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Au centre opérationnel d'urgence[br]du Liberia, de lutte contre Ebola

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en compagnie de mon collègue [br]Mosaka Fallah.

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Votre lutte contre Ebola est primordiale[br]puisque vous êtes aujourd'hui responsable

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des traceurs de contacts ici à Moravia[br]- Oui.

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Alors dites nous... Pourquoi est-ce[br]si difficile de suivre ces contacts ?

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Pour deux raisons principales.

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La première est une question de confiance.

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De confiance dans les traceurs eux-mêmes

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Ils ont de moins en moins confiance en nous[br]et c'est dû au fait que

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to them in time.[br]also there is an issue of... our non-Ebola

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health services is not developed , in case[br]they don't have Ebola, how do they get the

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best treatment?[br]That means if they have malaria, pneumonia

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or other sorts of diarrhea... they can't find[br]any treatment.

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Exactly. Since Ebola our health care system[br]collapsed on the wake of the emergency

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So they don't have an alternative to go[br]So they see their relatives go before... they don't

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have any alternative, so they are distrustful.[br]Why should they tell us? They don't have an

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alternative.[br]And the third thing is the issue of feedback.

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They have seen their relatives go to ETUs[br]and maybe die

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and they didn't have the feedback in a timely[br]fashion.

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And ETU is the abbreviation for the Ebola[br]Treatment Units

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that are the hospitals or tent hospitals specially[br]for Ebola.

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Yes, Dr. Hans.[br]But I mean... is it 8 monitors you have now?

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Oui.[br]Qui supervise cela…

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They are really wise.[br]When I have been in the morning meetings,

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they understand all the dynamics[br]and realities of people. Some of which are

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very poor.[br]So when you now became in charge of this;

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What is the most important? I know that you[br]are fixing the food now.

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Yes.[br]Because they need food the same day that they

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became a case, a contact,[br]so they can't go out and buy themselves.

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How are you planning to change or improve[br]the system?

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Because it's already good![br]Because you took it from a catastrophe.

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You took it from a 100 a day down to 10 a[br]day.

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What are the next things you want to change[br]now?

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First I want to restore the confidence and[br]I hope in building trust.

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Engaging local communities.

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Engaging lots of stakeholders. And ensuring[br]that they'll have a response

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in a timely fashion.[br]And we are talking about making

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practical field decisions.[br]Moving case-investigators, contact-tracers,

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psychosocial together.[br]Generate full list.

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Have the full list returned to the family[br]in a timely fashion.

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Providing the psychosocial support.[br]Working with local leaders.

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Supporting the local leaders building the[br]transport.

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Working on a feedback system where we now[br]gonna have

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case investigators working closer with us[br]and a data unit

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ensuring that they'll feedback in a timely[br]fashion.

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As of the status of; their relatives;[br]those in the ETU; and the lab results.

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Your people, the tracers, how many are they?[br]How many people do you have who go and visit

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these contacts?[br]In Montserrado county we have 305 tracers

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22 supervisors[br]currently in the two zones of the Montserrado

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county.[br]And they have to be like detectives almost.

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But then you say they have to be kind also.[br]They have to think about the family.

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Yes, so it's always a critical issue, because[br]they see them as representing the system.

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Because they are the ones that the first time,[br]if there is a death in the family, someone

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has to come see them first,[br]and they have to be the ones who go there

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everyday for 21 days.[br]So, yes they have to be empathetic.

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But also they have to be detectives.[br]They have to be able to see through them

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and know; those who have been honest[br]and those who are not saying the truth

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and after follow up investigation to find[br]all contacts.

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In this epidemic there is no room for errors.[br]You need to find 100% contacts.

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So they have to do the both.[br]Be kind, at the same time as being a detective,

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to find out all of the contacts.[br]And you never use force?

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I mean you don't threaten people.[br]It's just their free will?

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Yes, Sir! We encourage the free will,[br]even when deciding the concept of quarantine.

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We always say quarantine should be done by[br]the communities.

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You shouldn't get the police involved.[br]It should be done... it should be involved

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for discussion.[br]There's a consensus building.

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It's so important because the fear we always[br]have is that:

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if we use force, they could escape.[br]If we put them under huge pressure.

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It has to be a friendly approach; a comunity-based[br]approach

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You look like a very tough guy! That's what[br]has impressed me you know.

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I've seen you almost rush out from the morning[br]meetings.

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And then when you argue, you talk like a nun.[br]You are very kind to people!

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This is probably the most important[br]to be empathetic, you say?

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I think so. Yes![br]But you have two types of problems. One is

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that you don't get the contacts listed.[br]They are hidden some of them.

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And the other is that the contacts who get[br]sick, they leave

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because they don't want to be identified as[br]sick.

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What is the reason why they don't get listed[br]in the beginning?

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In the beginning of the epidemic there was[br]a couple of factors.

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One of them was that the burial team picked[br]up

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the body and we would not have the contacts[br]coming to us in a timely fashion.

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Some of them road commercial vehicles probably[br]ambulances, and went to ETUs.

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And those who did that without collecting send[br]back as a feedback

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and line then was sent to begin contact tracing.[br]That means that the list for them…

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and of course when they had someone who had[br]died at home

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that was a very emotional, and very sad moment[br]it's not an easy time to remember them.

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Exactly, and the exam of contacts and all[br]those kind of questions.

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It's an emotional period. That stage is critical[br]you can build friendship, you can build empathy

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and then they can reveal to you, by that time[br]when they are in the though period.

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So now you are going to have a system where[br]by

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those which we call "case investigators",[br]who just take care of the information of the

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sick[br]and your contact tracer, with a list of contacts

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and ambulances and the burial cars[br]they will be one system?

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Yes, we're hoping yes.[br]So there can practical field decision.

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Because most of the time we lost a contact[br]in the time past when the case investigator

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does the investigation and line listing,[br]between that and the data unit and coming

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back to the tracer,[br]there was a delay in time.

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So some of the contact listing got lost.[br]If there is a field level decision

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where the investigator does the investigation[br]the contact tracer takes the line listing

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and initiates investigation immediately.[br]In that case I'll be very confident that every

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case we've seen,[br]we've gone through that. We have the contacts

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listed and that we have followed up!