It may seem implausible now, but someday the news crews will go home.
The headlines in the West will trumpet another, different perceived threat. The infection rate will drop and, slowly, the people of Liberia will begin to construct a new sense of normalcy for their health system after the Ebola outbreak subsides. By the time this is over, Doctors Without Borders will be broke and bedraggled, hard pressed to continue its original mission in the region, which was to tackle run-of-the-mill infectious diseases.
When the deaths are tallied, the brunt of Ebola’s burden may well prove to be from the other medical conditions that have had to go untreated during the epidemic (Though with unprecedented insistence on hygiene practices, the opposite may also be true). A population scared of contracting Ebola in hospitals and clinics may continue to avoid them, and war- weary local health workers will, frankly, need some time to return to fully operational status.
It’s tempting to say we can confront these challenges when the current crisis ends, but Liberians need to prepare now. Issues of stigma and donor fatigue make it all the more important to harness the exceptional global attention to design for a better future. The worst case would be that the new clinics and infrastructure built to control Ebola crumble away amid the world’s inevitable loss of interest after this crisis is over. The US army is building a hospital and two mobile centers; and China has doubled down in the game of oneupmanship and pledged to rebuild the nation’s entire health system. Altogether, hundreds of millions of dollars have been rallied – much more than Liberia’s normal annual spending on healthcare.
Good, old-fashioned capacity building will win no innovation challenges. But it’s the most important.
So, how can we use Ebola-related funding to design for the future? Here are a few ideas.
1. Donate to lasting institutions.
It’s not flashiest strategy – good old-fashioned capacity building will win no innovation challenges. But it’s the most important. Private volunteers and emergency teams play an important role, but health organizations that have been working in Liberia since before the crisis will be the ones picking up the pieces when it is over. One is Last Mile Health, which has invested in frontline health workers in Liberia since 2009. If you’re donating to an NGO or health provider in Liberia, it may also be helpful to refrain from earmarking your donation for the Ebola crisis. Trust the local organization to know what is needed most.
2. Design for remote consultations and task-shifting.
Prior to the outbreak, Liberia had an estimated 60 doctors serving its four million people. Several of those doctors have since died, as have many nurses, community health workers and other staff. These people cannot be replaced quickly. Their local experience, institutional knowledge and relationships with one another were all critical in such a small health system. This means that nurses will be taking over roles traditionally assigned to doctors, with community volunteers pulling more weight in rural areas. Improving the region’s communications infrastructure can ease these constraints. Mobile phones for rural community health workers are useful for tracking medical emergencies and for maintaining ties to those communities once the aid workers leave. Computers for cataloging surveillance data serve a similar purpose. Higher-tech donors (I’m looking at you, US Defense Department) should absolutely consider incorporating video infrastructure for remote consultations into their new facilities. This would allow Liberia’s few remaining doctors to provide support remotely to their colleagues and their patients in hard-to-reach places. It would also allow international experts to provide their expertise without having to travel. The same methods that help protect us from Ebola also protect us from colds, the flu, and food-borne pathogens.
3. Maintain momentum on hygiene & sanitation.
Reminders for handwashing and good sanitation practices have been plastered all over Liberia, played as bite-sized educational snippets and even full musical productions on every radio station – all with a focus on preventing the spread of Ebola.
Fortunately, those same methods also help protect us from colds, the flu, and food-borne pathogens. It would be an enormous missed opportunity to halt these messages when the outbreak ends. Diarrheal disease and other sanitation-related infections are huge problems in Liberia. Hospitals, clinics and health organizations shouldn’t toss out the hand sanitizer and sound bites once new infections stop. Instead, they should channel this momentum to tackle other diseases. New facilities should include sanitizer dispensers at every door. Rural villages will benefit from keeping chlorine dispensers full even after the threat of Ebola has passed. With the right messaging and incentives, these new positive behavior changes just might prove infectious.
If you have more suggestions for channeling Ebola efforts toward good sustainable design, we’d love to hear them! Please leave a comment below.
