Category Archives: Global Health

These graphics are taken from The Washington Post’s article, The invisible threat: Rising temperatures mean insects can carry viruses such as West Nile to wider areas, that ran on November 28, 2015 (story by Joby Warrick; photos by Jeremy Lock). One Health is not just a slogan but it is a movement that sees the interconnection between animal health, human health and the environment.


 

As the world warms, the zones of cool temperatures keeping certain mosquitoes in check will move north. Rising temperatures will usher in tropical diseases, such as dengue fever, or “break-bone disease,” which is transmitted primarily by Aedes aegypti mosquitoes infected with the virus. Sources: Nature, Centers for Disease Control and Prevention, World Health Organization

As the world warms, the zones of cool temperatures keeping certain mosquitoes in check will move north. Rising temperatures will usher in tropical diseases, such as dengue fever, or “break-bone disease,” which is transmitted primarily by Aedes aegypti mosquitoes infected with the virus.
Sources: Nature, Centers for Disease Control and Prevention, World Health Organization

tick-spread-600

The black-legged tick, or deer tick, transmits Lyme disease, babesiosis, Powassan virus, and Borrelia anaplasmosis.
Sources: EcoHealth, Centers for Disease Control and Prevention

 

By Shane Powell.

Champassak province, Lao People’s Democratic Republic – Traveling the last stretch of road to Pha Kha village feels like looking out the window of an airplane that’s just broken through storm clouds and been greeted by a rich, blue sky.

Wet-season rice paddies – the road leading into Pha Kha village. Photograph by Judy Souvannavong.

Miles of dusty, potholed roads suddenly give way to vast fields of fluorescent-green rice paddies. The scene sweeps calmly to the horizon in every direction, broken only by streams and scattered, flattened rocks positioned like small islands.

Noy, 19, has spent most of her life in Pha Kha village, together with her mother and older sister. She says she likes the clean air and relaxed pace and she wants to raise her 9-month-old son here with her husband.

But having recently spent two years, caring for her younger cousins in the country’s capital city, Vientiane, Noy explains a few things she had to change once she returned home.

Noy, whose name means ‘small’ in Lao language, has helped to trigger big changes in her community in southern Lao PDR. Photograph by Cecile Lantican, Ph.D.

Noy, whose name means ‘small’ in Lao language, has helped to trigger big changes in her community in southern Lao PDR. Photograph by Cecile Lantican, Ph.D.

“I never realized how convenient having a bathroom would be,” she explains. “When I came back (from Vientiane), there was no way I was going to continue going into the fields. It was so uncomfortable.”

Noy uses the words ‘uht aht’ to describe how she felt at losing the convenience and dignity she previously had in Vientiane, forced to find a tree or bush to crouch behind. Roughly translated, the words connote the feeling of having an awkward itch that you can’t scratch.

“I told my mother ‘we’re building a bathroom’,” she says, recounting how her decision “was final”. A few weeks later, her husband and brother-in-law had finished building a brick bathroom just next to her home.

“Noy told us we had to have one,” her mother recalls. “At first, I didn’t really think it was necessary… I thought we should spend the money on something else. But now I can’t imagine not having it… And I wouldn’t want my daughters having to go without one.”

Noy’s family latrine was built in early 2014. Neighbors followed suit in their own construction of latrines, significantly raising sanitation standards in the surrounding community. Photograph by Judy Souvannavong.

Noy’s family latrine was built in early 2014. Neighbors followed suit in their own construction of latrines, significantly raising sanitation standards in the surrounding community. Photograph by Judy Souvannavong.

It wasn’t long before Noy’s neighbors also started building bathrooms. A construction salesman who lives just up the hill from her started designing a series of connected latrines and washrooms for his family that now rivals the size of smaller homes in the village.

While sending all the young women in such a village off to spend time in bigger, developed cities is not likely the answer to inspiring better sanitation in rural areas, Noy – whose name literally translates as ‘small’ – is a good example of how one person can start to catalyze a community.

“It’s happening now… it’s slow, but it’s happening,” explains Mr Bounpone, the head of the cluster of communities of which Pha Kha village is a part.

But arguably the movement to build latrines in Pha Kha is not so slow. It was just two years ago that the community had less than five latrines for more than 150 households. Today, the community has 78. Village authorities estimate that if solutions can be found to some of the village’s water problems, nearly every home will likely have a latrine in two more years.

