Shifting Trust in Outbreak Control

March 14, 2020

Sekou Kouyaté (MA) and Elysée Nouvet (PhD)

COVID-19 will not spare Africa. Many of the continent’s health systems are severely under-resourced. These are overwhelmed in the face of outbreaks. Political leaders and individuals responsible for the health of Africans have good cause to worry in the face of this new threat. But for the more general population, at least in Guinea, news of COVID-19 is provoking a different sort of reflection as well. 

Coverage of today’s global pandemic in this African country is a clear reminder of the 2013-16 Ebola Virus Disease (EVD) epidemic. On August 14, 2014, the Guinean government declared a state of public health emergency. Socio-economic consequences were immediate and dramatic. These included a reduction of flights coming into the country, the closure of businesses, the departure of European expatriates, and, with the consequent slow-down in economic activities and lay-offs in the mining sector. This was a period of undeniable hardship. Some did not accept this hardship as necessary. Many viewed the WHO guidelines for epidemic control that were implemented here as exaggerated and discriminatory:  “It’s because we’re Africans”. Some rejected the measures on the basis of those implementing these at the national and sub-national levels : representatives from the national government, public health authorities, the army responsible, foreign NGOs. In Guinea, as in many countries, trust in national and global authorities is consistently fragile. This is the result of several factors, including long-standing political and social divisions, and histories of colonial and outsider domination and exploitation. 

There is reason to be hopeful that trust of national public health infection control strategies will be different with COVID-19.  We have noticed in the last weeks that many of our Guinean colleagues and, in the case of the first author, co-citizens, are remarking on the outbreak control measures taken first by China, neighbouring countries of China, and now by an increasing number of countries in the face of the very real COVID-19 pandemic. What is underlined as notable is that these measures replicate those imposed in West Africa during Ebola: quarantine, reduced flights, limits on the movement of individuals out of affected areas, bans on public gatherings above certain numbers, closure of schools, universities, and places of worship. This is being interpreted and held up by many in the country as a powerful truth: such measures were never reserved for Africans. The dramatic response to COVID-19 by countries far from Africa – Italy, Canada, China – may do much more than curb this pandemic. Such measures, witnessed worldwide, may shift in significant and lasting ways narratives of distrust towards epidemic control measures where these exist.

As of March 12th, Guinea has confirmed its first COVID-19 case.  Adherence to infection surveillance and control measures will be key to what happens next. Hopefully, these measures will be recognized in Guinea and elsewhere as necessary, rather than unfair or duplicitous. The populations of countries like Guinea know what stands to be lost under such trying times. They are familiar with recommendations to limit the spread of the disease. It is more than a matter of telling the mice, “The cat is on its way, positions everyone!” Trust is key.  

 

Sekou Kouyate is a social anthropologist and project manager with the Humanitarian Health Ethics research group. He holds a Masters in anthropology and a Masters in development. He is based at the Laboratoire Socio-Anthropologique de la Guinée, in Conakry. 

Elysée Nouvet is an anthropologist and assistant professor in the School of Health Studies at the University of Western Ontario. She is a member of the Humanitarian Health Ethics Research Group, and an advisor to the World Health Organization Social Sciences Research Working group (good participatory practices) for COVID-19.

References:

  1. Wilkinson A, Leach M (2014). Briefing: Ebola-myths, realities, and structural violence. African Affairs 114(454): 136-148. https://doi.org/10.1093/afraf/adu080. Beyond Guinea:
  2. Blair RA et al. 2017. Public health and public trust: Survey evidence from the Ebola Virus Disease epidemic in Liberia. Social Science and Medicine 172: 89-97. https://doi.org/10.1016/j.socscimed.2016.11.016.
  3. Vinck P, et al. 2019. Institutional trust and misinformation in the response to the 2018-19 Ebola outbreak in North Kivu, DR Congo: a population-based survey. DOI: https://doi.org/10.1016/S1473-3099(19)30063-5

Colonial suspicions and hollow partnerships: one African research assistant’s failure to obtain a visa for a research seminar

By: Sekou Kouyaté

“As a member of the Humanitarian Health Ethics Research Group (HHERG), your presence is requested at a Dissemination and Workshop Event in Geneva, Switzerland hosted by CERAH (Centre d’enseignement et de recherche en action humanitaire de Genève – Geneva Centre for Teaching and Research in Humanitarian Action) from 23 September to 28 September 2018…

When I received this letter on July 9th, 2018, I was overcome with joy and hope. First, joy: for the feeling that I will become known by several colleagues I had corresponded with for over a year, and never met, and have the opportunity for them to hear me share my thoughts first-hand. Hope:  to meet international researchers in a renowned city. I immediately agreed because, as an African research assistant, the opportunity to participate in a workshop in Europe that focuses on public health research which affects thousands of Africans is rare and therefore impossible to refuse.

