World

Liberia's Information Minister Admits Mistakes, Defends Actions

By Ofeibea Quist-Arcton

Published September 4, 2014 at 10:40 AM CDT

Information minister Lewis Brown is proud of Liberia's strong response to Ebola but admits, "We think sometimes we could have done better — much quicker — to improve the response time."

For more than an hour, the Liberian government official took questions from NPR. Despite the tense times in his Ebola-stricken country, Lewis Brown, minister of information, cultural affairs and tourism, was welcoming and animated. His mood was upbeat, although not overly optimistic. He spoke with NPR's team in his office, furnished with black patent leather sofas. He was late for his next meeting because of the long interview but graciously dismissed any concerns we expressed about running late.

President Ellen Johnson Sirleaf declared a state of emergency — a public health emergency — in August. Was that too late?

People tend to forget we've had two waves of the Ebola outbreak. The first in the rural community, in the border town of Lofa, late in March. We survived the first 21 days with no new cases reported. We survived a second 21-day period, making it a total of 42, with no new cases reported.

Quite frankly, many of our partners folded tent and were leaving the country. The only advice was that we do not announce that we were Ebola-free, because there were still new cases being reported in neighboring Sierra Leone and Guinea.

The second wave — that occurred in Monrovia, the capital, in which around a third of our population currently resides. Not only was it now unprecedented — this was [one of the first times] in the history of the virus that it was breaking out in a capital city, in an urban center instead of a rural setting.

Many hospitals and clinics were forced to shut down after staff members were infected with Ebola, Lewis Brown notes. Redemption Hospital in Monrovia, shown above, has kept its doors open.

Another difficulty was that we started experiencing the outbreak in health care centers, hospitals, clinics, and many of these were forced to shut down as health care workers — including doctors — were stricken by the virus.

And so, not only was it difficult and unprecedented and would have challenged any public health service, let alone ours, which is recovering from 10 years of war, but the extent of the spread in an urban area — where the population moves more frequently and faster than ... in a rural area — made the second wave of our outbreak more difficult and even more challenging than the first.

We have had to adapt as we moved along. Don't forget — this is the first time that we're confronting such a virus.

It comes with the fact that our people think that there is a sense of deception here around this virus.

Around this time of the year, during the rainy season, it's quite common to have higher incidence in malaria, typhoid and other illnesses common to the tropics.

So the same symptoms are associated with Ebola. And here we are telling our people to abandon their cultural practices, their religious practices, funeral and burial rituals — essentially their way of life handed down to them over centuries, from their great-great-grandparents, throughout the ages, if you will — for something that looks like malaria, that they're used to.

When you ask people to alter the way they've always lived, you are met with initial doubt and resistance.

So there were initial doubts here and there about whether the virus existed. People had never heard about Ebola.

You say there were initial doubts. But there's continuing denial among many Liberians about the existence of Ebola.

I would argue that the denial we have today is not the same we had before. And this is across the three countries [Guinea, Liberia and Sierra Leone]. And it's not, as people have made it out to be, necessarily because of the government saying so.

So, the truth of the matter is — when you ask people to alter the way they've always lived, you are met with initial doubt and resistance.

Today, what we have more than doubt is fear — as people have seen loved ones die, have seen relatives die, as people demystify this virus, people have been encapsulated by fear.

What about West Point, the densely populated shantytown in Monrovia where the community and security forces clashed. West Point residents objected to a holding center for suspected Ebola carriers being located in their neighborhood. The facility was looted. Then the government imposed a quarantine on West Point. And West Pointers were saying, "Why us?"

I was building a perspective of West Point, so you understand.

So what happened was we have had to adapt to new measures. This began with a public health emergency announced by the president. And we've had to graduate it upward.

Knowing the possibility of spread in the capital and also knowing the mentality of our people, too often the two get mixed up. Often we've heard criticism associated with quarantine; "Oh, no, it's a medieval tactic that doesn't work," and, "It will not help to contain the outbreak."

