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We Must Be As Persistent as the Parasite

Screen Shot 2015-02-20 at 5.11.41 AMA few years ago I heard a Navy physician speak about a particularly difficult drug resistant strain of malaria in Cambodia. He was a specialist in malaria research. He speculated that the strain had developed during the U.S. war with Vietnam.

Malaria was rampant in the region. People affected by it took medication haphazardly to relieve the symptoms. But if the full course of treatment is not followed, the parasite can develop resistance.

He theorized this had contributed to a more virulent parasite. It’s resistant to artemisinin, currently the most effective drug to treat malaria. His concern was that the parasite could spread.

The Parasite Spreads

Now it appears this may be happening according to a study in the medical journal The Lancet Infectious Diseases. The parasite may be moving to a wider area, or reporting and documentation may be locating more cases.

In either case, the study points to the need for persistence to contain and prevent this parasite from spreading. The risk is that this strain could reach beyond Cambodia to India, Africa and other parts of southeast Asia.

If this were to happen it could reverse the enormous gains made against this disease in the past decade. This has happened before and the result was an increase in deaths and loss of productivity across whole regions of the world.

The study rings an alarm bell.

Continuing the Fight

We must continue the fight against malaria. The full range of technologies must be used:

  • continuing research to replace artimisinin where resistance occurs;
  • bednets to prevent night exposure;
  • effective education to assure people use medications properly;
  • getting counterfit drugs off the market;
  • residual indoor spraying for interior protection;
  • research to potentially alter the mosquito host and the parasite;
  • enviromental cleanup and water management to control mosquito breeding areas;
  • repairing broken, inadequate health systems.

Most importantly, donors, researchers, and health care providers must remain as persistent as the parasite.

Malaria is not a fad from which we retreat when it’s no longer the cause of the day. If the disease rebounds, the death toll will be worse than before, and that would be tragic.

Sustained, ongoing, dogged determination to contain this disease is the best approach. It’s not the easiest approach, but we know the results of doing less: needless suffering, lost productivity, countless deaths.

Campaign anticipates misuse of bed nets

Teresa Ad‹o Jo‹o (second from right) receives instructions about the proper use of her new mosquito net from Ilda Nanjembe during a 2012 distribution by The United Methodist Church's Imagine No Malaria campaign in Bom Jesus, Angola. A UMNS photo by Mike DuBose.

Teresa Ad‹o Jo‹o (second from right) learns about proper use of a bed net from Ilda Nanjembe during a 2012 distribution by The United Methodist Church’s Imagine No Malaria campaign in Bom Jesus, Angola. UMNS photo by Mike DuBose.

Bed nets intended to prevent malaria are used in fishing communities in Zambia to fish for food, which is sold in the local market, according to a report in the New York Times. The nets also trap fingerlings necessary for future stock. This decimates stocks and causes environmental harm.

The issue highlights an unintended consequence of the global effort to combat malaria, an effort that has reduced the death toll by half in the past decade.

The net distributions I have seen by the Imagine No Malaria campaign anticipated the problem of net misuse.

Before a distribution, community health workers and volunteers were identified and trained. During a pre-distribution education period, they learned how to prevent malaria, request permission to enter homes to hang nets, and explain proper use and care of nets.

Media campaigns, community meetings, fliers and word-of-mouth alerted local people to the future distribution. Communities were prepared in advance to welcome health workers and volunteers into homes. The trained volunteers hung nets and demonstrated how to use them.

As followup, health workers were assigned for six months to sectors to monitor net use and record the use rate. This identified issues for future distributions and reinforced behavior change practices that are critical for regular net usage.  For 9 to 12 months after a net distribution, there are regular check-ups to ensure proper use and care of the nets.

In the Bo District of Sierra Leone, for example, health workers determined 98 percent of the nets were in use six months after installation. In addition, Imagine No Malaria nets were not distributed around fishing communities. The use of nets for fishing is likely localized to those communities.

In the past, nets distributed without such precautions sometimes appeared in local markets and were used for many unintended purposes. But net providers learned and adapted.

Underlying problems

Secondary uses of netting, as with many other items, are common in many communities lacking resources.

While this doesn’t mitigate the environmental harm, it does emphasize that people are using nets to get food and fish for sale. The root of the problem is food self-sufficiency and a healthy local economy.

