Frontline lessons: From Ebola to Covid-19 | The Daily Star
12:31 AM, April 18, 2020 / LAST MODIFIED: 01:42 AM, April 18, 2020

Frontline lessons: From Ebola to Covid-19

"Although I did not comprehend what I was in at the time, when I look back and realise what I had been through, I ask myself, 'Really?'"

-- Hasina Akther Huq, former country director for Brac in Uganda during the Ebola outbreak, sees parallels between the current coronavirus situation in Bangladesh and the Ebola outbreak in the African nation.

On May 25 last year, Hasina Akhter, the then country director for Brac in Uganda, received a call from her colleagues alerting her to a possible outbreak of Ebola -- a rare but deadly virus -- in the landlocked East African country.

When the message came, Hasina was in the US to attend her daughter's graduation programme. But the call for duty took precedence over everything else and she set off for Uganda, reaching the country two days later.

"When I heard, I knew that if a suspected case was confirmed, I had to go. I couldn't leave my team behind. I had to not only think about my safety, but theirs as well," Hasina, the current area director at Brac's humanitarian crisis management programme in Cox's Bazar, told The Daily Star over phone recently.

Hasina, with her years of experience, said she saw some parallels between the current coronavirus situation in the country and the Ebola outbreak in Uganda at the time.

The one thing she stressed on was speed.

SPEED, SPEED AND SPEED

"We must react to this with utmost speed. No time can be wasted and that is what I saw in Uganda," Hasina said, recounting how the Ugandan government took immediate steps, including focusing on comprehensive resource mapping -- using lessons from the 2014 outbreak -- promoting quarantine practices and working towards setting up the needed infrastructure.

"By the time the first case was confirmed on June 3, the airport was already equipped with infrared and thermal scanners. The Ugandan government did not wait. They just activated the plan.

"Their health minister was very fast. They coordinated with NGOs. No one acted alone; everyone acted together. They managed to stop the outbreak right there," she recalled.

Hasina points out that although the first case was confirmed in the first week of June, the first suspected case was on May 25.

On May 27, the government even held the first coordination meeting, exemplifying the speed of their response. 

"That was amazing. I must appreciate how the Ugandan government joined hands with non-state workers. They knew they did not have enough resources. So they went for speed, the fastest they could help people," she said.

THE FRONTLINERS

One thing Hasina notes was how vital community-based health workers proved to be. 

"The healthy ministry's resource mapping was done very smartly. They used the lessons learned from earlier outbreaks. During these pandemics, there is no substitute for community-based health workers.

"Even in terms of Bangladesh, how many actually have access to health services? They [Ugandan government] mapped it out in the first week of June when the first case was identified, and it went a long way to decelerating the spread of the virus," Hasina said.

She also pointed out how during the crisis, the healthcare sector could become overburdened.

"People in Bangladesh are now going to doctors when they show any of the symptoms [ present in Covid-19 cases] such as a cold. Of course, they will do that as they are scared."

It was the same in Uganda, Hasina said. But since the government had restricted mobility early on, and suspected people were being identified quickly, it was easy for surveillance teams to provide healthcare to those who really needed it.

"That is why the healthcare infrastructure in Uganda did not break down, even being weak and almost non-existent in  rural areas. I still think for a country with so little resources they did something great," Hasina said.

Highlighting the dire straits the health sector was in at the time, Hasina said, "In Uganda there are areas where for hundreds of kilometres, there is no health infrastructure, but one will see Brac community health workers.

There was nothing else there. In the border area, Brac Uganda was tasked with training people, school teachers, religious leaders and frontliners.

"In border areas, they could not buy spray guns and sanitisers. Brac provided hundreds of litres of those," she said, adding that they even had to set up tents in bordering areas near Congo so that surveillance teams could ask people with suspected infections to wait in quarantine.

Hasina once again said this was down to the government's coordination with the NGOs and other non-state workers. She said at one point when they saw the government procurement was slow, the NGOs volunteered to do it themselves and the government gave the greenlight.

THE WILL OF THE PEOPLE

In the first week of June, the Ugandan government instituted social distancing and mass gatherings were also restricted, before being banned altogether.

No form of physical contact was allowed, including handshakes.

"Before any cluster was identified, they had gone for a lockdown. They found out in which counties and sub-counties there were outbreaks, and quarantined people from those places," Hasina said.

Awareness was also spread through religious preachers who are influential in their localities. 

"The Ugandan government took the decision for the betterment of the people very quickly. Plus, what stood out is how much the people actually listened to what the government was saying," Hasina said.

"They read instructions and followed those carefully. Radios also proved to be very helpful here."

"The government gave situation reports on TVs and radios. Newspapers also brought out a bulletin to give an update on the situation," Hasina said, stressing how the media played a big role, both in informing people and playing the role of watchdog to see if what was being said was actually being done on the ground.

Hasina surmised that the crisis brought people together, especially in ways they had worked together.

For instance, special responsibilities were given to resident district commissioners to supervise the Ebola response and preparedness. Their only mandate was to take care of Ebola-related issues. Although all the commissioners were political appointments, in this case they were not always state actors.

"When it comes to something like this, despite all the challenges, all the problems, people unite. They come together," Hasina said.

There was still hope after all.

The social distancing measures lasted a few months. And while there were curbs on most things, what stood out for Hasina was the end to handshakes, a simple action perhaps as old as mankind itself.

"When we were finally allowed to shake hands with each other again after a gap of five months, it was such a big moment, that we brought a cake just to celebrate the occasion," Hasina said with a laugh.

BACK IN COX'S BAZAR

"In Cox's Bazar, we have around 4,000 volunteers. We have some 2,300 staffers. Around 2,000 are on the frontlines," Hasina said of her current undertaking.

"Even I would call our doctors on the frontlines. We have 11 health posts and three clinics, and these health posts are inside the [Rohingya refugee] camps and the clinics are either in the camps or adjacent to those," she said.

Hasina praised the speed at which authorities in Cox's Bazar have been working, especially when it came to inter-agency coordination. 

In the camps, isolation centres are being set up and the UNHCR is taking a lead in this regard.

"Physical distancing measures are in place from our side when it comes to those visiting our healthcare or information centres or when food is being distributed, but it is still a challenge to make the community understand and follow all the instructions," Hasina said. 

"When I heard our workers were cleaning around 4,400 metres of the drainage systems, I asked how they were doing it while maintaining distance. They sent me pictures. They had even fashioned a makeshift scale to measure how far to stand from each other," she said, the pride evident in her voice.

Asked how she responded to being summoned to the Ebola crisis in 2019 and how she feels now that she is back amid something similar once again, she said, "My son and daughter were both concerned. But I would like to think they were equally proud. I knew I had to go. I could not leave my team behind.

"With Ebola we knew how it was transmitted. This time, we are not fully sure of any particular way of transmission. The thing is, in the line of war, we can only see what's in front. Nothing else matters."

She added that the nervousness and fear are not present. Nothing exists but the here and the now.

"Although I did not comprehend what I was in at the time, when I look back and realise what I had been through, I ask myself, 'Really?'"

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