Mohamed Koker, an emergency doctor in London, was born in Sierra Leone and went back to the country to help fight Ebola Mohamed Koker, an emergency doctor in London, was born in Sierra Leone and went back to the country to help fight Ebola Photo credit: Simon Davis/DFID
The Ebola crisis and the Sierra Leone diaspora
by Chukwu-Emeka Chikezie June 2015

The Ebola epidemic in West Africa exacted an especially heavy toll on Guinea, Liberia and Sierra Leone. According to the World Health Organisation (WHO), the death toll across these three countries had exceeded 10,000 by early March 2015, a year and three months after the first index case in December 2013. There is near-consensus that individual governments and the international community were slow to realise the significance of the outbreak and mobilise a response; indeed, Médecins Sans Frontières (MSF) was criticised in April 2014 for crying wolf when it warned about the seriousness of the looming crisis. Much has been said about all these failings, and hopefully lessons can be learned.

One aspect of the crisis that perhaps deserves more serious attention is the role that diasporas from the affected countries played in the response. Over the last 20 years or so awareness of how diasporas involve themselves in the development of their countries and regions of origin has grown. Today, such involvement in development or humanitarianism is taken for granted. The Ebola crisis is no exception. Focusing on Sierra Leone, this article examines the roles diasporas have played in the crisis, to what end, and whether they have been able to maximise the impact of their efforts.

What do we mean by African diasporas?

African diasporas are a diverse group. Typically, they are people who can trace their ties back to some country or part of Africa either in the recent historical memory of their own family (because they or their parents or grandparents were born there), or further back in their ancestry. What distinguishes a particular location’s diaspora is a shared sense of connection to and identification with that place of origin (which might be a region, a country or the whole African continent) and often, though not necessarily, a desire to see that place develop. We use the term diasporas in the plural to emphasise the diversity of people who identify themselves as, say, part of the Sierra Leonean diaspora. ‘The diaspora’ sometimes connotes a degree of homogeneity that is more imagined than real.

How diasporas engage

We can think of diasporas as deploying a range of resources in the service of development or humanitarian relief. One resource is financial capital, often in the form of remittances, but also in investment capital or even the capital that diasporas spend to purchase goods and services from their countries of origin. Intellectual capital includes the brainpower that diasporas are able to deploy, leveraging their skills and know-how for development. While we used to hear a great deal about brain drain, these days we are just as likely to hear about brain gain or brain circulation as diaspora brains return temporarily, permanently or virtually (for instance through electronic networks) to strengthen knowledge production in their countries of origin.

Diasporas can also deploy political capital in the form of advocacy for or against their countries of origin, for instance by lobbying their host country or tackling policymakers in their countries of origin. Cultural capital also comes into play: through the mix of home and host country experiences, diasporas often bridge two or more cultures, and may thus be able to help countries of origin engage meaningfully with the rest of the world, or assist host country nationals to navigate their way in the origin country environment. Finally, we might also think of diasporas as deploying social capital through trust networks, relationships and kinship links. Typically, these resources operate in composite form, with two or more combining to give meaning to diasporas’ intentions.

Diasporas organise themselves along a variety of lines. Hometown associations are an important feat-ure of diaspora life. For instance, during the early days of the Ebola crisis in Sierra Leone, diaspora descendants from Kailahun, a district in the east of country that shares a border with both Guinea and Liberia, were among the first not only to raise concerns but also to send material support back home. Diasporas also organise along professional lines. One example of this is Sierra Leone Action (SLA), formed by Sierra Leonean physicians and other professionals living mostly in North America. In some cases, long-established diaspora organisations find renewed vigour as a result of a crisis such as Ebola. The National Organization of Sierra Leoneans in North America (NOSLINA), formed in May 1998, was re-energised by the Ebola crisis. In London, the Sierra Leone UK Diaspora Ebola Taskforce (SLUKDERT) was formed in September 2014 after two ‘town hall’ meetings for Sierra Leoneans called by the High Commissioner to the UK. Diasporas also operate through almost invisible informal networks and as individuals. Indeed, when it comes to diaspora effort, informal networks and individuals may do the bulk of the heavy lifting despite the attention that formally constituted and more visible groups garner.

