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From: IRIN <
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Date: Fri, 27 Jan 2017 06:03:26 +0000
Subject: “People’s science”: How West African communities fought the
Ebola epidemic and won ...
To: ElisabethJanaina <
elisabet...@gmail.com>
Today's humanitarian news and analysis
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** “People’s science”: How West African communities fought the Ebola
epidemic and won
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Three years on from the start of the West African Ebola epidemic,
lessons are still being learned. And the most surprising are not
coming from the scientists, but from the affected communities
themselves; about how, with hardly any help, they tackled the virus
and won.
One of the curious aspects of the epidemic, which shook Guinea,
Liberia, and Sierra Leone, was the way in which the number of cases
started dropping before the main international response was in place.
In one area after another, the infection arrived, spread rapidly, and
then – apparently spontaneously – began to decline.
Ebola first crossed over from Guinea into Liberia's Lofa County in
March 2014. A rapidly erected treatment centre at Foya, on the border,
was soon full to overflowing. In September, it was treating more than
70 patients at a time. But by late October, the centre was empty.
** People’s science
------------------------------------------------------------
Paul Richards, a veteran British anthropologist, now teaching at Njala
University in Sierra Leone, has been worrying away at this phenomenon.
He is convinced the main driver of the reduction was what he calls
“People's Science
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”; the fact that people in the affected areas used their experience
and common sense to figure out what was happening, and began to change
their behaviour accordingly.
He told a recent meeting at London's Chatham House: “One of the pieces
of evidence which makes me think that local response was significant
is that the decline first occurred where the epidemic began, so that
the longer the experience you had of the disease, the more likely you
are to see tumbling numbers. So, someone was learning… People ask me,
'How long does it take to learn?' And we don't know, but on the basis
of this case study, it's about six weeks.”
A lot of national and international effort was put into public health
education, and the messages broadcast on radio were very widely heard.
But initially they were not very helpful, with a lot of emphasis on
the origin of the disease, and warnings not to handle dead animals or
eat bushmeat.
In fact, it now seems likely that only the very first case came from a
wild animal; all subsequent cases were caused by human-to-human
transmission.
The villagers interviewed by Richards and his team were sceptical
about the government’s warnings: “If eating bushmeat is dangerous, why
did no one get ill before”, was a typical question raised.
He found the conclusions they drew from their own observation and
experience were much nearer the mark.
“We know our own people,” they told him. “So, we know that it’s
socially obligatory to wash the bodies of dead people and to attend
their funerals. We monitor very closely who's not doing that, who's
not paying attention to their social duties.
“So, it very quickly dawned on us that the people who were attending
funerals were the ones that were dying, the good people, the ones that
do their social duty,” Richards recounted. “So, from that we knew that
it was something to do with funerals and we started modifying our
behaviour.”
A healthcare worker stands next to a woman who had died of Ebola
related symptoms. (Sep 2014)
Kieran Kesner/IRIN
A healthcare worker stands next to a woman overcome by Ebola
** Getting organised
------------------------------------------------------------
The areas where Richards was working in Sierra Leone had been badly
affected by the civil war. But that period had taught them how to
organise, and how to depend on their own resources. The Kamajor civil
defence groups, which had protected villages from the notoriously
brutal RUF rebels, were revived as taskforces to track cases, enforce
quarantine, and bury bodies safely.
Across the border in Liberia, the same thing was happening.
Nyewolihun, a small village in the forest, not far from the original
source of the outbreak, put itself into quarantine.
Matthew Ndorleh, the headmaster of the local school, told IRIN: “We
didn't allow anyone to go and sleep in any other place, and we didn't
allow anyone to come in. We set up a taskforce of young men to man
checkpoints at all the entrances to the village, and everyone obeyed
it.”
It was hard, and having to rely on its own resources meant the village
ran short of rice, but although Ebola reached the nearby town of
Kolahun, Nyewolihun stayed safe.
It is clear that one of the missed opportunities in the outbreak was a
failure to encourage these local initiatives and give local people the
tools and techniques they needed to do the job.
Governments and aid agencies preferred to recruit and train official
burial teams rather than teaching people how to bury their own dead
safely. But there were numerous complaints about difficulties in
contacting these teams, long delays, and disrespectful attitudes to
the deceased. More isolated communities had no alternative but to take
care of their own dead, whether they were trained and equipped or not.