“We want the status of having a clean and healthy village,” Mr Bounpone says. “The people here see others building latrines and they want them too. For some, it’s still a matter of money. For others, we first need to work on the locations for them to build.”

This is precisely the type of progress and development that the Lao Government’s Ministry of Health (MoH) wants to see in rural areas.

“We know that with the right inspiration, people will take ownership for their family and their community’s health,” says Dr Bouakeo Souvanthong, Chief of the Environmental Health Division in the National Centre for Environmental Health and Water Supply under MoH. “But it will take people seeing and realizing the benefits of a few, before it spreads to many.”

As for Noy, she says there are other conveniences she misses from living in a larger city. “Ease of shopping… some of the food… and nobody wanting to use my bathroom,” she laughs. “If (my neighbors) keep using this one, it’s going to overflow!”


 

The National Centre for Environmental Health and Water Supply together with the World Bank’s Water and Sanitation Program and other development organizations have partnered with Another Option, LLC to create a series of communication products that will help to inspire the use of improved sanitation facilities in rural areas.

Shane Powell is a communication specialist who has worked on behavior development issues for more than 10 years in Southeast Asia. His areas of work focus on health, nutrition, education and natural resource protection. Shane currently resides with his wife and two cats in Vientiane, Lao PDR where they maintain vast collections of tea and soap from around the world.

SOCIAL AND BEHAVIOR CHANGE COMMUNICATION:

Factors Influencing Rural Women’s Decisions about Sanitation in Lao PDR

Another Option’s social and behavior change communication (SBCC) is designed to reflect target audiences’ personal motivations and beliefs and the cultural and environmental factors that influence them. SBCC strategies range from mass media and digital communication to social impact gaming. It also includes interpersonal communication (IPC) and peer education, and advocacy and public relations to affect policy change and cultural and social norms.

Creating an enabling environment that supports individual and societal change requires a strategic approach. Societal and cultural norms as well as policy and regulations are the barriers that prevent change. Advocacy activities range from strategic public relations, thought-leader meetings, and engagement or participation in problem solving.

Program design begins with data and Another Option has extensive experience in designing qualitative and quantitative research to offer insights and information about key populations and segment audiences and to design effective programs.

Under a World Bank-funded program, Another Option developed a social and behavior change communication program on rural sanitation in Lao PDR. Other donors include UNICEF, Plan International, and SNV Netherlands Development Organisation. Dr. Cecile Lantican led the Lao activity and following a field visit meeting with women in the communities and rural areas she captured her observations in the following blog.


What motivates women?

By Cecile Lantican, Ph.D.

From June 7-13, 2015 I joined the team of Another Option LLC, commissioned by World Bank under the Water and Sanitation Program in Lao PDR to observe people’s motivation to change and improve their sanitation practices. This is a new assignment for me after six years working in this country on changing people’s mindset and behaviors that put them to risk when they interact with their domestic animals and wildlife that carry zoonotic diseases.

I attended a ceremony hosted by the Pinh District government in Savannakhet to recognize villages that have made progress in addressing poverty and achieved improved sanitation status (declared Open Defecation free). I talked with Lao women and listened to their stories about their aspirations, needs and motivations that may have influenced their decision to seek for better status in life. I was amazed and fascinated interacting with Lao women from the south who I saw to be very hardworking, loyal to their families, hospitable and warm to visitors.

Young Lao Loum girls in their traditional Lao dresses.

Outlining the situation of rural women in Lao

I have worked with rural and urban women in this country, but I noticed that there is limited scientific information about how Lao women make decisions that affect their lives. Ethnic, geographic, and ecological differences create variations in the Lao women’s way of life. Ethnicity persists through language and dress patterns.

Illiteracy among rural women is high, especially in certain ethnic groups where cultural attitudes hinder girls from going to school. Parents force them to drop out to assist with the farm or domestic chores. Their capacity to obtain employment and participate in decision-making is severely hampered by their low level of education.

Early marriage is common among rural women. Most of them marry at the age of 16 or 17 years. A UN report in 2012 revealed that almost twice as many women marry and bear children before the age of 18 in rural areas (43%) than urban areas (23%). The total number of children of women with no education is nearly three times greater than that of women with higher education1.

The majority of women, especially those in ethnic communities, suffer from poverty, food insecurity, and unavailability of health services. The Lao women carry a great responsibility in the family. Apart from housework, and child rearing, they are also engaged in generating income for the family through labor-intensive work like collecting non-timber forest products including wild animals, weeding in the rice paddy, harvesting, planting cash crops and selling these products in the local markets, tending their animals, weaving, and managing family food stores.

