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Travelling the last mile to zero Ebola cases in Liberia

In early December, President Ellen Johnson Sirleaf urged the people of Liberia to travel the last mile to reduce Ebola cases to zero. That last mile will be very long and difficult, and can only be achieved when every county has the capacity to find and isolate all cases, trace all contacts and bury all who die from Ebola safely. Here is the story of 2 remote villages travelling that last mile.

The number of new Ebola cases in Liberia has been falling in recent weeks. Now, hard-to-reach villages are at the frontline in the fight to drive cases to zero.

WHO Field Coordinator, Gebre Negash, and colleagues from CDC had set out early that morning, before dawn, driving for hours on roads and dirt tracks until they reached the end of the road from where they walked the final 2 hours to reach Bomota village in Bong County. There are no roads in this remote part of Liberia, only a small track that winds uphill and downhill through the tropical rainforest, crosses rivers and creeks, over and under fallen trees and through thick mud.

Village Chief Workpeh Donkpoie greets the team that has come to follow up contacts after an outbreak in the village several weeks ago. "I feel good that you people have come here to see us," says Chief Donkpoie. "It is very important for me. You educate us and we listen."

Talking about Ebola in the villages

Two hands go up in the air when the villagers are asked if anyone has been sick.

"I feel good that you people have come here to see us. It is very important for me. You educate us and we listen." Workpeh Donkpoie, Bomota Village Chief, Liberia

"It started with fever after a family member died," says James Yan. "I didn't touch the body but I was there. I was so weak that I could not do anything. Then I was taken to an ETU (Ebola treatment unit) and, by the grace of God, I'm alright now."

Phillip Jacobs also was infected with Ebola after participating in a funeral. "The day I got sick I left (the village). Today I am free from the sickness," he says, holding his certificate from the Ebola Treatment Unit in Bong.

"In Bong we are very lucky to have one of the best treatment units in Liberia. We are also fortunate that we have a laboratory. We can take your blood to test you, to find out if you have Ebola or not within a day," says Negash to the villagers. "So, please report any person who is not feeling well, even if you do not know if it is Ebola."

They nod, knowing the reality of the illness by now.
With contacts completing their 21 days follow-up, Bomota village has won its battle

"How will we know when it is all over?" asks one of the elders.

Patrick Moonan, an epidemiologist from CDC, explains that it will take 21 days since all contacts of the last patient are followed to be sure that none of them have been infected with Ebola.

Convinced that there is no one with fever in the village, and that they have raised awareness, the WHO and CDC team start their long walk back through the bush.

Later that week the team receives news that all contacts have completed their 21 days follow-up and Bomota village has won its battle for the time being.

Another journey into the jungle

The victory in Bomota is a fragile one; in Quewein, another remote village in the neighbouring county of Grand Bassa, the situation is much more grim.
Moses Jeuronlon, WHO staff, visiting remote villages during the Ebola outbreak, Liberia
Moses Jeuronlon, WHO staff, visiting remote villages during the Ebola outbreak, Liberia
WHO/R. Sorensen

WHO's Moses Jeuronlon is leading a joint investigation mission into Quewein with UNMEER and the County Health Team from the Ministry of Health. Once again, the journey is long, traversing thick forests and crossing rivers. This time, the group is not walking alone, it meets many porters on the way. One of them shouts: "Just one and a half more hours, and you'll be there".

By noon the mission arrives in Quewein. Two people have died there that same morning. A body wrapped in a plastic bag lies on the ground, until people dressed in rubber boots, gloves, masks and yellow suits carry it away. The team from Médecins sans Frontières (MSF), that arrived in the village 4 days ago, sprays the ground where the body lay.

MSF colleagues share the latest information with the joint mission. The deceased people were an elderly man, cause unknown, and a married woman in her mid-forties who had Ebola symptoms and was abandoned by her husband.

The WHO team follows up with registering people in the village who had contact with the 2 deceased people. Then the joint mission starts its two-hour walk back to the cars.

Informing nearby villages

Passing through neighbouring villages, they inform the chiefs on their way. Anyone with a high temperature is advised to report it to the village chief. He will then call the Community Health Volunteer to organize transport to the nearest ETU, in this case Bong. There, the symptomatic person can be isolated and given the best treatment available.

"There were 4 deaths in this village before MSF arrived, and they did not practise safe burial routines. Now we are up to 9 deaths already after 2 weeks. It could be the cause of the outbreak here," says Jeuronlon. Denial and unsafe burial practices in remote villages can make that last mile a very long one.



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