But what gets lost in that argument is the mentality of Liberians. We may not be experts in fighting the virus, let's make no pretense about it, but no one can pretend to know our people better than we do.

The quarantine in West Point was lifted after only 10 days, when it had been imposed for 21 days. Some residents are jubilant, saying they won. Did you mismanage West Point?

Absolutely not. And that is again part of the commentary we have to try to deal with and put into proper perspective. Let me zero in on West Point. The potential for an explosive outbreak was extremely high. So what was done was to quarantine the area as a containment measure. The fact that a few were jubilating and saying, "Yes, we were right, there's no Ebola here," was not the basis for the lifting of the quarantine.

West Pointers seemed surprised when the Ebola holding facility appeared. Not a lot of people in the community knew about that, and the same with the quarantine imposed in the middle of the night.

Show me one place where a quarantine is announced before it's imposed — you must always have the element of surprise.

Can you imagine saying to West Point, "Tomorrow at midnight we're imposing a quarantine," that you'd find anybody there? Obviously not. Obviously not.

A policeman directs a crowd of protesters in the West Point neighborhood after a quarantine was enforced on Aug. 20. Leadership is "not a popularity contest," says Brown, who believes it was the right move "to contain that possibility of an [Ebola] outbreak."

So the truth of the matter is — did all West Pointers like it? No, definitely not! Would you like it? If your days rely on your movement around the community, it's not something you're going to like.

Is it something the government liked? Obviously not. No, we did not. But what today is the outcome of those actions? Let's be judged by the outcomes.

I went with the president back into West Point. What I saw actually impressed me. I saw a community now literally rallied against Ebola. I saw a community where — I was talking to a group of ladies and one was leaning on the other. And one lady rebuked the other, [saying] "No, no please. Don't touch me."

Today, notwithstanding the criticisms — the people did not like [the quarantine], right — to lead is not a popularity contest, especially to make these kinds of difficult decisions about your own people.

It's not a popularity contest. You wouldn't do right. But it must be all the time what is right. And what was right was to contain that possibility of an outbreak.

Imagine what would have happened, after the violation of that holding center. Imagine if the community did not have a sense of ownership as they do now. Imagine if they were not in a position to identify the at least four people [who looted the health facility] who were taken for treatment.

Can you imagine saying to West Point, 'Tomorrow at midnight we're imposing a quarantine,' that you'd find anybody there? Obviously not. Obviously not.

The four would have become eight in no time. The eight would have become 64. The 64 would have become 128. Can you imagine, given your knowledge of West Point, can you imagine the possibility of a spread in West Point? That is the size of disaster we were looking at.

And we had to make a very difficult decision. It was not a cheerleading decision, it was not a decision we liked. It was a decision we felt compelled to make, to put in the kind of system that is today yielding the results that we have.

So there will be some who will quarterback this for as long as we probably will live. But the truth of the matter is we believe West Point is, today, best positioned to fight the Ebola outbreak — than other communities.

So, again, my answer is if you give notice about quarantine, you'll find nobody there. You must give the security [forces] the element of surprise. And ... the quarantine was not, contrary to what anyone may say, intended to hurt our own people. It was to help them.

Today, we believe West Point is more organized, better positioned to fight any outbreak. They've taken on the ownership — to the point that they are themselves involved in contact tracing. I'm sure you're aware of that.

They are themselves involved in the distribution of their own food. If food went into West Point today, it's West Pointers who would distribute it.

Previously, you probably would have had to put an army in there to distribute the food. But such is the change in the circumstances, that I believe we've made progress.

Now, did the quarantine do it? We'll never know. But certainly we are convinced as a government that it catalyzed it.

You admit that there are some faults with the government. What are those faults when it comes to fighting the Ebola crisis? Have you made mistakes?

Yeah, yeah. Quite frankly, we think sometimes we could have done better — much quicker — to improve the response time. In our initial approach to this, and what our people see more than anything else, is not all the behind-the-scenes maneuvers, discussions, etc.

