Au centre opérationnel d'urgence du Liberia, de lutte contre Ebola
en compagnie de mon collègue Mosaka Fallah.
Votre lutte contre Ebola est primordiale puisque vous êtes aujourd'hui responsable
des traceurs de contacts ici à Moravia - Oui.
Alors dites nous... Pourquoi est-ce si difficile de suivre ces contacts ?
Pour deux raisons principales.
La première est une question de confiance.
De confiance dans les traceurs eux-mêmes
Ils ont de moins en moins confiance en nous et c'est dû au fait que
to them in time. also there is an issue of... our non-Ebola
health services is not developed , in case they don't have Ebola, how do they get the
best treatment? That means if they have malaria, pneumonia
or other sorts of diarrhea... they can't find any treatment.
Exactly. Since Ebola our health care system collapsed on the wake of the emergency
So they don't have an alternative to go So they see their relatives go before... they don't
have any alternative, so they are distrustful. Why should they tell us? They don't have an
alternative. And the third thing is the issue of feedback.
They have seen their relatives go to ETUs and maybe die
and they didn't have the feedback in a timely fashion.
And ETU is the abbreviation for the Ebola Treatment Units
that are the hospitals or tent hospitals specially for Ebola.
Yes, Dr. Hans. But I mean... is it 8 monitors you have now?
Oui. Qui supervise cela…
They are really wise. When I have been in the morning meetings,
they understand all the dynamics and realities of people. Some of which are
very poor. So when you now became in charge of this;
What is the most important? I know that you are fixing the food now.
Yes. Because they need food the same day that they
became a case, a contact, so they can't go out and buy themselves.
How are you planning to change or improve the system?
Because it's already good! Because you took it from a catastrophe.
You took it from a 100 a day down to 10 a day.
What are the next things you want to change now?
First I want to restore the confidence and I hope in building trust.
Engaging local communities.
Engaging lots of stakeholders. And ensuring that they'll have a response
in a timely fashion. And we are talking about making
practical field decisions. Moving case-investigators, contact-tracers,
psychosocial together. Generate full list.
Have the full list returned to the family in a timely fashion.
Providing the psychosocial support. Working with local leaders.
Supporting the local leaders building the transport.
Working on a feedback system where we now gonna have
case investigators working closer with us and a data unit
ensuring that they'll feedback in a timely fashion.
As of the status of; their relatives; those in the ETU; and the lab results.
Your people, the tracers, how many are they? How many people do you have who go and visit
these contacts? In Montserrado county we have 305 tracers
22 supervisors currently in the two zones of the Montserrado
county. And they have to be like detectives almost.
But then you say they have to be kind also. They have to think about the family.
Yes, so it's always a critical issue, because they see them as representing the system.
Because they are the ones that the first time, if there is a death in the family, someone
has to come see them first, and they have to be the ones who go there
everyday for 21 days. So, yes they have to be empathetic.
But also they have to be detectives. They have to be able to see through them
and know; those who have been honest and those who are not saying the truth
and after follow up investigation to find all contacts.
In this epidemic there is no room for errors. You need to find 100% contacts.
So they have to do the both. Be kind, at the same time as being a detective,
to find out all of the contacts. And you never use force?
I mean you don't threaten people. It's just their free will?
Yes, Sir! We encourage the free will, even when deciding the concept of quarantine.
We always say quarantine should be done by the communities.
You shouldn't get the police involved. It should be done... it should be involved
for discussion. There's a consensus building.
It's so important because the fear we always have is that:
if we use force, they could escape. If we put them under huge pressure.
It has to be a friendly approach; a comunity-based approach
You look like a very tough guy! That's what has impressed me you know.
I've seen you almost rush out from the morning meetings.
And then when you argue, you talk like a nun. You are very kind to people!
This is probably the most important to be empathetic, you say?
I think so. Yes! But you have two types of problems. One is
that you don't get the contacts listed. They are hidden some of them.
And the other is that the contacts who get sick, they leave
because they don't want to be identified as sick.
What is the reason why they don't get listed in the beginning?
In the beginning of the epidemic there was a couple of factors.
One of them was that the burial team picked up
the body and we would not have the contacts coming to us in a timely fashion.
Some of them road commercial vehicles probably ambulances, and went to ETUs.
And those who did that without collecting send back as a feedback
and line then was sent to begin contact tracing. That means that the list for them…
and of course when they had someone who had died at home
that was a very emotional, and very sad moment it's not an easy time to remember them.
Exactly, and the exam of contacts and all those kind of questions.
It's an emotional period. That stage is critical you can build friendship, you can build empathy
and then they can reveal to you, by that time when they are in the though period.
So now you are going to have a system where by
those which we call "case investigators", who just take care of the information of the
sick and your contact tracer, with a list of contacts
and ambulances and the burial cars they will be one system?
Yes, we're hoping yes. So there can practical field decision.
Because most of the time we lost a contact in the time past when the case investigator
does the investigation and line listing, between that and the data unit and coming
back to the tracer, there was a delay in time.
So some of the contact listing got lost. If there is a field level decision
where the investigator does the investigation the contact tracer takes the line listing
and initiates investigation immediately. In that case I'll be very confident that every
case we've seen, we've gone through that. We have the contacts
listed and that we have followed up!