eha Founders Podcast, Episode 06

Episode Title: West Africa Ebola Response
Release Date: December 13, 2022
Hosts: Evelyn Castle and Adam Thompson (E Health Africa founders)

Episode Overview

This episode features E Health Africa (EHA) co-founders Evelyn Castle and Adam Thompson reflecting candidly on their experience as early responders during the 2014–2016 Ebola outbreak in West Africa. They chronicle EHA’s rapid scale-up across Sierra Leone, Liberia, and Guinea, highlighting the operational chaos, personal challenges, impact on local health systems, interactions with global health agencies, and the evolution of emergency coordination models. Their discussion provides a rare inside account of both the technical and human dimensions underlying large-scale epidemic response.

Key Discussion Points & Insights

1. Getting the Call to Action

• Direct ask from CDC: The EHA team was recruited to expand their successful Nigerian Ebola response (including building Emergency Operations Centers—EOCs) into Sierra Leone, Liberia, and Guinea, partly at the request of then CDC director Tom Frieden ([01:35]).
• Initial confusion: The team accepted without a clear sense of scope, committing to assess needs and rapidly design response plans in-country ([02:55]).

2. First Impressions: Entering Sierra Leone

• Challenging journey: Adam recounts the surreal and difficult logistics reaching Freetown, including restricted flights, deserted hotels, and surreal boat rides ([03:48]–[05:24]).
  • “By the time I reached the other side...the sun was coming up. It was a long, long journey.” —Adam ([03:59])
• Atmosphere: Upon arrival, the atmosphere was tense, with expat evacuations leading to near-deserted aid environments. Early EHA hires like Olu had to “get a visa and get on a plane…as quickly as humanly possible.” ([02:08]–[05:24])

3. Rapid Response & Early Wins

• Building the EOCs: EHA quickly established Emergency Operations Centers, providing basic infrastructure, internet, and communication where none existed—especially in Sierra Leone ([06:51]–[07:46]).
• Critical logistics: EHA managed call centers (“117” in SL), organized cash and food delivery under lockdowns, and arranged transport of lab samples via motorcycles ([06:51], [14:51]).

4. Coordination Chaos: Navigating Agencies

• WHO resistance: Early friction with the World Health Organization (WHO), who resisted handing over coordination to EOCs, downplaying the crisis, while MSF sounded the alarm ([11:22]):
  • “WHO would be like, everything’s great, nothing to report…MSF would attend those meetings and just yell at everybody.” —Adam ([11:41])
• Military pragmatism: The British military in Sierra Leone proved notably receptive to structured, coordinated response, allowing EHA to implement models that dramatically improved turnaround times for Ebola case follow-ups ([10:29]–[10:58]).

5. Different Dynamics in Liberia & Sierra Leone

• Liberian approach: In Liberia, there were more actors, but also more competitive and fragmented coordination, with overlapping donor intentions (especially USAID vs. CDC funding) and early technical wins like the “Tag-and-Go” app for tracking patients ([13:28]–[14:28]).
  • “People just went to the counties with their grant money and did whatever the hell they wanted and kind of ignored the coordination mechanism.” —Adam ([25:53])
• Hiring: The Sierra Leone team was run by local women with prior experience, while the Liberia team was young expats, which influenced internal culture and relationship with host governments ([23:58]).

6. Money, Systems, and Scale

• Hiring and scale: At the height of the response, EHA had roughly 1,200 staff across the region, hired at simply unprecedented speed—with 30-minute interviews leading straight to job offers ([28:33]–[29:33]).
• Money management: Funding ballooned from ~$30M (Nigeria polio) to $65M/year. Both hosts admit their own systems, and those of global partners (“CDC Foundation finance systems”) were not ready for this scale ([29:56]–[32:42]).
  • “I remember sending a spreadsheet…It literally was like…‘we need $3M for the next month of expenses.’ And the line I got back was like, ‘No problem, it’ll be in your account on Monday.’” —Evelyn ([30:19])

7. Memorable & Surreal Moments

• Fatigue culture: Staff worked so hard they turned up in mismatched shoes (“not a joke”), parties emerged in “ghost town” capitals as more aid groups arrived ([07:46]; [16:45]–[17:34]).
  • “It went from ghost town, scary Ebola to like parties on the beach…just weird.” —Evelyn ([16:45])
• Office politics: Numerous turf wars with local officials and other agencies, especially in phone/call center contracts, sparked bizarre incidents—including a rival named Evelyn trying to have them kicked out ([18:01]–[19:31]).

