Amos Gborie

Amos F. Gborie

Q: This is Sam Robson with the CDC [United States Centers for Disease Control and Prevention] Museum here in Monrovia, Liberia, at the EOC [emergency operations center]. It is March 13th, 2017, and I am here with Mr. Amos Gborie. Did I pronounce that anywhere close to correct?

GBORIE: Correct. You are the first American that pronounced my name correctly.

Q: Yay. [laughter] I will take that as a victory. We're here talking as part of our CDC Ebola Response Oral History Project. These are interviews in Liberia and Sierra Leone with people who worked alongside CDC to halt the Ebola epidemic of 2013 to 2016. Mr. Gborie, I very much appreciate you taking the time for me. I guess the first thing I could ask, would you mind saying, "my name is," and then pronouncing your full name?

GBORIE: My name is Amos F. Gborie. The F stands for Fallah. It's a traditional name. That tells you that I hail from Lofa County, in another part of Liberia. 00:01:00I'm a Kissi by tribe, and I have been working for the Ministry of Health [and Social Welfare] for a little over thirteen years. I have a background in environmental health, but I'm also a public health specialist. I got my training, my environmental health training, at a local institution called the Tubman National Institute of Medical Arts. Then I matriculated at the University of Liberia, where I got my bachelor's degree. Then I got a scholarship from the United States government where I studied my public health degree in the Netherlands. Basically, this is my background in terms of who I am, my origin, but also my education.

Q: Do you mind, I'm going to check your--

[interruption]

Q: So you were describing your journey. You've been working with the Ministry of Health for the last thirteen years, is that right?

GBORIE: Correct.

Q: What is your current position?

GBORIE: Currently, I am managing the emergency operations center, which was established during the Ebola response. I will speak later on, on how the EOC supported the Ebola response. The incident management system operated within the EOC. CDC folks were highly instrumental in making sure that we have an EOC that mirrors the EOC in Atlanta. But my background also as an environmental health professional made me support the burial team, which was one critical component of the Ebola response. I can speak later on, on that, how the safe disposal, safe management of infectious bodies helped to stop a disease like Ebola.

Q: That would be great. I would love to hear about it. Did you actually grow up in Lofa?

GBORIE: I grew up in Monrovia, but I had some little movement around as a child. I once went to school in Lofa, and then in Monrovia. When the war broke out, I had to flee to Sierra Leone, and I fled to Guinea, and then I came back to Liberia, [laughs] and then I went to the Netherlands.

Q: What interested you especially about environmental health?

GBORIE: I grew up in Liberia. The most part of my life is in Liberia, and I've always had a dream of being in the health field. In Liberia, we have interests in terms of clinical medicine, but I realized that as I grew, I became more interested in public health. During my days in Liberia, when we were studying 00:04:00public health, there was no university that could teach public health as public health. We only had one institution, which is the Tubman National Institute of Medical Arts. It's a mid-level health workers training institution. TNIMA, for short, trains nurses, physician assistants, environmental health technicians, and a few other cadres like laboratory technicians. Since my interest was in public health, environmental health is that component of public health that I thought that I could engage myself in.

Q: What were you doing immediately before the Ebola epidemic started in Liberia?

GBORIE: I served as the deputy director for the environmental health program. While I worked with the environmental health program, when I graduated from 00:05:00TNIMA, I went to the University of Liberia. Then I joined the Ministry of Health as the coordinator for the occupational health program, and then later on became the deputy director for the environmental health program. When Ebola broke out, the current incident manager, who was then the Preventive Services Bureau assistant minister, but now the [National Public Health Institute of Liberia] Director-General, Honorable Tolbert [G.] Nyenswah, then asked me to manage the EOC, which was newly formed with CDC's support.

Q: Can you tell me what happened then?

GBORIE: In retrospect, it was tough because I remember before the EOC was set up, the incident management system was established with CDC support, but in 00:06:00terms of operations, you could see that the various thematic groups were meeting in several places. For example, one team that I really worked with was the Dead Body Management Team, and the DBMT was holding meetings on 9th Street. You have the Epi [Epidemiology] Surveillance Team having meetings in the Ministry of Health in one other room. It was chaotic. But when the EOC was set up, we then brought all of these teams at a central location on 18th Street. The government decided to use the LIBTELCO Building to house the EOC, and that was where the EOC was established. From then, we started to see the response better coordinated.

Q: What were some of your early challenges?

GBORIE: First and foremost, the location. Once we had the location, the next 00:07:00challenge became clear to us that hey, we needed some technical assistance. CDC is good at emergency operations. I was the first EOC manager for the Republic of Liberia. One of my greatest challenges was, how do I make functional the EOC? Mind you, I have a public health background, but emergency management in terms of managing the EOC is something else that is--I don't want to say unique to CDC, but CDC has a lot of expertise in that. Working with the CDC folks initially was my greatest challenge. How do I work with a team that is well knowledgeable about how the EOC operates, and how do I leverage that support to also help my country? But also challenging was the number of responders that we 00:08:00have to coordinate, the number of meetings that we have to manage. The staff really was enormous. In a day, we would have more than thirty meetings in the EOC. How do you manage that process? You have responders that are getting into the EOC, over two hundred, working twenty-four hours, around the clock. That was really challenging.

