Lincoln Gbabow and Jacob Timmah, both of whom graduated from the Liberia Field Epidemiology Training Program (FETP) and now work as District Surveillance Officers who are actively engaged in the response to COVID-19 in Liberia, share success stories from their work on community engagement to reduce the stigma of COVID-19 and on improved data management for decision-making.
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.
Jacob S. Timmah, Frontline Graduate and Current Intermediate Resident, Liberia FETP
Since the outbreak of the novel coronavirus in Liberia on March 16, 2020, we have made every effort to prevent the deadly virus from entering our county, Grand Gedeh County. We swiftly deployed health workers at various ports and points of entry in order to do temperature checks, enforce hand washing and wearing of masks, take the history of all travelers, and immediately report all alerts to the next level in order to prevent COVID-19 from entering Grand Gedeh County.
We initiated weekly Incident Management System (IMS) meetings aimed at creating awareness of COVID-19 and mobilizing resources among stakeholders and the public at large. Our major challenge was having limited resources and limited knowledge on COVID-19 for preparedness and response. In April, there was a major reshuffle by the Grand Gedeh County Health Team which resulted in a change of assignment that brought me to the county's capital. We put all of our efforts into keeping our county the only "green zone" among Liberia's fifteen counties from March until July 20, when our county registered its first COVID-19 case. The people could get information only during IMS meetings and from the radio once a week. Yet, with this situation, daily information and data sharing became very necessary and vital.
It is with this backdrop that I created an epidemiologic surveillance data dashboard that could provide the daily COVID-19 situation in-county using the County Health Team and partners' social media platforms. Having this dashboard has greatly facilitated daily information-sharing on COVID-19 as compared to the past.