Lessons Learned

Chernor Bah

Sierra Leonean Global Education Advocate and Champion for Girls, Leader of the Population Council’s Work on Post-Emergency Programs for Adolescent Girls in Sierra Leone

There are strong parallels between the situation for girls and women and the concentration of the Ebola outbreak in Sierra Leone. As I look at the data on my work around girls in Sierra Leone and compare it to the arc and geography of the outbreak, it’s hard to miss the strong correlation. It suggests something that we have always suspected – the health and well-being of a community is as strong as its primary caregivers and providers: girls and women.

The outbreak has also reinforced the need to focus on education. At its heart, Ebola is an education crisis. Sierra Leone’s lack of literacy, coupled with the lack of sufficient health workers and the structures that support those – as well as the lack of people-led accountability demands on government – were at the core of what fueled this crisis. Failure to invest in the long-term education of the girls of Sierra Leone – 90 percent of them do not finish high school today – will breed countless other shocks and emergencies. Outside expertise is appreciated, but the affected countries need a wide ranger of human resources that will be the bedrock of resilience during a future crisis.

Cecilia Tubman

Liberian Nurse at MSF’s ELWA Ebola Treatment Unit, Monrovia

The biggest thing I ever learned during the Ebola period is simple: the importance of washing hands. As a country, we never used to wash our hands. All day long we would touch things. Then we would go home and eat together. But the fingers move everywhere. Ebola came so that our life and our activities could change for the better. People say that Ebola stripped our culture, but I think good hygiene practices have added more value to our culture.

Now, Liberia needs infrastructure, equipment, supplies and human resources. So many NGOs are now involved in training workshops for health workers. Most importantly, I think our government and international NGOs should do more health education than ever before.

Otis S. Bundor

Liberian Contact Tracer and Economist, West Point, Monrovia

Whenever there’s another epidemic, Liberians will need to remember this: don’t be so doubtful. People doubted the existence of Ebola and went about living the same wild life. They were doubtful because they believed it had been made up to stop them living their normal lives, practicing their customs and traditions. It was the same with HIV/AIDS – when it first came, people said it was an American attempt to discourage sex. People transferred this idea to Ebola.

With unity, Liberians can move forward. During the time of Ebola, you found community members getting together to speak about Ebola. If you had an enemy who fell ill, you had to inquire what the problem was. If you didn’t keep up to date with the latest information, you might come into contact with infection. It created an avenue for people to ask what happened and to play safe. Now, with the recurrence, Liberia has gone back to being concerned. People are still not shaking hands.

Liberia needs infrastructure. It needs trained men and women, building on the human resources capacity in the field of medicine, the life sciences and business. In economics, there’s something called the balance/unbalance growth theory; the government has to impact all sectors at once. With unbalanced growth, you have to look at how best to address needs. For instance, if you start with education, other sectors will be impacted. The health sector is fed by the education sector.

Sean Casey

Regional Director for International Medical Corps (IMC) Ebola Response in West Africa

Ebola isn’t as scary as we all thought. Back in July and August 2014, everyone was panicking. Epidemiological projections painted a doomsday scenario. Humanitarian organizations that usually rush in to crises initially refused to engage, and health workers, watching their colleagues die around them, refused to work. Bodies were piling up. The prevailing discourse was one of fear and paranoia.

As some of the first responders to this outbreak, what we quickly learned was that Ebola can be defeated, patients can survive and health workers can stay safe – with the right resources, the right protocols and the right dose of political will. Our first Ebola Treatment Unit, in Bong County, Liberia, had a survival rate of nearly 50 percent; we’ve had zero staff infections after serving more than 500 patients in 2014; and we think we have the happiest Ebola Treatment Unit in West Africa – complete with a karaoke machine in the confirmed ward, movie screenings every night and regular dance parties with patients, staff and survivors. Responding to Ebola is by no means easy, but we learned that we shouldn’t cower from it – we can beat it by fighting it head-on.