Q: Can you tell me about some of the people from CDC you worked with most closely?

GBORIE: Yes, I remember some great guys: Harvey, Luis, a good number of them, Dr. Kevin [M.] De Cock who worked with--I mean, those days when the response was really bad. But on the other side of it, we worked with--currently we have Dr. Desmond [E.] Williams, we have his deputy [E.] Kainne [Dokubo], we have Dr. 00:09:00Denise Allen. As a matter of fact, Denise and I worked on the piece which was looking at the problem of why people were dying at home. There was a study or an assessment that was done to inform the incident management system that hey, the reason why people are getting infected or the infection is spreading could be linked to certain practices or certain misconceptions or preferences people have. That study looked at why were people not seeking treatment in ETUs. Our findings are being published. But that really helped the incident management system to say hey, we need to put a stop to a practice which was encouraged during the Ebola outbreak, and that is the issue of cremation. Mind you, we are 00:10:00from a culture where cremation is not allowed. Religiously, we are majority Christian, a few Muslim, but traditionally in Liberia, we do ground burial. We don't cremate. During the Ebola outbreak, we saw ourselves constrained to introduce that policy, which then made it difficult for our citizens to seek healthcare in ETUs.

Q: I'm wondering if just starting from the beginning of the response, we can review some of your most vivid memories of specific instances that strike you.

GBORIE: Well, I have a number of memories, and even as we are discussing, I'm thinking. One key memory which I always recount is the fact that we had this 00:11:00problem of stopping cremation. There were people who thought it was impossible. I would like to mention one great partner who was very instrumental in making sure that we have a safe burial site with the support of the Liberian government, and that is Global Communities. I worked with great colleagues from Global Communities, the likes of Piet deVries, Josh Borser, and several staff--Liberian staff--my colleagues, Dehwehn Yebah, George Woryonwon. We worked as a team to make sure that we have a site, because initially, safe burial was practiced but the citizens were against it because of the perception that once an Ebola victim is buried within their neighborhood, every one of their neighbors would get infected. To have a new site that will now accept hundreds of corpses was challenging. But when we got on the site--I mean, along the 00:12:00highway, there's Disco Hill, we call it Disco Hill, which is a safe burial site. I remember when we got there one day to see the new site, we didn't believe that it was going to be possible. But before we got the Disco Hill site, we had gone to Careysburg to identify the site where the cemetery could be for safe burial practices. We did not succeed because there was some community resistance in all of them. Finally, when we got to Disco Hill, there was community acceptance because an element that was crucial in the Ebola response, which is community engagement, was used. When we started using community engagement, to engage locals within the vicinity of Disco Hill, we saw that locals were also interested in making sure that Ebola was eradicated. Once we had Disco Hill, we started safe burial. We then started to see that the trend was going down. The 00:13:00number of new cases was reducing because we now had somewhere to take the deceased, safely manage them. But the news also went to the public that hey, cremation is no longer encouraged, the government has abolished cremation, so if you are sick, go for treatment. If someone dies at the ETU, they are not going to be cremated, they will be safely buried. We opened the cemetery up for people to witness the practice because there were a lot of rumors about how people were buried. Once we made it transparent, people then started to bring in the sick, but also to encourage safe burial.

Q: Do you remember any conversations in particular with leaders around Disco Hill, about accepting bodies being placed right near their community?

GBORIE: Well, some of the comments they had was, how could they be involved? 00:14:00Like I said, once they were engaged, we didn't have resistance. However, people were clear that Disco Hill was for burial. They do not want any act of cremation. One sticky issue was, how do we move the remains of those who were cremated to Disco Hill? That day I remember vividly, there was almost serious tension, but because we engaged the traditional leaders, likewise the religious leaders, we found out that the process was smooth. Then we moved the cremated remains to Disco Hill.

Q: What did the tension look like? What form did it take?

GBORIE: It was in terms of the traditional people were interested in having only 00:15:00burial at Disco Hill. They didn't want to see cremated remains moved there. They thought that was an act that the government--we were not sticking to the rules that they had laid. Hey, Disco Hill is for burial only but not for cremation. But once we explained the process, that this is just going to be to make sure that those who lost their lives and who were cremated are also respectfully kept at Disco Hill, then the tension was gone.

Q: And these are things that you're hearing in conversation with them?

GBORIE: Yeah. During the process, as we were going through the removal process of the ash remains, yeah, those were conversations that I particularly eavesdropped.

Q: Thank you. Can you tell me about some other inflection points that stand with 00:16:00you about the Ebola response, the challenges that you had, or moments of relief?