8. Conflict and Politics in Guinea

• Leadership challenges: In Guinea, a problematic in-country coordinator fueled ongoing bureaucratic harassment, blocking progress through daily complaints after a dispute over staffing ([40:19]–[44:17]).
  • “At that point [she] stopped managing the response and focused solely on getting us kicked out of the country.” —Adam ([43:49])
• Big wins (despite obstacles): Yet EHA still delivered call centers, constructed eight “gorgeous” modern health facilities, and a national EOC that's still in use ([45:23]–[45:53]).

9. Biggest Wins

• STRIVE trial: EHA’s management of the complex STRIVE Ebola vaccine trial, ensuring operational logistics and financial management in a chaotic environment ([33:30]–[37:37]).
  • “It ended up going really well. It was the only one that actually collected the needed amount of trial data.” —Adam ([35:40])
• Strong district coordination: Especially in Sierra Leone, their EOCs improved data, response times, and became blueprints for ongoing public health emergency infrastructure ([37:47]–[39:10]).
• Getting frontline workers paid: Ensuring that burial teams, ambulance drivers, and others received salaries was key to preventing breakdowns in response ([39:10]).

10. Hard Lessons and Regrets

• Missed opportunities: Over-investment in custom software (rather than commercial solutions) and optimistic infrastructure investments in countries they didn’t stay in ([48:07]–[49:26]).
  • “If we had known then what we wanted to be today, we would have made so many different decisions.” —Evelyn ([49:27])
• Personal toll: Most difficult moments included staff layoffs (entire Guinea team) and confronting the human tragedy of Ebola’s toll.
• On exit: Marking the “Ebola free” moment was anticlimactic—burnout eclipsed celebration ([51:00]–[52:17]).

Notable Quotes & Memorable Moments

• On operational overwhelm:
  “I think we were so overwhelmed and so stressed during this time that both Adam and I have a really hard time remembering many of the specifics from the response.”
  —Evelyn ([00:30])

• On the surreal atmosphere:
  “There was a much stronger US force there… At some point…all of a sudden…Liberia had like this weird, like, party atmosphere.”
  —Adam ([16:45])

• On coordination versus chaos:
  “In Sierra Leone, everything was coordinated. … In Liberia, everyone still kind of did their own thing. … People just went to the counties with their grant money and…kind of ignored the coordination mechanism.”
  —Adam ([25:53])

• On the lack of financial controls:
  “Our finance systems were not in place to do this, but I also…cannot believe how not in place…CDC Foundation finance systems were.”
  —Evelyn ([30:24])

• On “biggest wins”:
  “STRIVE was a huge win for us… it was the only one that actually collected the needed amount of trial data.”
  —Adam ([35:40])

• On failures:
  “Millions of dollars…could have gone into something more useful and more of a global good.”
  —Adam ([48:48])

• On worst moments:
  “A lot of those fights with that woman were pretty bad… The other worst moments were just early on in Sierra Leone when cases were spiking…that was pretty awful.”
  —Adam ([50:05])

Timestamps for Key Segments

| Segment | Timestamp | |------------------------------------------------------------------|-------------| | CDC request and EHA's start in West Africa | 00:50–02:55 | | Entering Sierra Leone; first impressions | 03:34–06:21 | | Early wins: EOC setup, call centers, outbreak logistics | 06:51–09:44 | | Friction with WHO, entering coordination via military | 09:44–11:22 | | Liberia: staff, “Tag-and-Go” technology, lab sample transport | 13:28–16:07 | | Culture shift: expat arrivals, emergence of party scene | 16:45–17:34 | | Contradictory donor/government funding streams in Liberia | 25:53–27:39 | | Scale-up, hiring, and finance systems breakdown | 28:33–32:42 | | Discussion of major wins: STRIVE, call centers, coordination | 33:17–39:37 | | Guinea: leadership meltdown, operational roadblocks | 40:19–44:17 | | Regrets: technology overspend, infrastructure, lessons learned | 48:07–49:26 | | Emotional lows: firing staff, confronting human impact | 50:02–51:32 | | "Ebola free" milestone and team exhaustion | 51:32–52:23 |

Final Remarks

The episode closes with Evelyn and Adam expressing a mixture of pride and honest self-critique, emphasizing the impossibility of perfection in the chaos of epidemic response. They regret some tactical decisions but affirm the enormous commitment and impact of their teams—especially on coordination, logistics, and sustaining frontline workers. Their open, sometimes irreverent storytelling highlights both the gravity and the absurdities of crisis response in global health.