People see how fast are they picking up bodies from communities, how fast are we picking up sick people. If a body will lie in a community for two, three days, then the government is doing nothing. Everything else pales in comparison to that — especially when our people now know that to touch a dead body is to contract the virus.

So we could have a lot better with that — the collection of bodies. Another area, I think, is mobilizing international support. We could have done a lot more with that, because we launched a $20 million medical response effort.

Our national plan is around $20 million [U.S.] from the Ministry of Health. I think we could have spent some time mobilizing, engaging the international community — fighting wherever with the World Health Organization and strategic partners to get that money in country.

We put up $5 million [U.S.] under our difficult circumstances. You know, our budget still has not passed. We were just renewing the budget when all of this went down. So it was a rather difficult legislating progress.

But I believe, if we had gone out — when we produced our national plan — if we had gone gung-ho with them ... and found the resources to support that national plan immediately, perhaps a lot could have been done.

But again, as we have moved along, we have increased international support that has come in. You've heard about the African Development Community giving a $60 million [U.S.] grant to the three countries [Liberia, Sierra Leone and Guinea] through the World Health Organization.

You heard about the Centers for Disease Control working with us in a strategic partnership? One thing is we are beginning to see a higher appreciation of the sense of urgency about this.

The last three doses of the experimental drug ZMapp were dispatched to Liberia for three medical workers. Liberia is the first African country where these drugs have been used. What do you feel is the future for experimental drugs in Liberia?

We're keeping all of our options open. If there's one big lesson from this Ebola fight, it's never close the door on any option.

So we're keeping all of the options open. But even as we do, we don't begin — knowing our people — we don't want to emphasize curative over preventive.

One thing we want to do is to put prevention at the front end — because we still know that prevention is better than cure.

I tell you, when the ZMapp experimental drugs were brought in — if you went back to our daily situation reports — we had a spike in people turning themselves in at the hospitals.

Suddenly, the impression was a cure had been found. Knowing our people, when that message gets out — people abandon prevention because, don't forget, most of the preventive methods that we are informing about are actually against how people have always lived.

So as soon as you tell them it works, there is now a "cure," suddenly people go back to old habits and old practices. And we don't want that, so much as we're keeping the options open, not just for ZMapp, but for [other drugs], we're insisting on prevention. We're insisting on public awareness. We're insisting on community ownership.

Because, again, if our people soon hear, "Oh, there is now a cure," suddenly folks start burying their bodies again, folks start returning to the rituals and we can't cut the transmission.

So we're keeping all our options open. We've done the best we can, continuing behind-the-scenes discussions with drugmakers, the Food and Drug Administration of the United States and many other countries.

One thing we want to do is to put prevention at the front end — because we still know that prevention is better than cure.

And let me just close on this note: Our country, Liberia, has come a long way in its development, in its progress. Over the last 10 years [since the civil war ended], we've covered a lot of ground — but we would be the first to admit that we're not where we thought we could be.

So our hope is that, as this virus has rightly so exposed many of the weaknesses of our country, that it [does not end up] hurting the country and undermining its stability.

I say that because often if things don't get put into context, then we lose the full picture. And, as you will find, it's so easy. And we will continue to encourage, at home and abroad, discordant voices to be heard, in our mind not because they're right, but because they have a right to say it.

And in exercising that right, especially at this point, we're hoping that we can focus not just on saving lives but giving people a way of sustaining their livelihood.

That is the challenge we face today. And for us, there's nothing bigger than this. Because we know we will win this fight [against Ebola], we must win this fight or else all of us get consumed by it. We must — there's no choice here.

But do we want to limp across the finish line? Do we want to roll back all of the progress [since the civil war years], or do we want to keep moving forward? Building the kind of society that permits us in being more responsive to people, that permits us to provide more opportunity to people to live to their fullest potential, that is the challenge we must face every day, and these are the decisions we must make every day.

Some we don't like, but, again, they're decisions we must make — with an eye toward the long term and toward the future.

This interview has been condensed and edited for clarity.