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- Convenors:
-
Juliet Bedford
(Anthrologica)
Anita Schroven (Max Planck Institute for Social Anthropology)
- Location:
- FUL-101
- Start time:
- 9 September, 2015 at
Time zone: Europe/London
- Session slots:
- 1
Short Abstract:
Anthropology has played a prominent role in the Ebola response in West Africa. This panel presents new empirical data generated across the response and the three affected countries, and explores the tensions in "operationalising" anthropological knowledge in the context of a global health emergency.
Long Abstract:
Anthropology has played a prominent role in the Ebola response in West Africa. In the context of a global health emergency, unprecedented numbers of anthropologists were actively engaged, both in-country and working remotely. By providing a contextualised understanding of 'the local', their contribution was often framed by the need, as perceived by national and international agencies, to translate or mediate between communities, the responding institutions and their interventions.
The papers in this panel present new empirical data generated by anthropologists and other social scientists working 'on' and 'in' the response across Liberia, Sierra Leone, Guinea and West Africa more broadly. The papers are based on primary fieldwork and secondary data, and provide rich ethnographic accounts of Ebola and the response from multiple perspectives.
Using the papers as case studies, the panel addresses tensions in "operationalising" anthropological knowledge in policy and practice within the larger global health emergency. From challenges in conducting rapid data collection and analysis in an environment where movement and social interaction was restricted, to issues of collaboration, coordination and negotiation, and questions about how knowledge was translated, packaged, circulated and utilised, the panel explores ways in which anthropologists contributed to an emerging evidence-base that was used (to a greater or lesser extent) to shape and influence the strategies and interventions of the Ebola response over time.
Accepted papers:
Session 1Sharon Abramowitz
Paper short abstract:
This presentation highlights community-based responses to Ebola, community-based understandings of Ebola, and co-morbidity and co-mortality in a context of health systems failure at the height of Monrovia Liberia’s Ebola epidemic in August-October 2014.
Paper long abstract:
Ebola in Monrovia: Lessons Learned and Unlearned
This presentation draws upon interdisciplinary analyses of ethnographic and qualitative fieldwork on community-based responses to Ebola, community-based understandings of Ebola, and co-morbidity and co-mortality in a context of health systems failure at the height of Monrovia Liberia's Ebola epidemic in August-October 2014. Key insights include: the pace of health information dissemination in the context of epidemic outbreak; the complex character and multifaceted engagement of local communities in combatting the epidemic in the absence of external supports; and an examination of how health-seeking behaviors in a context of health systems collapse can be leveraged to facilitate epidemic response. In addition to identifying the critical anthropological lessons learned for epidemiology, epidemic response, and public health outreach in the West African region, this paper offers challenges conventional models of anthropological knowledge production by reconsidering how anthropologists can contribute to global health and humanitarian crises from remote locations.
Najmeh Modarres (Johns Hopkins University Bloomberg School of Public Health)
Paper short abstract:
A qualitative study was done to understand community perspectives on attitudes, norms and practices related to the Ebola outbreak in Liberia. The key findings highlight the importance of the role that communities have played in the Ebola response.
Paper long abstract:
As reports of reduced incidence of Ebola infection in Lofa County surfaced in October 2015, there were concerns among international agencies as to the underreporting of Ebola cases and deaths. Considering the widespread misconceptions surrounding Ebola that fueled, it was reasonable to assume that many cases of the infection went unreported. Within this context the Johns Hopkins University Center for Communication Programs assisted the Government of Liberia and its partners, not to verify or validate claims about the reduction in incidence counties, but to assess differences in community perceptions and varied responses to Ebola across the three counties of Lofa, Bong and Monteserrado. The study used key informant interviews, focus group discussions, and a timeline analysis to unpack and understand attitudes, norms and practices that have changed throughout the course of the response taking into account active community readiness and resourcing towards collective efficacy, prevention and care. Data was collected from a total of 39 key informants and 14 focus groups in the three counties. Key findings discuss the crucial role that communities have played in the response and reduction of cases: through the involvement of community and religious leaders, as well as the formation of task forces through existing community structures, leading to effective mobilization efforts prior to the scale up of formal Ebola social mobilization efforts. The importance of situating this knowledge from the viewpoint of the local communities and using their existing social structures for all forms of the Ebola response is highlighted.
Sergio Bianchi (MSF-Switzerland)
Paper short abstract:
The proposed paper exposes how public messaging as well as a set of social factors influenced health-seeking behaviors during the declining phase of the Ebola epidemic in Sierra Leone.
Paper long abstract:
At the end of January 2015, eight months after the official beginning of the Ebola epidemic in Sierra Leone and one year after the first case in West Africa, symptomatic individuals in Freetown still avoided the centralized triage and referral services. Moreover, once the initial symptoms had appeared, Ebola suspect cases opted for home treatment rather than seeking medical assistance from Ebola emergency medical services. Such services were only sought once the deterioration of health status was palpable. The patent incongruity between these behavioral patterns and the public health prescriptions promoted through social mobilization invites for an analysis of health-seeking behaviors' determinants in Sierra Leone.
The proposed paper demonstrates how health-seeking behaviors inconsistent with public health prescriptions were influenced by both social factors and public messaging. More precisely, it shows that negative perceptions of Ebola emergency services, the implementation of quarantine, as well as ambiguous health promotion messages concerning what to do after the appearance of symptoms, encouraged the avoidance of centralized triage and referral services. Similarly, denial and inadequate perceptions about Ebola symptoms as well as viral transmission contributed to the preference for home-based health care over the search for Ebola-specific medical assistance. On the contrary, active case finding and stigmatization reduced the opportunities for home-based health care of symptomatic individuals. In a similar way, the engagement of community leaders in the control of the outbreak via Ebola trainings boosted surveillance and the use of centralized triage and referral services.
Nell Gray (Medecins Sans Frontieres UK) Beverley Stringer (Medecins Sans Frontieres)
Paper short abstract:
Local acceptance and adoption of control measures has proved a challenge in stopping the spread of Ebola. A qualitative study is underway to ensure an in-depth understanding of community perceptions and practices with regards to control measures in order to inform current and future Ebola response.
Paper long abstract:
In order to provide a better understanding of community interaction with the Ebola response in Sierra Leone and inform intervention strategies. A description of community and local-level perspectives and attitudes on control measures used during the Ebola outbreak was intended. The study used a flexible participatory method to gather data by means of field notes and in-depth interviews, 25 Survivors, 24 community members 16 health workers, from rural and urban settings participated. Results focus on a practice of Ebola denial throughout the outbreak up to the point until it is experienced directly. Mass media and communication is only of tributary value in this context with sensitisation deemed as more effective if given by those with first-hand exposure or surviving the disease. Use of control measures by the population is motivated by how the rules for controls and resources are valued or appreciated. The availability of resources were viewed better if good care was experienced and human reactions in terms of expressions of dignity, respect and compassion were a key attribute to positive engagement with mechanisms implemented for disease control. To achieve effective control for the Ebola outbreak there must be reliable community leadership and governance, with proximity and collective understanding as integral to the approach.