More women are engaged in earning income for the family.

Rural women face complex decision-making when it comes to meeting their basic needs. Most often, they follow their elders’ advice. They feel restrained from expressing what they actually have wanted to happen in their lives.

The critical role of education for women

In Ban Sa-phang village, Mounlapamok district in Champasack province, a young mother of a three-year old boy married when she was nineteen. She did not finish primary school because she had to stop and help her parents on the farm. She married the first man who came into her life who promised her a better future since he was working in Thailand.

She was emotional when she sad, “I dreamt of living in a big house and wanted to earn money to buy food for my family, but that did not realize. My husband’s income from being a construction worker at the border, and most of the times seasonal, is not even enough for us.”

“If I was given the chance to have full control of my life, I would finish schooling. I think my life today would be different,” – Mother in Ban Sa-phang

She recognized that lack of education hampered her from finding work outside the farm. Unlike other women in her village who had entered their first year of secondary school and worked as migrant workers, she could not find work off the farm.

Women supporting their families

Anecdotal evidence showed that an increasing number of undocumented Lao women migrate to Thailand as workers in service and domestic sectors, vulnerable to abuse, exploitation and human trafficking.

Madame Bunkhong, 55 years old, was one among the attendees of the ceremony in Pinh district. She married at twenty-two and had four children.

After college, she worked in a private bank. But after two years, she had to stop working to take care of her sick father and to help her mother manage a small food stall at home. “I gave up my desire of being an employed and earn money for myself because I needed to follow my family’s decision.”

“ I wish good life for my family – to have a home and always have food on the table.” – Mdm. Bunkhong

“If I had complete control of my life before, I wouldn’t give up my dreams.” She affirmed that she is happy with her own family now, but it could have been more self-fulfilling if she had decided for herself.

Making decisions to improve sanitation

Looking closely at rural women who chose to access improved sanitation, I approached a woman who attended the PSI and district Nam Saat-led sales event for latrines. Her name is Madame Tongkham, 30 years old.  She has three children.  She married at eighteen.  Six months ago, her husband left them. She was aware that he may never comeback having heard that he has another woman.

“I should decide now for me and my children’s life.” – Mdm. Tongkham, Ban Pinh, Muang Pinh, Champasack.

It was her third time attending the latrine sales event in the village. The village council members encouraged her to attend. Earlier, she could not decide for herself because she needed to consult her husband. During this event, she ordered from the sales agent the delivery of one latrine package worth LAK 500,000. She made a deposit of LAK 50,000. “I felt devastated when my husband left. I worry about my three boys, and my old and sickly mother living with us. I have no regular income. My family now only relies on my niece who works in Thailand,” she said. “I did not finish school. I can only do farming and sometimes go with neighbors to the nearby village to harvest coffee beans. From these activities, I earn some amount to buy food for the boys,” she added.

I asked if someone had discussed the health risk of defecating in the open with her.  She replied, “ No one gave us briefing on the health risk. But I do remember that sales agent told us that having a toilet would give us convenience, safety and privacy.”

What made you decide to have the toilet this time?, I asked. “I have waited for my husband to decide.” She continued in her low voice. “ I need this toilet. I have fears when my boys defecate in the river along with other young boys. Many young boys have died of drowning in the river. My old mother needs it too,” she said.

Laotian women as community leaders

Laotian women’s confidence and self-esteem increase when they have greater knowledge, economic assets and income-earning capacity. Their low participation in decision-making is often due to stereotypes in their culture, which assign men the role of decision maker in the family and domestic affairs.

I met two Lao Women Union (LWU) community leaders at the ceremony. The district government recognized their unwavering support to uplift the living conditions and promote the role of rural women through training and participation in community affairs where their knowledge, skills and decision-making are essential.

Mdm. Phavoun (left) and Mdm. Khamphet (right) display their certificates of recognition.

The two women received training on various women-related issues from the national chapter of LWU that would empower rural women. Under the rural poverty reduction program of their district, they include provision of information on importance of education, sanitation and hygiene.

This travel provided me anecdotal evidences that rural women in Lao PDR can decide for themselves and their families. Under difficult circumstances, they can cope with their situation and can find solutions to their problems. They can improve their social status if given the opportunity of social support, correct information and networking.


1 Country Analysis Report: Lao PDR. Analysis to inform the selection of priorities for the next UN Development Assistance Framework (UNDAF) 2012-2015, UN in Lao PDR , Vientiane.