Mr. Gerry Clare

Ophthalmologist Who Treated Ebola Survivors Liberia with Médecins Sans Frontières (MSF)

Working as an ophthalmologist with MSF in Liberia confirmed to me that the global response to the outbreak roundly ignored the impact of the disease on the eye. There were no provisions to screen for, diagnose or treat Ebola-related uveitis, even though the association has been known from previous outbreaks. As a result, many survivors lost their vision unnecessarily. The fact is that eye disease is not given the importance it deserves by the main actors in emergency scenarios – as in this case, or in war zones.

Having said that, healthcare infrastructure for the treatment of eye conditions is so basic in many developing countries that avoidable sight loss is a depressingly frequent occurrence. I would like to see more importance given to preventing avoidable blindness, both in the service provision of governments and in the emergency responses of nongovernmental organizations. It is vital that healthcare organizations work together to combat the extreme health inequality that we face in this particular domain.

Sheikh A.B. Conteh

Head of Inter-Religious Council, Sierra Leone

Religion and health cannot be treated as entirely separate issues; they are linked in many ways, especially in a country with an already-fragile health system. We underscored the government's response, and in turn they asked us for recommendations made by religious leaders. We wanted to get the word out about Ebola as widely as possible, to ensure early and prompt testing.

In fact, in our country, for any national program to have effective momentum, the involvement of diverse religious people is crucial. So we went into action; we extracted appropriate koranic and biblical statements in support of the messaging. We mobilized our religious leaders, alongside the government and international agencies. Together, we agreed that all bishops and all imams must factor the messaging around Ebola into their weekly congregational prayers and major religious ceremonies. The important thing is that we did it together.

Dr. Benjamin Djoudalbaye

Head of Mission, African Union Support to Ebola Outbreak in West Africa (ASEOWA)

The capacity of the African continent to respond to such a crisis was a huge lesson learned. The African Union deployed more than 800 health workers to the affected countries. None of them were infected with Ebola. Not one. They were calling themselves foot soldiers. This is a big achievement and something to remember when we think about homegrown solutions.

We started talking about creating an African Center for Disease Control (CDC) way back in 2013, just to focus on health issues on this continent. We were already working on it, but this outbreak brings an additional opportunity to justify its need. This outbreak may serve as the foundation for the African CDC. Now we know exactly what we need to do.

Mustapha Dumbuya

Sierra Leonean Human Rights Journalist, Gordon N. Fisher/Journalists for Human Rights (JHR) Journalism Fellow at Massey College, University of Toronto

The Ebola outbreak was disastrous, but it has opened our minds to a new way of thinking. It's given us – not only West Africa, but the world – the opportunity to reflect on what we're not doing right, so that we can work on building resilient health systems in developing countries. The international community did not seem to care about what was going on in West Africa until they realized that Ebola posed a direct threat to their own existence. That was when Ebola stopped being seen as an epidemic of the other, and became an international public health concern. The international community response was late, but it eventually helped in containing the virus.

It’s not the WHO and the international community that should shoulder the burden of criticism. Our local authorities should have their own share of the blame too. Deep-seated corruption in Sierra Leone by public officials breeds discontent and distrust between the communities and their local authorities. Going forward, as much as I believe it is important to develop the country's health infrastructure, it’s equally crucial for officials to prioritize community engagement on public health issues. Engaging communities should be the first step rather than the last resort. Engagement with local influencers in communities would have given us better insight earlier to come up with the best solutions to the problem.

We need to have a different approach in future interventions should we have an outbreak of similar nature. Journalists and media institutions need to reach out more to the communities and get them to participate in content development. It's dangerous to assume that we know what messages to pass on to these communities without involving them.

Julia Duncan-Cassell

Minister for Gender and Development, Liberia

The lack of a national emergency response strategy, irrespective of the type and scope, affected the country's ability to take control of the Ebola epidemic. Various beliefs caused it to widen its grip and toll, but the involvement of communities and the establishment of task forces and contact tracing teams may have contributed to reducing the spread of the virus.

Now, on a wider level, we need a regional West African policy founded on mutual support that will improve prevention and response and recovery. It should consider cross-border trade, marriages between nationals of different countries and other socioeconomic and cultural practices.

