Rejoinder To The FrontPage Africa Article-Liberia: 2,000 Trained Ebola Contact Tracers Being Sidelined For 6,000 New Covid-19 ‘Recruits’
I have tried to remain focus on the COVID-19 response over the past several weeks as I am convinced that if it becomes explosive it would cause irreversible damage to our very existence as a people and as a country. I have remained silent while working 20 hours a day when a few journalist wrote that I should not be confirmed because I prevented Liberians from getting their just benefits from the ebola virus. While this accusation was laughably unfair to me, I chose to remain silent. My silence was never an admission of guilt but I felt that the lives of the 4.5 million Liberians rest on my conscience and on the heads of other like-minded colleagues who are active in this Coronavirus response.
By Mosoka P. Fallah, PhD, MPH, MA
I am now constrained to respond to the article written by Rodney Sieh on April 11, 2020, the publisher of the FrontPage Africa under an article captioned, “LIBERIA: 2,000 TRAINED EBOLA CONTACT TRACERS BEING SIDELINED FOR 6,000 NEW COVID-19 ‘RECRUITS’
In this article he intimated that we failed to recruit 2.000 trained contact tracers for COVID-19 response and that the 6,000 persons recruited by the MCC/NPHIL team are more than all of the teams across the country. He further went on to write that prior to taking over as Director General of NPHIL, I was head of an NGO, named and style Rescue Place International and the my NGO has become a party to this efforts to recruit the 6,000 active case finders, which according to the article, presents a potential conflict of interest. It was also reported that the Community-based Initiative (CBI) that I founded during the ebola was now being sidelined for the MCC.
In the next few paragraphs, I will attempt to address the issues raised in this article and offer clarity. I am convinced that information cited in the article was provided by corrupt and misguided individuals with no credibility. .
Conflict of Interest and using Rescue Place International to benefit from the recruitment of the 6,000 active case finders
I had hoped that my learned publisher would have taken the time to grant me a fair chance to explain myself and my patriotic contribution to our dear country Liberia without any conflict of interest. Firstly, none of the employees of Refuge Place International works with the COVID-19 response team. They are currently involved with the management of our NGO clinics. Secondly, I did not transition from the Founder/CEO of Refuge Place to my current position as Director General of NPHIL. I was appointed as the Deputy Director for Technical Services by Former President Ellen Johnson-Sirleaf, after I helped to build NPHIL. From my appointment in 2017 until I was asked by His Excellency Dr. George Manneh Weah to serve as Director General, I was paid by PREVAIL Liberia and did not take a single dime from National Government as salary.
Thirdly, I founded Refuge Place International in Kentucky, USA, when I was doing my doctorate to help to bring health care to poor Liberians. Since, my returned to Liberia in 2013, my board and I have completed 2 clinics that treated over 50,000 patients for free during the ebola outbreak. We are constructing additional 2 clinics in Montserrado County, 1 in lower Bong County and 1 in Lofa County. We have provided free lenses to over 2,000 students. All the funds for these projects have come from two major sources. Royer Charitable Foundation started supporting me since 2014, with the initial 3,000 US dollars, and increased it to $120,000 in 2019. The second major funder is Liberia Mercy Partners that provides us $1000.00 US dollars every month and in February of 2020 made a single donation of $10,000 so we could build more clinics to serve our people. There have been some support from my classmates and board members in the US who believed in my humanitarian work in Liberia. When the COVID-19 preparedness began in December, of 2019, I quickly realized that we needed to quickly mobilize funds to enhance the surveillance at the RIA. Since funds was slow in coming, I instructed one of our workers to withdraw $10,000 from Refuge Place International account and later withdrew an additional $5000 to support the response. I have kept their receipts and hope to seek reimbursements later.
6,000 active case Finders over 2000 contact tracers and greater than all
Contact tracers from the 15 counties. Other health professionals are left out.
Contact tracing is involves contact identification and contact follow up. Contact tracing is a passive process that first waits for a case to be identified. When I deferred my trip back to the USA in 2014 to help my country fight the ebola crisis, I realized that contact tracing would never be sufficient to end the ebola outbreak. I then initiated community-level active case finding using the Tuberculosis model. There was nothing written at the time, I had to adapt the model to Liberia. At the height of the ebola outbreak, there were 5,700 active case finders and over 300 support teams. These were students, teachers, Imams, pastors, community leaders and even a 75 year old Kissi governor. Due to the moderate rate of transmission of ebola, we had 1 active case finders to cover 50 households to check for the sick, the dead and provide awareness. For the population of 1.3 million people the 5,700 active case finders was sufficient to ensure that all cases and the sick in Liberia were found and turned over to the contact tracers.
