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Ebola response: Change attitudes by enforcing byelaws

NOVEMBER 12, 2014 By Joseph Dumbuya

CEO of NERC Rtd Major Alfred Palo Conteh
CEO of NERC Rtd Major Alfred Palo Conteh

I completely agree with the new Chief Executive Officer of the National Ebola Response Center (NERC) Paolo Conteh that change of attitude is key to breaking the chain of transmission and by extension putting an end to the Ebola disease. But I think there was too much focus on change of attitude through education rather than enforcing byelaws on Ebola.

Now let me set the tone of this piece with a couple of questions to think through. Apart from the all too familiar washing and not shaking hands, what other difference is education making in the Ebola campaign? How does education compare with enforcing bylaws in terms of the campaign? But they are complementary. I know! What evidence is there to suggest that the latter is responsible for the difference between the South and East on the one hand and the Western Area and North – with the exception of Koinadugu District – on the other?

Now, talking about education, who does not know breaking the chain requires the washing of hands several times a day? But this is not something most people are used to. It is therefore not uncommon to see men urinate in street corners and then go about shaking hands of others without washing their hands! I will not bore you with the risk of transmitting diseases which goes with it.

Who does not know breaking the chain also means shunning the things we hold very dear. Treat everybody as a suspected case regardless. We should eschew touching people, even the much cherished culture of shaking hands. We should not get close to dead bodies even those of loved ones, let alone touch or attend funerals. We should not encourage visitors – even relatives.

Also, we should not eat bush meat especially monkey which is considered a delicacy by some. I know of friends who would insist monkey soup is always on the menu during visits upcountry.  They do not have a care how this effects wildlife; all they care about is the monkey soup. But it sounds a bit selfish. I know.

During the several radio interviews granted by Paolo on Ebola, he said over and over again that attitudes should change to defeat the disease. I Agree! And this was amply demonstrated when he was guest on Radio Democracy on November 5. He used the phrase ‘change of attitude’ in reply to almost every question. It was a bit monotonous. I know.

This is understandable. We must not lose sight of the fact that a lot of efforts had gone into awareness-raising on the disease. Recently MPs were given 7.6 billion Leones to do ‘sensitization’. By the way, why do you have to give money to MPs to sensitize their constituents on Ebola? Did their intervention make a difference? This is a matter for debate, but I doubt it.

But, change of attitude can be a very controversial subject within the Sierra Leone context. A lot of people become very suspicious and uncomfortable when it is thrown into a discussion. This is because what is seen as bad attitude by some say politicians and their cheerleaders may be the reverse for others. Also, it is often used to stifle dissent and by extension create a docile public.

Let me give you an example. The other day, the gentleman leading the Ebola campaign in Koinadugu District, Momoh Conteh caused a stir by describing opposition to the appointment of Paolo Conteh as head of the National Ebola Response Center by sections of the public as a bad attitude. As if this is not insulting enough, he branded these people as unpatriotic. In the wisdom of Momoh Conteh disagreeing, in this case with the President, is a very bad attitude. You ask my view, I would say disagreeing and proffering alternative ideas on appointments, policies and issues is a hallmark of a vibrant democracy.

What I did not hear from Paola is to underline the importance of existing byelaws to change attitudes. He did not establish a link between change of attitude and byelaws on Ebola, which, it must be said, has been very effective in reducing the infection rates in the East, South and Koinadugu district in the North. The empirical evidence suggests it is making a world of difference.

Well, nobody is saying the information should not be reinforced from time to time, which the media continue to do for free anyway. At the same time, it is not enough to go on radio and keep repeating change of attitude as though it exists in a vacuum and expect everybody to follow suit. There should be a strategy for those who do not believe in the message that Ebola is real and behave in a manner that is inconsistent with the law and as a result pose a danger to other members of the community. For this group you can force them to change their attitudes by the enforcing the byelaws.

The philosopher Aristotle said: ‘A social instinct is implanted in all men by nature. Yet he who first founded the state is the greatest benefactor. For man when perfected is the best of all animals but when separated from law and order is the worst.’ This finds resonance with the current Ebola campaign. Some of the problems we face as a nation stem from a failure to implement our laws. Make no mistake we have very good laws like those of other vibrant democracies in African and parts of the West. The difference between us and the others is that our record at enforcing laws is nothing to write home about. We simply cannot enforce laws to the letter.

This demon is now hunting us as we grapple with the Ebola outbreak. The difference in the Ebola response between the South and Eastern regions on one hand and the North – with the notable exception of Koinadugu – and the Western regions on the other hand has to do largely with enforcing byelaws.

We have seen a strong commitment on the part of the former to enforce the byelaws. The same cannot be said of the latter, which has demonstrated an apparent lack of seriousness in enforcing byelaws. Therefore, we continue to see a steady decline in infection rates in the South and East while the reverse is true for the Western Area and most parts of the North.

It does not help the illiteracy rate is highest in the Northern Province while the Western Area is the most densely populated part of the country. In fact, it is an open secret the byelaws on Ebola are useless in the Western Area. Those who are aware of them do not take them seriously, not even those in the Western Rural.

You remember how the darling of the Freetown media, the Mayor of Makeni, Sunkara Kamara, hoodwinked us into believing Bombali was on top of the situation in the Ebola campaign. In very high profile radio interviews she granted in Freetown few months ago, she authoritatively told the nation that unlike other parts of the country which are struggling to get rid of the disease, Bombali is on course to kill the disease so that it does not rear its ugly head again. Well, shortly after, Bombali started losing the fight against Ebola and since then there has been no end in sight. The district has overtaken Kailahun and Kenema Districts and now has the second highest infection rate in the country after the Western Area.

Authorities in the South and East are enforcing the byelaws without fear or favour and this is why the rates are falling. Those who broke the byelaws are made to face the music. They are made to pay prohibitive fines regardless. With the wave of hardship sweeping across the nation you appreciate why people in those areas are very careful not to fall foul of the byelaws.

A friend recently visited Lower Bambara in the Kenema District to do a survey and spent half of the day registering with the structures put in place, including the taskforce and the Paramount Chief, and explaining the reasons for his visit. He was treated like a leper by the locals. Needless to say he was very relieved to complete his work and leave.

Unfortunately, the apparent lack of commitment to enforce the byelaws in most of the North is not reflected in the media and politicians are careful not to say these things for fear of causing offense among those whose responsibility it is to enforce the byelaws.

I think it is important to underline the use of lawful means to change attitudes. What we have seen over time is a focus on what to do and what not to do, but hardly anything on repercussions for failing to do the right thing. Granted a lot of resources have gone into education on the Ebola. So, if people refuse or are reluctant to change habits, then you cannot blame it on lack of information or education. As a matter of fact, we have achieved a lot more with enforcing the byelaws. And the evidence is there for all of us to see.

There is therefore a compelling reason to shift the focus on enforcing the byelaws. This is because a key challenge is that education is not bringing about the expected change of attitude. Otherwise, the Western Area which has benefited the most from sensitization on the disease should not be recording the highest infection rates in the country. It is one thing to receive the message, it is quite another to act on it and put it into good use.

Against this backdrop, there is a compelling case to focus on forcing change of attitude through lawful means, that is, enforcing the byelaws to the letter.  I consider this the most crucial at the moment. Also, I would suggest a fine for Ebola deniers. This is because they pose another serious challenge to the campaign. There is no question you have to believe Ebola is real to take the necessary precaution. It is as simple as that!

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