The first step for this trip to Europe, I quickly learnt, posed an immediate challenge. I was to obtain a visa at the Swiss embassy located not in my home country (Guinea), as there was no such embassy in Guinea, but in Ivory Coast. Travelling there was costly. My economic limitations made me begin to lose hope, as travelling there overland would take days, and a plane ticket would cost 300 USD. The visa itself would cost 60 USD. Luckily, these financial concerns were short-lived. As soon as my Canadian supervisor and professor, Elysée Nouvet, heard that I needed to travel out of country for my application, she assured me all costs of this process would be covered by the project, and sent me the funds. I was off to Abidjan.

The submission of the application files, and the discussions that followed did not allow me to expect a departure to Europe. Neither my commitment to return to Africa after the workshop nor the invitation letters from CERAH and HHE, and the authenticity of my own files were sufficient or reassured the Swiss Embassy to grant me the visa. I was granted an interview at the embassy in Abidjan. During interview with more than one official, I was told that I seemed honest enough, but inevitably as a young African (I was 40 at the time), I essentially posed a risk of illegal migration. It seemed impossible, statistically and socially, to the officials, that I would return to Guinea if I made it to Europe. I was stunned, and frankly offended, that it was assumed no African would choose to stay in Africa if given access to Switzerland. I entreated my interlocutors with as many details of my commitments in Guinea. My father had been a diplomat, and I knew the situation was delicate and not in my favor. I learnt that my lack of PhD seemed to evoke distrust in and of itself: how could a socio-anthropologist without a PhD (from Africa) have enough to contribute to a workshop to merit his invitation to such an event? In the end, the interview lasted less than an hour. I felt devalued and judged. I felt I was being seen as a potential criminal and liar, which was like being called a criminal and liar. I am a deeply religious man, and my word was my honor, but this meant nothing. I showed them proof of dependents in Guinea and two small children, as well as research positions that were contingent on my ability to conduct interviews and analysis in Guinea: this was insufficient.  

From the Ivory Coast, grief, shame, and disappointment filled my heart and my head. These combined to create in me a feeling of profound rejection. I did not answer my phone for several days afterwards as I processed what had happened. This failure to obtain a visa was not only a notification of non-participation in the workshop. It was confirmation of the existence of unfair assumptions about the inherent appeal of moving to Europe for all Africans, and the bias of visitor visa granting based in colonial thinking and policy.  It was then that I lost all hope that the symbolic partnership would be transformed into an authentic partnership between researchers from the South and the North.

I write this short piece, because I think it is worthwhile to record. I aim to share my experience with all the decision-makers in health research, in humanities and policies, so that processes for visa applications and approvals for researchers from the south be rethought. Colleagues from the north come to Africa with ease, and with relatively limited worry over visa. Current policies strike me as unfair. They are also extremely costly, stressful, and even depressing. If we are serious about decolonizing research, there has to be more support for the mobility of African researchers to partake in international events where their contributions will be discussed. It is time to replace rhetoric. It is no longer acceptable for Africans to be on the receiving side of lessons from non-Africans. We are not just part of research to color the soup. 

During seminars and workshops in Europe, the consideration of the perception and experience of African researchers beyond Skype is an important element in the re-foundation of this cooperation. In the relationship between southern researchers and colleagues from the European and North American continents, it should be mentioned that the only initiative that can achieve sustainability is the one which facilitates the free movement of researchers.  

It is regrettable to consider that in the 21st century, the remnants of colonization are still visibly persistent in health research, while security, international trade and politics have been able to repaint the board. Nowadays, political advisers, diplomats, and security experts are no longer worried about their status (beginner, intern and senior) for obtaining visas to travel to Europe or America.

In the context of public health, Africa is considered a research site on diseases (infectious, non-infectious, neglected, experimental studies…). For a better understanding and consideration of the experts’ recommendations to policy makers and financial partners, it is necessary for Africans to participate in disseminations and to be given a voice in explaining the perceptions, reactions and representations of diseases. After all, the idea of the principle of justice is one of the pillars of health research ethics.

 

Reflections December 2019 Available!

The December 2019 edition of Reflections is now available! This edition focuses on Community Engagement in Humanitarian Healthcare, and features commentary from Yusuf Kabba, President of the Sierra Leone Association of Ebola Survivors (SLAES). You can find it at the link below- and don’t forget to subscribe for future Reflections!

Link to Reflections December 2019. 

From Tokenism to Meaningful Partnerships

North-South research partnerships are a critical means of advancing global health research. However, research partners from the Global South have described feeling they were included to full funding requirements, and offered only token roles, saying “we were there to colour the soup.” Despite good intentions, researchers from the Global North often fall into patterns of tokenism. This 2-page report captures key lessons learned from our experiences of and data collected from two elrha-r2hc funded studies: (1) Aid when there is ‘nothing left to offer’: A study of ethics & palliative care during international humanitarian action, and (2) Isolation, quarantine, and research in Ebola management: A comparative study of stakeholder perceptions and experiences. These reflections point to possible strategies to move toward the goal of authentic partnerships during humanitarian health research. It reflects the reality that the overwhelming majority of transnational partnerships are collaborations in which researchers from Global North countries partner with researchers from what are essentially “research site” countries in the Global South.

