Field Notes : Caring for the Sick

Understanding why ebola deaths occur at home in urban Montserrado County, Liberia

Ebola Virus Disease (EVD) home deaths occur as the result of infected persons not being detected early and sent to Ebola Treatment Units (ETU) where they can access care and have an improved chance of survival. From a public health standpoint, EVD deaths should not occur at home. Individuals suspected of being infected with EVD should be identified through case investigations or contact tracing efforts and then referred to an ETU, thus decreasing their risk of dying as well as minimising the risk of exposing Continue reading →

Community-Based Ebola Care Centres: A Formative Evaluation

The Ebola outbreak in West Africa differed from others in its unprecedented size and the high proportion of human-to-human transmission occurring in the community. This report presents an analysis of the impact of Community Care Centres (CCCs) on communities in Sierra Leone. Much has been written about the leadership and coordination of the response – or the lack of it. The emphasis of this evaluation is on the views on the development, implementation and relevance of the CCCs from the perspective of the communities next Continue reading →

How Ebola infection spreads and terminates in rural Sierra Leone

Ebola is a new disease in Upper West Africa. Populations have taken time to learn the nature of the risk it poses. Persons carrying infection initially do not know that they have the sickness. They carry out their daily activities, and seek help from their families and traditional remedies when and where they become symptomatic. Nearly all infection, so far as is known, is associated with the “wet” phase of the illness and handling the corpse of a deceased victim. This period of major infection Continue reading →

Community perceptions of Ebola response efforts in Liberia: Montserrado and Nimba Counties

This study aimed to support Oxfam’s Public Health Promotion (PHP) strategy through a rapid qualitative assessment of the remaining social barriers to compliance with Ebola prevention and treatment messages. At the time of the study, most Liberians had a high awareness of Ebola prevention and treatment information. However, new infections continued to occur in “hot spots” around the country. A preliminary assessment suggested that negative perceptions and fear of Ebola response efforts contributed to non-compliance and resistance in some areas. Research activities assessed the sources Continue reading →

Unsung Heroes on the Ebola Frontline

The “selflessness of aid workers and medical volunteers” was praised both by the Queen in her Christmas message and by TIME magazine, who named ‘The Ebola Fighter’s their person of the year 2014. This emphasis on international staff, particularly doctors and nurses, gives a misleading impression about who is doing what in West Africa, and overlooks the huge contribution that national staff are making in their fight against ebola. Even when national staff are recognised, the focus again tends to be on the doctors and nurses, with some attention Continue reading →

Village Responses to Ebola Virus Disease in Rural Eastern Sierra Leone: Second Interim Report

This report provides further output from an anthropological study of 25 villages affected by Ebola Virus Disease in eastern and central Sierra Leone, undertaken as part of the DFID-funded social mobilization initiative for Ebola prevention in Sierra Leone. Eight focus group transcripts for 3 villages in Kenema District are presented, covering local responses to health issues, and Ebola in particular. Supporting material from a matching questionnaire-based study of health behavior and perceived causes of Ebola is also provided. Of particular relevance are two summary tables Continue reading →

Village Responses To Ebola Virus Disease In Rural Central Sierra Leone

Bawuya is a small, isolated Kpa-Mende farming village about 3 hours walking time from Taiama, headquarters of Kori chiefdom in Moyamba District, Southern Sierra Leone. Bawuya experienced an Ebola outbreak in September 2014, in which 9 people died and 3 infected persons survived, connected to a prior outbreak in a neighboring village, Fogbo. No further cases have since occurred. Bawuya serves as a representative example of how an isolated rural community becomes infected, and how such outbreaks end, where outside intervention or assistance is limited. Continue reading →

Community-based reports of co-morbidity, co-mortality, and health-seeking behaviors in four Monrovia communities during the West African Ebola epidemic

This working paper reports on a study to collect data on co-morbidity and co-mortality among urban Liberian populations during the Ebola epidemic from September to October 2014. Particular attention is paid to how local communities defined their symptoms and sicknesses, the patterns of healthcare-seeking that they pursued in a context of highly restricted health care access, the types of treatment regimens that they deployed to support home based care within their communities, and their perceptions of the causes of disease.  

Community-Centered Responses to Ebola in Urban Liberia: The View from Below

This working paper reports on a study to identify epidemic control priorities among 15 communities in Monrovia and Montserrado County, Liberia. Data were collected in September 2014 on the following topics: prevention, surveillance, care-giving, community-based treatment and support, networking/hotlines/calling response teams and referrals, management of corpses, quarantine and isolation, orphans, memorialization, and the need for community-based training and education. The study also reviewed issues of fear and stigma towards Ebola victims and survivors, and support for those who have been affected by Ebola. The findings Continue reading →

Woman saves three relatives from Ebola

It can be exhausting nursing a child through a nasty bout with the flu, so imagine how 22-year-old Fatu Kekula felt nursing her entire family through Ebola. Her father. Her mother. Her sister. Her cousin. Fatu took care of them all, single-handedly feeding them, cleaning them and giving them medications. And she did so with remarkable success. Three out of her four patients survived. That’s a 25% death rate — considerably better than the estimated Ebola death rate of 70%.