Contact tracers need multiple skills FactPod #14 starring Mosoka Fallah

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

en compagnie de mon collègue
Mosaka Fallah.

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

des traceurs de contacts ici à Moravia
- Oui.

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

Pour deux raisons principales.

La première est une question de confiance.

De confiance dans les traceurs eux-mêmes

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

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

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

best treatment?
That means if they have malaria, pneumonia

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

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

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

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

alternative.
And the third thing is the issue of feedback.

They have seen their relatives go to ETUs
and maybe die

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

And ETU is the abbreviation for the Ebola
Treatment Units

that are the hospitals or tent hospitals specially
for Ebola.

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

Oui.
Qui supervise cela…

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

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

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

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

Yes.
Because they need food the same day that they

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

How are you planning to change or improve
the system?

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

You took it from a 100 a day down to 10 a
day.

What are the next things you want to change
now?

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

Engaging local communities.

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

in a timely fashion.
And we are talking about making

practical field decisions.
Moving case-investigators, contact-tracers,

psychosocial together.
Generate full list.

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

Providing the psychosocial support.
Working with local leaders.

Supporting the local leaders building the
transport.

Working on a feedback system where we now
gonna have

case investigators working closer with us
and a data unit

ensuring that they'll feedback in a timely
fashion.

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

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

these contacts?
In Montserrado county we have 305 tracers

22 supervisors
currently in the two zones of the Montserrado

county.
And they have to be like detectives almost.

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

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

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

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

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

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

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

and after follow up investigation to find
all contacts.

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

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

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

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

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

We always say quarantine should be done by
the communities.

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

for discussion.
There's a consensus building.

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

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

It has to be a friendly approach; a comunity-based
approach

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

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

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

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

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

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

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

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

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

In the beginning of the epidemic there was
a couple of factors.

One of them was that the burial team picked
up

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

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

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

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

and of course when they had someone who had
died at home

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

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

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

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

So now you are going to have a system where
by

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

sick
and your contact tracer, with a list of contacts

and ambulances and the burial cars
they will be one system?

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

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

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

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

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

where the investigator does the investigation
the contact tracer takes the line listing

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

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

listed and that we have followed up!