It’s compounded by lack of awareness of the harm done to fish stocks.

The story also points to the need for alternatives to nets where practical and for more education.

A greater emphasis on screens and doors in living quarters is proposed. Due to construction practices and cost, this is more practical in some areas than others.

Indoor residual spraying is practical and safe, and it is used in some regions.

Responding to the challenge

Media campaigns can encourage proper use of nets and point out the harm done by this particular secondary use. Local leaders can speak against harmful fishing and build community support for prevention.

Addressing the diseases of poverty is a complex challenge. Solving one problem can lead to others. Unintended consequences reveal themselves.

Disease, poverty, education, food sufficiency and environmental stewardship are interrelated, complex human concerns. We are challenged by them to find life-enhancing solutions.

The story points to the need for thoughtful, comprehensive development to address these interrelated issues of life and death.

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This post was edited to remove a sentence that said the NY Times article did not refer to new nets. The article quotes a fisherman who says new nets are better because they don’t have holes.

Relating to Cuba

Doctors attend to newborn in pediatric hospital in Havana

Doctors attend to newborn in pediatric hospital in Havana

A nurse slowly squeezed a manual respirator to keep the newborn breathing. Two physicians worked quietly and methodically on the distressed child. We were in the critical care unit of the central pediatric hospital in Havana, Cuba. It was more than 15 years ago, but as I hear criticism about the normalizing of relations with Cuba today, it makes me wonder how much has changed since then.

A Grave Situation

I was photographing medical care for children at the invitation of a pediatrics official as part of a visit with friend and colleague Joe Moran of Church World Service. We were documenting the humanitarian work of Cuban Christians and others. Cuba has long emphasized quality health care and many South American nations send patients to the island nation for care.

As I concentrated on photographing them, I was not aware of the gravity of their efforts. An X-ray negative was taped to a window. It revealed the baby had been born with a single lung.

As I looked through the viewfinder, concentrating on focus and composition, one doctor stood erect after having leaned over the child’s bed. The nurse put down the respirator. The three laid their equipment aside and looked toward me. The child had died.

I leaned against the wall, shocked and humiliated by my lack of awareness. Tears welled in my eyes. And these people who had just completed heroic efforts to save this child came over to console me!

Embargo Results

As we talked, they explained the difficulties of caring for the child. His chances of survival were dire. One of the challenges was a lack of needles small enough for the tiny veins of  newborns. As with many other medical supplies and equipment, they attributed the shortage to the U.S. embargo that had been in effect for the past 30 years.

Except for case-by-case humanitarian exemptions, medical supplies made in the U.S. were blocked from entering Cuba. And this had recently been extended to equipment under U.S. patent. This meant that materials from third party sources could not be imported if they were patented in the U.S.

This was only one of the hardships visited on the vulnerable, like this infant, that resulted from the embargo. The Cuban economy was anemic. Travel to the U.S. was  prohibited. Remittances from family in the U.S. were limited. Trade with the U.S. was restricted.

Tourism from other nations was just beginning to attract foreign exchange, but a dual economy–one for tourists and one for locals–only highlighted financial inequality.  Life was hard for most people.

Putting the Past Behind Us

I thought of this experience when I heard of the agreement to normalize relations between Cuba and the U.S. I thought of the Cuban people: the children in the pediatric hospital, the pleasant old woman in a senior residence who told me with a smile as I was leaving, “Remember, you have a grandmother in Cuba,” the teachers and children in the schools I visited, the farmers and the health care workers.

They are everyday people seeking to live meaningful, purposeful lives like you and me, under difficult circumstances made unnecessarily more difficult by political differences that have festered now for a half century.

I understand the Cold War ideology. I lived through it: the missile crisis, the political detainees, the human rights violations. But this baby had nothing to do with that. He was simply born into this world of hubris and hatefulness, without a fighting chance for survival.

Things have changed since my visit, but slowly and incrementally. And not enough to greatly improve the lot of most Cubans. The normalizing of relations will notch up the change. But it does not end the embargo. That requires an act of Congress.

It will be a political struggle. But this, too, must happen. So long as it continues, it undermines our best values, and punishes the innocent.

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The National Council of Churches in the U.S. and Cuban Council of Churches have issued a joint statement about normalization nd future steps: http://nationalcouncilofchurches.us/news/2014-12cubastepsforward.php

We must support Dr. Salia, Ebola caregivers

Dr. Martin Salia, shown at the United Methodist Church's Kissy Hospital outside Freetown, Sierra Leone, in April, has tested positive for Ebola. Photo by Mike DuBose, UMNS.