Ada Nkem Ezeokoli

Editor, Nigeria Health Watch and Health Communications, EpiAfric

Health is difficult to report on, because unlike politics and sports, not every opinion is valid. We have a responsibility to stick to facts that are evidence-based and opinions from health-sector professionals who are qualified to have them. People do not always understand the technical language with which health professionals write and speak. Rumors spread like wildfire, but if you can get correct information to spread at the same rate, then you have a better chance of reducing the impact of rumours.

During public health crises, the government needs to take the lead because it should be a credible source of information. It’s important [for other organizations] to work alongside the government to give out information that is useful, relevant and easily understandable.

Dr. Tom Frieden

Director, U.S. Centers for Disease Control and Prevention (CDC)

Ebola shows us how important global health security work is. It reinforces that we’re all connected, and that a weak link anywhere is a risk everywhere. The U.S. has come in big with resources to address this. Other countries and the private sector have also, so that we don’t have another situation like this, with so much preventable illness, death and economic dislocation.

We need good surveillance systems around the world so we detect problems, we find things – soon after they emerge. We need rapid-response teams; one of the things we did in Liberia was to implement rapid-response capacity, so that when cases emerged in rural areas we sent a team out immediately and they were able to stop the virus within one or two generations of it. We need increased prevention wherever possible.We need to get these pillars of global health security up in as many places as possible. We can’t predict where the next threat will come from, but if we’re not proactive, we’ll be at risk.

Galm Guyo

Ebola Field Epidemiologist, African Union Support to Ebola Outbreak in West Africa (ASEOWA)

I felt that the international media had exaggerated the impact of Ebola on daily life. Before I left my home country of Kenya to join the Ebola fight, my family was against me going. They even said, “Why would you go to Liberia to die? We need you.” My wife came to the airport, pleading with me not to go. According to the media reports they had seen, people were dying everywhere. But when we landed, we saw a different situation. The outbreak had a severe impact, of course, but life was still going on. On the way from the airport in Liberia, we saw people. We saw restaurants open. We even saw people playing football. I was surprised. I had to call home and say, “Things are different. Please don’t get worried.”

I learned so much by volunteering to help during Ebola. When you are learning about disease at institutions like universities, you are just taught theoretically. But I came directly face to face with disease. After all that theory, you see it in practice. When you are taught, you must remember all the signs and symptoms of a disease, and it’s easy to forget. But if you practically come and see, you will always remember, maybe for the rest of your life. I am sure my country and mygovernment will benefit from what I have learned.

Patrick Hettinger

Senior Country Economist, African Development Bank, Liberia

I don’t think the Ebola outbreak came as a surprise. We knew there were fragile systems that faced challenges with delivering basic services to the people. At the same time, Liberia was dealing with a population with limited education that historically has been excluded and doesn’t trust the government. All of these factors came together to allow the outbreak to develop. Much of the response work was local, and local organizations helped spread messages about how to counteract the virus, and they were key in doing so. They made significant inroads before international actors stepped in. The outbreak was a locally grown problem, but there was also a locally grown solution.

Liberia needs a stronger medical system, but you can’t develop that in isolation. There needs to be stronger education throughout, from primary all the way to medical school. There needs to be a stronger economy so that there can be more resources to support the education and health systems. There’s a need for improved infrastructure, particularly good roads; they are a cross-cutting improvement, increasing access to markets and government services.

Erin Hohlfelder

Policy Director, Global Health at ONE Campaign

The world has learned many lessons – or at least heard clear reminders – from the Ebola outbreak, including the importance of strong health systems, the value of early detection systems paired with swift global action and the importance of meaningful community engagement. But above all, ONE’s engagement with the Ebola outbreak taught us that we cannot assume there is a system in place to track the many types of pledges made by donors in a health crisis. In fact, the opposite is true. Despite many disparate tracking efforts, there is no one-stop shop for donors, implementers and the public to use. There is a need for a system that can reliably measure, understand and compare the amounts and types of resources that have been pledged, what resources have been disbursed and what gaps remain unfilled.