Diaspora innovation

SLA was formed in August 2014 with a vision to tackle Sierra Leone’s Ebola epidemic through the introduction of convalescent serum therapy (CST).+CST involves the transfusion of plasma from Ebola survivors to help current patients increase antibodies that can boost immune systems to fight the infection. Although used during the first Ebola outbreak in 1976 and subsequently, including in the latest one, its efficacy is as yet unproven, though many of the US medical professionals infected by Ebola received CST treatment, and all were cured. The organisation secured the necessary approvals for CST use in Sierra Leone, and the US company Fresenius Kabi donated nine Fenwal Autopheresis-C instruments (these devices extract Ebola survivors’ plasma and return other blood components to the donor, so donors are not left as denuded of nutrients as with methods that do not return other blood components).+SLA initially used advocacy to argue for use of CST in battling the epidemic, and a blog article and petition called on the US Food and Drug Administration to expedite trials into drugs and vaccines. SLA secured other essential equipment from other donors. On the ground in Sierra Leone, through partners, SLA identified and pre-screened Ebola survivors willing to donate plasma for CST. The organisation also raised funds to pay for training, additional equipment and clearing fees to get goods through customs in Sierra Leone.

On paper this looked like an innovative, ground-breaking project with significant prospects. The nine machines are in Freetown, the capital, and the regulatory approvals have been granted. Yet the machines remain unused, no donor plasma has been extracted and no Ebola patient has benefited from CST. Why? It seems clear that SLA was able to mobilise significant intellectual capital, drawing as it did on a membership with notable medical expertise. SLA was also able to mobilise some of the financial capital needed to see the project through, and there is every reason to believe it could have secured more. To the extent that it was able to persuade Fresenius Kabi to donate nine machines suggests that its members had built up significant social capital in their host locations.

The supply side, then, looked reasonably strong. But what about the demand side? It is no secret that Sierra Leone’s Ministry of Health and Sanitation was operating on the Ebola frontline and its officials were busy, even overwhelmed, and may have lacked the space to engage constructively with SLA around this innovative project. Although SLA worked with partners and representatives on the ground, it did not have the substantive operational presence that would have enabled it to get its views across during meetings in Freetown. More importantly, it lacked the social and political capital to effect change and push its proposals through. A deeper presence on the ground would have enabled SLA to understand the local context and the underlying factors, including perverse incentives and self-interest, driving decision-making.

The environment for diaspora initiatives like SLA’s is anything but enabling. The government of Sierra Leone established an Office for Diaspora Affairs (ODA) inside the Presidency in 2007 to facilitate diaspora engagement in the country’s development. Sadly, the ODA seems to be moribund, or certainly ineffective. Sierra Leone lacks a diaspora policy, though the Ministry of Political and Public Affairs has declared its intention to develop one. If implemented well (it would almost certainly entail an overhaul of the ODA), such a policy could make the difference.

With the epidemic on the wane, though stubbornly still present in Sierra Leone (and Guinea), the moment for CST to have a major impact on this particular outbreak may have passed. However, the wider significance of the SLA initiative should not be lost. First, a positive spill-over from CST would have been to help Sierra Leone strengthen its overall blood transfusion system, which offers wide medical and public health benefits. This was one of the reasons why the World Health Organisation (WHO) supported CST. But beyond Ebola and CST, SLA represents an important resource for Sierra Leone as the country sets about rebuilding its battered healthcare system, robbed by the disease of some of its most experienced medical professionals. While CST may have been SLA’s first offering, there is much more that this group, and others like it, could offer the country. If no crisis should go to waste, then Ebola should be an opportunity to reengage Sierra Leone’s diasporas in strengthening the healthcare system.

Conclusion

When it comes to helping countries ravaged by the world’s worst-ever Ebola epidemic get to zero cases and resuscitate their battered healthcare systems, economies and societies, their diasporas represent a vital resource. There is work to do on the supply and demand sides and the enabling environment. Diasporas, countries of origin, host countries (particularly where these are developed countries) and the broader international system all have their work cut out.

While slow to realise the significance of the Ebola epidemic, the international community did eventually mobilise a significant effort in Guinea, Liberia and Sierra Leone. Yet a surprising omission in the strategies that international organisations and supporting countries have deployed is a proactive approach to helping affected countries tap their diasporas, even though in each case diasporas have agitated to do as much as they could. Certainly, diasporas have found ways to work with various elements of the international community and make their own contributions to the Ebola fight. But there has been no comprehensive approach by any of the major actors to think through creatively how they might mobilise diaspora resources as an integral approach to their intervention strategies. Perhaps this is because large-scale humanitarian efforts generally tend to stifle or snuff out local initiative and capacity, especially in the early parts of interventions when there is a heavy international presence, often accompanied by distrust of local institutions (the limitations of which may have been part of the systemic failures that led to the crisis or its spread). It may also just be that the international system isn’t yet set up to seriously consider the potential contribution diasporas can make to humanitarian efforts and development.

As Ebola-ravaged countries turn their attention to early recovery and development, now is the time for diasporas, origin and host countries and international actors to revisit their strategies and find new ways of working.

Chukwu-Emeka Chikezie is the Director of Up!-Africa Ltd. He tweets as @cechikezie.

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