Fears and Misperceptions of the Ebola Response System during the 2014-2015 Outbreak in Sierra Leone

Abstract

BackgroundFuture infectious disease epidemics are likely to disproportionately affect countries with weak health systems, exacerbating global vulnerability. To decrease the severity of epidemics in these settings, lessons can be drawn from the Ebola outbreak in West Africa. There is a dearth of literature on public perceptions of the public health response system that required citizens to report and treat Ebola cases. Epidemiological reports suggested that there were delays in diagnosis and treatment. The purpose of our study was to explore the barriers preventing Sierra Leoneans from trusting and using the Ebola response system during the height of the outbreak.MethodsUsing an experienced ethnographer, we conducted 30 semi-structured in-depth interviews in public spaces in Ebola-affected areas. Participants were at least age 18, spoke Krio, and reported no contact in the recent 21 days with an Ebola-infected person. We used inductive coding and noted emergent themes.FindingsMost participants feared that calling the national hotline for someone they believed had Ebola would result in that person’s death. Many stated that if they developed a fever they would assume it was not Ebola and self-medicate. Some thought the chlorine sprayed by ambulance workers was toxic. Although most knew there was a laboratory test for Ebola, some erroneously assumed the ubiquitous thermometers were the test and most did not understand the need to re-test in the presence of Ebola symptoms.ConclusionFears and misperceptions, related to lack of trust in the response system, may have delayed care-seeking during the Ebola outbreak in Sierra Leone. Protocols for future outbreak responses should incorporate dynamic, qualitative research to understand and address people’s perceptions. Strategies that enhance trust in the response system, such as community mobilization, may be particularly effective.

Citizens, dependents, sons of the soil

“…Building on a history of struggles over definitions of personhood and for the achievement of human dignity, the views of Kambians who took part in the vaccine trial and emphasised their sacrifice for the nation also make clear that there is not a single story about the Ebola outbreak. Mistrust, fear, and avoidance undoubtedly played a large part as a number of anthropologists have rightly highlighted (Yamanis, Nolan, and Shepler 2016;Wilkinson and Leach 2015;Pellecchia et al 2015;Fairhead 2014), but the perception that this was a national threat that could be overcome through collective sacrifice was equally important. This brings us to the second important point, which is that despite the depiction of Sierra Leone as a 'fragile state' and the absence of state services as made evident by the epidemic, the state remained present in participants' political imagination.…”

Rapid qualitative research methods during complex health emergencies: A systematic review of the literature

“…The length of the research varied and, in some articles, it was difficult to determine the exact length of data collection. The shortest study was four days (Brennan and Rimba 2005) and the longest was one month (Yamanis et al 2016), but about half of the studies were carried out within two weeks. Eleven articles described studies where data were collected from healthcare staff or government officials, six studies collected data from community members, four collected data from healthcare staff and community members, and one article did not specify the study participant population.…”

Personal, Interpersonal, and Media Predictors of Fear of Ebola

“…Fear and related disorders, such as posttraumatic stress syndrome, have also been associated with diminished cardiovascular fitness (Suls & Bunde, 2005), decreased immune system functioning (Segerstrom, Solomon, Kemeny, & Fahey, 1998), and degraded psychological health (Silver et al, 2013). At the community level, fear can accelerate the spread of disease (Schulz et al, 2016), cause delays in care seeking (Yamanis, Nolan, & Shepler, 2016), disrupt health care delivery systems (Barrett & Brown, 2008), and diminish trust in health services (Van Bortel et al, 2016). Fear can also produce unwanted outcomes at the state and national levels.…”