Earlier today, NPR Global Health tweeted me, wondering if I had a link to an official Sierra Leone government statement about Dr. Khan falling ill with Ebola. I'm a big fan of NPR Global Health, so I checked through my usual sources and a few unusual ones, came up dry, and tweeted my apologies.
Then I did a double-take. Wait a minute: A doctor is sick in West Africa, and a major US news system is asking a retired teacher in the suburbs of Vancouver, British Columbia, for information about the case?
It was a reminder of the effectiveness of online communication, and of its major failures. If we're online we can follow news events almost anywhere in the world. If we're not online, we may not even be in the same century.
Repeatedly over the years I've followed disease outbreaks in countries where the governments have only the most rudimentary web presence. This makes sense if few of your citizens are online and may not even be able to read (or afford) a newspaper. Haiti, for example, seems to have thriving system of radio stations.
But in a serious outbreak like Haiti's cholera or West Africa's Ebola, the government has to inform the rest of the world as well as its own people. And of course any government must be able to advocate for itself and its country. Otherwise it's at the mercy of the international media's famously short attention span, aggravated by competition from other problems.
When Ebola broke out in Guinea, I was discouraged to find that its ministry of health had a genuine "cobwebsite"—it hadn't been updated in years. And sometime this spring it was hit by an Indonesian hacker. Liberia's Ministry of Health and Social Welfare website is reasonably good, while Sierra Leone's Ministry of Health and Sanitation has settled for a Facebook page that at least updates every day.
This afternoon I did discover the website of the Sierra Leone Open Government Initiative, which is "aimed at promoting and supporting effective governance through efficient free-flow of information between government and the people." It's an attractive site, though most of its pages are blank or offer only years-old official documents. I searched for "Ebola" and got nothing.
Aggravating the problem is the atmosphere of the local media. Guinea has seen no recent Ebola cases, and its news sites have dropped the subject in favour of football and political gossip. Sierra Leone's news site are soapboxes for various political factions, and they prefer to attack their adversaries' Ebola failures rather than simply report what's going on. So we see slanging matches between the media and the Minister of Public Health, carried out largely on Facebook; it's more like teenage cyberbullying than health communication.
And if Ebola has taught us anything in the past four or five months, it's that communication is absolutely critical to fighting the outbreak. Communication won't happen without mutual understanding and respect. I know this is a challenge for the educated elites of poor countries (and rich countries, for that matter). If those in power are seriously out of touch with their people, everything they say will sound self-serving, patronizing, or outright dishonest.
We could fight outbreaks like Ebola far more effectively if every emergency aid package contained a non-negotiable requirement: That the host government set up and maintain an adequate health-communication system. It would include not just a website but content for local radio, TV and print media. While drawing mostly on local people, the system would employ foreign experts as well. If need be, the donor nation or agency would include training for local journalists and technical people, not to mention the recipient country's government information staff.
Local culture, as we've seen in West Africa, can make an outbreak worse. But the local political culture, if it doesn't make communication a priority, is at least as serious a threat to public health.