This is not a dry accounting challenge; this is a matter of life or death. To this day, more than a year and a half since the crisis began, no one can accurately answer the question, “How much has been pledged and delivered for the Ebola crisis?” Confusion as to what donors’ pledges are makes it difficult to hold donors accountable, which may leave millions of promised funds unspent – a disastrous outcome in a world filled with unmet global health and development needs. If we are truly to learn all that we can from this outbreak, we must put in place a new system that can track these resources more effectively and accountably. Until we do, we are doomed to repeat our collective mistakes and lose time, resources and lives in the next crisis.

James Kaikai

Administrator, James N. Davis Jr. Hospital in Paynesville, Liberia

As painful as the process of Ebola was, also it has its positive side. The negative side was that it cut out lives. But it has exposed the weaknesses of the health sector. This has given us, as hospital managers, a broader perspective as to how we can improve our system. Let the government focus on health, because health is the key. If you’re healthy, you can sit in the classroom. If you have a sound mind, you can sit in the classroom. Health must come first.

There are still many gaps and challenges for us. We don’t have enough oxygen supplies for our patients. And there’s a need for the current to be on; city power is just not reliable enough to do surgery. The electricity generator needs to be on, so we need fuel. If we could be beefed up in our budget allotment, trust me, we have the expertise that can deliver. Other hospitals are in a position where they have a bigger budgetary allocation. We only receive about $100,000 from the government each year. It’s very little.

Evangeline Kamara

Guinean Pharmacist and Ebola Survivor

We don’t know everything. I went to university and I grew up in a supportive family where we were encouraged to learn and study. But still, I didn’t believe that Ebola was real. They say that Ebola is a crisis of trust. But me, I trusted myself and my family too much. Ebola has taught me that we must question everything, including what we believe. Even the best scientists didn’t know much about Ebola.

We need more trusted channels of information – not just rumors or sensationalism, but facts and truths. We need this in Guinea, but we also need it everywhere in the world. We should condense our information and find better ways of sharing what is important – by phone, radio, text message, internet – so we can all benefit.

Dr. Rashida Kamara

Sierra Leonean Medical Doctor Who Led Care at Waterloo Ebola Treatment Unit, Freetown

The Ebola outbreak exposed our country’s rotten health system to the rest of the world. With such a terrible health system, there was no way we could have stopped the epidemic. As a country, we have now learned always to be prepared for the unforeseen.

Ebola started with just one case. So my advice for medical doctors and health workers is this: no health problem should ever be too small to dismiss. In delivering healthcare, we must be involved, enthusiastic and compassionate. In medicine, curiosity should always be a primary factor. The quest for knowledge should always be there. Medical education never stops, and we need it more than ever in Sierra Leone.

On a wider scale, I’ve learned that you need to be your own soldier – as an individual, a community and a country. No one will ever fight your battle the way you do. Do not rely on anyone to solve your problems. And, of course, it goes without saying that we need capacity building, more human resources and better outbreak alert communication and response.

Abu Kamara

Liberian Active Case Finder in West Point, Monrovia

During the Ebola outbreak, I went from house to house in Monrovia’s West Point slum – one of the hardest-hit areas – looking for sick patients on behalf of Liberia’s Ministry of Health. At first people didn’t listen to us. They felt scared. Rumors spread that we might be the ones injecting them with the Ebola virus. It was very difficult to get messages across. One of the most confusing things for the community was the number of different actors on the scene. They all had different messages to share. There was a real need for more succinct, cohesive messaging. Eventually, the Ministry of Health convened joint workshops with other organizations. Placards came out, serving as a central source of information.

I found that the most successful way of getting people to listen to Ebola information was to physically go to their houses and show them what they could do to protect themselves. Before, when we only talked to them, they felt afraid. They saw risk in the chlorine buckets we handed them. They didn’t believe what was inside them. But when we showed them how to spoon the chlorine in themselves, they began to trust the process. That made all the difference.

Enku Kebede-Francis

Advisor in Global Health Governance

We learned many things from the recent Ebola outbreak. Yes, having treatment protocols was important and lifesaving, but the most important lesson for all was that we need effective health communication. Not only in developing countries but also in developed countries, fear and a lack of credible information frustrated the medical community and patients. Moving forward, we ask governments to implement effective surveillance, prevention and management of infectious disease – but we also ask that they incorporate effective and inclusive communication mechanisms.