Dr. Martin Salia, shown at The United Methodist Church’s Kissy Hospital outside Freetown, Sierra Leone, in April, has tested positive for Ebola. Photo by Mike DuBose, UMNS.

In an interview with United Methodist Communications in April, Dr. Martin Salia explains why he works in Sierra Leone. He provides health care to all who come to the hospitals where he serves. “I took this job not because I want to but because it was a calling and that God wanted me to,” he said.

Like many health care workers across the African continent, Dr. Salia’s motivation is deeply religious.

Dr. Salia is a key figure at Kissy Hospital run by The United Methodist Church of Sierra Leone. Sierra Leone has three physicians for every 100,000 persons in the country. Kissy is one of the facilities that Dr. Salia has been serving.

The average income in Sierra Leone is $347 per year. According to the U.S. State Department, this translates to “over 72 percent of the population living on less than $1 a day, in extreme poverty.”

Kissy serves those who cannot afford to pay for medical care. It is one of the faith-based hospitals that provide 40 percent of the health care across Africa. In the course of my work in reporting on Africa, I’ve been in clinics and hospitals like Kissy. I’ve seen people pay for services with chickens, goats and mangoes.

The world owes a debt of gratitude, and more, to health care workers like Dr. Salia. We should do all in our power and our resources to assist them.

At great personal cost, Dr. Salia’s spouse has arranged for him to come to the U.S. for treatment for Ebola. A physician who has given so much of himself in treating others, Dr. Salia is now an Ebola patient himself. Kissy Hospital has been forced to close temporarily.

This complicates the challenge of controlling this virus. It also adds to the burden of untreated cases of malaria, diarrhea and other killer diseases of poverty.

Tragedy upon tragedy. And yet, heroic individuals like Dr. Salia put themselves in harm’s way to bring well-being to West Africa.

Dr. Salia is going to the University of Nebraska Medical Center in Omaha for treatment. I’ve had intimate experience with this medical center. It’s among the nation’s best. I think the state can take great pride in its personnel to care for Dr. Salia.

We know that with proper care, equipment and interventions, the survival rate for Ebola patients treated in the U.S. is favorable. It’s understandable that people fear Ebola, but we know that control of the virus is possible. And after missteps in Dallas, the health care community has shown it can self-correct. It has demonstrated a capacity to care for this disease responsibly.

If ever there were a time for welcoming and hospitality, it is now. And if ever there were a time for the world to contain its fears about Ebola and act responsibly toward those who are working under extraordinarily difficult conditions to contain this virus, this is it.

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The Foundation for United Methodist Communications has established an emergency communications fund. With your help, we can provide communications support in the event of a crisis or disaster. Donate here.

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The Great Plains Conference of The United Methodist Church has established a fund to receive gifts toward the cost of his transportation to Omaha and related medical costs not covered by other sources.  Contributions can be made through any United Methodist church, or sent directly to: Great Plains Conference Office, 4201 SW 15th, PO Box 4187, Topeka, KS 66604.   Please put “Dr. Salia Fund” on the memo line.

No one should live outside the web of connectivity

The national health systems of Sierra Leone and Liberia are barely functioning, and increasing pressure on them risks a complete meltdown, according to reports in popular media. Coordination of services to contain the Ebola outbreak remains fragmented and under resourced.

A woman uses a smartphone in contact tracing, a method used to trace people who have had contact with Ebola patients. Video screen shot, Centers for Disease Control and Prevention

A woman uses a smartphone in contact tracing, a method used to identify new Ebola cases quickly and isolate patients as soon as they show symptoms.  Video screen shot, Centers for Disease Control and Prevention.

In an article as tragic as it is frightening, Adam Nossiter of the New York Times details how people are dying from Ebola in Makeni, Sierra Leone. The article reads like the script from a horror movie with no happy ending in sight.

The story sent shivers down my spine, and it coincided with my return from a meeting near London of IT and communications professionals with major international agencies gearing up to meet this crisis at scale. The fact is, the response is far behind the spreading virus, and while this is belatedly being addressed, it will take long-term, sustained attention to bring the contagion under control. Time is an enemy, and the complications of scaling up are many.

