Book Review:  Getting to Zero – A Doctor and a Diplomat on the Ebola Frontline

March 12, 2019

     By Duncan Green     

Guest post by Melissa Parker and Johanna Hanefeld 

This excellent book provides a fascinating account of the 2014-2016 Ebola outbreak in Sierra Leone. It is co-authored by Sinead Walsh, who was Irish Ambassador to Sierra Leone at the time of the outbreak and, Oliver Johnson, a medical doctor, who was based at Connaught Hospital in the capital city, Freetown, and head of the King’s Sierra Leone Partnership.

Written in the style of personal memoirs, Walsh and Johnsons’ distinct perspectives are clearly stated in every chapter. Together, they capture the uncertainty and horror of a viral haemorrhagic fever spiralling out of control. As Ebola spread from Eastern parts of the country to Freetown, they detail the woeful lack of resources enabling the health system to respond effectively.

It is shocking to learn, for example, that several months after the first case was diagnosed, senior staff in the Ministry of Health were struggling to find an accurate list of the country’s hospitals, health centres and units; district health personnel were not systematically connected to e-mail; and colleagues in Freetown were emailing documents to friends and colleagues working for INGOs, asking them to circulate printed copies of infection, protection and control measures to district hospital staff struggling to respond.

The District Medical Officer in Kenema had so little faith in the health system that he resorted to texting the Minister of Health in the early hours of the morning: there was, he explained, no other way to reliably place an order of gloves for his staff.

Complex political dynamics compounded the problem. We are told, for example, that the WHO was reluctant to declare a Public Health Emergency of International Concern because they did not wish to alienate the governments of Sierra Leone, Guinea and Liberia, and they were worried that it would be interpreted as a hostile act.

When the UN declared Ebola a threat to international peace and security, resources began to flow and large numbers of humanitarian agencies worked alongside Sierra Leonean staff on the frontline. With remarkable detail, Walsh and Johnson map out the global, national and sub-national connections, and disconnections. In so doing, they show how actors did, and did not, coordinate as the outbreak unfolded. It becomes clear that while humanitarian agencies knew from the outset that it was important to coordinate their activities, and to take account of domestic politics, the reality was that none of this worked, or worked too late and in isolated pockets. When it did work, this was down to the work of dedicated individuals, rather than the effectiveness of the international system.

Getting to Zero is a compelling read. It provides new and unique perspectives of the multiple challenges facing humanitarian agencies and the Sierra Leonean government in Freetown, while simultaneously highlighting the bravery, humanity and commitment of the many responders we meet in the book. In some respects, their work complements anthropological research, which has suggested that local initiatives and local learning were influential in containing the outbreak (see Paul Richard’s book, or Melissa’s blogpost with Tim Allen). Above all, Walsh and Johnson demonstrate, in awful and terrifying circumstances, the ability of individuals to make a difference.

March 12, 2019
Duncan Green