Monrovia, Liberia – More than 4,800 people died from Ebola between 2014 and 2016 in Liberia—the West African country hardest hit by the outbreak. Now, just four years later, the country of 4.8 million people is facing a new threat — the deadly uncertainty of the coronavirus epidemic.
Government officials in the capital city of Monrovia, where confirmed cases are just starting to ramp up, are optimistically reporting that Liberia can draw on its Ebola experience to overcome COVID-19. Doctors in the trenches, however, still fear the country is woefully under-equipped for a large outbreak.
Already decimated by back-to-back civil wars from 1989 to 2003, Liberia’s economy is still reeling from the impact of Ebola. About half of all Liberian’s live on less than two US dollars a day (1.75 euros), according to the World Bank. The healthcare system is generally acknowledged as underfunded, fragile, and lacking the Personal Protective Equipment (PPE) needed for healthcare workers.
Liberian authorities are acutely aware of the risk. Coronavirus cases remain relatively low for now, but they are rising rapidly. In neighboring Guinea—which was also hit by Ebola, and which suffers many of the same problems—infections have skyrocketed.
Perhaps most troubling, nearly one-third (28%) of all the confirmed coronavirus cases in Liberia have been among health workers themselves, according to the National Public Health Institution of Liberia (NPHIL). The organization’s director has said that fighting the virus outbreak will be difficult because the entire country has only one ventilator to help critical COVID-19 patients breathe.
On April 11, Liberian President George Weah declared a 14-day State of Emergency and locked down Monrovia, the country’s largest city with 1.5 million residents. Liberia’s legislature recently extended the country’s State of Emergency to 60 days. Despite those stay-at-home orders, confusion has reigned as false information about the coronavirus has been disseminated causing panic in some of the city’s overcrowded districts and frequent clashes with security officials.
Doctors Without Borders – Médecins Sans Frontières (MSF) teams are racing to respond to the coronavirus pandemic not only in Liberia but also in the more than 70 countries where they run existing programs. Confirmed COVID-19 cases in Liberia have now risen past 100 while the number throughout Africa now exceeds 30,000.
Worldwide, the response to COVID-19 has relied heavily on large-scale lockdowns of populations and physical distancing measures, with the aim of reducing transmission and preventing health systems from becoming overwhelmed. But for people dependent on daily activities for their very survival, such as day laborers and those living in Monrovia’s overcrowded settings, self-isolation and lockdowns are not realistic.
“Most recommendations for protecting people against the virus and slowing down its spread simply cannot be implemented here,” says Cristian Reynders, a field coordinator for MSF operations. “How can you ask homeless people to stay at home to avoid infection? Those living in tents in camps don’t have homes.”
That means, of course, that the COVID-19 playbook that wealthy nations have come to know—stay home as much as possible, keep a six foot distance from others, wash hands often—will be nearly impossible to follow in much of the developing world. Even hand-washing is problematic in Liberia where 35% of residents do not have regular access to soap and water, according to the World Health Organization (WHO).
Public hand washing stations in Liberia—which were effective in the fight against Ebola—are often as simple as two buckets—one filled with chlorinated water, and one to catch the wastewater. Sanitation, however, is as problematic in big cities as it is in rural areas. In Monrovia, less than half the city’s 1.5 million people have access to working toilets, according to Liberia’s Water and Sewer Corporation.
The fight against coronavirus will not be won until every country in the world can control the disease. But not every country has the same ability
to protect people.
Dr. Wafaa El-Sadr,
Director of ICA, a global health organization at Columbia University in New York City
Monrovia residents who display coronavirus systems are currently taken to a military hospital where they—along with other “high risk contacts” are tested and, if necessary, treated, according to the Acting Director General of the NPHIL. According to the organization, Liberia has only one lab in the entire country that is available for COVID-19 testing.
Because the lockdown included the closing of schools across Liberia on March 16, Forgiveness Education classes and after-school forgiveness programs have also been disrupted. Education providers, however, including those working with the International Forgiveness Institute (IFI), are racing to launch remote learning options as students once again face the prospect of staying out of school for months.
“We are now using an extension-outreach approach so children can continue to learn about forgiveness,” says Bishop Kortu Brown, Chairman/CEO of Church Aid and national coordinator of the Liberia Forgiveness Education Program that was established by IFI-co-founder Dr. Robert Enright more than 8 years ago. “Instead of teaching students in a classroom, our teachers prepare notes that are distributed to children at home. Parents then help deliver the message and assess the performance of their children.”
Bishop Brown, who is also president of both the Liberia Council of Churches (LLC) and the Inter-Religious Council of Liberia (IRCL), said those organizations are spearheading “a massive coronavirus awareness campaign,” helping train COVID-19 contact tracers, and distributing food and hygiene materials.
“Meanwhile,” Bishop Brown added, “we call on all churches and Liberians, in general, to continue to observe the preventive measures and to continue to pray for the safety and wellbeing of the country.”
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