Faculty from UNC Advise Public Health Officials in Liberia on Response to an Ebola Outbreak

March 10, 2017
During the 2013 Ebola outbreak in Liberia, government officials placed signs across the country to convince people the virus was a real threat. But fewer than 50 percent of Liberia’s population can read.

During the 2013 Ebola outbreak in Liberia, government officials placed signs across the country to convince people the virus was a real threat. But fewer than 50 percent of Liberia’s population can read.

“I don’t want you to go; it’s too dangerous.”

Aimee Wall smiled at her nervous 11-year-old daughter. “I promise you it’s safe,” she says. “Liberia has been free of Ebola for months. You have nothing to worry about.”

An hour later, as she finished packing her bags, Wall’s phone beeped. It was a text from her brother with a link to a news report.“Have you seen this yet?” the text reads.

The day was April 2, 2016, and a new case of Ebola had just been reported in Monrovia, Liberia — where Wall was heading the next day.

Connecting Carolina to Liberia 

In October 2015, Wall, the Thomas Willis Lambeth Distinguished Chair in Public Policy at the University of North Carolina at Chapel Hill School of Government, received a phone call from Francis Kateh, the chief medical officer for the Liberian Ministry of Health. Kateh knew Wall from a decade earlier when he served as the health director in Anson County, North Carolina.

“We regularly assist counties across the state of North Carolina with confidentiality laws and protocols,” Wall says. “In the same way that we helped him in Anson County, Dr. Kateh wanted us to help him in Liberia.”

At that point, in the fall of 2015, the worst of the Ebola outbreak was over, and Kateh and his colleagues were busy looking for ways to better prevent and control future outbreaks. In order to quarantine a house, or a neighborhood, there must be a law on the books that details how and when to do so, and public officials must know it.

That was one of Kateh’s biggest frustrations during this unprecedented, widespread outbreak. Liberia did have laws on the books for Ebola response, but people did not understand them or know how to use them. Kateh had health officials in place, but when he went to them and said, “Do this, it’s the law,” they responded with, “Wait, what law?”

It is a bit like having highways and state patrol officers, but no one knows the speed limit. The infrastructure is there, but the knowledge is not.

Kateh presented Wall with a technical, three-part request. First, he wanted to organize foundational training for officials in Liberia to explain how law is integral to an effective public health system. “Dr. Kateh felt that there was a gap there. People didn’t understand how important the law was to public health response. He wanted to build that foundation from the ground up.”

Next he wanted Wall and her colleagues at the School of Government to help a team of Liberian attorneys and officials rewrite old laws and draft new legislation to bring Liberia’s health codes up to date. “We help legislators draft legislation to do those exact things in North Carolina, and Dr. Kateh knew that,” Wall says.

Kateh’s third aspiration included some kind of continued training in the future. “So we take this new body of law and train people in it,” Wall says. “But we also have to help build capacity within the country to do that kind of training for public officials.”

These were three ambitious and arduous goals, in a complicated country recently ravaged by a terrible virus. “There weren’t a lot of people who were willing to take that on,” Wall says.

She, however, told Kateh she would look into it.

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