International agencies are dealing with major crises from Syria to Gaza to the Central African Republic. The World Health Organization currently lists eight Grade 3 emergencies, which are situations that require substantial international response. They are: Central African Republic, Guinea, Iraq, Liberia, Nigeria, Sierra Leone, South Sudan and The Syrian Arab Republic.

This means the various agencies designed to deal with such emergencies were already being stretched before Ebola struck. Equally frustrating is the fact that this crisis graphically demonstrates how the lack of reliable communication today is a matter of life and death, but communication infrastructure lags behind human need.

The tipping point

Nearly every input imaginable is needed for this crisis from skilled personnel, to vehicles to transport the ill and the deceased, to a supply chain for materials, to communications for internal operations and external messaging, to technical personnel to support the technology, to facilities for isolating ill persons and myriad other physical and personnel needs.

What is called for now is urgent placement of skilled staff in the affected regions, facilities to support isolation and treatment, and material resources such as gloves, disinfectants, medications, body bags, protective suits and equipment.

But too many leaders, including global leaders and church leaders, have underestimated the significance of communication and the infrastructure necessary for it to work. We have reached a tipping point in our understanding of humanitarian aid. It is no longer limited to food, shelter, clothing, water and medicines. Lack of communications capacity has exacerbated this crisis.

The ability to communicate and the quality of the information delivered are matters of life and death. Pure and simple, communication is aid.

And humanitarian aid, like so many other necessary daily functions, is becoming digitized. This means that globally, communication infrastructure, messaging and personal communication devices will become essential for daily affairs, much as they already are in the global North.

Text messages, such as this one from United Methodist Communications, represent the new form of digital aid being used in the international response to the Ebola virus outbreak. Photo by Kathleen Barry, United Methodist Communications.

Text messages, such as this one from United Methodist Communications, represent the new form of digital aid being used in the international response to the Ebola crisis. Photo by Kathleen Barry, United Methodist Communications.

A paradigm shift

In the short-term future, we will see a paradigm shift toward digital humanitarian aid through the use of smart cards and mobile services. And this is changing older methods of providing aid because the new model is faster, more efficient and more economical, and it will reach more people. It also makes aid customizable and personal. And this means it is measurable, and the delivery system can be made more accountable.

This may seem like a pipe dream, but we are, in fact, already seeing how digital tools are being used in refugee settlements in the Middle East, and this will only grow as the systems become perfected.

The Ebola crisis is demonstrating that in this new age of pervasive technology, no one on the planet is so isolated that they can exist outside the global web of connectivity that delivers life-enhancing, and life-saving, information. And it is demonstrating that those concerned with humanitarian assistance to people in crisis situations must be at the forefront of this new era of technology for good because to do otherwise is to allow events to spiral out of control, with tragic results.

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The Foundation for United Methodist Communications has established an emergency communications fund. With your help, we can provide communications support in the event of a crisis or disaster. Donate here.

A new front in the Ebola crisis

United Methodist Bishop John K. Yambasu, chairman of the religious leaders task force, demonstrates to participants a new way of greeting instead of the traditional handshake. New traditions are being created to help prevent the spread of the Ebola virus. Photo by Phileas Jusu, UMNS.

Bishop John K. Yambasu, chairman of the Religious Leaders Task Force in Sierra Leone, demonstrates a safe way of greeting instead of the traditional handshake. Photo by Phileas Jusu, UMNS.

With the killing of a delegation of health officials, journalists and a pastor by a mob of rural villagers in Guinea, an even more tragic page has turned in the Ebola crisis.

The mission of the group was to dispel rumors about the outbreak, but the villagers thought they had come to spread the virus. The people attacked the group with rocks. Eight bodies were later found, bearing signs of having been attacked with machetes and clubs.

The event is a severe example of the irrational fears that are rife across the region. In Sierra Leone, the government’s Emergency Operations Center issued a release to dispel a rumor that soap to be distributed during the three-day lockdown, known locally as Ose to Ose Tok (House to House Talk), had been infected to spread the virus.

Fear drives these rumors. The immediate challenge is to arm trusted local people with accurate information to correct the inaccuracies and dispel the fear. The Ose to Ose Talk during the three-day lockdown in Sierra Leone is an example.