We learned that communicating with rural populations in various dialects is a difficult task but that each government must have a built-in system that the public trusts. When governments provide useful health information regularly in local languages and dialects, the public starts trusting them. We learned that trust was missing in many communities. Since the building of trust cannot start at the time of a major outbreak, we ask that a system of effective communication be incorporated into existing healthcare policies. It was Ebola yesterday but it will be something else tomorrow. Disseminating health information regularly is good governance, which will lessen the impact of disease outbreaks, lessen the spread of misinformation and promote good health and longevity.

Dr. Sakoba Keita

National Ebola Response Coordinator, Guinea

I've learned that infectious diseases are like people in a way: they are born, they grow and they die. That's their nature. But it's only through the actions of human beings that they can complete that life cycle. It's up to human beings to break it.

We've learned that the virus moves with people, and so our contact tracing has had to reflect human traffic. We’ve tried to collaborate our efforts with taxi drivers and minibus drivers. Liberia relied heavily on the cremation of dead bodies as a means of halting the spread of the virus, regardless of whether the dead were Christian or Muslim. That allowed Liberia to dramatically reduce the chances of transmission from dead bodies. The recent persistence of Ebola in Guinea, on the other hand, was largely due to unsafe burials.

Josiah Kormie

Pharmacist, West Point, Liberia

We, as Liberians, don’t care enough about health. Even Liberian doctors often aspire to work overseas or do other work. Some of them aspire to go into politics. Some of them are looking for money. They don’t all have passion for their jobs. Health work is not just for money and respect – we should all be humanitarians and put patients, and the health system, first. That’s what happened here. Our people don’t want to take care of people. In this country, we don't care enough about poor people. That needs to change.

We need to encourage people. Look, we’re taking medical cases from here to Ghana for operations. We’re taking health workers to Ghana and Nigeria for training. Liberia is an older country than Ghana. The best way to address this is to bring trainers here and keep our health workers in the country. For the cost of transport and accommodation overseas, you can do thorough training sessions here. If you take health workers away from here for training, they will then want scholarships and they will go away. Sometimes, they won’t come back. That’s the problem that Liberia has.

David Kyne

Founder, Africa United

As the Ebola outbreak continued, we saw firsthand the critical role of communications in changing behavior during and between crises. Too often, communication in a crisis is an afterthought – a tactical consideration rather than a strategic driver of the overall response. Through our own experience in managing Africa United, a health communication platform that leverages the celebrity of African football stars to stop the spread of Ebola, we’ve established what determines success when attempting to deliver coordinated, accurate and trusted communications to effect life-saving health behavior in any crisis:

Informed by our shared experiences, we must continue to bolster international efforts, working with partners to get to zero cases of Ebola everywhere (and stay there) and find ways to integrate health communications in at-risk areas before we see another outbreak.

Peter Labouchere

Executive Director, Bridges of Hope Training

A crisis like Ebola can alter the perceptions of images used in training and education programmes, and it is vital to pre-test images in the specific context in which they will be used. This was one of the lessons I took from working on a consultancy contract with the Health Communication Capacity Collaborative (HC3) Liberia Ebola team to create the Bridges of Hope Liberia training kit for low-literacy communities.

The kit's participatory activities linked behaviours around preventing, avoiding and surviving Ebola to progressing towards a healthy future, represented by an image of an island. I submitted a laminated card image of what I considered an attractive island with a shady tree and treasure chest, which had already proven effective in many other health and HIV-related programmes throughout Africa. The feedback from the pre-test by the Liberia team shocked me: the ‘treasure chest’ was widely perceived instead as a coffin, thereby having precisely the opposite association to that intended, and rendering the training activity useless! There followed a very rapid revision of the image with further pre-testing of the revised image.

Lesley-Anne Long

Global Director, mPowering Frontline Health Workers

What happened in West Africa was a microcosm of what’s happened more broadly across sub-Saharan Africa and South Asia; it was an incredibly fragmented landscape, with lots of small solutions being delivered by multiple organizations. There’s been very poor coordination, with not much in the way of harmonization, and standardized approaches to development. Many of the international community players who understandably wanted to leap in and help had a very poor understanding of what life was really like on the ground. Solutions were being proposed that just didn’t fit the terrain, the poor connectivity and the sheer lack of health workers to be trained and supported.

