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Community control

The power of collective action

IT WILL SOUND bizarre, but the pandemic has permitted me significant international movement this year. By early November, I’m in Greece on a break from work in Afghanistan: Athens has been my home base (rather than a home) in recent years, and a flight back into Australia is almost impossible to secure at this time. The announcement of a second round of national Greek lockdown restrictions lands during a big news week: there’s talk of a successful vaccine trial, and parties in the streets as hatred and lies are denounced in the US in the wake of the election. Meanwhile the virus proliferates, and public health services cannot meet the increasing demand for clinical care. It’s a consistent story across Europe, where coronavirus cases soar to numbers inconceivable to most Australians – more than 70,000 in Greece, 800,000 in Germany and almost two million in France. No one talks of reaching zero in Europe, with its many nations and porous land borders. Instead, there’s an unspoken holding pattern: anguished expectations of perennial ebbs and flows and phased control measures until scientists develop a vaccine.

In February, I observed the rising spectre of the virus while on assignment in Sierra Leone. It was my first return since living there in 2014 and 2015 to work on the Ebola epidemic. Misinformation about COVID-19 – the mysterious new disease in China that was incubating on cruise ships and turning up in wealthy cities – provided real-time case studies for the journalists I was there to train. It held alarming relevance as they vividly recalled their own experience of virus outbreak. I returned to Athens in early March as the virus was declared a global pandemic, and returned ‘home’ to Melbourne soon after, making a snap – and very privileged – decision to situate myself somewhere with a high-functioning public health system.

At that time, Europe was reeling from the first surge of the virus through Italy, and I sensed a strong possibility of being stuck, sick or profoundly unprepared for what might come. By mid-March, I was packing a single large suitcase with clothes for all seasons and scenarios, based on a series of uninformed decisions. On reflection, I see I was (subconsciously, but correctly) guided by the expectation that I’d be part of the global response to this crisis. Its scale was unprecedented, but, having worked on other humanitarian and health emergencies, I recognised familiar territory, now writ large. Neither Europe nor the wider world was prepared for this disaster. Greece’s crippled health and welfare systems would have no way of providing adequate support, particularly for the most vulnerable, its poorest citizens, including the camp-bound asylum seekers. Punitive or heavy-handed approaches would become the default, it turned out, and community solidarity – food drops and handmade mask-making – would be required.

The day before my flight was punctuated by phone calls with friends in far-flung places who were also trying to decide where to be. In the evening came an emergency SMS from the Greek government warning people to stay home. Europe announced it was closing its borders to all visitors from the US and elsewhere, effective immediately. I felt I was dashing back to Australia before the drawbridge was hauled up – possibly forever – behind me.

 

I ARRIVED IN Melbourne as great uncertainty, confusion and a sense of impending dread settled across the world. These were the moments before the first Australian lockdowns were announced, but whiffs of existentialism and nostalgia were already appearing around radical shifts in the look and feel of everyday life. Soon after I arrived, I began working as an advisor to World Health Organization on their Risk Communication and Community Engagement program to tackle the virus in Afghanistan – remotely. Online meetings and calls with colleagues filled my afternoons and evenings, defying the days’ natural rhythms. I became increasingly confronted by the dissociative experience of this routine. My physical location – with its coffees, mealtimes and sunsets – was not the place that preoccupied my mind, or screen. The latter took precedence: there was an emergency to respond to. But could this be healthy? As this metaphysical experience swelled uncomfortably inside my head, I wondered if I should commit to working in Australia. Who would I be if I stayed here forever? One cold day in July, as panic was peaking in Melbourne, I decided to align my dislocated parts and fly into the eye of the storm.

Departing for Kabul on a rare flight out of Melbourne’s deserted airport felt like one of the strangest risks I’d taken in my outward-bound life; Australia’s caution and isolation rendered the rest of the world distant and dangerous. Would I contract the virus? Would I ever return? Arriving uneventfully in Kabul, I was immediately energised by the familiar smells and sights of the city where I’ve spent some years, and the relief of marrying on-screen faces with real-life names and voices. It was the right place to be.

 

COMPOUND LIFE, WHERE curfews and other forms of containment are a permanent condition, delivered me relative normality after Melbourne in the Stage 3 winter lockdown. Outside the compound walls, it was another story. In May and June, COVID-19 had swept like a devastating wave through an already traumatised population, exhausted from decades of war and day-to-day insecurity. Historic peace talks were making headlines amid the flaunting of ceasefire agreements while the virus took a terrible toll on communities – WHO research estimates around a third of the population had contracted the disease by July 2020. Polio cases were increasing again as people avoided vaccinations and medical facilities – not only for fear of contracting this coronavirus, but because of the stigma associated with having it, or seeking treatment for it. I heard stories of people hiding dead relatives to avoid ridicule and was alarmed by the prevalence of such stigma, by the ways this virus thrashes at our humanity.

