'Fear will be your enemy'

Everyone who is parent to or otherwise spends time with a girl under the age of, say, 13, will know that when fear grips you, bad things can happen.  Especially if you are an ice-wielding princess struggling to control her powers (even if you don’t have any children as an excuse, I still recommend the film ‘Frozen’ as a heart-warming if cheesy use of 108 minutes).  In Liberia, the main reason the Ebola outbreak is not under control is the potent combination of fear, denial and distrust.  We often think of fear as irrational, something that causes senseless action.  It might be tempting to read events like families hiding cases of Ebola in their homes, patients running away from treatment centres, or communities rioting to escape a quarantined area, in this way.  But I think that if we can put ourselves into the position of a person behaving in this way, we can begin to see the logic, consistency and good sense in their actions – and the challenge to change perceptions that the Red Cross and others playing their part in the outbreak response face.

Of course, we’re all a little bit scared of Ebola – it’s a terrifying disease.  Even when we read news articles (or even blogs) about places over three thousand miles away, it still causes us a little anxiety knowing that there are diseases like that out there.  But Liberians have other reasons to be afraid.

Many people in Liberia have had very little contact with Western-style medicine.  Access to health care is very poor in Liberia, and during the civil wars it was virtually non-existent.  Alongside this, there is very poor access to education, particularly in rural areas, for the poorest people in the population and for women, so there has been little opportunity to learn of the benefits of modern medicine.  Rather, people have always relied on traditional healing, including both the use of herbs and roots, and magical interventions, in order to address their ailments.  Many people have rarely or never faced a situation where they have had to trust Western medicine.  Then a relative falls sick with a fever that looks just like the malarial fever that everyone has had at some point in their life.  They are taken away by strangers in strange suits to a medical facility.  Then, their condition worsens, and they die a terrible death like nothing anyone has seen before.  From that perspective, you might be forgiven for thinking, at best, that Western medicine is ineffective, or at worst, that someone has maliciously tortured and killed your loved-one, either directly or through some malevolent magic.  In order to trust someone or something, you need to believe that it is competent to do what is needed, and that it is benevolent to do it.

Then there are the measures that the government is taking to contain the outbreak: road blocks, quarantining communities, soldiers going house-to house to find families who are hiding cases of Ebola in their homes.  This would be intimidating for anyone, but Liberia is a post-war country where most of the population has experienced these things before.  Now I'm not saying these measures are wrong - you would have to ask a Liberian living in the country to make that kind of assessment, I'm in no position to judge the pros and cons of the government's actions.  A Ugandan friend tells me that a tough approach from their government has previously prevented Ebola outbreaks from spreading in his country.  Still, imagine what it is like to have a soldier force his way into your house when the last time this happened, people were screaming, gunshots were being fired, there were bodies in the street and children running into the bush to hide. Houses looted, young boys kidnapped, women assaulted and many people arbitrarily executed. There is a real danger of retraumatising a population with a lot of bad memories.

Survival is a daily challenge for the majority of Liberians, over 60% of whom live below the national poverty line.  Recently, the prices of staple goods such as rice and drinkable water have rocketed by 80%.  The main commercial hub of Monrovia is the Waterside area,  and 70% of traders who serve this economic centre live in the quarantined community of West point,  which had been barricaded for at least three weeks to contain instances of Ebola in this one of the poorest and most densely populated areas in the country.  Add to that the restrictions in cross - border and cross - country trade, and the supply of rice and water, the essentials of life, is in serious jeopardy.  People who already live on the edge of survival cannot afford these price increases - as a Liberian aid worker pleaded on CBC news,

"We need food, we need water. We're not just fighting Ebola here, we are fighting hunger too."

Trust is something that we badly need in order to cooperate with other people without unbearable anxiety.  In order to trust, whether that is medical workers, the government, NGOs, traders of basic commodities or other citizens, people come from a place of vulnerability and uncertainty about how they will be treated. Drawing on past experiences, cultural background and the advice of influential others they assess whether they expect a favourable outcome to arise through trusting. In order to trust, they must make a leap of faith, accepting their vulnerability and acting as if the outcome will be good even though they don't know whether this will be the case. Trust could not be more relevant and essential to Liberia, and it is in the balance in this crisis. A lot hinges on the successful management of the outbreak.