Fighting Ebola's Fear Factor

ICAP findings: community centers prove to be a crucial tool against the Ebola outbreak in West Africa

A controversial method of community-run care developed to fight Ebola in West Africa is turning the tide against the outbreak. According to ICAP researchers from Columbia’s Mailman School of Public Health, community-based care centers will prove to be a crucial resource as the region undertakes what could be the most challenging chapter: the final push to end the epidemic.

ICAP's Susan Michaels-Strasser

Even before Ebola hit, West Africa had some of the world’s weakest health systems. Each of the three countries hardest hit by the outbreak had fewer physicians than a mid-sized urban hospital. This vulnerability helped the disease gain a foothold then exacerbated the situation as hundreds of doctors in the region fell ill. To buttress these battered health systems, the British government supported a novel strategy to leverage community recourses to quickly isolate and care for patients in the villages where they live. Subsequently, they invited ICAP to assess if they were making a difference.

Last week in Freetown, the capital of Sierra Leone, Susan Michaels-Strasser of ICAP presented the results of that three-week assessment of community care centers, funded by the UK’s Department for International Development. Their analysis found that even in a few short months, the clinics—dozens which now exist throughout the region—added desperately needed clinical capacity and restored the trust of the people most affected by the epidemic. The report also allayed the fears of some in the public health community skeptical of the community approach.

Early on several of the agencies tasked with implementing the plan balked at one of its provisions to staff clinics with locals regardless of their clinical experience. A showdown was averted when the clinics were able to find sufficient numbers of nursing students and retired nurses. But until the ICAP report, many remained skeptical about the value of the community-centered approach.    

At the height of the outbreak, Michaels-Strasser explains, people were wary of leaving their villages for poorly managed regional hospitals that charge for care and where risk of infection from Ebola was very real. By contrast, the community clinics are free, nearby, and staffed by familiar faces. And unlike traditional Ebola clinics that isolate patients behind blue tarps—a terrifying experience for family members, many of the clinics have an open-air design so family members can see into the clinic as loved ones receive basic care like hydration and pain management.

“When a weak health system is overwhelmed and collapses, community engagement and community solutions are essential to restoring trust in medical care,” she says. “These clinics have helped restore hope so that people are now more willing to seek care.” 

The ICAP report identifies several areas for improvement, including a need for better data on measures like how long it takes to diagnose patients with Ebola, but Michaels-Strasser emphasizes that the community centers have made major strides. In stark contrast to the traditional health system, not a single health worker has been infected with Ebola in any of the dozens of community centers.  

The Bumpy Road to Zero

While the worst of the Ebola outbreak is in the rearview mirror, Michaels-Strasser says the community clinics will continue to play an important role along the “bumpy road to zero”—the World Health Organization’s description of a path to the end of the outbreak with occasional flare-ups as families and health workers let their guard down. The risk is that “zero” will never happen; Ebola could become endemic in the region with one or two cases bubbling up now and then.

“As Ebola becomes uncommon and the television crews and donors go home, people still need to know that there’s a safe place they can go,” she says. “Community trust is more important than ever.”

Community care centers and the health workers who staff them could serve as building blocks as countries rebuild their health system. Or to use another metaphor: an immune system to ward off the next epidemic.  These health workers have cared for more Ebola patients than anyone in history, observes Michaels-Strasser. “We need to look at the people and skills that have been developed and use them wisely going forward. They’re a huge resource.”