Getting to Zero: A Doctor and a Diplomat on the Ebola Frontline, Sinead Walsh and Oliver Johnson

Abstract

Reviewed by: Getting to Zero: A Doctor and a Diplomat on the Ebola Frontline by Sinead Walsh and Oliver Johnson Clement Masakure BOOK REVIEW of Walsh, Sinead, and Oliver Johnson. 2018. Getting to Zero: A Doctor and a Diplomat on the Ebola Frontline. London: Zed Press. 422 pp. On 25 May 2014, officials in Sierra Leone confirmed their first Ebola case, and from 2014 to 2016, hospital staff in various capacities, different nongovernmental organizations, and government agencies battled the ensuing epidemic. In total, 11,310 people died, and more than 10,000 survivors were severely affected by the disease. This was one of the worst outbreaks of Ebola in history. Sinead Walsh and Oliver Johnson, authors of the book Getting to Zero: A Doctor and a Diplomat on the Ebola Frontline, were at the heart of efforts to contain the outbreak, and they provide a fascinating account of the struggle against it. Getting to Zero is a story of how a diplomat, a medical doctor without much experience in tropical medicine, and indigenous hospital workers (including security guards) mobilized whatever resources were at their disposal to manage the outbreak, nursing the sick and the infirm. It is a narrative about humanitarian agencies in their local and international manifestations, just as it is a story that emphasizes the potential impact of diseases on national, regional, and international security and peace. When the first case of Ebola was confirmed, Sierra Leonean health infrastructure was not ready for what was to come. Indeed, a key issue that conditioned the response to the outbreak was the nature of the national public health infrastructure, which made it difficult for Johnson and his team to handle the initial outbreak effectively. Worse, the main hospital in Freetown was poorly resourced, and it experienced numerous problems with a demotivated staff. That Johnson and his team transformed the emergency unit into an isolation ward that became the center of Ebola management and containment, even though they had limited resources at their disposal, points to the dedication and sacrifices they made in providing care to patients. [End Page 147] The responses were conditioned by a complex set of issues, including relations between international organizations and the central government and international concerns that the outbreak might extend beyond West Africa. For political reasons, the Sierra Leone government responded slowly to the challenge, significantly delaying the containment of the outbreak. The authors highlight how international organizations failed to provide coordinated responses. Only after it became clear that the outbreak could become an international emergency, with massive implications for international security and peace, did more sustained and coordinated responses come from international organizations, such as the World Health Organization. In weaving this story, the authors rely not just on their direct experiences and on documents from organizations involved in the response to it, but use eighty-five interviews of survivors and local health workers. By including local voices within the narrative, they manage to bring to the fore the role of ordinary folk in managing the outbreak. Among the high-profile people they interviewed were the president of Sierra Leone and the secretary general of the United Nations. This methodology enabled the authors to make a nuanced examination of the outbreak and to offer important recommendations for health professionals, humanitarian workers, and institutions that might face such an emergency in the future. Indeed, significant lessons for managing future outbreaks can be drawn from this case. Most importantly, local communities played a key role in the response. As the authors argue, "Only the communities of Sierra Leone were ever going to be able to bring the Ebola epidemic under control" (340). There is no doubt that without the participation of local communities, efforts at containing the epidemic would have failed to meet their goals. In broad terms, the authors highlight the need, on the part of international workers and international organizations, to empathize with and respect the communities with which they work, if ever they need programs to succeed. Another lesson to be gained from the book revolves around leadership and coordination of responses to epidemics. For the authors, it was the nature of leadership—local, governmental, international—that "was central as to why...