It starts with hand washing. The basic preventative measure to staying well from a wide array of infectious diseases is to correctly wash your hands with soap and water.

In grade schools all over the world, students learn songs that teach them how to wash their hands. In the United States, signs are posted in public bathrooms reminding us to wash our hands.

But, really, how many of us wash our hands thoroughly and correctly every time? And, if asked, how many of us could demonstrate the correct way to wash our hands?

It sometimes is very hard to understand that a behavior as simple as washing your hands with soap and water can combat an illness as deadly as the Ebola virus. But it can.

That’s why WCI’s social mobilizers are participating in refresher training on hand washing and taking that behavior to their communities.

Continuing the Hand Washing Behavior

During the height of the Ebola virus outbreak in Liberia, chloride-water solution stations were installed at public buildings and a number of households, and they were regularly used. People of all ages in both urban and rural communities were instructed on how to use the chloride solutions.  Among the first messages disseminated in response to the Ebola outbreak was to wash your hands with chloride-water This message was strongly supported by the government of Liberia’s Ministry of Health and disseminated through social mobilization activities like WCI under the Ebola-Community Activity Platform (E-CAP).

In Liberia, reported cases of the Ebola virus are diminishing, and the shift from chloride-water to soap and water is underway. Hand washing remains a critical long-term public health strategy for Ebola prevention, and it is important that people continue the behavior as the country moves forward.

Social Mobilization Training

Though we all think we know how to correctly wash our hands, it is important to have refresher training. WCI organized a refresher training session for its social mobilizers in Tubmanburg in Bomi County. The training was led by field officer Morris Taweh. In addition to the refresher on how to correctly hand wash, there was a discussion with the mobilizers on how to ensure the practice of hand washing continues in homes, schools, and public places, and throughout rural communities.

With the expense of chloride and reduced availability of subsidized sachets, the focus is on using soap and water. Iron Soap, a locally-made soap, is affordable and widely available.  Iron Soap can be shaved and used as a powder for cleaning or used in its original solid block form for hand-washing.

Mobilizers at the training session explained that it is just as important to promote hand washing with Iron Soap as it was to use chloride solution to keep Liberia Ebola-free in the future. They focused on how to reinforce effective hand-washing techniques and make sure people take their time and don’t rush through the steps. . “We need to figure out simple ways to remind people to do it and do it right,” one mobilizer said.

Training poster illustrating the steps for effective hand washing

Training poster illustrating the steps for effective hand washing.

At the training session, Morris shared the graphic instructions on how to correctly wash hands. Then, the mobilizers each demonstrated the correct hand-washing procedure and talked through each step so that they could help reinforce the behavior in their communities.

A mobilizer demonstrates hand-washing following instructions from the training chart.

A mobilizer demonstrates hand-washing following instructions from the training chart.

After finishing the demonstration, a number of the mobilizers suggested that the chart should be posted at hand-washing stations in schools and other public places as a good reminder of the steps.

WCI will continue to demonstrate hand washing  as a preventive action against Ebola infection as part of its community mobilization efforts. WCI plans to produce the graphic as a flyer to be distributed and posted in homes and schools and throughout the communities.

“Washing hands is a critical behavior for preventing the spread of the Ebola virus,” Morris reminded the group.  “Everyone knows it. Let’s make sure they remember to do it.”

Women’s Campaign International currently is an implementing partner with UNICEF and USAID’s Ebola-Community Action Platform (E-CAP) in Liberia.

In collaboration with UNICEF, Women’s Campaign International (WCI) is using its grassroots approach to tell rural communities about Ebola prevention in the remote southeast region of Liberia. Travel to southeast Liberia is a major challenge: it is difficult and expensive to reach this part of the country because it is very remote and the infrastructure is less developed.

WCI Program Manager Rebecca Martinez visited River Gee and Maryland Counties to conduct a one-day training with 28 communicators in Fish Town and Plebo. She joined the WCI regional field officer Dominic Dennis and gave this report back about her visit and her observations.

Rebecca flew in and then travelled four hours by motorbike to reach southeast Liberia.

Rebecca flew in and then travelled four hours by motorbike to reach southeast Liberia.

Challenges in the Southeast

River Gee and Maryland’s location has affected these communities’ assessments of the Ebola virus. The region has been fortunate in that there have been only a few cases of Ebola. However, this has contributed to a lack of belief that the disease is real. The mobilizers have said that one of their biggest challenges is convincing people to use preventative measures – such as hand washing with soap and water, not touching people, or following certain protocols at funerals – against something that they have heard of but not personally seen or experienced.

