This study analyzes findings from a rapid-response community-based qualitative research initiativ... more This study analyzes findings from a rapid-response community-based qualitative research initiative to study the content of Ebola-related communications and the transmission of Ebola-related behaviors and practices through mass media communications and social learning in Monrovia, Liberia during August–September 2014. Thirteen neighborhoods in the common Monrovia media market were studied to appraise the reach of health communications and outreach regarding Ebola prevention and response measures. A World Health Organization (WHO) research team collected data on social learning and Ebola knowledge, attitudes, and practices through focus group–based discussions and key informant interviews over a 14-day period to assess the spread of information during a period of rapidly escalating crisis. Findings show that during a 2- week period, Monrovia neighborhood residents demonstrated rapid changes in beliefs about the source of Ebola, modes of contagion, and infection prevention and control (IPC) practices, discarding incorrect information. Changes in practices tended to lag behind the acquisition of learning. Findings also show that many continued to support conspiracy theories even as correct information was acquired. The implications for community engagement are substantial: (1) Under conditions of accelerating mortality, communities rapidly assimilate health information and abandon incorrect information; (2) Behavior change is likely to lag behind changes in beliefs due to local physical, structural, sociocultural, and institutional constraints; (3) Reports of “resistance” in Monrovia during the Ebola response were overstated and based on a limited number of incidents, and failed to account for specific local conditions and constraints.
Anthropology's response to the West African Ebola epidemic was one of the most rapid and expansiv... more Anthropology's response to the West African Ebola epidemic was one of the most rapid and expansive anthropological interventions to a global health emergency in the discipline's history. This article sets forth the size and scale of the anthropological response and describes the protagonists, interventions , and priorities for anthropological engagement. It takes an inclusive approach to anthropological praxis by engaging with the work of nonanthro-pologist " allies, " including qualitative researchers, social workers, and allied experts. The article narrates how the concept of " anthropology " came to serve as a semantic marker of solidarity with local populations, respect for customary practices and local sociopolitical realities, and an avowed belief in the capacities of local populations to lead localized epidemic prevention and response efforts. Of particular consideration is the range of complementary and conflicting epistemological, professional, and critical engagements held by anthropologists. The article also discusses how to assess anthropological " impact " in epidemics. 421
The 2014 West African Ebola epidemic prompted reconsideration of West African health systems’ res... more The 2014 West African Ebola epidemic prompted reconsideration of West African health systems’ resilience to external shocks. To understand the post-conflict histories of West Africa’s health systems reconstruction, it is necessary to understand the health systems in place when the epidemic emerged. This paper recounts the debates that shaped Liberia’s post- conflict health sector from 2003 to 2014, with particular attention to 2006–2008, when two Med́ecinsSansFrontier̀es(MSF)unitswithdrew,andWorldVisionclosedclinicsacross Liberia, prompting a national healthcare crisis. These debates highlighted medical non- governmental organizations’ (NGOs’) obligations to provide health care to vulnerable post- conflict populations; the restricted support available for health care in low-income post- conflict countries; and the demand for Liberian sovereignty over the national healthcare sector. They juxtaposed financial, bureaucratic, and logistical demands against public health, political, and post-conflict security risks. Through interviews with insiders in the Liberian government, medical NGOs, and Liberian healthcare providers, this paper presents a narrative of post- conflict health sector transition that reveals how post-conflict transitions create moral, bureaucratic, and procedural dilemmas requiring ad hoc responses from humanitarian and national government actors. Although funding for the Liberian health sector was ultimately obtained, the surveillance, coordination, testing, and social mobilization vulnerabilities then in place set the stage for the 2014 Ebola epidemic.