However, if you compare the transmission rates of ebola to COVID-19, you will realize that the rate of transmission of the COVID19 is higher than ebola. Since, 1976 when ebola was first discovered to 2020, there has been about 37,000 cases with an average of 50% deaths. However, from December, 2019 to April, 2020, COVID-19 has had 1,793,728 cases and 110,196 deaths. As a result of these factors, we have realized that we would need 15,000 active case finders to support the 2000 contact tracers. Given the fact that there is a higher risk of infection and the special protection it requires to do active case finding, we proposed one active case finder to cover 20 houses a day to check for the sick and provide awareness messages every day for the next three months. We took into consideration that Montserrado County has 1,500,000 people and, at 5 persons per household, we determined that there are 300,000 households in Montserrado County. Hence, we would need 15,000 active case finders to cover the entire Montserrado County. Thus, the 6,000 active case finders was a welcome opportunity for us and would need to work closely with the Montserado County Health Team (MCHT) and incorporate other health workers. Montserrado County needs an additional 9,000 active case finders to identify all of the potential cases and contain the current spread.
The second point is the confusion between active case finders and contact tracers. The contact tracers are normally fewer in number and are activated only after a case is investigated. I have worked with the Montserrado County Health (MCHT) to train and activated 15 case investigators. Upon investigating a case and establishing contacts, contact tracers are deployed to follow-up contacts. The active case finders are solely responsible to check for cases because they know their communities and check on all visitors and those who may be sick and hiding. To say that the 2000 contact tracers are being neglected is a fabrication. There is a strong need for them to complement each other. The third point of correction is that given the acute shortage of trained health care workers like nurses, it is best to use them in specialized areas like the management of our Precautionary Observation Center (POC). Hence, we have employed over 300 of them to manage these centers and the treatment unit. Some of them are employed to regulate people coming through RIA. The final point of correction is that CBI is currently actively involved in active case finding and searching for high risk contacts and confirmed cases who are on the run.
“The CBI members have been sidelined by Dr. Mosoka P. Fallah”
When the ebola outbreak ended on May 9, 2015, I wrote multiple project proposals to continue the support for active case finders so they could help in community recovery. However, CBI was never able to obtain the needed funding. With five other members, we evolved into a non-profit named and styled the Community-based Initiative for Surveillance and Sustainable Development. One of our main focus was to be able to quickly support response to the resurgence of any ebola outbreak and identify support for ebola survivors and orphans. Hence, my team was instrumental in quickly resolving the re-emerge ebola outbreaks in Needowein in June, 2015, Duport Road in November, 2015 and Soul clinic in April, 2016. We started a program to train survivor women in coding, sewing and arts and craft. We collaborated with a donor in the US to support over 250 ebola orphans for the last four years.
When I was asked to head the COVID-19 response, the first group I contacted was my colleagues from CBI. I asked them to provide training and guidance to the MCC folks. I further asked my CBI team to work with the County Health Officer (CHO), Dr. Yatta Wapoe in tracking cases and helping to find challenging cases. So, how can the learned publisher say I have sidelined my own guys who fought with me in the slums and risking our lives together to end ebola.
I am of the very strong conviction that Liberia is a society filled with strong suspicion and the notion that one cannot be above corruption. We think that every Liberian is in it for their personal aggrandizement. I want to inform Mr. Sieh that there are still a few good Liberians who put the country above themselves. In 2014, I had the opportunity and the ticket to pack up and leave for the USA during the ebola crisis, but I chose to stay and to go places where no one wanted to go. I have raised money and sacrificed my salary to support our country.
Liberia is going through a difficult time and we need to rally as citizens, irrespective of our political alliances, to ensure that this country is safe. I am appealing to everyone on the press to leave the politicking for now. We can go back to that if and when we survive the Covid-19 outbreak. Please allow me to focus on my job so that we can strive to save all of our citizens. In future, please reach out to me for clarification when you hear unsubstantiated rumors. I have worked very hard to earn my reputation. Don’t taint it with rumors and innuendoes.
Mosoka P. Fallah, PhD, MPH, MA
National Public Health Institute of Liberia (NPHIL)
Email: [email protected]
FPA EDITOR’S NOTE: Dr. Fallah did not respond messages seeking answers or explanations to concerns and lingering issues prior to the publication of the article referred to in this rejoinder.