Correcting misinformation

In addition, commentaries on television, radio and in print by trusted leaders such as Bishop John Yambasu, the United Methodist leader in Sierra Leone, are helping to correct misinformation and encourage cooperation with health programs to halt the spread of the disease.

United Methodist Communications is providing text messages to clergy in rural areas as well as cities in Sierra Leone and Liberia. These messages are consistent with those developed by the World Health Organization and the Centers for Disease Control. The church’s advantage lies in its grassroots network of clergy and leaders who live in the affected regions and are trusted.

Two messages are sent daily. The morning message is usually about health practices. For example, these messages were sent this morning:

Community health workers are trained to help us all and are essential to beating Ebola. Please cooperate with them during the lockdown. – Bishop J. Yambasu (Sierra Leone)

In the Ebola crisis, handle animals with protective clothing. Thoroughly cook animal products (blood and meat) before eating. – Ad., WHO (Bishop J. Innis) (Liberia)

Each afternoon a message based on Scripture is sent. For example: Do not worry … in everything by prayer and supplication with thanksgiving let your requests be made known to God.” (Philippians 4:6) – Bishop J. Innis or Bishop J. Yambasu

We are also distributing solar cellphone chargers to give these messengers a cost-free means of keeping their phones charged.

The long-term challenge 

This crisis underscores a truism: Poverty breeds social discontent and mistrust of unresponsive government. Liberians clearly do not trust their government. At the outset of the crisis, the rumor spread that the outbreak was false, created by the government to bring more foreign dollars into the country to pay corrupt government officials.

In the long term, the challenge is to provide education that leads to better understanding of disease and how to prevent infections. This will require effective public education. It is also necessary to build effective, accessible public health systems, and equally important to establish responsive, transparent governance.

Building public infrastructure that is common in societies in the global North, such as sanitary sewers, clean water, and Wi-Fi and mobile phone systems, is also  a long-term solution.

Addressing inequities 

Africa’s leaders must gain the trust of their citizens by ending corruption and conducting government affairs with transparency, and citizens must have access to the information they need to make responsible decisions. Access to information is a human right in this information rich age. It’s essential to good citizenship.

The stark realities of the Ebola crisis make clear the need for these basic changes. The world must stem the immediate crisis. But that is not enough. We must address the underlying deficits that periodically surface and remind us that inequities in the world make all of us less secure and threaten global well-being when systems break down.

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The Foundation for United Methodist Communications has established an emergency communications fund. With your help, we can provide communications support in the event of a crisis or disaster. Donate here.

Their problems are our problems

As the Ebola epidemic continues to spread amid warnings by Doctors Without Borders that it is out of control, Dr. Michael T. Osterholm writes that health professionals are not talking publicly about the potential for Ebola to mutate into an even more dangerous form by developing the ability for airborne transmission. This has not happened yet in humans, but he says controlled studies have confirmed respiratory transfer of the Ebola Zaire strain from pigs to monkeys.

In addition, Osterholm says Ebola Reston, a different strain, passed through air transmission in a study group of monkeys in 1989 and the animals were euthanized to contain the virus.

If the virus reaches the megacities of Africa, he says, the opportunity for mutation could lead to more dire consequences, endangering many more people. Even without this speculative possibility, one mapping model predicts the number of victims will far exceed WHO estimates and could take a year or more to contain.

The rising rate of infections and deaths is cause for more than words of concern. It’s a call to action.

Poverty must be addressed

The Ebola virus carries the disease, but the disease is transmitted by ignorance, mistrust and resistance to proper care by ill-informed people. Ebola gains its foothold in poor communities where lack of understanding of the virus and how it is transmitted is widespread.

It gains momentum because these communities lack basic health care services and medical staff. It roars forward where people do not trust the information they are given by government officials. This escalating pyramid results in a contagion that threatens communities, nations, and potentially, the world. The underlying culprit is poverty.

Obviously, the immediate crisis must be contained. But we cannot stop there.

We must address poverty in a systematic, comprehensive way. Too many people are still dying of malaria, HIV/AIDS and other diseases of poverty. This will require a more effective, coordinated approach than we’ve mustered so far. Small one-off projects and uncoordinated development efforts will not get at the problem of poverty.

We need to provide people with access to accurate information, better education, more effective, well-staffed and well-equipped health facilities, treatment and immunization that cover the entire population, clean water, sanitation systems and economic opportunity.

