WEBVTT 00:00:00.720 --> 00:00:04.996 Au centre opérationnel d'urgence du Liberia, de lutte contre Ebola 00:00:06.023 --> 00:00:09.046 en compagnie de mon collègue Mosaka Fallah. 00:00:09.546 --> 00:00:14.820 Votre lutte contre Ebola est primordiale puisque vous êtes aujourd'hui responsable 00:00:14.820 --> 00:00:18.170 des traceurs de contacts ici à Moravia - Oui. 00:00:18.170 --> 00:00:23.210 Alors dites nous... Pourquoi est-ce si difficile de suivre ces contacts ? 00:00:23.210 --> 00:00:27.700 Pour deux raisons principales. 00:00:27.700 --> 00:00:31.920 La première est une question de confiance. 00:00:32.100 --> 00:00:35.280 De confiance dans les traceurs eux-mêmes 00:00:35.280 --> 00:00:41.850 Ils ont de moins en moins confiance en nous et c'est dû au fait que 00:00:41.850 --> 00:00:48.000 to them in time. also there is an issue of... our non-Ebola 00:00:48.000 --> 00:00:53.079 health services is not developed , in case they don't have Ebola, how do they get the 00:00:53.079 --> 00:00:56.340 best treatment? That means if they have malaria, pneumonia 00:00:56.340 --> 00:00:59.860 or other sorts of diarrhea... they can't find any treatment. 00:00:59.860 --> 00:01:04.769 Exactly. Since Ebola our health care system collapsed on the wake of the emergency 00:01:04.769 --> 00:01:09.380 So they don't have an alternative to go So they see their relatives go before... they don't 00:01:09.380 --> 00:01:13.590 have any alternative, so they are distrustful. Why should they tell us? They don't have an 00:01:13.590 --> 00:01:17.139 alternative. And the third thing is the issue of feedback. 00:01:17.139 --> 00:01:20.359 They have seen their relatives go to ETUs and maybe die 00:01:20.359 --> 00:01:22.590 and they didn't have the feedback in a timely fashion. 00:01:22.590 --> 00:01:26.030 And ETU is the abbreviation for the Ebola Treatment Units 00:01:26.030 --> 00:01:29.850 that are the hospitals or tent hospitals specially for Ebola. 00:01:29.850 --> 00:01:35.259 Yes, Dr. Hans. But I mean... is it 8 monitors you have now? 00:01:35.259 --> 00:01:37.060 Oui. Qui supervise cela… 00:01:37.060 --> 00:01:40.979 They are really wise. When I have been in the morning meetings, 00:01:40.979 --> 00:01:47.139 they understand all the dynamics and realities of people. Some of which are 00:01:47.139 --> 00:01:53.369 very poor. So when you now became in charge of this; 00:01:53.369 --> 00:01:56.340 What is the most important? I know that you are fixing the food now. 00:01:56.340 --> 00:01:59.270 Yes. Because they need food the same day that they 00:01:59.270 --> 00:02:04.579 became a case, a contact, so they can't go out and buy themselves. 00:02:04.579 --> 00:02:08.848 How are you planning to change or improve the system? 00:02:08.848 --> 00:02:11.370 Because it's already good! Because you took it from a catastrophe. 00:02:11.370 --> 00:02:14.420 You took it from a 100 a day down to 10 a day. 00:02:14.420 --> 00:02:16.590 What are the next things you want to change now? 00:02:16.590 --> 00:02:20.849 First I want to restore the confidence and I hope in building trust. 00:02:20.849 --> 00:02:22.890 Engaging local communities. 00:02:22.890 --> 00:02:26.319 Engaging lots of stakeholders. And ensuring that they'll have a response 00:02:26.319 --> 00:02:30.549 in a timely fashion. And we are talking about making 00:02:30.549 --> 00:02:34.689 practical field decisions. Moving case-investigators, contact-tracers, 00:02:34.689 --> 00:02:37.370 psychosocial together. Generate full list. 00:02:37.370 --> 00:02:40.120 Have the full list returned to the family in a timely fashion. 00:02:40.120 --> 00:02:43.560 Providing the psychosocial support. Working with local leaders. 00:02:43.560 --> 00:02:46.170 Supporting the local leaders building the transport. 00:02:46.170 --> 00:02:50.939 Working on a feedback system where we now gonna have 00:02:50.939 --> 00:02:53.829 case investigators working closer with us and a data unit 00:02:53.829 --> 00:02:55.959 ensuring that they'll feedback in a timely fashion. 00:02:55.959 --> 00:03:00.329 As of the status of; their relatives; those in the ETU; and the lab results. 00:03:00.329 --> 00:03:06.019 Your people, the tracers, how many are they? How many people do you have who go and visit 00:03:06.019 --> 00:03:09.319 these contacts? In Montserrado county we have 305 tracers 00:03:09.319 --> 00:03:14.250 22 supervisors currently in the two zones of the Montserrado 00:03:14.250 --> 00:03:17.810 county. And they have to be like detectives almost. 00:03:17.810 --> 00:03:21.640 But then you say they have to be kind also. They have to think about the family. 00:03:21.640 --> 00:03:27.060 Yes, so it's always a critical issue, because they see them as representing the system. 