Regional community leaders explained that if people do not see Ebola, then it is not real. One mobilizer said that if Ebola came to River Gee, “plenty of people would die because belief is not there”.

These counties’ citizens follow very traditional burial practices. There also is a high level of fear and distrust of the Ebola Treatment Units (ETUs) and burial teams. There is a fear among the citizens of being stigmatized if they go to the ETU, so they have stayed away.

That is very different from others parts of Liberia. There have been positive reports of Liberians leaving the ETUs healthy, and people are beginning to believe that it is possible to survive the ETUs. This message still needs to be strengthened within the communities, and this has been a central part of WCI’s work in the region.

WCI’s Approach to Fight Ebola

Mobilizers reviewing training materials on Ebola prevention.

Mobilizers reviewing training materials on Ebola prevention.

The trainings in Fish Town and Plebo emphasized Ebola prevention practices and basic information about what the ETUs are and how they should be utilized. In addition to the classroom training, there were demonstrations and practice by the communicators on effective hand washing with soap and water and correct preparation of cleaning solution.

 

Though there have been few reported cases of Ebola in the southeast, there are rumors and misinformation about the virus, its treatment, and the ETUs. A portion of the training was spent clarifying incorrect information about Ebola, the ETUs, how people become sick, and how to respond if someone seems sick. Dennis and Rebecca spent considerable time explaining when someone should go to the ETU and what to expect when a patient goes there.

 

There is a lot of stigma surrounding the ETUs. People are afraid to go to them because they believe they will die there. One of the roles of the social mobilizers is to make the ETUs less threatening by explaining what type of health care the patients receive there and that they are there to help, not harm.

Successes 

The mobilizers told Rebecca about changes they see among their communities in Maryland and River Gee. The people are increasingly receptive to the government of Liberia’s message that “Ebola is Real”, and they understand that people that visit ETUs can and do survive.

For hand washing, Samaritan’s Purse previously distributed hand-washing supplies and installed hand-washing stations in front of almost every household and place of business in Maryland. Though behavior change requires more than knowing what to do, having the necessary supplies available makes it easier for people to adopt preventative practices.

WCI’s mobilizers are pleased with the progress they have seen and will continue their strong efforts to keep Ebola out of these communities where its prevalence has been low so far.

“Sailing forward to a brighter future for Liberia”.

“Sailing forward to a brighter future for Liberia”.

Additional comments from field officer Dominic Dennis

 “Since the Ebola outbreak in Liberia, many other NGOs have been trying to fight this deadly virus that causedmany people to lose their lives. Among those groups helping to stop the spread ofEbola, WCI has partnered with the Liberian Ministry ofGender and Development and, through funding from the USAID and privatedonors, they are implementing multiple programs to empower the National RuralWomen Program of Liberia. The National Rural Women Program has worked with more than 20,000 rural women and men for many years and since three months ago they have established a strongnetwork which stresses community engagement to fight against Ebola across Liberia, including in the southeast region. WCI empowers the national Rural Women by building their social mobilization through training them in the area of preventing the spread of Ebola in more than 85% of the communities in the southeast including Sinoe County.

WCI has trained eight mobilizers, forty-one communicators, eightcounty leads and forty community leads  in Sinoe, Grand Kru, Maryland,and River Gee Counties. Two assistants have been employed in the southeast.

In partnership with UNICEF, our organization is still carrying on thepreventive measures of the awareness of Ebola activities in thecommunities in the Southeast.Through E-CAP, the Rural Women have also been trained to use the iPhone to take pictures and to send reports using the U-Report.”

When a public health emergency like the Ebola outbreak occurs, sharing correct information and managing uncertainty at the local level are critical steps towards preventing the spread of the virus and reducing deaths.  Working closely with the government of Liberia, Women’s Campaign International (WCI) has used their established reach – 20,000 volunteers that are part of the National Rural Women’s Program in all 15 counties, including remote rural populations – and presence in the communities to conduct Ebola prevention and response.

             WCI’s Approach to Communication on the Ground

In a conversation with Wilfred Kokeh, WCI field officer for Lofa, Nimba, and Grand Gedeh Counties, in February in Kakata, he talked about how WCI has applied its social mobilization skills to support USAID, UNICEF, and the government of Liberia’s response to the Ebola virus.