This requires global resources. We know this, but we don’t approach it holistically.

What we don’t talk about

This neighborhood in Bom Jesus, Angola, is representative of many communities in sub-Saharan Africa.

This neighborhood in Bom Jesus, Angola, is representative of many communities in sub-Saharan Africa. Photo by Mike DuBose, United Methodist Communications.

The poor have no constituency. Their voices go unheard. And yet, they are not invisible. Faith organizations have been working with poor people for decades, and within faith communities, poverty is seen for what it is, a dishonoring of the sacredness of the human spirit.

But faith organizations have been focused on limited goals and have admirably addressed human needs within this limited perspective. Today, however, the need is for a broader approach and advocates who seek to change public policy in addition to performing their own good works locally.

Before they head for their destination, every mission team should make it a priority to be briefed on the conditions that contribute to the poverty that afflicts those they go to serve. And they should commit to addressing those conditions upon their return by advocating for public policies to alleviate the root causes.

We need to see the social, economic and political context in which Ebola, malaria, HIV/AIDS and other diseases of poverty thrive. This is what we in faith communities don’t talk about.

Thinking – and acting – globally

Palliative measures will ease the immediate suffering, but they do not change the conditions that are at the root of human ignorance and suffering. These roots are structural and systemic. They result from poor governance, economic inequity, lack of empowered citizens and corporate responsibility.

We must build out the digital infrastructure that carries reliable, useful information, make it accessible to everyone and train people how to use it. This infrastructure has not only shrunk the world, it contains the store of the world’s knowledge, and everyone needs access to it.

We must change our thinking that diseases like Ebola, and those affected by it, are remote from us. We must foster a global understanding. We think of Ebola as thousands of miles across the ocean, but it’s all-too-clear today that it’s really only  a six-hour flight away.

Like it or not, we are global citizens, and “their problems” are our problems.

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The Foundation for United Methodist Communications has established an emergency communications fund. With your help, we can provide communications support in the event of a crisis or disaster. Donate here.

Responding to worst Ebola outbreak in history

In Sierra Leone, Phileas Jusu receives an  Ebola text message from Bishop John K. Yambasu using mobile technology. The message addresses both health and spiritual needs. (The entire message reads as follows: "This message is from United Methodist Communications on behalf of Bishop John K. Yambasu. Please save this number as UMC Alerts to identify future messages. As we struggle with Ebola, I pray that faith – not fear – will be our response. This is not the time for blame or denial. It is a time to respond in love.") Photo courtesy of Phileas Jusu

In Sierra Leone, Phileas Jusu receives an Ebola text message on behalf of Bishop John K. Yambasu using mobile technology. The message, sent by United Methodist Communications, addresses both health and spiritual needs. Photo courtesy of Phileas Jusu.

The cross-border Ebola epidemic continues to spread and claim lives. The World Health Organization said this morning that the death toll could reach 20,000, and the virus is reported to have surfaced outside Nigeria’s capital city.

A doctor in Port Harcourt, the center of international oil shipping from Nigeria, died of the virus. This means the virus was not contained in Lagos, the capital, as had been thought. It also raises concerns about containment in a region with international workers in the oil industry.

Another strain of the virus, unconnected to the West Africa outbreak, has surfaced in the Democratic Republic of Congo.

Nigeria has closed its schools until October, and countries neighboring the affected nations have been advised to step up surveillance. Air France has joined the international carriers that have temporarily stopped service to Sierra Leone, Liberia and Guinea, complicating the challenge of getting supplies and health workers into the region.

In addition to the challenge of getting disinfectants, cleaning supplies, gloves, masks and related medical tools into the region, the mistrust of public health services and government announcements continues to contribute to the misinformation and disbelief that only exacerbates the spread of the virus.

United Methodist Communications is sending two text messages a day to networks of local contacts in Sierra Leone and Liberia with content approved by health officials. And the organization is inviting bishops and church leaders in other African nations to join in this information effort as they deem it necessary.

The messages can be read on conventional mobile phones, which the majority of Africans use. They are cost-free for the recipient, so they don’t add a financial burden to end-users. The messages are sent under the approval and sponsorship of bishops in the affected countries in the belief that local trusted leaders are more likely to be heard.

In addition to text messages, UMCom is exploring an audio message system to provide information to people who cannot read. It’s clear that communication serves a fundamental need in this crisis, and it’s essential to employ as many communication tools and strategies as possible to help get the contagion under control.


