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

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.”

 

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)

How well was HHErg represented at HEI Research Day 2019? Extremely well, thank you.

On March 14, McMaster’s Department of Health Research Methods, Evidence and Impact hosted its annual Research Day.

The HHErg was well represented this year with two poster presentations (below) and an oral presentation entitled, “Dying in the Margins:  Palliative Care, Humanitarian Crises and the Intersection of Global and Local Health Systems.”

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Pictured from L to R, Jhalok Talukdar, Rachel Yantzi, and Takhliq Amir.

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Downloadable PDF of the Natural Disasters Array poster.

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Downloadable PDF of the Opportunities and Challenges poster.

 

 

Reflection 7(1) is ready for you to read.

Follow the link for online reading of Reflections 7(1)..

This edition of the HumEthNet newsletter looks at picturing humanitarian health ethics and two important new studies of perceptions & experiences of people often the subjects of aid campaigns.

Thank you to our contributors, Philippe Calain (MSF-Suisse & HumEthNet member), Siobhan Warrington of Oral Testimony, and David Girling from the University of East Anglia.

Can a Television Change Perceptions of Ebola?

13942782618113Fear and dread of Ebola is shared by patients, healthcare providers and the general public. Some of this fear comes from a lack of understanding of how the disease is experienced combatted. Follow this link to read a commentary by HHERG’s Sonya de Laat, Postdoctoral Fellow in Humanitarian Health Ethics at McMaster University, on the role of a television set in contributing to a change in perception about Ebola Virus Disease.

Television and Ebola. How televisions can change disease perception & reduce stigma