Ebola has shone a light on the issues more broadly; better mobilization, better engagement with communities, better understanding of what frontline health workers need to be able to respond to a crisis. As a result of the Ebola crisis, I’m certainly seeing much more of a focus on collaborative efforts and data that speaks to each other across different programs.

Dr. Maxo Luma

Medical Doctor and TB Expert, Partners in Health

I’ve learned that the Ebola outbreak in Liberia was an acute-on-chronic situation. It worsened a preexisting fragile health system. In 2013, Liberia already had a high maternal mortality rate of 1,072 deaths per 100,000 live births. The ratio of physicians per 1,000 people was 0.01 (the WHO recommends 0.55 as a bare minimum). Only 42 percent of HIV-positive women were receiving antiretroviral therapy (ART), and only 23 percent of HIV-positive TB patients had access to ART. Ebola was not the only devastating force during the outbreak; the fragile health system was just as deadly.

How do we fix this? There’s a need for a paradigm shift in the way we think about international aid. After the WHO declared Liberia Ebola-free, some donors cut their health funding, which is a good recipe for the reemergence of the disease or another outbreak. We must understand that every neglected disease in Liberia can cause as many deaths as Ebola, and even more on a long-term trajectory. Building a resilient health system that focuses on empowering Liberians to take care of their brothers and sisters is crucial.

The international community needs to accompany the Liberian government in designing lasting interventions to serve their population, instead of parallel activities based on donors’ interests. As such, strengthening the health system after Ebola requires the necessary realignment of NGOs with government efforts. Diseases such as HIV/AIDS and TB often knock on the doors of the poorest first. It’s crucial for donors to be more involved in helping poor countries build strong primary healthcare, to make treatment available, accessible and free of charge for the poorest people.

Carl Manlan

Executive Secretary, Africa Against Ebola Solidarity Trust

Ebola survivors – numbering 15,000 – are mainly spread across Guinea, Liberia and Sierra Leone, a reminder of a collective inability to build on lessons learned from other epidemics including HIV/AIDS. Stigma remains a deadly virus.

This emergency gave the world something to take note of: the work of African health workers. A total of 856 health workers from 18 African countries defied stigma in order to contribute meaningfully to the international response. We ought to remember that none of them was infected during their intervention at the heart of communities. Now is the time to prepare for the next outbreak.

Khadijatu Mansaray

Sierra Leonean Radio Reporter, Writer and Diaspora Responder

A stitch in time saves nine. The disastrous effects of the virus could have been avoided if the initial response had been prompt and effective. In Sierra Leone, we struggled to get people to follow safety guidelines, showing the importance of having trustworthy people in positions of authority. The virus also showed us what we need to fix urgently in our country. As well as inadequate healthcare and the poor standard of education, it’s time to make health and safety precautions standard practice.

As for the lessons we didn’t quite learn: the whisperings of corruption and mistrust of those in charge. Through it all, I learned that we have great reserves of resilience that could see us through anything. Long live Sierra Leone.

Dr. Fatou Mbow

Medical Doctor and Ebola Community Response Consultant with Save the Children, Guinea

During the Ebola outbreak, I learned that the obvious was not obvious. In Guinea, people who knew nothing about the disease worked on communication strategies; people who were meant to be separated from one another for infection control measures were not; laboratories – the essential diagnostic tools expected to be at the heart of control measures – were not widely available to patients at basic health facilities. We were lucky that the French military brought technical competence and know-how for those most at risk of Ebola: health workers (both conventional and traditional).

I learned that very few decision-makers or evaluators actually spent any meaningful time in an Ebola treatment unit, in a training session or in a focus group discussion on the ground. They came with lots of noise to “inaugurate” and “close” sessions, repeated what their predecessors had said or reiterated the most commonly expressed ideas (“we started late”, “we’re overwhelmed” or “not enough is being done”) and then disappeared for a while. Those who worked on the ground saw the reality, including almost 900 health worker infections; 60 percent of health workers who contracted Ebola died; one-third of them were doctors. I saw no plans to provide scholarships for medical, nursing or midwifery students in the three countries’ post-epidemic “reconstruction” plans.

