When I first heard in February that Lugbu chiefdom was one of the few in Bo District, Sierra Leone, that had not recorded a single case of Ebola, my interest was immediately triggered. On 2 March 2015 we got to visit the chiefdom’s main town, Sumbuya, for several hours of meetings with local leaders, youth, a traditional healer and business people to find out more. In our quest for answers, we got permission from the local Paramount Chief, (PC) Mohamed Allie Nallo, who gave his blessing and got in touch with key people to help us in our research. We held group meetings, one-on-one interviews and even carried out spot visits.
It is important to understand these community success stories to see the sorts of indigenous responses to Ebola that are being developed. You can build as many Ebola Treatment Centres as you want, but if communities aren’t engaged in the fight little progress will be made.
One of the first people we heard from was the official Chiefdom speaker, Braima Samu: “Lugbu chiefdom is strategically located with several entry points – accessed by both land and water. It is a diamond mining area with a large influx of people and a constantly mobile population. It borders four chiefdoms which were all Ebola hot spots – Bagbo, Jaiama Bongor, Tikonko and Bumpe Gao chiefdoms. It was therefore highly necessary that we take extraordinary measures in order for the chiefdom to remain Ebola free.”
That seemed like a lot of reasons why Ebola was likely in Lugbu. So, how did the chiefdom escape?
In the view of the Chiefdom speaker, it was through good leadership. He said the Paramount Chief “instilled a very robust teamwork spirit in all of us to ensure the people understand and accept the existence of Ebola very early.” The whole community was encouraged to get involved as contact tracers, alongside those who formally held that title. Local chiefs were told to keep a look out for those in their community, and every resident was encouraged to keep an eye on his or her neighbour.
In my notebook, I wrote down three important responses:
- Early acceptance by the chiefdom population of the reality of Ebola
- Strict enforcement of the chiefdom by-laws
- Good/strict neighbourhood watch
To ensure the involvement of all, the traditional leadership developed their own form of a ‘cluster’ approach. They set up five main chiefdom committees: a Chiefdom Taskforce and then groups for sensitization, oversight, surveillance, and discipline.
Again, according to the Chiefdom speaker, the by-laws [local rules] were fully implemented without fear or favour: “When the Paramount Chief’s nephew died and we found out that he (the Paramount Chief) had never reported or sought medical care, he was fined Le 500,000 [about $116] which he paid up front before we called the burial team.”
A swab collected by the burial team was tested and later proved that the nephew was negative for Ebola meaning he died of some other cause, but the Paramount Chief incurred the fine nonetheless for failing to report the illness.
All actions and measures taken were fully documented by the chiefdom secretary, Chief Denis Kaimasa, in his ledger. He explained to us the community rules enacted to fight Ebola, including:
- A ban on all social public gatherings, including local markets, apart from mosques & churches.
- A ban on all traditional practices including community burials, and the practices of herbalists throughout the chiefdom.
- All strangers/visitors entering the chiefdom including residents outside the chiefdom, had to report to the authorities – in most cases they were not even allowed to spend a night.
- Vehicles were not allowed to move within the chiefdom after 7pm.
- Thirteen checkpoints were erected at all strategic entry points including riverine communities and villages. These were all manned by security personnel and community groups who were personally taken care of by the Chiefdom in terms of incentives. All boats that normally ply the smaller riverine entry points were either removed or strictly not allowed to land after 6pm. Only the major riverine entry point in Sumbuya town remained open but with very serious monitoring.
- Any resident leaving the chiefdom for more than three days was either not allowed back, or – if allowed – was quarantined in their home without anyone visiting them.
On that last point, a prominent community businessman, Mohamed Mansaray (known locally as “Capitalist”), told us he himself had been affected: “Initially I was very aggrieved when I was quarantined after I returned from a two week visit to my relatives outside of Lugbu chiefdom. However I am now happy and appreciative of the action taken by the chiefdom as I believe that this also contributed to Lugbu being free of Ebola.”
I mentally noted the importance of discipline and community ownership of the response. I was impressed that the communities arranged their own incentives for those involved in the Ebola fight because they recognised it was such an important issue.
Madam Gladys Kanagboh, a women’s leader, disclosed how some of the women’s groups were vigilant in identifying and locating sick persons, and helped in taking them to the health facilities. This disclosure was also confirmed by Edward Massaquoi, the chiefdom Taskforce chairperson who is also a contact tracer.
One of the chiefdom youth leaders, who also doubles as a teacher and contact tracer, Edward Demby, explained the youths’ vigilance in ensuring compliance with by-laws. “We were highly supported and motivated by the leadership and the chiefdom people so we never encounter any resistance.”
Mr. Samu summed up their successful work in keeping Ebola out down to committed leadership, teamwork, vigilance, cooperation and conformity of the chiefdom’s people. It was hard to disagree.
Margaret James is a Health Officer with UNICEF Sierra Leone.