WCI field officer Wilfred Kokeh (left) syncing phones with Rebecca Martinez, WCI Program Manager

WCI field officer Wilfred Kokeh (left) syncing phones with Rebecca Martinez, WCI Program Manager

Mr. Kokeh explained that WCI’s approach differs from most other NGOs in that it is “bottom-to-top” to effect change. The overriding goal of WCI is to help people help themselves by working within their own communities to help their neighbors learn how to work independently, and create sustainable livelihoods. WCI does this by being community-oriented and what activities it starts it eventually transfers to local authorities to continue.

For the Ebola outbreak, Mr. Kokeh said that WCI “knew how to respond [to the outbreak]” from their democracy work “going door-to-door in the community.” He went on to say that “they have been successful doing exactly that” and it has made a difference in Ebola.

WCI field officers from l to r Wyaette Willet Moore, Binda Freeman, Morris Taweh, and Wilfred Kokeh (not pictured: Dominic Dennis).

WCI field officers, from left to right: Wyaette Willet Moore, Binda Freeman, Morris Taweh, and Wilfred Kokeh (not pictured: Dominic Dennis).

When the first Ebola cases were reported in Lofa County in early 2014, it spread quickly throughout the communities. WCI was working in the community on civic participation in run up to the elections and in August 2014 was asked by the Ministry of Health and Social Welfare to apply its social mobilization skills to the Ebola hotspots to deliver public health messaging and logistics for the delivery of food and water.

Mr. Kokeh succinctly summed up why WCI was asked to perform this activity, [WCI] was’ “not recognized as experts in Ebola, but […] as experts in Liberia.”

WCI is a unique NGO because of its close ties and relationships to the communities where it works. Community members interviewed talked of how they “felt relief” when they saw that NGOs including WCI were part of the Ebola response, and they became worried when stories circulated that the NGOs were leaving.

Wyeatta Willet Moore, WCI field manager for Montserado and Grand Bassa Counties, reiterated this response from the communities: “like after the [civil] war – NGOs coming in gave us hope and a return to normalcy.”

WCI social mobilizer (right), Makoya  Komara, and communicator (left) Mamie Sendolo, Nimba County

WCI social mobilizer (right), Makoya Komara, and communicator (left) Mamie Sendolo, Nimba County.

             The Critical Role of Women in the Ebola Response

WCI is women-centric and its core principles are to elevate the role of women in society with an emphasis on the rural, low-literate, and poor. In its Ebola social mobilization gender plays a role. It is estimated 90 percent of their mobilizers and communicators are women; the mobilizers live in the communities where they are conducting the work; and they are trusted and respected members of their community – teachers, midwives, pastors, and business women.

WCI is a partner in the USAID Ebola-Community Action Platform (E-CAP) working in Liberia.

WCI has five field managers assigned to five regions in Liberia. Each field officer is responsible for approximately 40 mobilizers and 50 communicators. Wilfred Kokeh is the field manager for Lofa, Nimba and Grand Gedeh Counties that cover a geographic area of 1000 miles. Wyeatta Willet Moore is field manager of Montserado County that includes Monrovia and Grand Bassa County. Morris Taweh works in Bomi, Grand Cape Mount and Gborpolu; Binda Freeman oversees Bong, Magribi and River Cess Counties; and Dominic Dennis is field manager for Southeast Liberia – River Gee, Maryland, Sineo and Grand Kru Counties.

 

Monrovia, Liberia. Reported by Phil Sedlak.

Women’s Campaign International (WCI) is partnering with UNICEF and USAID on their Ebola Virus Disease (EVD) social mobilization prevention and response initiatives. With UNICEF, WCI is working in 15 counties in Liberia, and in early February, mobilizers from Grand Cape Mount, Montserado, Nimba and Bong Counties participated in training mobilization workshops. Participants were primarily women – about 90 percent. Several were teachers and educators, others were health mobilizers, and others small businesswomen.

When the mobilizers talk about their roles and what it will take to stop the virus from spreading, their commitment and dedication is apparent. They identify the barriers to them succeeding in their job. Not surprisingly, these barriers are about behavior.

Two mobilizers – Grace Nagbe from Gbarnga and Janet Benson from Ganta – participated in the mobilization trainings and were interviewed separately on what motivated them to be social mobilizers and what they see as the way to stop Ebola. An abbreviated summary of the interviews follows:

Grace Nagbe was a mobilizer with WCI prior to the Ebola outbreak, and she also has been a family planning health mobilizer. She is a WCI Field Assistant and will be coordinating the social mobilization in three counties. When comparing her past experience as a mobilizer to the Ebola work, she firmly noted that “none of those experiences have been like this…”

Grace Nagbe

WCI Field Assistant, Grace Nagbe, talks about the importance of communication and behavior change to stop Ebola.