00:03:27.400 --> 00:03:30.939 Because they are the ones that the first time, if there is a death in the family, someone 00:03:30.939 --> 00:03:33.799 has to come see them first, and they have to be the ones who go there 00:03:33.799 --> 00:03:37.499 everyday for 21 days. So, yes they have to be empathetic. 00:03:37.499 --> 00:03:40.920 But also they have to be detectives. They have to be able to see through them 00:03:40.920 --> 00:03:44.300 and know; those who have been honest and those who are not saying the truth 00:03:44.440 --> 00:03:47.520 and after follow up investigation to find all contacts. 00:03:47.530 --> 00:03:52.049 In this epidemic there is no room for errors. You need to find 100% contacts. 00:03:52.049 --> 00:03:56.129 So they have to do the both. Be kind, at the same time as being a detective, 00:03:56.300 --> 00:03:58.959 to find out all of the contacts. And you never use force? 00:03:58.959 --> 00:04:03.840 I mean you don't threaten people. It's just their free will? 00:04:04.620 --> 00:04:10.080 Yes, Sir! We encourage the free will, even when deciding the concept of quarantine. 00:04:10.090 --> 00:04:12.750 We always say quarantine should be done by the communities. 00:04:12.940 --> 00:04:15.720 You shouldn't get the police involved. It should be done... it should be involved 00:04:15.730 --> 00:04:17.920 for discussion. There's a consensus building. 00:04:17.920 --> 00:04:20.370 It's so important because the fear we always have is that: 00:04:20.370 --> 00:04:23.560 if we use force, they could escape. If we put them under huge pressure. 00:04:23.560 --> 00:04:27.200 It has to be a friendly approach; a comunity-based approach 00:04:27.200 --> 00:04:31.610 You look like a very tough guy! That's what has impressed me you know. 00:04:31.610 --> 00:04:34.890 I've seen you almost rush out from the morning meetings. 00:04:35.120 --> 00:04:41.220 And then when you argue, you talk like a nun. You are very kind to people! 00:04:41.820 --> 00:04:47.300 This is probably the most important to be empathetic, you say? 00:04:47.900 --> 00:04:53.720 I think so. Yes! But you have two types of problems. One is 00:04:53.720 --> 00:04:59.330 that you don't get the contacts listed. They are hidden some of them. 00:04:59.330 --> 00:05:02.530 And the other is that the contacts who get sick, they leave 00:05:02.530 --> 00:05:05.380 because they don't want to be identified as sick. 00:05:05.380 --> 00:05:08.420 What is the reason why they don't get listed in the beginning? 00:05:08.620 --> 00:05:12.560 In the beginning of the epidemic there was a couple of factors. 00:05:12.980 --> 00:05:16.160 One of them was that the burial team picked up 00:05:16.170 --> 00:05:22.140 the body and we would not have the contacts coming to us in a timely fashion. 00:05:22.140 --> 00:05:26.380 Some of them road commercial vehicles probably ambulances, and went to ETUs. 00:05:26.600 --> 00:05:28.440 And those who did that without collecting send back as a feedback 00:05:28.440 --> 00:05:34.330 and line then was sent to begin contact tracing. That means that the list for them… 00:05:34.330 --> 00:05:37.330 and of course when they had someone who had died at home 00:05:37.330 --> 00:05:42.750 that was a very emotional, and very sad moment it's not an easy time to remember them. 00:05:42.750 --> 00:05:45.600 Exactly, and the exam of contacts and all those kind of questions. 00:05:45.600 --> 00:05:51.840 It's an emotional period. That stage is critical you can build friendship, you can build empathy 00:05:51.840 --> 00:05:55.940 and then they can reveal to you, by that time when they are in the though period. 00:05:55.940 --> 00:05:58.990 So now you are going to have a system where by 00:05:58.990 --> 00:06:04.430 those which we call "case investigators", who just take care of the information of the 00:06:04.430 --> 00:06:08.460 sick and your contact tracer, with a list of contacts 00:06:08.460 --> 00:06:13.140 and ambulances and the burial cars they will be one system? 00:06:13.140 --> 00:06:16.210 Yes, we're hoping yes. So there can practical field decision. 00:06:16.210 --> 00:06:21.330 Because most of the time we lost a contact in the time past when the case investigator 00:06:21.330 --> 00:06:25.620 does the investigation and line listing, between that and the data unit and coming 00:06:25.620 --> 00:06:28.180 back to the tracer, there was a delay in time. 00:06:28.180 --> 00:06:32.650 So some of the contact listing got lost. If there is a field level decision 00:06:32.650 --> 00:06:36.500 where the investigator does the investigation the contact tracer takes the line listing 00:06:36.500 --> 00:06:40.400 and initiates investigation immediately. In that case I'll be very confident that every 00:06:40.400 --> 00:06:42.820 case we've seen, we've gone through that. We have the contacts 00:06:42.820 --> 00:06:45.000 listed and that we have followed up!