From fatalism to hope in emergency response; A story from our Ebola response work.
Abiy Seifu:
Back in early March 2020, before the coronavirus had reached pandemic proportions, I was in Liberia to continue the work of Episcopal Relief & Development with faith leaders. When I arrived at our meeting I found my colleagues had already set up a system for hand washing and social distancing. How had they been able to respond so quickly and positively? The Liberians had learned the hard way, through the 2014/5 Ebola epidemic. This story is of the lessons we carry from that time as we respond to this current crisis.
In 2014 I was the senior program officer leading the efforts of Episcopal Relief & Development to mitigate the effects of the Ebola epidemic, which had begun in Guinea and, within weeks, had spread to Liberia, Sierra Leone, and the Gambia. Sierra Leone and Liberia were countries emerging from civil conflict, with fragile health systems and little trust in the government's ability to protect their populations. As evident from events as they unfolded in 2014/5, by our own actions it is all too easy to transgress the key humanitarian principle of Do No Harm. This is the story of how we recognized this, and what we did to re-center our approach more effectively.
The common approach to managing a crisis is to tell people what to do. In 2014 the directives were carried in simple messages,
“Ebola has no cure and those that have the disease will die.”
These messages were fatalistic, stoking fear and, consequently, undermined the trust that we, as outsiders, had previously built. Efforts to put protection methods in place were severely hampered by the growing sense of complete hopelessness. Villages, where the disease had arrived, were placed in quarantine, villagers saw the health workers return to collect the bodies of the dead, and nothing more. There was no help, no protection. A major transmission point of the virus was the burial ceremonies, where people paying their respects would touch the forehead of the deceased, and where handwashing was carried out through a common bowl. Women were especially affected because it was their role to oversee the washing and cleaning of bodies. Government workers arrived to take away the bodies. This was seen as an abomination, which went against traditional practices, creating further conflicts. Some health workers were chased away, others killed. To maintain traditionally accepted practices, people resorted to hiding or concealing their dead. People who survived Ebola - their homes were seen as contact points and they were attacked or burnt down by neighbors.
When there is no hope, people resort to familiar strategies to mitigate their fears. In the context of Ebola, several of these traditional practices were extremely harmful. As suffering and death continued, many used healing prayer and joint prayer sessions as a place of solace. In joint prayer-sessions, people remain very close together. As a result, whole prayer groups in Liberia were wiped out.
I think it was only when we saw thousands of people dying that we all began to realize our health messages were not achieving their goal. We needed to re-center them on restoring hope, reducing fear, and stigma and, of course, supporting the community to find their own ways to effectively protect themselves from harm. How?
Resilience was built by working with the faith leaders to repurpose activities around community-centered crisis response. Together we examined in-depth the key questions: How can we bring about positive change in behaviors and practices? How can we restore trust and hope and reduce fear? How can we support a sense of collective agency in mitigating the Ebola virus?
In response, Episcopal Relief & Development and ECLRD mobilized faith networks to channel emergency assistance such as basic sanitary and hygiene supplies, protective equipment, and food. The organizations also trained faith leaders on how to promote spiritual and emotional support, using scripture to reinforce messages and reduce stigma and risky behaviors and practices - particularly, gendered practices linked to caring for infected family members and performing burial rights.
Denial and misinformation about Ebola had been a part of the landscape. Faith leaders worked to rebuild trust and hope through open dialogue. Faith leaders supported community volunteers to reach out to all families, even those in hard-to-reach areas. Volunteers, supplied with effective personal protection equipment, delivered an integrated package of emergency assistance tackling health, hygiene, and food security. Through this community network, radio broadcasting, and other forms of media, we were then able to share re-centered messages about the virus as well as bring about community-centered changes in social and cultural practices. The radio was also used to provide a safe alternative forum for joint prayer. We share with you examples of these messages in our video of this story.
Chiseche Mibenge:
As we work with partners to center gender-specific harms and vulnerabilities in their emergency responses, we have benefited from the learning about recovery that arose from our experience in 2014/5. Faith leaders continue to have a profound role in preparing for a post-crisis response, much as they were central to drawing up future plans in the post-Ebola context. Then, as now, they are engaged to address family disintegration, loss of livelihoods, the reduction of the stigma that surrounds survivors, and issues of child protection, gender equity and equality.
As the Director for Gender Initiatives, I support our partner program in Liberia with a Violence against Women and Girls (VAWG) project that centers faith leaders as change agents and advocates for prevention and response. Our experience with motivating faith leaders’ response during the Ebola crisis was valuable. In the initial stages of the VAWG program in 2016, our experience was that faith leaders, the imams, and pastors, were ambivalent about change. Again we found that change began with a deep reflection on their own prejudices. We discussed with faith leaders how they have used the pulpit and other faith platforms, to stigmatize, to discriminate, whether it's against women or other groups that are marginalized in their communities. After a process of reflection, faith leaders came to see that the Church has done harm, and they acknowledged the harm they might do if they do not engage directly in their own transformation, their own critical engagement with scripture, without which they can't have community trust in their messaging. Through this process, faith leaders recognized the harmful exclusion of women and youth in decision-making. The response was to lead targeted outreach and support initiatives, such as the creation, with youth leaders, of safe spaces in schools, building on the intricate knowledge of the youth leaders of where violence and unsafe spaces may exist. Each context, after all, determines its own influencers, its own leaders. With community trust, faith leaders provide a powerful collaborative force for positive development whether the issue is responding to violence, violence against women, Ebola, or COVID-19.
The impact of social distancing and emergency measures during COVID-19 has had a gendered impact on women and girls. Reports on women’s vulnerabilities as primary caregivers and health professionals and increased incidence of violence against women and girls (VAWG) have circulated widely. Society often focuses on the vulnerabilities of women, but we should also acknowledge that, in 2014/5, women were key in developing improved behaviors and practices. During the Ebola response, it was the women who spearheaded acceptable sanitary and health changes during caregiving and at the sensitive time of burial. As we address Covid-19 we must recognise that the profound influence of women community leaders in the domestic space can surpass that of men. Women leaders are aware of which homes eat only one meal a day, for example, and are well situated to identify which households are the most vulnerable. Women will play a key role in creating an effective and integrated response.
Abiy Seifu:
Episcopal Relief & Development is a faith-based organization, and as our name says, we both respond to crises and disasters, as well as help communities build a more resilient future. We work with faith leaders to build dignity, relationships, and trust through an asset-based approach. As we have narrated in this approach, dialogue generates an intentional recognition and reinforcement of people's existing assets, or social capital, to create positive and effective leadership. Our experience in the Ebola crisis draws attention to the positive impact of working with people to address their uncertainties. Through constructive messaging, we can bring about a flourishing of effective responses. But through attempting to do good we must also actively avoid doing harm. The learning continues to have relevance today.
From your experience of the COVID pandemic where have you seen parallels and contrasts to the experiences we have shared with you?
Recommended reading
Gender dimensions to the Ebola Outbreak in Nigeria, (2016)
Pandemics and VAWC (2020)