Like so many in Liberia, Grace has lost friends and loved ones to the virus. She told the story of a good friend who was a nurse at Bong County hospital who became ill with the Ebola virus that she may have contracted from a pregnant patient. The patient, her newborn child, and Grace’s friend died. Grace was prompted to join WCI as a mobilizer because she felt so strongly about stopping the virus.

Ms. Nagbe is forthright in her opinions and her main complaint about the job is that “people are so stubborn… They don’t want to change.” She referred to the common belief among many in Liberia that Ebola is not real or that it is designed to make the “rich richer”. Grace emphatically said, “If we can get through to these stubborn people and convince them to take the right measures, we can stop Ebola in its path.”

Janet Benson is one of the WCI UNICEF Community Leads, whose job is to bring the message down to the communities and households. There is little doubt that she will succeed. WCI selected Janet Benson because of her strong commitment to how the Ebola prevention training should go and how she thought that community activists should do their job.

Janet Benson

Janet Benson, a WCI UNICEF Community Lead, is committed to bringing information to people in local communities to fight Ebola.

Ms. Benson told WCI that she wanted to “achieve things in her community.” She wants to influence leaders and community members to “shape up” and do things correctly to stop the progress of Ebola. In addition to “achieving things in her community,” she could also “teach other young people.”

She became interested in working on the Ebola mobilization, which only “arrived” in her community recently. She “learned about other peoples’ lives and how Ebola had infected them” and found out “what she could do” to help. That led her to WCI.

When asked about the future of Ebola in Liberia, she said that “a lot of what will happen is up to us [social mobilizers], the people who work in the communities.” We have to “carry the information to the people. Then they can do the right thing. They can finish this Ebola.”

“Ebola will finish because … we won’t give up. We are not quitters. Is truth,” she stated.

She went on to explain that “Now we have to work with school kids … They’re going to be harder because kids sometimes just do what they want, not what we think they should do. If we can get the parents to talk with the kids and get the kids to talk with the parents and if we can get the pastor of the local church involved – this guy has a lot of influence around the community – then we can beat Ebola.”

Ms. Benson and Ms. Nagbe are strong advocates to Stop Ebola in Liberia. They show the commitment and dedication the WCI social mobilizers bring to this initiative. And as Ms. Benton said, “we are not quitters. Is truth.”

Couldn’t have said it better.

WCIlogo

WCI Projects in Liberia

WCI Projects in Liberia

Women’s Campaign International’s (WCI) mission is to empower women to transform communities. Specializing in transitional and post-conflict contexts, active and serving leaders throughout the 15 counties in Liberia since 2008, WCI has a long-standing relationship with actors at the national and county levels.

The majority of WCI’s staff members are Liberian and are embedded locally throughout the country. They provide contextual perspectives on how local Liberians are responding to the outbreak, its stigma, and the misconceptions surrounding it. Equally important, there is a high-level of trust and understanding because they are from the community and are talking among their peers. The communicators also have long-standing relationships and connections to decision-makers and key stakeholders.

When the Ebola outbreak occurred in early 2014, WCI was asked by the government of Liberia to provide health education outreach on the Ebola Virus Disease (EVD) in communities where they were working. In September, the Ministry of Health and Social Welfare (MoHSW) authorized WCI to travel to 50 communities in nine counties in restricted regions to provide humanitarian support.

In November 2014, WCI was funded by USAID’s Ebola Community Action Platform (E-CAP) to facilitate community outreach, working closely with its partner, the National Rural Women’s Program (NRWP), to educate local communities about correct preventative and response behaviors to avoid the EVD. The NRWP are trusted local communicators and serve as champions on Ebola prevention and stigma reduction. Additionally, the ECAP Training also emphasizes recovery from the devastating social and psychological impacts of the virus. In its first round of trainings held in November, 12 women from three counties (Gbarpulu, Bomi and Grand Cape Mount) were trained in Monrovia. The remaining 24 mobilizers for the additional six counties (Bong, Margribi, Grand Gedeh, Nimba, Maryland and River Gee) were trained within a week. Among those trained was a survivor from the virus who shared her personal experience. She lost her mother to Ebola and her older sister also died. It was especially distressing because her sister refused to take any type of treatment because she believed the myths and rumors about the treatments and side effects.

