The Foreign Service Journal - January/February 2018

THE FOREIGN SERVICE JOURNAL | JANUARY-FEBRUARY 2018 33 daily operational command and control in case of an out- break, and it was unknown whether health workers would stay on the job to battle the disease. We and our fellow assistance donors, along with international security and health experts, judged that, so far, the preparedness actions Ghana had taken were necessary but not yet sufficient for its own protection. Embassy Strategy to Assist Ghana FSOs at USAID teamed up with experienced professionals from the Centers for Disease Control and Prevention (CDC), one of whom was on detail to USAID for malaria work and one of whom was on the country team for HIV/AIDS work. We were joined by a small specialized team from CDC, its International Task Force for Unaffected and Less-Affected Countries. With the political leadership of our ambassador, we came up with a strategy for helping Ghana move to a higher and more reassur- ing level of preparedness. Our strategy was based on what we had learned so far from the three most affected countries—and especially from Nigeria’s success at containing its own outbreak. We knew that having a robust health sector capability would not, by itself, be enough. Ghanaian citizens had to understand what would happen in case of a disease outbreak: there would be quarantines. Security services and police would have to assertively investigate and detain people for health observation, and treatment if infected—using force, if needed, while respect- ing citizens’ rights. Normal sick patient visitation and long- standing cultural and religious burial practices by relatives and religious authorities would have to be dramatically altered, if not curtailed altogether, because any contact with the corpse of an infected person would further spread the disease. Normal transit of people and goods might be stopped; shortages and hoarding were likely. Accurate public information would be at a premium, both to inform and to reassure the people. In collaboration with the visiting CDC team and with the help of USAID/Nigeria, we decided to try to find a way to expose the very top of the Ghanaian government to Nigeria’s experience We were concerned that two or three levels down, the government of Ghana did not seem to share our sense of urgency.