 

The Foundation for United Methodist Communications has established an emergency communications fund. With your help, we can provide communications support in the event of a crisis or disaster. Donate here.

Post-war trauma, mistrust, fuel Ebola crisis

A posse of young boys armed with slingshots blockades a road to prevent a Red Cross vehicle from bringing medical supplies into a village wracked by Ebola. In another area, residents throw stones at an arriving health team. And in a another, villagers flee when a health worker in a white lab coat makes calls in the neighborhood.

Christian Zigbuo (right) works to distribute printed information to educate people in Liberia  about the Ebola virus.  Photo courtesy of Christian Zigbuo.

Christian Zigbuo (right) works to distribute printed information to educate people in Liberia about the Ebola virus. Photo courtesy of Christian Zigbuo.

Why?

These reports remind me of conversations I have had with survivors of horrific conflict. Having worked around the world, I have seen and heard the fear and mistrust that people have of government and others in official capacities in places such as Kampuchea, Ethiopia, Somalia, Mozambique, Sierra Leone, Liberia, and South Africa. In these places, the common historical theme is social conflict, and in some places outright war.

I recall a conversation I struck up with a young man sitting under a large umbrella by the roadside in Monrovia a few years ago. He was selling lottery tickets and gasoline in quart glass bottles. I learned he was a high school student when his education was interrupted by the civil war in Liberia. He wanted to study agronomy, but the post-war economy was making survival difficult and the dream of college unrealistic.

I asked him where he spent the war. His voice lowered and his expression changed.

“I moved about,” he said. “Sometimes to the bush, sometimes hiding in the city.”

Pointing to a now-empty swimming pool in an abandoned hotel across the street, he said, “See that pool? I was caught once by a gang of young guys who put a tire around me and threw me into that pool to drown. They were crazy.”

As if the war was not horrific enough, when peace came, gangs of young men armed with military weapons roved the city, robbing and intimidating the people until the U.N. established order and disarmed the former fighters. Without effective government, there was no security, and pronouncements by those who claimed leadership were unreliable. The nightmare of war does not end when the shooting stops.

Liberia and Sierra Leone are post-conflict societies. They are recovering, but strong civil institutions and governance are still evolving. Infrastructure such as sanitation, electricity, communication, health and education are weak. In both, a generation of children lost their childhood because they were born in a time of war. They didn’t attend school, and many were internal migrants or refugees in neighboring countries. And they’ve experienced trauma.

Health systems, never particularly strong, remain weak and fragile. For example, in the county most affected by Ebola in Liberia, according to a story in the New York Times, the health surveillance officer does not have a computer to track disease statistics. As a consequence, the health officer could not track the outbreak of Ebola in real time, and was relegated to an inadequate pen and paper record that was woefully behind the rapid spread of the virus.

Trust depends on the effectiveness of the government and its institutions to deliver adequate, impartial service to its citizens. Weak institutions cannot do this.

Hidden source of conflict

It’s true that people fear the Ebola virus and the toll it takes. But I think there is another, less obvious factor at work as well. It is the residual emotional state of people who are recovering from traumatic experiences in post-conflict societies. This trauma is often masked.

In daily survival it goes unnoticed, and in many places it does not figure into ongoing relationships. In others, of course, it remains a prickly source of conflict that has not been resolved. However, it’s been my anecdotal experience that in post-conflict societies, trauma is not far below the surface, and in times of crisis, when trust is on the line, it can rear its head.

Efforts to create reconciliation commissions have been tried with varying degrees of success. Sometimes they provide a platform for the abused to have a voice, sometimes they exacerbate unresolved divisions.

When I talk with people who have been through terrible experiences such as civil war, I often hear stories told in soft voices that surface pain and loss. Sometimes this pain is expressed with strong language that reveals unresolved feelings of injustice and indignity. Sometimes people are reticent to talk about their experiences at all. They fear retribution. Some don’t want to recall horrible memories. These unresolved conflicting emotions are carried silently. They reflect great personal loss. Spouses, children and whole families have been lost. Homes and sometimes entire communities have been wiped out.

Steps to rebuilding trust

Nurses listen intently during a panel discussion at The United Methodist Church's Mercy Hospital in Bo, Sierra Leone, to help prepare health care workers for dealing with the Ebola virus. Photo by Mike DuBose, UMNS.