I learned that humankind privileges comfort over truth. Even in an Ebola epidemic.

Dr. J. Soka Moses

Liberian Medical Doctor Who Led Ebola Care at Monrovia’s Ministry of Defense Ebola Treatment Unit

Ebola taught us about courage in the face of danger. Imagine being a medical doctor working in a hospital where people are dying from a disease that no one knows how to cure. Imagine senior doctors running away from the hospital, fearing their own death. Now imagine that you want to help. The one thing that will keep you there is courage.

Now Liberia needs its health system to be strengthened. Our health service needs to be able to respond better to any medical disaster. We need to empower health workers, pay higher salaries and offer more training. We need to go back into the communities and help people start their lives again. We must also set up an early-warning system to detect emergencies before they get out of control.

I’d like for us to honor those who died from Ebola with a proper monument that lists their names. One hundred years from now, people should remember those who died. It will allow them to take better measures for their own future.

Ashoka Mukpo

Journalist and Ebola Survivor

The story of Ebola was ultimately one of privilege and power. Most of the people whom the disease killed were among the world's most powerless and neglected -- people who exist at the bottom rung of our world's economic ladder and whose humanity is too often obscured by our lack of empathy and imagination. What if Ebola had been less contagious, or if it hadn't been so compellingly nightmarish? Would the help that was so late to arrive have come at all?

We still struggle to see our own dignity and dreams in one another across the world's oceans and borders. The specter of dying Africans only became an international issue once we started to hold our breath and imagine: could that happen to me? Just as the Paris attacks shocked and infuriated us more than the daily drumbeat of horror, poverty and violence that so much of the world is subjected to ever does, Ebola briefly punctured the thin bubble of safety and comfort that we imagine separates us from miseries we would prefer to look away from. These are conditions they must endure, we think, never questioning whether we have some role or stake in creating them.

I know the privilege of Ebola more than most ever will. If my face had been black and my passport hadn't been blue, I may not have been here now to write these sentences. I'm thankful for my life, but I refuse to accept the conditions that permitted that jet to remove me from danger while so many others had their humanity reduced to "victim" inside muggy tents and sweltering shacks. They are my brothers and sisters, and they are yours, and until we can build a world where they do not need to helplessly flail their arms, hoping that their plight will be compelling enough for them to be rescued by the rich, Ebola will exist as another chapter in our ongoing shame. May the families of the victims and those who emerged, gaunt and broken, from treatment tents find peace, and may our children find themselves in a more just world than we do now.

Robtel Neajai Pailey

Liberian Academic, Author and Activist

As Paul Farmer argued in his groundbreaking book Infections and Inequalities, infectious diseases are rarely exclusively biologically determined. Ebola did not happen within a vacuum in Liberia, and we cannot divorce the outbreak from its larger geopolitical, economic and social determinants. Liberia has pursued a textbook state-building agenda for far too long, while failing to realize that health systems represent “a face of the state.”

Ebola exposed the pitfalls of this approach, which is misguidedly touted by international actors as the panacea to postwar recovery. During Ebola, the Liberian government effectively lacked legitimacy, and it was ordinary Liberians at home and abroad who filled service delivery gaps when the state and international actors failed to act with urgency. These are the stories that must be documented. These are the important lessons learned.

Tiffany Persons

Founder and Director of Shine On Sierra Leone

Ebola has illuminated just how powerful a community can be when they work together. It has been an honor to work alongside the heroes within our community and make a powerful, sustainable impact against Ebola. We are a global village. And even though Ebola is a human rights tragedy, in many ways it has slowly but surely been bringing the importance of the village to the forefront.

I also learned the importance of connecting at root level with community members in a time of crisis. It’s not just communication that’s key, but the type of communication. Fear kills even faster than Ebola.