The pandemic’s ghastly presence is one among many sources of fear in Afghanistan, and a virus will thrive in a culture of fear, competition and suspicion. I am struck (not for the first time) by this country’s apparent commonalities with the United States – the prevalence of violence, mistrust, anger and misinformation – that enable this virus to proliferate. Rumours in both countries would have people believe that the pandemic never existed. Conspiracies abound. Mixed messages coming from leadership, including that Afghans are immune, are derailing our collective efforts to prepare the population for the expected winter surge; this situation is familiar to the Americans in the room. In Afghanistan, the public seems to be more or less convinced that ‘Covid is over now’ – as I’ve learnt from Afghan colleagues and from the assessment reports that capture communities’ perceptions about the pandemic. Denial in this context is an understandable reaction: the virus is a problem that has no apparent solution. What to do but brace against another unwelcome and destructive truth?

While prevention and control are possible, behavioural change and access to safe healthcare remain challenges. The methods to achieve these things are known. They are participatory, localised and community-based in nature and deeply rooted in trust between those who know (experts), those in charge (authorities) and those affected (communities). It has been consistently observed, particularly during the Ebola outbreaks, that denial, stigma, rumours and misinformation accelerate the spread of viral infection – born out of misguided hopes and explicit fears. Acknowledging and addressing them directly through community engagement is thekey to limiting transmission and mitigating the impacts on the economy and society beyond the illness itself. In Afghanistan, we worked specifically to engage religious and community leaders to promote empathy and community solidarity and address stigma alongside our public health counterparts’ efforts to improve the uptake of testing, treatment and self-quarantine. In the absence of a vaccine, we have this most powerful tool – engagement – to combat COVID-19.

 

VIRUSES ARE SOCIAL in nature, and other outbreaks have taught us that they start and end in communities. Even with a vaccine, or treatment, it’s only when communities act collectively, and with resolve, that they can completely overcome and eliminate a virus. Throughout this pandemic, I have recalled – over and again – this vivid instruction from the lead epidemiologist in Liberia during the Ebola outbreak in 2014–15: ‘You do not isolate people. You isolate the virus.’ How? You test and trace, contain and treat the clinically ill, quarantine and observe their contacts safely, while never leaving them alone with their fear or grief, the swirls of misinformation. You ensure authorities and experts communicate continuously with the public about what to do. And even as conditions change, you give advice on preventative measures through trusted peers, members of the community themselves. Melbourne eventually got there. And before that, Liberia, Sierra Leone and the Democratic Republic of Congo succeeded in eliminating the Ebola virus.

But even better than containment is prevention. It’s unheroic yet effective in protecting societies and economies, and it’s perhaps the real goal for the ongoing handling of this pandemic and the many crises it manifests. Before Melbourne’s success story, Australia’s Indigenous health leadership at the National Aboriginal Community Controlled Health Organisation (NACCHO) and its state counterparts had provided the playbook for how rapid action can prevent an outbreak of COVID-19. Theirs is a context where communities are engaged; people are known and supported. Trusted channels of communication are already established; information is available in the right language and in ways that make sense to people and empower them to control and prevent the spread of the virus and mitigate its dreadful impacts. The community-controlled health methodology worked to keep infection rates low in Australian Indigenous communities, with zero deaths, despite high vulnerability and comorbidity. This is a rare success story globally, although it remains uncelebrated nationally.

Those of us who have worked in crisis settings know well that communities will benefit in the longer term – and in the face of other crises that will come – by bridging the gulf between those in charge, the experts and decision-makers, and those affected, including the most marginalised and vulnerable. Lengthy debates among progressives in Western democracies – who advocate for seizing the pandemic’s lessons as a reset towards community-led solutions – resonate for those of us who have advocated for this approach in emergency response and humanitarian action. Ebola gave us the evidence we needed: elimination is possible when communities lead prevention and recovery efforts. This pandemic has elicited a resounding endorsement of collective, accountable, participatory approaches to crisis: the credibility of community engagement in disasters and emergencies made a leap this year and these methods are now more likely to be perceived as critical, rather than peripheral or epiphytically attached to core operational programs. In galvanising the methods for halting transmission, we can build resilience and opportunities to shift the power to where it belongs: at the heart of communities.

 

15 November 2020


 

 

This article is supported by the Judith Neilson Institute for Journalism and Ideas.

It's the final instalment in an occasional COVID-19 chronicle series published as part of Griffith Review's Friday Great Reads.

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