Pandemics are scary. There’s fear of getting sick, but there’s also uncertainty and lots of unanswered questions: Who do we turn to for care? When will there be a treatment? How long will it take for things to return to normal? And where do we go from here?

A once-in-a-lifetime crisis, the COVID-19 pandemic threatens to upend the work of global health organizations and years of collective progress on many fronts.

But what tests our work, and the humans behind it, can often make it stronger. This was the case for MiracleFeet’s young program in Liberia during the 2014-15 Ebola crisis. As the outbreak swept through West Africa, all odds seemed against the team—but instead of failing, their work flourished. That year they hit 92% of their treatment targets, and today they are reaching the majority of children born with clubfoot every year.

We look to their courageous, strategic, and compassionate approaches working on the front lines of Ebola, and their innovation and resilience in the face of uncertainty and disaster, for answers and a hopeful path forward in navigating today’s challenge with our partners worldwide.

Creative Lessons for Weathering COVID-19

Support your partners’ immediate needs.

Call it task-shifting or survival-mode, it’s okay to shift resources and focus towards a prevailing threat.

By 2014, MiracleFeet and the Liberia team built a national network and system for addressing a condition once completely neglected in the country. It was going well. Then almost overnight priorities changed and extinguishing one of the deadliest viruses on earth took precedence over immediately providing clubfoot treatment. As obvious as it sounds, deciding how to direct time and funds during an emergency of any nature—an outbreak, natural disaster, political or social conflict—is complex.

Changing operational focus can make any mission- and target-driven NGO, and their donors, squeamish. During the Ebola outbreak many chose to halt all operations until their core work could reliably resume. But for organizations like MiracleFeet, that exclusively work with local partner teams, there is more at stake.

Executive Director Chesca Colloredo-Mansfeld put it this way: “Scaling back our support to partners would hurt everyone involved in MiracleFeet’s programs, and we are fortunate to be a nimble organization, with donors who support our long-term strategic growth.”

MiracleFeet’s Liberia team and partners anticipated the devastation the outbreak could have on all aspects of the health system, clubfoot treatment included, and coalesced around a plan to ensure the safety of children in treatment, plus helped in other critical ways. This gave the team a purpose and kept their mutual work intact, while refocusing served their communities in more immediately relevant ways.

“These are our partners,” continues Chesca, “people who work under extraordinary challenges every day, and we must support them. In many countries, like Liberia, if our program were to dissolve because we failed to assist during a crisis, there would be no one else there addressing clubfoot treatment at scale. There is no fallback for children who will need this care for years to come. Preserving and supporting these invaluable networks we have created with partners to solve this problem long-term is paramount.”

The Liberia team included a powerful outreach group of community volunteers called Foot Soldiers organized by dedicated physician’s assistant Augustine Chiewolo. The Foot Soldiers’ original focus was to advocate for clubfoot awareness and treatment services; during the outbreak, they expanded their focus to educate communities about Ebola transmission and prevention. They also provided supplies to health facilities and support to families affected by the ensuing tragedy.

“These are our partners, people who work under extraordinary challenges every day, and we must support them.

Chesca Colloredo-Mansfeld

Instead of buying plaster, with MiracleFeet’s support, the Foot Soldiers secured and delivered personal protective devices, chlorine tablets, and other life-saving supplies to affected populations in towns, villages, and homes. The delivery piece was critical: many organizations had supplies but nobody to deliver them on the ground. Foot Soldiers became a trusted network for delivering essential material aide, like food and sanitizing equipment.

They also took the lead in Ebola information dissemination, creating a media campaign with clear messaging that promoted best practices and combated dangerous and rampant misinformation.

Amid their outreach, the program continued to train volunteers in identifying clubfoot patients in the community—and this network proved vital for triaging and referring new cases to treatment, both during and after the outbreak, when fewer mothers delivered at health facilities. Without the efforts of these trusted volunteers many cases would have slipped through the cracks.

The Liberia program’s success was due almost entirely to the personal relationships the Foot Soldiers fostered through Augustine’s leadership, the trust and networks they built, and the community they created among parents and health workers during one of the country’s darkest hours.

And so, we adapt.

Times like these underscore the need for flexibility and adaptability. Prepared or not, ready or not, organizations everywhere are having to modify how they do business.

During Ebola our Liberia program adapted quickly, mobilizing teams and campaigns. Now we must again quickly adjust to protect patients, staff, and providers as the world is faced with a very different but equally frightening health crisis: COVID-19’s rapid global spread.

“Just as it was during Ebola, our first concerns are equally the safety and well-being of patients and families currently in treatment—and the health and livelihoods of partner staff, health workers, and volunteers” explains MiracleFeet’s Director of Programs, Jen Everhart.

Following recent guidance from the World Health Organization (WHO) and the Center for Disease Control (CDC), MiracleFeet strongly recommended that all partners in the 27 countries where we work suspend clinic operations and focus on triaging patients for treatment once clinic operations can safely resume. Many of our partners’ staff will shift to tracking new cases and connecting those parents to clubfoot clinics once they reopen.

Our clinic coordinators are shifting from hands-on in-person work, to parent outreach and communication and our Program Operations team is using data and modeling to develop a plan for when we can safely reengage. The moment we can re-start treatment, MiracleFeet will be ready with improved resources and processes in place.

“Being highly adaptable, ready to change plans, and deal with ambiguity are all critical public health skills in any circumstances. What we learned from working with the Liberia team through their outbreak is that sometimes ‘hitting pause’ on one approach leads to new and more effective ways of working. We learned a lot from community outreach that has served other programs since,” continues Everhart.

Never underestimate the human element of care.

The thing that all health interventions have in common is human contact. It’s inevitable, unavoidable, and those providers are at the heart of success. We put extraordinary faith in people, often working under incredible stress, to make health care work, from treating little feet to dealing with global pandemics.

People with compassion, resilience, and dedication are what allowed MiracleFeet’s Liberia program to be successful despite Ebola, and it’s these same health workers who will prevail and whose safety we must prioritize to navigate the COVID-19 outbreak.

The question isn’t what makes health systems work, it’s who.

“MiracleFeet’s mission evokes deep passion and commitment from a network of over 600 health workers and partner NGO staff working to deliver a very specific treatment to children who need it. We are humbled by their work now more than ever. And we are optimists. Working together, our partnerships can grow stronger, more agile, and responsive through this unprecedented challenge.”