Monrovia Mayor Clara Doe Mvogo on Ebola's lessons
How’s this for unlucky timing? Clara Doe Mvogo was inducted as mayor of Monrovia, the capital of Liberia, in March of last year. Right about the same time, the country’s first cases of Ebola were confirmed.
The Ebola outbreak would go on to claim more than 4,800 lives in Liberia, many of them in Monrovia. That toll is worse than what’s been seen in the other two most affected countries, Guinea and Sierra Leone. But Liberia was also the first of the three West African nations to be declared Ebola-free, in May. (A handful of new cases were reported last month.) A number of factors helped put Ebola down in Liberia, from leadership by President Ellen Johnson Sirleaf, to international aid, to door-to-door community education and engagement efforts, to the heroic work of medical professionals and volunteers.
Local leadership also played a role. I recently spoke with Mvogo about what other mayors could learn from her experience leading a city of about 1 million people through a scary and complicated epidemic. This interview has been edited for length and clarity.
Christopher Swope: You were inducted into office right when the first cases of Ebola began in Liberia. What was it like to handle that as a new mayor?
Mayor Clara Doe Mvogo: It disrupted a lot of the plans you make as a mayor. I was inducted into office in March. Then the Ebola thing started exactly the same month of March, but it got ugly about July. By July, we were really entrenched in Ebola, Ebola, Ebola, trying to figure out, “What are we going to do? Where are we going? Why this? Why now?” It was quite a challenge for those few months between July last year and about March this year, quite a challenge.
Q: What was that challenge like in the beginning?
A: At the beginning there was a lot of denial. People did not want to admit that the Ebola disease was here, and they did not understand how it was transmitted, how they could prevent it, what would be the consequences when it entered our communities.
A lot of the outbreaks we had were because of this denial. People would feel they had the symptoms or think they were exposed, and they would go home. Especially in the informal community settlements, the slums, people were hiding relatives who were sick. They didn’t want them to go to the hospital, because they thought they would die.
Q: How did the situation begin to turn?
A: The communities were encouraged by the volunteers who went door to door. The community workers gave out information on how the disease is acquired, the symptoms, what to do in case you even thought you had the symptoms, where to report. People started hearing that people were living and coming out of these ETUs, the Ebola treatment units. Once they saw now that people do live and come out of Ebola treatment units, they had more people reporting, those who had symptoms.
“Instead of the Ebola chasing us, we started chasing it.”
Contact tracing became an extremely important part of this. There’s a doctor called Dr. Mosoka Fallah who managed that. I tell you, in the unsung heroes, he’s one of those. He and his team worked day and night to make sure they were following the virus.
Instead of the Ebola chasing us, we started chasing it. By chasing it, I mean we went after where it was and where we thought it was. Going to the community levels, getting the block leaders to give us information, to share our information with their people. In other words, train them on the symptoms, how to prevent it, how to report it. Those three things became like a common message all over the country, on billboards, radio, televisions, everywhere.
Q: What’s the role you play as a local leader in a situation like this where there’s strong involvement from the national level and the international aid community?
A: What happened was we went to the UNMEER, which is the United Nations Mission for Ebola Emergency Response. This was me and the mayor of Paynesville, a suburb of Monrovia. We went to them and asked for funds to help us do sensitization, awareness and prevention, awareness in the city. They referred us to UNICEF, which funded a program we called Operation Stop Ebola. It was about us going into communities and training people, and actually working first with the community leaders.
In Monrovia, we have what we call commissioners, and in each commissioner’s area there’s about 20 community leaders. These people are elected by their communities to be community leaders. Then, each community has so many blocks. Some have four blocks, some have 10, some have 25. Each block has about 50 to 100 homes. We went to the grassroots.
We had to be totally organized and focused on giving the block leaders and the volunteers the material and support they needed to spread the news that Ebola is here, these are the symptoms, this is what you do if you think you have it. This is how to prevent getting it, simple things like washing your hands and not being in crowded places. The key thing was reporting.
“We had to be totally organized and focused on giving the block leaders and the volunteers the material and support they needed to spread the news that Ebola is here, these are the symptoms, this is what you do if you think you have it.”
In each of these communities I personally went and talked to the leaders. We brought them together, we gave them training in the Monrovia City Hall. Then we went into each of their communities and did training with their block leaders. My staff and I worked very hard to carry this message. The solid waste people who collect waste in the city were spreading the news. The community service department was spreading the news. The environmental health department was spreading the news. Everybody got to be part of this.
Q: As urbanization picks up in Africa, outbreaks of disease in crowded places seem more likely. Do you have any insight into that, having seen how the Ebola outbreak played out in the slums, for example?
A: When you say urbanization, we have to first of all look at the structure, the governance system in each of these communities. That’s one of the things to do with urbanization. Then after that you look at what are the benefits the people in those communities need to make them take ownership for their own welfare. Do you provide clean drinking water? Do you build toilets inside the communities that have no real toilets so people are defecating in the street, or between houses, or in plastic bags and throwing it in the garbage? What do you do?
These are simple things, but these are things that happen in very crowded areas where there isn’t any facilities. When people get sick, is there a clinic nearby where they can go and get some medicine for an ordinary thing such as malaria? That’s one of the top killers of babies in Liberia. It’s finding ways of getting social benefits to areas that don’t have it, and setting the structure in place so that people are trained to take care of themselves.
I know it’s loaded thing to say, but in Liberia today people want the government to do everything for them. The government cannot. Communities need to take ownership of what’s happening in their communities, form groups that can come out and say, “This is what we need in this area, that area,” and get benefits from local authorities or whatever institution, be it government, NGOs, church or anything that’s willing to help upgrade your standard of living.
Q: What lessons should mayors in other cities take from your experience?
A: One of the shortfalls in addressing the Ebola crisis at first was a lack of organization. The NGOs, the government people, they were going into these communities not in an organized fashion. You go in and deal with one group, you go in and deal with another group.
“It has to be a ‘we’ thing. It has to be working together as a team.”
They have to come in an organized fashion to the community leaders. You cannot have the ministry of health helping some people in a little town over here and these other people are being helped by another group. It has to be coordinated. Then people will listen to you all, because the same message is getting across. That was the mistake at the beginning. Everybody was doing their own thing in these communities. So many NGOs, so many people felt good about wanting to help, but it wasn’t organized.
Q: What did that lack of organization mean for you as a local leader?
A: It makes the job harder. As mayor, you want to go into the community and say, “We have this much help for you.” But then people raised hell and said, “We haven’t seen it.” We’d say, “Oh, they’re supposed to be bringing water to you.” And the people would say, “We haven’t seen it.” And we’d say to people who have caught the virus or are quarantined, “They’re supposed to bring you medicine, they’re supposed to bring you food.” And they’d say, “Oh no, we haven’t seen it.” Because the aid efforts would be going on in one area and not the other area.
The coordination is a very strong part of what I would push for in that situation. Be it Ebola or any epidemic that breaks out, the powers that be, the international community, the government must have real coordination of what their support is to a community.
Q: So what can you do as a mayor in that situation?
A: I had to go to the commissioners for the different areas of Monrovia and basically tell them, “You have the authority. If someone is in your community doing something, ask them, ‘What are you doing here? Who is in charge of what you are distributing? Who are you giving information to, to take out into my community?’”
I had to do that. I had to bring all the commissioners in. I had to help them understand that they had the authority then to work with their community’s leaders, to take charge of who were coming in to their community. I think it worked very well. It has to be a “we” thing. It has to be working together as a team.