More than medicine needed against Ebola

Fighting Ebola is about fighting distrust. Information on disease prevention must be disseminated in the right way to the people of West Africa. Aid workers need to be responsive and culturally sensitive, social anthropologist Mats Utas stresses.

This week, a group of Swedish doctors, nurses and aid workers prepared for a mission in West Africa by attending a crash course in Ebola prevention at Karolinska Institutet in Stockholm. In addition to learning about the protective clothing they will soon be wearing and sterilisation equipment they have got acquainted with the cultural and social dimensions of their mission.

Mats Utas, researcher at NAI, was one of the experts who served as their guides to the West African society. With over 20 years of field experience in Liberia, Sierra Leone and Côte d'Ivore, Utas explained some of the local traditions that Westerners have difficulty in understanding. For instance, in response to a question by one participant about why so many relatives want to take photos and videos of dead Ebola patients, he replied:

"They want to show the pictures to relatives who are not present. Funerals and rituals surrounding death are extremely important in West Africa. Those who go there have to be aware of that and respect it."

Distrust hampers information flows

A common problem with international relief operations is their lack of sensitivity to the characteristics of society: their operations look alike no matter what of what continent they are working in. In Utas's opinion, the response to the current Ebola crisis should have been more sensitive to cultural and social issues. He does not shy away from calling it a failure.

"In the beginning, the operation focused solely on the medical aspects without taking into account the malfunctioning states of Liberia and Sierra Leone. In general, people distrust the governing elite and discount the information coming from then. This had a huge impact on the early responses to Ebola", Utas argues.

The widespread distrust stems from the elite's exploitation of Liberia's and Sierra Leone's people, exploitation that gave rise to civil wars. Power is still concentrated in the hands of a tiny elite.

Traditional leaders key

According to Utas, information on the virus should have been relayed through traditional leaders: village elders, teachers and seniors, figures whom the people trust. If these "gatekeepers" are not involved in the communication strategy, a key link in the the information chain is broken.

"Moreover, if the traditional leaders feel excluded, there is a risk they will purposely start spreading disinformation. They will feel challenged and will not want outsiders pulling the strings."

A couple of months into the operation, international relief agencies are beginning to adjust to West African cultures, Utas believes. However, aid workers still need to be sensitive and know the local situation well when they deliver information on Ebola.

"It was a mistake to go to into Muslim Mandingo societies along with Christian relief organisations. It resulted in riots because people felt threatened by the Christian presence", Utas says.

Daily routines can provide solutions

There is already a critical shortage of beds in temporary Ebola centres, and there will not be enough new ones in the coming months to accomodate all those infected. The next step is community-based care, with people taking care of those infected in their homes. Aid workers try to create systems and routines for how relatives should take care of infected in the safest way.

"This has never been done before, so it is an extremely difficult challenge. We have no choice, as the clinics will not be able to muster enough resources. The alternative is to let people die in their homes", Utas says.

Information should build on what people already feel comfortable with. Utas uses salad as an example. When eating fresh salad in Freetown, it has most likely been washed in chlorine. Chlorine, which also kills the Ebola virus, is already used in homes, so new hygiene routines can be taught based on this established knowledge.

"It's all about associating new information with something that is already part of people's daily lives. People are suspicious of everything coming from outside. We need to describe things from their point of view", Mats Utas concludes.

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