** DIY response
------------------------------------------------------------
American anthropologists, who interviewed people in urban areas of
Liberia during the outbreak, found a sense of frustration that the
information campaigns told them about the origin of Ebola, how it was
spread, but didn't give them practical advice on how to care for sick
relatives, how to transport them safely to hospital, and what to do
with corpses when the burial teams didn't arrive.
They wanted training, and they wanted access to protective equipment.
“We have heard the messages,” said
(
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) one interviewee, “but most people do not know how to practicalise
them.”
This was because Ebola is such a dangerous disease that home nursing,
the transport of the sick, and do-it-yourself burials were being
strongly discouraged. It took six months for Sierra Leone to finally
produce a poster giving some advice on caring for the sick, and even
then it was headlined, “Taking Care of Someone with Suspected Ebola:
Be Safe While You Wait”. The clear message was that this was only a
stopgap – professional care had to be the norm.
And yet, in reality, people did have to take care of Ebola patients at
home. The early stages of the disease are not obviously different from
any other fever, and so would be nursed in the usual way. Once Ebola
became obvious, patients were sometimes too sick to be safely moved,
especially from off-road villages where the only form of patient
transport was a hammock.
Richards met communities that had worked out the dangers of hammock
transport for themselves, without it having been mentioned in official
health messaging.
** Care in the community
------------------------------------------------------------
Some patients were kept at home because they and their families were
terrified of the big Ebola treatment centres, where patients, once
taken away, disappeared behind high fences and were often never seen
again.
“They would transport you from your village to Freetown. You had never
been to Freetown, never seen these town places,” explained Esther
Mokuwa, who worked with Richards on his study. She was told by
patients: “If you take me from my loved ones, even the discouragement
would kill me.”
Mokuwa said the Community Care Centres that were eventually
constructed in late 2014, although modest, were much more acceptable.
“People could go there; they had their colleagues working inside who
could take messages; so they could relax. At the CCC, even though you
were very safe, you could see them, and even stand talking. You could
cook food and bring to them in the centre. Like pepper soup – pepper
soup is very important in [West] Africa!”
This was much more like normal care. People finally had a way to
express their love and support, and do what they considered the proper
thing for their loved ones.
The team investigating urban attitudes in Liberia met women who had
planned in advance what they would do if anyone in their family became
infected, and had worked out how they could nurse them as safely as
possible. Many had seen the news reports of a student nurse who
improvised protective kit from plastic bags and bin liners – and
successfully nursed several family members without becoming sick
herself – and were thinking how they might do the same.
With hindsight, it might have been wiser to acknowledge these powerful
and understandable emotions, and the practical difficulties of
providing professional Ebola services in remote areas, and to place
more trust in the communities who wanted their own training and
equipment.
But at the height of the epidemic there was no time to have a debate
about community action and how best to harness it. The hope now is
that the work being done can inform future policy, should another
deadly epidemic emerge.
eb/oa/ag
TOP PHOTO: Community volunteers in Liberia. CREDIT: Morgana Wingard/UNDP
MAP SOURCE: Centers for Disease Control and Prevention/IRIN
Three years on, lessons are still being learned from West Africa's
Ebola outbreak ebola_community.jpg
(
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Elizabeth Blunt (/authors/elizabeth-blunt) Feature (/feature) Aid and
Policy (/aid-and-policy) Health (/health) LONDON
(/publication-location/london) IRIN (/byline/irin) Africa (/africa)
West Africa (/afrique/west-africa) Guinea (/africa/west-africa/guinea)
Liberia (/afrique/afrique-de-louest/liberia) Sierra Leone
(/afrique/afrique-de-louest/sierra-leone)
Read on (
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** Refugees are not “political resources”
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------------------------------------------------------------
Academics and policymakers alike have begun to push back, in earnest,
against popular conceptions of refugees as a burden on their receiving
societies. While these conceptions certainly ought to be challenged,
we must be careful not to overlook refugees’ voices – and our own
obligations – in the process.
In a provocative article
(
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in The Guardian on Sunday, Professor Alexander Betts (director of the
Refugee Studies Centre at Oxford University) argued that a view of
refugees as potential economic contributors to their receiving
societies must be complemented by a more radical “rethinking of the
role of refugees in society”, one that sees refugees as political
resources for reshaping regimes in their countries of origin. Within a
day, the article was shared
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on Facebook by Melissa Fleming, official spokesperson for the UN’s
High Commissioner for Refugees, with the caption “refugees don’t just
have economic potential – they are a political resource too”.
