It's not just the US — Liberian officials are rethinking Ebola quarantines

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Marco Werman: I’m Marco Werman with The World here in Boston. A nurse goes for a bike ride and suddenly everyone’s got an opinion on quarantine. We’ve seen that play out in the Kaci Hickox case up the road from us here in Maine. A judge finally stepped in today, saying the nurse can go where she wants because she’s showing no symptoms of Ebola. But he also ordered Hickox to coordinate with state officials. The fact is this whole idea of quarantine is confusing for a lot of people. In Liberia, perhaps the country most affected by the Ebola outbreaks, they tried quarantining a whole neighborhood. That was in August, in the West Point shantytown in the capital, Monrovia. After officials sealed it off, there were a lot of angry residents and chaos. BuzzFeed correspondent, Jina Moore, is in Monrovia. We reached her on a hotel balcony where she found some WiFi, and she says things have changed since August.

 

Jina Moore: I think that the West Point quarantine was a bit of a turning point for the quarantine policy. These days, what tends to happen when the word “quarantine” comes up is that it’s individuals who are being “quarantined” in their own homes. Often after having been persuaded to do that by their neighbors or community leaders. If someone was sick or someone died in the house, there’s usually a conversation that will transpire -- “Can you just hang out for 21 days while we come in and check on you and make sure that you’re okay without bringing this around to the rest of the neighborhood.” And that, having been sort of a bottom-up notion of quarantine, sort of a neighbor responding to neighbors with care and concern, seems to be going a bit better. But the top-down and circling counties or neighborhoods with armies isn’t something that’s happening anymore.

 

Werman: You interviewed the information minister in Liberia, Lewis Brown, and it was he, along with President Ellen Johnson Sirleaf, who issued that quarantine order. What did he say about why the quarantine policy has retracted a bit?

 

Moore: It was the president who issued the order. She’s the one with the ultimate authority to do that. I’m sure the minister, along with the defense minister, health minister, other folks were sort of advising the president on all of the decisions, but ultimately it’s an issue that came from the president. The idea had been to try and get a handle on the disease. Minister Brown told me the other day “Look, back then we didn’t really know much about what we were dealing with.” The truth of the matter is if you, in August, went online and said “Ebola Response Manual,” there wasn’t a whole lot of information that you would have been able to come up with. One of the words that you would have run into is the word “quarantine.” “Okay, monitor people for 21 days.” But the problem in applying that idea that lingers from these much smaller Ebola outbreaks we’ve seen in very rural places in Central Africa, which is completely different than the outbreak we’re seeing now, is that when you scale up that quarantine to a community level, it doesn’t necessarily work. It’s almost not going to work from the get-go because the goal of the quarantine is to separate the sick from the healthy. But if you’re locking everybody up together, it becomes much harder to do that.

 

Werman: And that’s what you’re hearing from medical professionals, both Liberian and foreign professionals in Liberia right now?

 

Moore: That’s right. The minister of information said “We have better information now. There’s a reason that that’s not something we’re continuing to do.” The Centers for Disease Control also said “When you want to do a quarantine, that’s the goal, is to make a separation and make it as efficiently and as clearly as you possibly can.” They Centers for Disease Control also raised another point that I think was really interesting, which is when you lock off a neighborhood, you have much less access to information unless you coordinate it in advance -- information pathways -- than you do when people can move about freely, including contact tracers or case management officers, or the individuals who go door-to-door and check on people and see how neighbors are doing day-to-day in the course of this now very long outbreak.

 

Werman: You’re not a psychologist, but you did try to find out how targeting human behavior and psychology could be crucial to getting Ebola under control, kind of a substitute for quarantine. What did you learn?

 

Moore: I had a really interesting conversation with Ian Bray, who’s the spokesperson for OxFam here, and that was a point that was critical to him and also at this part of Oxfam’s own response, which has focused very differently than some of the top-down supply chain-oriented responses, which themselves are very important for very different reasons. What Ian was saying is if you don’t understand what people are thinking and how they’re going to react to whatever public health measure you’re trying to convince them to follow, then you’re kind of fighting the battle with only half the tools that you need. That’s because no matter how good a science is or no matter how clear it is to experts or epidemiologists, or even contact tracers who ultimately are members of this communities, if you can’t get people trust the information that you’re giving them and if you can’t understand what other concerns they have that they bring to the table about a measure you’re asking them to follow, then chances are you’re not going to follow it. It’s just average, ordinary human behavior. We’ve got to do what we’ve got to do, and that’s getting to work, that’s feeding our kids, and in a neighborhood like West Point, it’s even something as simple as figuring out where you’re going to use the toilet when you can’t get out a of place where there’s no running water.

 

Werman: I gather today is your last day on assignment in Monrovia, and you were one of the first foreign journalists to head there to cover the Ebola outbreak. What’s your big takeaway from this assignment?

 

Moore: It’s been really interesting to see, now that I’m here, how different things are than they were in August, and I have a much greater appreciation now actually for just how terrible August really was. Not everything is perfect, not everything is working the way it should be, supplies are needed, resources are still needed, personnel is still needed. I’m sure probably in spite of the vast donations that have been given, money is still needed.  But so many things are functioning so much better than they were in August, and so even more than what I see around me today, that retroactive looking back has been fairly stunning for me.

 

Werman: The global women’s rights reporter for BuzzFeed, Jina Moore, in Monrovia. Thank you very much Jina. Good to speak with you.

 

Moore: Thanks so much.