12/25/14 Christmas Day
l. Somatosphere, the science, medicine, anthropology website, has an article on building health infrastructure in West Africa by Alice Street, an anthropologist from University of Edinburgh. The author makes the point that health infrastructure does not come ‘in a box’. Infrastructure depends on people to be successful, so infrastructure has to be relational. People have feelings, foibles, make mistakes, get tired, and sometimes just don’t care. The author gives West African examples of how the best plans can go afoul: hired villagers won’t work if another village’s workers are also hired; too few ambulances are available to get patients to EBOV treatment centers; non-EBOV health centers are closed because febrile patients who visited centers are later diagnosed with EBOV; a love affair between workers causes them both to flee and no paychecks are distributed. Read more about the ‘nitty-gritty’ of building infrastructure at: http://somatosphere.net/2014/12/rethinking-infrastructures.html
2. A NY Times report of mishandling of an EBOV sample at CDC (after previous mishandling of anthrax and flu specimens) is an example of the ‘nitty-gritty’ of building health infrastructure. The CDC is a state-of-the-art health infrastructure, yet mistakes repeatedly occur because humans repeatedly make mistakes. See: http://www.nytimes.com/2014/12/25/health/cdc-ebola-error-in-lab-may-have-exposed-technician-to-virus.html?ref=science&_r=0 for an account of the latest CDC human error.
3. A recent article in The Lancet 18 December by Chandler, et. al. from the London School of Hygiene and Tropical Medicine, highlights how cultural anthropology can help HCW in EBOV-infected countries work productively with villagers. Chandler, et. al. tell HCW that ‘just saying no’ to cultural practices does not work:
“From the perspective of afflicted people, however, the evidence that biomedicine is helping communities affected by Ebola can be hard to discern. Health facilities have been sources of Ebola transmission13 and many patients admitted to treatment centres do not survive. How can trust be established or collaboration developed if local people are expected to accept ideas and practices that do not accord with their own observations and experiences? In the context of a general willingness to adopt multiple modalities to achieve care and wellbeing, safer practices can be adopted without changing people’s core beliefs”
See the entire article at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62382-5/fulltext
4. Chandler, et. al. article has a reference to the Ebola Response Anthropology Platform which lets HCW know how best to interact with West Africans and EBOV-infected communities to get positive results. See the website at: http://www.ebola-anthropology.net/
5. WHO reports that the Kono District in Sierra Leone, where the latest outbreak of EBOV is located, has 14 chiefdoms. WHO and other big organizations have involved the chiefs of all these chiefdoms and set up procedures for preventing more EBOV. 300 contact tracers have been trained, and 45 people from the chiefdoms have been trained in EBOV prevention and treatment. See: http://who.int/features/2014/ebola-response-kono/en/ for details on the WHO response in Kono. Note how suspicious of the WHO measures the chiefs look in the photograph displayed.