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Local Engagement in Ebola Outbreaks and Beyond in Sierra Leone

Oosterhoff, P. and Wilkinson, A. Local Engagement in Ebola Outbreaks and Beyond in Sierra Leone, Practice Paper in Brief 24
Abstract / Summary: 
'Containment strategies for Ebola rupture fundamental features of social, political and religious life. Control efforts that involve local people and appreciate their perspectives, social structures and institutions are therefore vital. Unfortunately such approaches have not been widespread in West Africa where response strategies have been predominantly top-down. Authoritarian tactics have had questionable effect, potentially worsening the epidemic and contributing to social and economic burdens. Failure to involve local people and their concerns is often justified by budgetary and practical restraints such as lack of time and resources. However, some of the current Ebola responses reflect problematic assumptions about local ignorance and capability. These sentiments are deeply rooted, having evolved with unequal power dynamics over long periods of time. The emerging evidence on successful local responses suggests that local populations can learn rapidly to adjust high-risk traditional practices and reduce transmission in conjunction with solid public health measures. Recognising and supporting local resilience will be essential in successfully and sustainably engaging populations in effective Ebola responses'
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Authoritarian regimes
In December 2014, Sierra Leone's President Ernest Bai Koroma cancelled Christmas. Holiday travel and gatherings were banned in an effort to bring the country's worsening Ebola epidemic under control. Instead, the Freetown peninsular was to undergo the '˜Western Area Surge' (WAS) devised by the National Ebola Response Committee (NERC). On the orders of the president, the WAS included house-to-house visits and the following '˜fact-based messaging', designed to '˜shock':
- '˜How bad does it need to get before you take notice and start to fight this disease? You have wasted seven months, let's make the next one count.'
- '˜Do you really want to die? Do you want to kill your family? Don't conduct secret burials.' For good measure, this was supplemented by a warning, '˜Those that conduct secret burials are spreading this disease. It is their fault that your friends and relatives are dying. They are destroying our nation and I (the President) will see that they are punished for their illegal, selfish behaviour'.

'It is hard to know if these messages actually reached people on the ground, but we do know that control efforts have been structured around curfews, mass cremations, lock-downs, quarantines ­ of houses, villages and entire regions ­ andand the use of force to maintain these measures. These strategies have been justified as necessary in order to deal with unruly populations who have ignored advice and resisted medical teams due, it is said, to ignorance of biomedicine, irrational distrust and a refusal to abandon '˜traditional culture'. Far less attention has been paid to the '˜culture' of the
response, specifically how dominant technical and biomedical norms and practices for outbreak control may have limited the scope of engagement with local actors. From a lacklustre start, national and international Ebola responses have mushroomed into vast and complex multi-actor operations. Coordination ­ both naational and international ­ has been limited and differeences in opinion, history, funding and style have led to a variety of approaches being implemented.'

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Oosterhoff, P. and Wilkinson, A.
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