ECAP-trained social mobilizerShe received care at the Gbarnga Ebola Treatment Unit (ETU), where she recovered and was immediately hired to work. Though this tragic story has a good ending, she has been a victim of stigma from the community, which has not accepted her since she had the virus. She did say at the training that people are beginning to slowly understand that she can be useful to her community.

“Whether or not they accept [me] life goes on and I thank God for everything. My only regret is that at eighteen years [of age], I am working and making good money and my mother is nowhere around to enjoy some of it.”

Though officials are reporting that Liberia is on the verge of containing the spread of Ebola, communities must remain vigilant to its threat. Localized efforts in community engagement and resilience building have proven to be one of the best approaches to educate the nation and eradicate the virus.

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Whenever the Mega Millions jackpot hits obscenely high numbers, like it did last week, I start making a list of what I would buy and where I would make contributions or investments if I won. One place would be in working to control or minimize dengue fever.

It is a disease close to my heart — and lurking in the back of my mind — and I feel like its lone champion, because it is overshadowed by malaria. It’s particularly frustrating because Federal funding ignores it as well, yet could control it with a minor investment. In the great scheme of things, we aren’t talking about a lot of money.  This infectious disease could be managed and controlled, and thereby we could reduce or eliminate a critical public health issue.

Dengue is one of several infectious diseases that is so underserved that the World Health Organization lists it among its “neglected tropical diseases.”

Neglected. Wow. Strong word.

They’re called neglected because they are underserved, underfunded, and under researched — particularly when measured against the threats they pose.

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Case in point: This week, the U.S. Centers for Disease Control and Prevention (CDC) put out an alert:  Chikungunya, a devastating infectious disease, which had never before been seen in the Western Hemisphere, arrived in the Caribbean. The alert told travelers – more than 9 million Americans journey to the Caribbean every year – what to do to prevent becoming infected.  And they would be wise to take precautions: An infection typically causes severe symptoms including headache, joint pain and fever.

Dengue is already endemic in Latin America, and cases have been seen in California and Florida. There’s even a new dengue virus type to worry about. Experts are already postulating that Chikungunya will follow. These aren’t diseases or illnesses that are prevalent “somewhere else,” but are viruses right here in the U.S. And it will take more than individual behaviors to keep them out. Funding for research to find a prevention, to enforce border protection, and multi-lateral agreements to address and contain the sources of the disease are priorities.  Then you work on changing individual behaviors.

I didn’t win this week’s mega lottery. But humanity would win big if we worked to remove the “neglected” from the common moniker of this collection of sly diseases, and slide them to the “Controlled” or “Managed” columns instead.

PS: After drafting this blog, I was talking to one of my social marketing mavens about Neglected Tropical Disease and he said, “The first thing you do is change the name? Neglected?! No.  We need to rethink how these viruses are known.”

— Dee Bennett

Ok. I will admit. I have a crush on Atul Gawande.

I love his book, The Checklist Manifesto and his no-nonsense approach to avoiding medical errors which plague health facilities in the US.

Rather than pointing fingers he provides a practical tool for hospital staff to ensure all steps are covered during hospital procedures.

In his recent article in the July 29th New Yorker, SLOW IDEAS: Some innovations spread fast. How do you speed the ones that don’t? http://www.newyorker.com/reporting/2013/07/29/130729fa_fact_gawande Gawande examines how important global health practices can “stick” given the right approaches and tools.

As someone who has been following the literature and practice of behavior change for 30+ years, such a treat to come across this article that succeeds in explaining behavioral theory, research and practice in one easily digestible, non-academic article.

The big take from Gawande’s article….

The gold standard for behavior change is positive personal interaction. High touch (personal interaction, mentoring, one-to-one instruction) interventions in many cases can be more effective than low touch (mass media, instructional curricula, and technology) interventions.

So in keeping with his checklist approach I will share with you my checklist from his article:

1. Observe and understand the context for why a behavior is or isn’t being practiced
2. Learn why people are doing what they are doing- and what is getting in the way of doing things the right way
3. Don’t assume that technology is the best solution (especially in global health)
4. Instructions (a checklist) followed by careful mentoring can reinforce positive behaviors for health professionals
5. Mass media is helpful to sustain a behavior over time
6. Community interventions that require a community learning a new practice need: individual interventions that demonstrate the practice; observations of community members trying the practice and monitoring of the practice over time.

I’m eagerly awaiting his next book.