic crisis in the future. This should also be replicated in both Liberia and Guinea.

I strongly agreed with Farmers because i had an experience in my community where a family came down with the virus with the little advice from health authority we gathered together and quarantined the family providing food, water and every necessary means for them including medication through the health authority, but unfortunately two dies out of three. we the community members need to get involve fully

Dr Paul Farmer is a brilliant Man, the Specialist! I wish that authorities would read his books and articles more often.
Ebola must make humans more humane.
Thank you for sharing and publishing his opinion!
With love from Uzbekistan!

So TRUE, a vibriant community health system is an integral part of the solution to eradicate Ebola and quell future problems that will be left back hy Ebola after it has been dealt with. Needs information and training on how to start a vigorous community health program. Pls advice. Thanks and God bless!

Dr. Farmer you are true in your observations and statements with regards the Ebola outbreak in the Region especially the Sierra Leone case. We are at the mercy of God Almighty as our health care services have been an issue ever since and now the excuse has also been ''this is a new out break''. However, we need to double our sensitization skills and methodology (ies) to let our people accept and adhere to the preventive measures, visit the health facilities for early medication, avoid the traditional burial practices, minimize travels to other areas.
Most community people are farmers and these people at a stage abandoned their farms when they needed scare birds and other animal from damaging their crops. In as much as we are asking our Government to improve on the medical situation in the country, we would be very grateful also if humanitarian organizations could come to the aid of our health worker and structures in terms of trainings and consider other sectors - Line ministries like agriculture, Ministry of Social Welfare Gender and Children's Affair , Education etc to help minimize many issues related to Ebola outbreak after all..

you are right, we all know that the real problem is governance, leadership particularly in a country like mine Guinea everything is politicized by the government of that period.

The just want to keep their system even they see it is not working. We need a global policy and solution to save lives and time.

All what Dr. farmer said is true. Our organization Taia Development Programme (TDP) support the clarion call of all to put efforts, resources, time, energy togather to rebuild ravaged nations of the Ebola virus disease particularly Sierra Leone, Guinea and Liberiaa who are the haedest hits west African countries.

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