Caring for the Sick

Developing nuanced analysis about the location and practices of patient management; involving survivors, caretakers and community leaders in improving home-based and institutionalized care; rights and realities of palliative care; understanding the medical and social implications of triage and isolation; social integration of community based care facilities; developing a continuum of care; supporting sero-discordant mothers and new-borns.

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 →

Ebola Survivors: using a stepwise re-integration process to establish social contracts between survivors and their home communities

We propose that the point of discharge of someone who has survived Ebola virus disease (EVD) should become a staged transition back into the community, linked to a social contract that ties targeted support to adherence to infection control practices. This offers important benefits to how people perceive the infectious risk of survivors, improved social cohesion through collectively agreed stages of re-integration, and a mechanism for directing psychosocial and material support to those who most need it.

Stigma and Ebola: an anthropological approach to understanding and addressing stigma operationally in the Ebola response

‘Stigma’ is an umbrella term for the direct and indirect consequences of a number of processes that brand someone as different in ways that result in discrimination, loss of status and social exclusion. It can be short-term or evolve into a long-term and life-long issue. Who and how people are being socially labelled – plus the material, political, social and moral consequences of this labelling – often change rapidly throughout the course of an epidemic, particularly from the early stages of an emerging outbreak to Continue reading →

Ebola and Older People in Sierra Leone, Liberia and Guinea

The limited evidence available on age-disaggregated fatality rates of Ebola Virus Disease (EVD) consistently highlights the poor survival rates of older people compared with young adults. The particular roles that older people play in societies put them at differing patterns of risk of contracting EVD compared with younger adults. While many older people will be less likely to undertake at-risk care and burial practices, those with for example fostering or non- formal caring roles may be at increased risk of transmission. Older people, in particular Continue reading →

On gloves, rubber and the spatio-temporal logics of global health

On the 5th of September, 2014, the blog Konakry Express recounted a report from Mme Fatou Baldé Yansané that there are severe shortages of gloves in health facilities in Guinea. Mme Baldé Yansané writes that midwives have only one or two pair of gloves each week. As a consequence, they have to reuse gloves or merely rub their hands with chlorine after consultations. This message was written over five months after the WHO’s confirmation of an Ebola outbreak in Guinea on their webpage. When I read the blog Continue reading →

Increasing early presentation to ECU through improving care

Current Ebola epidemic control policy in Sierra Leone focuses on (a) triage and isolation in decentralised, ideally community-based Ebola Care Units (ECUs), leading to (b) transfer to Ebola treatment units (ETUs) for those diagnosed as positive. Increasing early presentation to ECUs is essential for this strategy to be effective in reducing Ro. This note outlines ways in which improved and socially-appropriate care – in ECUs, and at home – can assist this.

Do Funerals Spread Ebola?

Some attention has been paid to the alleged role of funerals in spreading Ebola Virus Disease in Upper West Africa.  This has led to attempts to control funerals, causing both distress and active resistance.  Critical examination of the role of the funeral event as a mechanism of Ebola transmission seems in order. In this paper, it is argued that funerals are inseparable from care for the sick, as far as Ebola transmission is concerned.  The focal issue then becomes not control of funerals but reduction Continue reading →

Care and Burial Practices in Urban Sierra Leone

Funeral practices in Freetown are varied with differences between typical Muslim and Christian practices. Muslims typically bury the body the same day, or the day after, the death, whereas Christians might wait for up to several weeks while arrangements are made. Muslims normally bury bodies in a shroud, whereas Christians use a coffin. The bodies are typically prepared for burial (washed) by family members.  This background paper gives more information on care and burial practices in Urban Sierra Leone.