PDF: FROM TOKENISM TO MEANINGFUL PARTNERSHIPS – FINAL [EN]

PDF: FROM TOKENISM TO MEANINGFUL PARTNERSHIPS – FINAL [FR]

 

Suggested Citation(s):

Humanitarian Health Ethics Research Group. (2019). From Tokenism to Meaningful Partnerships. Isis A. Harvey designer. Available Online on the Humanitarian Health Ethics Website.

Humanitarian Health Ethics Research Group. (2019). Du symbolism aux partenariats authentiques. Traduction [de l’anglais]: Aziza Mohamadhossen. Isis A. Harvey conception graphique. Disponible sur le site web de Humanitarian Health Ethics.

 

Ethics and crisis translation: insights from the work of Paul Ricoeur

New Paper by Donal O’Mathuna & Matthew Hunt

https://www.emerald.com/insight/content/doi/10.1108/DPM-01-2019-0006/full/

“Paul Ricoeur was one of the leading philosophers in the twentieth century, writing on a wide variety of topics. From these, his work on translation and on ethics provided suitable ways to examine ethical issues in crisis translation. In particular, his concept of “linguistic hospitality” provides an important lens through which translation ethics can be examined. In addition, Ricoeur’s approach to ethics emphasized relational and justice dimensions which are crucial to examine in humanitarian settings.”

 

Epistemic Injustice and Humanitarian Action: The case of language and translation

Ryoa Chung is an Associate Professor in the Department of Philosophy at the Université de Montréal.

Matthew Hunt is an Associate Professor and the Director of Research in the School of Physical and Occupational Therapy at McGill University.

This article originally appears on the University of Edinburgh Law’s Justice in Global Health Emergencies & Humanitarian Crises Blog. 

“Access to information has been described as a humanitarian good, alongside other basic needs such as food, water, shelter and healthcare [1]. Accountability is a major priority in the humanitarian sector, including accountability of non-governmental organizations toward the communities they serve. Coordination of aid between humanitarian organizations, and with local governments and agencies, has been identified as a key concern for effective crisis response [2]. And yet, All three of these activities – sharing information, practicing accountability and coordinating aid responses – are predicated upon the mobilization and exchange of knowledge, and serve to illustrate their centrality to humanitarian action. Important ethical concerns exist, however, when some individuals or groups are excluded from the pooling and exchange of knowledge. One source of exclusion relates to the linguistic dimensions of humanitarian aid: what languages are spoken by whom and for which purposes, what language barriers exist, what credibility or authority is or is not associated with people speaking certain languages, and whether translation is available….”

READ MORE AT: https://www.ghe.law.ed.ac.uk/epistemic-injustice-and-humanitarian-action-the-case-of-language-and-translation/

[1] Greenwood F, Howarth C, Poole D, Raymond N, Scarnecchia D. The Signal Code: A Human Rights Approach to Information During Crisis. Cambridge; 2016.

[2] Stephenson, Jr, M. (2005). Making humanitarian relief networks more effective: operational coordination, trust and sense making. Disasters, 29(4), 337-350.

On World Humanitarian Day, let’s reflect on relieving suffering through palliative care.

Follow this link to see how Dr. Lisa Schwartz and the HHE team were the focus of a reflection on World Humanitarian Day by the McMaster Global Health Office.

This team is tackling injustices in global health emergencies & humanitarian crises

A little over a year ago, several researchers working on ethical and justice based questions arising in global health emergencies (health crises of global concern) and in other humanitarian crises came together on a Wellcome Trust funded project entitled:  “Vulnerability and Justice in Global Health Emergency Regulation: Developing Future Ethical Models.”  Our key concerns were around how inequalities, vulnerabilities and various forms of injustices are often reinforced in these contexts, and how future public health responses could be better attuned to these issues.

We are delighted to announce that we recently launched our website “Justice in Global Health Emergencies & Humanitarian Crises”.

On this platform, we’re aiming to explore issues around vulnerability and justice during global health emergencies and humanitarian crises through a range of media:

  • Short animations that explain concepts that are central to our project, such as structural injustice, epistemic injustice, the importance of denaturalising disasters, among others.
  • Blog-like applied illustrations of the relevance of central concepts in real-world scenarios and examples.
  • A podcast, “Just Emergencies”, where we sit down with humanitarian workers and researchers to talk about their work and interests.
  • A series of invited blog posts, which capture the knowledge and experiences of a diverse range of people who share with us the pressing issues of working in the global health and humanitarian sectors.
  • A developing section dedicated to modelling for global health emergencies in the future.
  • A list of articles, books and websites that might be of use to those researching, teaching or generally interested in these topics.

We’re hoping that this website is a useful resource to academics, humanitarian workers, students, and the interested public alike. Ideally, we would like this to develop into a platform where researchers and humanitarian actors can engage with these topics and in dialogue with us.

If you are willing to share your thoughts and experience as practitioners or researcher in the form of a blog post, or would like to talk about your global health emergency or humanitarian crises experience on the podcast, please get in touch at ghe@ed.ac.uk.

New content will be posted on a regular basis, so we warmly invite you to sign up to our newsletter. You can also follow us on twitter (@GanguliMitra)