GBORIE: Yes. Those of us who are football fans, we know ninety minutes is the number of minutes that are allocated for the game to be over. The declaration from WHO became that ninety minutes for all of us that were in the response. We never thought we would have reached a declaration, period, in the response in 2014. But when it became clear that all of these different response areas were now taking shape--for example, we had the cemetery now that could hold Ebola victims in terms of their corpses, but also we had ETUs that were coming online 00:17:00all over the country. We had responders that were now committed to working. We had the EOC that was coordinating the response. We didn't realize that the ninety minutes, which is the WHO declaration, was possible. When we first started to count after almost a year responding--when Liberia started to count the first twenty-one days and we passed the twenty-one days, then we started to become--I mean, the excitement grew. When we got the first declaration, we got a sigh of relief. However, the nature of the disease was one that we as scientists--public health practitioners, we knew that there would be pockets of cases that would reemerge. We were clear that there would be flare-ups, but we asked ourselves, are we prepared to contain any flare-ups? The answers were not 00:18:00clear. Unless we have the first flare-up and we contain that, the second flare-up, then we knew that we have the capacity, we have the logistics, we have the expertise to contain EVD [Ebola virus disease].

Q: Mr. Gborie, is there anything else that you'd like to say for the record about your experiences with the Ebola response or what has happened since?

GBORIE: Well, I think I've said a lot. But now, what I would like to stress is, how do we sustain these capacities we have? Also, how can we be sure that if an incident of a different type is to occur in Liberia, do we have the capacity? For example, I ask colleagues, if we were to have a chemical release of an 00:19:00unknown agent, do we have the skills to contain the situation? My answer to that is no. For example, we are just looking at PPEs [personal protective equipment] in-country. Currently, the PPEs we have are skewed towards infectious diseases. But is it infectious diseases of all types? I'm not sure if we have an infectious disease of, let's say, the airborne type, influenza, [virus outbreak] influenza, the nose masks we have in-country may not be adequate. The clinician's orientation around treatment--but that's just--what if we have a chemical release? The PPEs that are in country cannot be applied to that. If there is any radiation emergency, those PPEs cannot be applied to that. I'm still worried, and this also has bearing to the responders. For example, the 00:20:00teams that we manage, both the sick and the dead, could be exposed to the hazard that may occur if it is a chemical incident or if it's a radiation incident. They could be exposed, and we could go back to a day like the Ebola crisis, and then we struggle, then we pick up. Going forward, we are looking at developing instruments like the all-hazard plan that would help us to--within the EOC, using it to take charge of encouraging exercises and drills of not only infectious disease, but all hazards, multi-hazard exercises. That way we can all sit back and say, I think Liberia is ready for major events.

Q: Thank you. I suppose one last question also I have--CDC, like so many other organizations, has gone through this process of internal review and trying to assess how it did on the Ebola response. From your own experiences of 00:21:00interacting with CDC, is there any area to which you'd point and say, this could use some work if another response was to happen like this again?

GBORIE: I think we work a lot with the CDC folks, and CDC has a great--I mean, we look at the resource base of CDC in terms of human resources. They are great. But working with Denise as an anthropologist--in Liberia, most of the problems we have are cultural. If CDC is to continue to strengthen the relationship with the Ministry of Health support, it is good to look at other technical areas or skills that may not seem obvious but are highly important in terms of working with countries like Liberia, where we have a lot of cultural issues. Understanding those cultural drivers would really help. For example, why is it 00:22:00that when someone dies, people want to wash the body? There are reasons, but understanding those reasons and linking them with, how can we devise better strategies in terms of mitigating those negative cultural practices, but not also doing away or discouraging those cultural practices. Because if you were to do away with the cultural practices, if that's your target, I can tell you for sure you may not achieve it. [laughs] Because these are the cultural practices that people have lived with for many years. They may not [want to abandon them], but can you help them improve on some of them? Sure. So these are areas that I think CDC may pay attention to and then also research. Research is not only Western science. I am a fan of empirical science, especially Western, but I also 00:23:00think that sometimes there is a Western bias in the way we look at things. We have to look at things in context that we work in. Contextualizing most of our interventions would be something to look at.

Q: Could you give an example of that point when it came to Ebola?

GBORIE: Yeah. For example, Ebola, some of the folks that came to support us were clear that hey, we must stop people from washing dead bodies, and we could not understand the reasons why people would not want to stop washing the dead bodies. But I am from Lofa, and I grew up in Lofa, and I know that one of the reasons why people wash the dead is for the last respect. The last respect--there is nothing that is more important to a father or an imam than 00:24:00giving the last respect. As we identified that as being more important, then we pressurized CDC to help us develop tools that would rule out Ebola. Tools were then developed--for example, the swab, the oral swab was developed quickly. Once we developed the oral swab, we then changed our policy to make sure that all dead bodies were swabbed. The negative bodies, those that were non-reactive, for example, with the RDT [rapid diagnostic test]--once we realized that this body is of lower risk in terms of Ebola exposure, we will give the body back to the traditional people who would normally handle the body in a safe manner. We also encouraged them to wear gloves. We started to train them, gave them some PPE, chlorine--instead of using ordinary water, we used chlorine to wash those 00:25:00negative bodies. Is it enough? No. But this is something that we could invest in, in terms of research that would help us to have the culture, but also the science work hand-in-hand or hand-in-glove.

Q: Thank you very much for your time. I very much appreciate it Mr. Gborie. Thank you.

GBORIE: Thank you, and it was a pleasure talking to you, as well.

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