In my earlier post on tackling coronavirus in slums, I recommended that community leaders be enlisted and supported to lead the response.
Local chiefs or councillors, religious leaders, traditional healers and other respected figures, I argued, “are best placed to advise on the appropriate isolation units and on the measures and constraints that might be accepted by the inhabitants of each informal settlement. This is particularly important in slums where the state has limited legitimacy and capacity … [Leaders] can also develop measures of their own, which may be more appropriate to the local context than broad-based policies developed by central governments.”
In his book Ebola: How a People’s Science Helped End an Epidemic, Paul Richards provides an excellent example of a community-led effort.
Musa Kallon, the paramount chief of Jawei chiefdom in eastern Sierra Leone, lost his wife and daughter to Ebola shortly after the disease entered the country across the nearby border with Guinea in May 2014. He himself wasn’t fully trusted by some of his constituents, who believed he and the ruling political party were somehow using Ebola to reduce opposition votes, and his warnings about the importance of safe burials (the virus is passed on through bodily fluids, and the washing and burial of corpses is a key transmission channel) were initially ignored.
The funerals of the chiefdom’s first victims accelerated the spread of the disease, and after Chief Kallon went into self-isolation, he almost succumbed to despair. Then he remembered that he was descended from a line of warriors. ‘All is not lost,’ he told himself. ‘I go nowhere and fight for the chiefdom I love.’
Paul Richards describes what the chief did next:
“Allowing no one to come physically close to him, he arranged the recruitment and training of fifty-two young men from all parts of the chiefdom, as an anti-Ebola task force. The job of this force was to teach villagers about the disease risks, find the sick, and raise the alarm. It also supplied recruits as surveillance workers, contact tracers and members of burial teams.
“Bye-laws were drafted to regulate local movement, and task force members blocked roads. The rule became that if the village chief did not know a visitor that person would be prevented from entering a village. The message was ‘no roaming, stay at home.’ Chief Kallon made ‘a noise’ about Ebola wherever he could, including on the radio, and with agencies such as Médecins sans Frontieres, who supplied buckets, chlorine and other items.”
It took a while for the task force’s work to be appreciated. Many people steered clear of the chief’s compound and some task force members were evicted from their homes (Chief Kallon housed them in his compound). But when infections began to decline rapidly, people were won over. Outside responders such as MSF and the government supported rather than dictated the chief’s efforts, and the chiefdom was soon free of the disease.
A response led by the community and supported by outsiders is likely to be the most effective means of controlling COVID-19 in slums. Chief Kallon’s bye-laws also have resonance, particularly if streets or districts isolate themselves into self-sufficient cohort units. That communities were won round only after they saw positive impacts of the approach, moreover, points to the need for humility when it comes to imposing laws – compliance cannot be taken for granted just because a law comes from on high, and even people with little formal education can develop a strong enough grasp of emerging science to assess the merit of different disease control strategies.
An approach based on respect gradually evolved across Sierra Leone. Chief Kallon’s approach later became a model for local responses across the whole country, and an epidemic that the US Centers for Disease Control had predicted would infect 1.4 million people (with an average case fatality ratio of 50%) was ended after only 29,000 infections and 11,000 deaths.
As Richards observes, “In effect, communities had begun to think like epidemiologists, and epidemiologists (in providing timely and relevant advice to local agents) had begun to think like communities. An evidence-based people’s science of Ebola control had begun to emerge.”
