Liberia FETP Graduates Tackle Community Stigma of COVID-19, Create New County Surveillance Data Dashboard

Lincoln Gbabow, Graduate, Liberia FETP

On August 2, 2020, it was reported that one of the health workers at Borkeza Clinic in Zorzor District, Lofa County, Liberia was suspected of COVID-19 and was transferred to the Curran Lutheran Hospital isolation ward, where he tested positive one week after admission. Borkeza is one of the largest settlements in Zorzor District, with a population of 3,101 inhabitants and two community health volunteers trained in active case search and COVID-19 preparedness and response under the Community Event-Based Surveillance (CEBS) Program.

The 54-year-old male was the registrar of the facility and interacted with nearly everybody who accessed its health services, thereby putting the entire community at risk. Previously, he had been suspended from work for not wearing a mask, although he reported suffering from a known respiratory problem. As the result of the case investigation, 22 persons were identified as contacts in the community, so the District Rapid Response Team (DRRT), of which I was a part, went there to bring the situation under control. The community members resisted and even threatened to harm us because of their high denial of COVID-19. A situation that put the entire team at risk. The tension grew until the team retreated back to Zorzor.

The community refused to accept the DRRT response due to COVID-19-related stigma and lack of knowledge on the spread of the disease. With anger, the chief lamented, "I am not a health worker, but there is nowhere in the world where somebody will transmit sickness to another person when he himself is not sick." Social distancing and wearing of masks was not practiced except when people were going to the clinic. Buckets were available in some areas of the community, but people were not washing their hands frequently.

The next day, after the district Incident Management System (IMS) meeting, we designed a new strategy where the local authorities of the community were included in the response team to carry on community engagement and social mobilization. At the same time, we recruited some community youth as contact tracers and social mobilizers, which helped to affect the response. As a result of the inclusive teamwork, community dwellers' behaviors changed positively. Frequent hand washing with soap and clean water and the use of nose masks was instituted. Additional contacts were identified, with at least 11 samples collected for investigation. All high-risk contacts were monitored in their various homes for a 14-day period. The outbreak was over when all of the 11 high-risk contacts completed 14 days of monitoring with negative test results, and no additional cases were identified.

Community involvement is paramount in outbreak control and should not be taken for granted. They always see their lives or society at risk if their members are excluded from response actions. However, the objective of our team was achieved by preventing the outbreak from spreading with zero deaths.  

Acknowledgement: Thanks to the Lofa County Health Team IMS and AFENET for their continued technical and field support toward FETP projects in Zorzor District.