John-Arne Rottingen

Co-Investigator of the successful rVSV-ZEBOV Ebola vaccine trial, Director of the Division of Infectious Disease Control at the Norwegian Institute of Public Health, Adjunct professor of Global Health and Population at Harvard University

I learned that here’s a long distance between theory and practice. It’s really important to strengthen capacity on the ground, so we can follow through with what is being said and learned. That also goes for trials, because without appropriate implementation, medical and vaccine trials would not be successful. I’m very impressed by the way the rVSV-ZEBOV Ebola vaccine trial was implemented in the field, by the World Health Organization (WHO) and the West African teams there. That’s what I’ve learned. I believe the way that this trial has been implemented contributed to the control of Ebola in Guinea.

Timothy La Rose

Chief of Communication, UNICEF Guinea

In an outbreak as unprecedented both in scale and response as Ebola in West Africa, many lessons have been learned, which is why it is essential that we document and share what precedents we’ve set. For the children, we have proven that even during an outbreak, with proper preparations, all children can safely go to school. In fact, by going to school, they can learn about the nature of the disease and share those lessons within their community.

Most importantly, Ebola has proven that we simply cannot have countries in this world with health systems as weak as they were here before, during and after the outbreak, regardless of the political or financial landscape of a nation. The people who live without access to even the most basic medical care suffer immensely, and epidemics are more likely and could easily spread beyond their borders. It happens regularly. We’ve seen it with preventable diseases such as cholera, meningitis, measles and others endemic to the region. After Ebola, if we don’t get the follow-up support to widely increase the health services available to people, we will lose the end game and risk additional devastating outbreaks.

Dr. Pardis Sabeti

Genetic Scientist Who Sequenced the Ebola Genome, Harvard University Professor

This outbreak of Ebola has taught us that we have the technology and capacity to have the upper hand against deadly viruses, but that we can do so only when we work openly and together. The Ebola outbreak, like all threats to humanity, was fueled by mistrust, fear, confusion and distraction. It benefited from our early choices in the outbreak; to make what was happening to our fellow humans an issue of the “other” for so long. It thrived because we built barriers between us.

But unlike the other threats to humanity, Ebola is one threat in which we are all the same. We have the same vulnerability and the same strength. We have the same fears and the same hopes. This is a war we can win together. For all of those who sacrificed their lives for others in the outbreak, who were in this fight with us, let us be in this fight with them always. And help us not to let our earth be defined by the destruction of one virus, but illuminated by billions of hearts and minds in unity.

Aruna Turay

Sierra Leonean Journalist and Newspaper Editor

Complacency was a key factor responsible for the rapid spread of Ebola in my country. My government, medical authorities, security forces and the entire population of Sierra Leone were very much complacent in the fight against the epidemic. It was as if Ebola were a good friend who came to the country to dine with its people. Not until the virus had succeeded in claiming the lives of health workers, including doctors, did we really start to respond to the outbreak.

In Sierra Leone, Ebola was also widely politicized. Opposition political parties initially blamed the ruling government with initiating the epidemic and called on them to end it. On the other hand, the ruling government cast blame on the opposition, accusing them of undermining government. They both refused to tackle the virus promptly in its early stages. It was not until the virus made its way halfway around the country that they all came together, stopped the blame game and focused on fighting the epidemic.

Fatou Wurie

Sierra Leonean Writer, and Concept Innovator, The Survivor Dream Project

I have learned that fear breeds miscommunication and misinformation; it is the force that sparks blame and has the ability to immobilize people. I learned this at the onset of the Ebola outbreak, when confusion and deep fear grappled Sierra Leone – hindering efforts to break transmission. I also relearned the human capacity for sacrifice, strength, reconciliation and healing when community leaders stood up and developed their own community mobilization mechanisms at a time when all else seemed to fail.

The people of Sierra Leone were failed by the systems that govern their lives: social, political, health and international partners, further compounding the negative consequences of the epidemic. Yet I also bore witness to individuals who fought to ensure that people lived, survived and had a chance to thrive.

I want the world to know that it played an integral role in containing Ebola in West Africa, but the world must also know that the diaspora and locals on the ground moved, shifted, stretched, innovated and supported one another to get through one of the most difficult times in Sierra Leone’s history. At the local level, there are silent heroes in schools, in government, in healthcare, in business, in the village and in cities who saved lives.

The world must know that we saved ourselves over and over again through self-determined community mobilization and engagement, through kindness and through our own resilience.