Nurses listen intently during a panel discussion at The United Methodist Church’s Mercy Hospital in Bo, Sierra Leone, to help prepare health care workers for dealing with Ebola. Photo by Mike DuBose, UMNS.

This emotional reservoir, along with weak government, social structures and economies, creates a stew of uncertainty, unmet needs and struggle. In the case of Ebola, I think it points to a need for clear, trusted voices to interpret the reality of the virus, and to encourage people to get medical care and avoid traditional healing. It’s also important for the church to provide messages of hope, comfort, encouragement and concern. In this circumstance, it’s a form of public witness in addition to a vital community service.

This alone cannot heal the broken trust, but it is a step toward healing. Other actions must be taken as well. Improving the health system, physical infrastructure, education and governance are critical. Economic development is necessary to improve work opportunities.

The church has another important gift to offer people in these societies. While large group gatherings are being discouraged during the contagion, under better conditions local congregations are communities of support where spiritual comfort and assurance are given, and personal growth and development occur. In faith communities, people are assured that life is sacred. Life is a gift of God, and God’s intent is not for us to suffer, kill or be killed. God’s intent is for us to flourish, and to find purpose and meaning. In The United Methodist Church, we speak of God’s graciousness. In post-conflict societies, the community of faith can be a means of grace.

What the Ebola crisis has revealed is that residual trauma and weak civil society infrastructure have long-term effects. Untended, these can threaten global well-being in unexpected ways. But this is not the end of the story. It is only the beginning.


 

The Foundation for United Methodist Communications has established an emergency communications fund. With your help, we can provide communications support in the event of a crisis or disaster. Donate here.

Ebola: Texting hope and busting myths

Ebola text message from Bishop Innis

The first Ebola text message from Bishop John Innis addresses both health and spiritual needs. Photo courtesy of Julu Swen, Liberia Annual Conference.

Ebola is real. It kills with little warning. Please adhere to health messages to safeguard your family. Let us be in prayer. God is with us. – Bishop John Innis

This first text message coming from Bishop John Innis to people in Liberia was not only history-making, but more importantly, it addressed a popular rumor that Ebola is not real but a ploy constructed by the government to get money into the country.

Ludicrous as this sounds, it was used as the pretext for gunmen to force patients from an Ebola isolation unit in a Monrovia suburb a few days ago.

The bishop’s message encourages people to follow the officially recommended precautions. It calls people to use their spiritual resources, and it says God is with us — that Ebola is not a punishment inflicted upon us by God.

Trusted voices must be raised to encourage people to take the threat of contagion seriously and seek medical attention when symptoms appear. And religious leaders can affirm our spiritual resources, as Bishop Innis has done.

Julu Swen in Monrovia, Liberia receving text message on Ebola from Bishop Innis

Communicator Julu Swen in Monrovia, Liberia, receives a text message on Ebola, written by Bishop John Innis. Photo courtesy of Julu Swen, Liberia Annual Conference.

When trusted leaders address rumors and misinformation, it’s more likely the rumors can be deflated. Texting is not the only way to do this, but it’s important in this crisis in particular. Mobile messages can reach a significant segment of the population. Sixty-nine percent of Liberians have a mobile phone, and texts can be received by conventional mobile phones, not just smartphones.

In addition, mobile messages can span broad distances. This is especially important. Text messages can reach people in affected areas that have been cordoned off by the military. They can remind people they are not forgotten.

Recognizing this, United Methodist Communications has been laying groundwork for the distribution of messages through mobile technology in areas where the need is great.

Now, for the historical part of this post. Because the communicator in Liberia was experiencing difficulty preparing and sending texts from the conference office, he requested United Methodist Communications’ assistance. A list of names provided by the conference was uploaded to a cloud-based database, UMCom staff got the message from Bishop Innis, and the text was sent on his behalf from Nashville to people in Liberia. The software used is open source and cost-free.

It was a first for us, and perhaps a first for a faith-based organization. It reveals how the world has shrunk, how information and communication technology contribute to our well-being and how valuable the connection of The United Methodist Church is as a strategic asset, especially in circumstances such as this.


 

The Foundation for United Methodist Communications has established an emergency communications fund. With your help, we can provide communications support in the event of a crisis or disaster. Donate here.

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