Betts makes a persuasive case. Recent research
(
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, he points out, focuses on the economic benefits of resettling
refugees in European states while neglecting the political benefits of
using them to support “long-term transitions to peace and democracy
back home”. Fostering diaspora networks and providing political
resources may not only prove a more successful but also a less
expensive means of encouraging democratic transitions in “troubled
countries” than current efforts to effect change through aid or
intervention. Western democratic governments that refuse to
acknowledge this potential, so the argument continues, will forgo the
opportunity to fulfill their liberal foreign policy commitments while
meeting refugees’ immediate material concerns, including legal status
and temporary resettlement.
This proposal, though elegant, has several blind spots. It neglects,
for example, the refugees who would prefer not to be associated with
the political situation in their home countries, let alone be expected
to return and change them. Many seek to distance themselves from
recent trauma, while others deliberately adopt new identities (some
even rejecting the label of “refugee” altogether) in order to start
new lives and find new communities. It also neglects the refugees
whose social networks and personal resources are less easily mobilised
for political change in their home countries – those whose families
are at risk of severe repercussions, for example, or those who are
already marginalised in their societies of origin. Treating refugees
as “useful” for political change implicitly devalues those who lack
either the desire or the means to aid the rebuilding process.
But there are deeper problems at the root of this argument. Attempts
to reconcile refugees to host states’ agendas represent an erosion of
the basis of the refugee protection regime: the understanding that
states have obligations towards refugees, and ought to reconcile their
own agendas to fulfilling them. Specifically, states’ policies should
recognise that refugees are in need of protection precisely because
their individual freedoms – including the freedom to determine their
own political actions – have been overridden by their home nations,
leaving them, in the words of the 1951 Refugee Convention, “unable
[...] or unwilling to avail themselves of the protections of [those]
countries”. The primary duty of a receiving state is thus to restore
the refugee’s personal agency: something that is easily occluded by
re-framing the refugee, instead, to suit its foreign policy goals.
Sadly, these are not hypothetical criticisms. Refugees have,
historically, borne the costs of being treated as political resources
by their hosts or powerful neighbours. As Ben Rawlence argued
(
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last year in The New York Times, Kenya’s decision to close the refugee
camp at Dadaab – the world’s largest – and return close to 600,000
Somali refugees could be seen as an attempt to extract political
concessions from Western donors and foster unrest in Somalia. To be
fair, Betts acknowledges that past attempts to mobilise refugees for
political change, such as US reliance on “refugee warriors” in
Honduras and Pakistan, have been problematic, and seeks to distance
his proposal from these examples through an emphasis on “non-violent
political opposition”. But while the projected ends of democratisation
and political change seem to be more subtle, peaceful, and legitimate,
it is hard to argue
that they justify the means – which similarly risk obscuring refugees’
wishes and aims.
Betts argues that states should “empower refugees”. We agree. But the
idea of conceptualising refugees as “useful” to an international
agenda does just the opposite. In order to truly empower refugees, we
must eschew the rhetoric that they can be our “resources”. Otherwise,
we view refugees as valuable only in so far as they are worth
something to our rebuilding projects. And under this framing, to
borrow Phil Cole’s words
(
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, the refugee “has their representation determined for them”.
Rebecca Buxton is a student at Oxford University, reading for an MSc
in Refugee and Forced Migration Studies. She also served as president
of the KCL Student Action for Refugees from 2015-2016.
Theophilus Kwek was formerly vice-president of the Oxford Students’
Oxfam Group. He is also reading for the MSc in Refugee and Forced
Migration Studies at Oxford University.
(TOP PHOTO: Newly arrived refugees at Dadaab refugee camp, Kenya,
2011. UNICEF/Riccardo Gangale)
rb-tk/ag
201107180839560213.jpg
(
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Opinion (/opinion) Aid and Policy (/aid-and-policy) Migration
(/migration) Refugees are not “political resources” Rebecca Buxton
(/authors/rebecca-buxton) Theophilus Kwek (/authors/theophilus-kwek)
IRIN (/byline/irin) A reply to Alexander Betts OXFORD
(/publication-location/oxford) Africa (/africa) Americas (/americas)
Asia (/asia) Europe (/europe) Global (/global) Middle East and North
Africa (/middle-east-and-north-africa)
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