While working as a health volunteer in River Cess County, rural Liberia, during the Ebola outbreak, Elizabeth Tweh often found herself helping communities with wider health issues, some of them totally unrelated to the disease.
“During Ebola, I joined a volunteer task force, sharing information with communities about how to prevent catching the disease,” Tweh says. “But some people, especially pregnant women and young mothers, started asking me different questions as well. They wanted to know how they could cure their children of other health complaints, or whether some of the myths about pregnancy could be true.”
In Liberia, programs such as the USAID-funded Ebola Community Action Platform (ECAP) were credited with slowing the spread of Ebola. The social mobilization project worked through networks of local organizations to share information about how to respond to the outbreak, contributing to improved preventative measures and the acceptance of safer burial practices. After the outbreak ended, the project continued to train community health volunteers, building 1,500 committees around the country.
While donor funds and the international health community continue to focus on disease in Liberia, ECAP’s committees and volunteers are now shifting their attention to broader health issues, including maternal and child health. Liberia has one of the highest maternal mortality rates in sub-Saharan Africa, with a death rate of 1,072 per 100,000 births, according to 2013 figures from the Liberian Ministry of Health.
Tweh now works with a small community health committee, sharing information about contraception, pregnancy and labor with women and girls in rural villages.
“One of the things that Ebola showed us is the importance of information about other kinds of health issues, such as reproductive health,” Tweh says. “In my work now I go to communities and I tell women, especially younger ones, about all the things they will experience during pregnancy and labor. I tell them not to be afraid, and I connect them with the nearest clinics or traditional birth attendants.”
As with Ebola, Tweh says she sometimes has difficulty ensuring the women listen to the information she provides. “At the beginning, some of them did not trust me, but now they know me,” she says. “Sometimes we use theater or other forms of entertainment to get our messages through.”
According to Chea Sanford Wesseh, assistant minister for vital statistics at Liberia’s Ministry of Health, there are hopes that investment in community health information could help reduce the toll of maternal and infant mortality.
“The only way we can reduce maternal deaths is by empowering women and improving women’s education so they can make the decisions they need to make,” he says.
Wesseh adds that women are often bound by the decisions of their husbands or fathers, particularly in rural areas where access to education is more limited. “We recently had a case where a woman was very sick during her pregnancy and badly needed to go to a clinic,” he says. “It was an emergency, but she refused to go because her fiance was not there to give her the marching orders.”
More and more community health volunteers are sharing information around a variety of health issues, including mental health, tuberculosis and leprosy.
Margaret Johnson is a community health worker for Partners in Health and a registrar at the J.J. Dossen Memorial Hospital in Maryland County – one of Liberia’s most isolated regions, cut off by waterlogged roads during the long rainy season.
“I’m a community health worker because I like to see patients getting better, to see improvements,” Johnson says. “I work all day as a registrar at the hospital, then after I knock off, I go to the field to visit my patients. On Saturdays, we do visits and health talks. I particularly like to talk to women in the communities because they don’t usually have the same access to information as men.”
“We talk about stigma,” she adds. “If someone is sick, you don’t have to say it to them or talk about them in public. You don’t expose someone who is sick. You talk to them [privately] and encourage them to take their treatment.”
In River Cess County, Tweh hopes all women in Liberia will one day have access to community health volunteers. “If women can get information about reproductive health and other things, they will not suffer as much,” she says. “Some of them may not even die. Community health information is no small thing for Liberia.”