In Liberia, Making the Change They Want to See
In July 2015, months after I supported the Ebola response in Sierra Leone, I was back in West Africa. I was struck by a message shared by a Liberian woman with my colleagues at the International Rescue Committee.
The woman was pregnant and lived in Monrovia, the capital of Liberia and the epicenter of the country’s outbreak during the 2014–2016 Ebola epidemic. “I need a change in my community,” she had written.
The World Health Organization (WHO) declared the end to the West African Ebola epidemic in January 2016. World news has moved on to other crises. But for this woman — and many others in Monrovia — major health problems remain unaddressed. The reality was that Ebola did not simply create challenges and weaknesses in health systems; it exposed those that had long existed in a country that suffered from long and brutal civil conflict.
Fortunately, the crisis did not simply expose these issues. It provided a chance to address some of them. We decided to seize upon one of the critical lessons we learned from the Ebola response: transmission in some of the poorest communities was ultimately stopped because community members took actions into their own hands.
If community members could help stop Ebola, why couldn’t they solve the other problems that they continue to face today?
Plenty of evidence indicates that this approach works. Growing evidence shows that people will make decisions that are effective in improving their lives if given unconditional cash transfers. If that’s the case, why do we design programs to be delivered to clients? Why don’t we have clients design programs for themselves?
With these questions in mind, I returned to Liberia to attend a Participatory Action Research (PAR) training for maternal health in urban Monrovia. In the New Kru Town neighborhood, our team worked with community members to use this research method to address maternal health.
Participatory Action Research recognizes that community members should be primary sources of knowledge, as well as researchers and agents of change.
Women in New Kru Town have long had poor access to maternal health services. This limited access came to a stop when the maternity ward at Redemption, the only public secondary hospital in Monrovia, shut down after several patients and staff were infected with Ebola in 2014. During the low-transmission and post-Ebola period, access remained a problem.
Since that training in July 2015, the research facilitators — including pregnant women, staff from Redemption hospital, and community members — have conducted meetings with their peers and representatives from each group. Next they systematized and analyzed evidence about maternal health issues in their community. They prioritized areas for intervention, and developed and executed action plans.
One of the plans proposed by the pregnant women was to organize a drama group to perform a piece they titled, “Nurses be Nice, Patients be Patient.” The performances, held throughout the community, told women what to expect during a hospital birth. After the performance, participants engaged in discussion about maternal health services. The group was supported by two midwives from Redemption Hospital who provided technical input.
Changes are already underway.
Surveys with the research participants before and after the process showed that their feelings about communication and relationships between pregnant women and healthcare workers had improved. Nurses listen to patients now. They are “talking good,” said patients. Attendance at antenatal care also increased.
At a review meeting in December 2015, all participants reflected on progress of the action plans and what they had learned.
“The Big Belly [pregnant women] and nurses are also feeling together now,” one participant said. Another declared, “We have learned to do things on our own.”
I hope this is true. As is the case in many emergencies, funding for our staff to support the coordinating committee has ended. Ebola revealed not only the needs facing communities in Liberia, but the power of people to address them.
We must remember two key facts in the wake of Ebola. The spotlight of the epidemic may have moved on, but the need for change has not. More importantly, neither have the people best positioned to lead it.
The International Rescue Committee responds to the world’s worst humanitarian crises, helping to restore health, safety, education, economic wellbeing, and power to people devastated by conflict and disaster. Founded in 1933 at the call of Albert Einstein, the IRC is at work in over 40 countries and 26 U.S. cities helping people to survive, reclaim control of their future and strengthen their communities.
