Leticia Linn (left), a WHO communications expert in Liberia. Photo courtesy of WHO
The World Health Organization (WHO) is publishing a series, "Ebola Diaries," with first-person accounts of WHO staff and others deployed to the field for Ebola response since the first cases were reported in West Africa on March 23, 2014.
When Leticia Linn arrived in Monrovia on July 13, 2014, most people in Liberia were not taking Ebola seriously and denial about the outbreak was widespread. A communications expert, Linn worked with the Ministry of Health’s team to liaise with the media and inform the public about the disease. And when Ebola jumped to Nigeria and the U.S. and cases tripled in Liberia, Ebola denial turned to fear. This is her story.
“'We don’t hug now. We greet each other like this, with the elbow, to prevent Ebola,' a woman explained to me when I arrived at the Ministry of Health of Liberia for my first meeting on the outbreak. It was 14 July 14, 2014, a few hours after I had arrived in Monrovia, and indeed there would be no hugs for me until I left Liberia 3 weeks later.
"Between March and early July last year, Liberia recorded about 140 cases of Ebola, including more than 80 deaths. The outbreak was centered in Monrovia and in Lofa County on the border with Guinea and Sierra Leone. But Ebola was yet to have a major impact on daily life: thousands of people still flocked to the daily street markets, churches were full and taxis continued to shuttle passengers back and forth.
"I had heard that many, if not most, people were refusing to accept that there actually was an Ebola outbreak. But it was only after arriving that I began to grasp the true meaning of this. During my first week in Monrovia, there was almost no mention of the outbreak on the radio, except on the United Nations radio station, which devoted a daily timeslot to the disease. The newspapers were reporting on political debates and on a great variety of subjects, including supposed 'cures' for Ebola, but there seemed to be no interest in talking about the outbreak itself. I remember seeing one sign in the hotel and another in the UN building that offered advice on how to prevent Ebola.
Radio stations talked about Ebola virus disease, how to prevent it and measures the government was taking. Photo courtesy of WHO
"Some radio stations started playing two songs recorded by local performers with the message that 'Ebola is real' and volunteers visited every home with pamphlets explaining how to prevent the disease, but Ebola denial continued. At meetings in the Ministry of Health, the volunteers reported that people did not want to believe them or simply paid no attention to them. Weariness and frustration were palpable among the Ministry’s Ebola team and workers from other agencies and organizations supporting them. Clearly, disease prevention messages did not seem to be reaching the population and rumours were complicating the situation even further.
"My initial assignment was to answer questions from journalists but, during my first 2 weeks, media attention was focused not on Liberia but on Guinea and Sierra Leone. I joined other colleagues to work to prepare other counties in Liberia that were not yet affected by Ebola, strengthening coordination with partners already in the field, and looking for other ways to make sure that disease prevention messages would reach the population.
"One way was through testimonials by people who had survived Ebola – to show how timely care could save lives and also to prove that the disease existed. These testimonials were shared with tribal chiefs at a meeting between Liberian authorities and WHO representatives. The chiefs listened to them with surprise and confirmed the value of hearing from survivors. They asked many questions, particularly about how to address questions from their people about the disease.
"With the help of UN Radio, the chiefs agreed to record messages in their dialects to warn their communities about Ebola. Then they would travel to their regions to speak directly with each community.
"Events began unfolding very rapidly, though, in the country. During those weeks, a man traveled from Liberia to Nigeria and died from Ebola. Days later, two American health workers were confirmed as having contracted the disease while treating Ebola patients. This focused global attention on Liberia and the calls from international journalists began to pour in.
"The seriousness of the situation in Liberia was heightened by the death of a well-known local physician from Ebola. The government canceled the celebration of Liberian Independence Day on July 26 because it would mean thousands of people traveling from different parts of the country to the capital, increasing the likelihood that cases would multiply. The start of the new school year was also postponed. All areas of government were called on to collaborate with the Ministry of Health in the Ebola response.
"Suddenly Ebola was everywhere. Radio stations began talking almost exclusively about the disease, how to prevent it, and measures the government was taking. Airlines considered stopping flights to Liberia. All public places — government offices, hotels, restaurants, churches — had huge containers for hand washing with chlorine. The few people walking the streets of Monrovia were wearing latex gloves and face masks.
"Denial gave way to fear. It became a challenge to trace people who had been in contact with Ebola patients, because many were afraid and fled. In Monrovia, work was under way to expand the treatment center, because more patients were expected to arrive. However, neighbors were afraid and resisted having the centre set up near their homes. I saw a group of residents who had cut off a street and were demanding that authorities go find a suspected Ebola patient.
"By early August, when I left Liberia, the number of Ebola cases had tripled in three weeks to 470 with 220 deaths. Ebola denial gave way to Ebola fear. But fear speared action – and action turned the tide. The situation became far worse before it became better."