(2016): Community-based reports of morbidity, mortality, and health-seeking behaviours in four Mo... more (2016): Community-based reports of morbidity, mortality, and health-seeking behaviours in four Monrovia communities during the West African Ebola epidemic, Global Public Health,
Medical humanitarianism—medical and other health-related initiatives undertaken in conditions bor... more Medical humanitarianism—medical and other health-related initiatives undertaken in conditions born of conflict, neglect, or disaster —has a prominent and growing presence in international development, global health, and human security interventions. Medical Humanitarianism: Ethnographies of Practice features twelve essays that fold back the curtains on the individual experiences, institutional practices, and cultural forces that shape humanitarian practice.
Contributors offer vivid and often dramatic insights into the experiences of local humanitarian workers in the Afghan-Pakistan border areas, national doctors coping with influxes of foreign humanitarian volunteers in Haiti, military doctors working for the British Army in Iraq and Afghanistan, and human rights-oriented volunteers within the Israeli medical bureaucracy. They analyze our contested understanding of lethal violence in Darfur, food crises responses in Niger, humanitarian knowledge in Ugandan IDP camps, and humanitarian departures in Liberia. They depict the local dynamics of healthcare delivery work to alleviate human suffering in Somali areas of Ethiopia, the emergency metaphors of global health campaigns from Ghana to war-torn Sudan, the fraught negotiations of humanitarians with strong state institutions in Indonesia, and the ambiguous character of research ethics espoused by missions in Sierra Leone. In providing well-grounded case studies, Medical Humanitarianism will engage both scholars and practitioners working at the interface of humanitarian medicine, global health interventions, and the social sciences. They challenge the reader to reach a more critical and compassionate understanding of humanitarian assistance.
Contributors: Sharon Abramowitz, Tim Allen, Ilil Benjamin, Lauren Carruth, Mary Jo DelVecchio-Good, Alex de Waal, Byron J. Good, Stuart Gordon, Jesse Hession Grayman, Jean-Hervé Jézéquel, Peter Locke, Amy Moran-Thomas, Patricia Omidian, Catherine Panter-Brick, Peter Piot, Peter Redfield, Laura Wagner
Sharon Abramowitz is Associate Professor of Anthropology and Africa Studies at the University of Florida and author of Searching for Normal in the Wake of the Liberian War, also available from the University of Pennsylvania Press.
Catherine Panter-Brick is Professor of Anthropology, Health, and Global Affairs at Yale University, and Director of the MacMillan Program on Conflict, Resilience, and Health. She has coedited six books, most recently Pathways to Peace.
Medicine Anthropology Theory seeks to ‘open up’ medical anthropology by ‘embracing the concept of... more Medicine Anthropology Theory seeks to ‘open up’ medical anthropology by ‘embracing the concept of open access’ (Moyer and Nguyen 2014). The hope is that making all content free and easily accessible on the MAT website will engage broader publics, including scholars at international institutes who are unable to afford the access fees of for-profit journals; scholars without a formal affiliation to a library, such as underemployed academics and recent graduates on the job market; and practitioners and advocates in the communities where we work.
As a journal focused on health and medicine, there are, however, a number of ethically and politically complex concerns raised by the widespread dissemination of MAT’s contents. The imperative of ‘openness’, which resonates with efforts to make data ‘open’ within biomedical sciences (and related institutions that fund, publish, or grant ethical approval), can raise problems for medical anthropologists who work in communities where patient anonymity and vulnerability is a concern, as well as those working in places where indigenous property rights destabilize ‘the good’ of democratic distribution. Since navigating the nuances of openness and access is central to the practice of carrying out social science in the fields of health and medicine, we have gathered together six scholars who have worked in medical settings, and asked them to discuss frictions surrounding the dissemination of knowledge they have encountered in their research.
A word about the ‘we’ here. This conversation was initiated by Emily Yates-Doerr, and curated in collaboration with Jenna Grant (Reviews Editor at MAT). We have asked the contributors to reflect on how ‘open access’ – in the broadest sense of the term – plays out in their research and writing. Our hope is that this collectively written document will enrich the open-access conversation, as it unfolds both within and beyond the field of medical anthropology. The aim is not to critique the current momentum of open access as much as it is to raise and think through some of its complexities.
Background
The West African Ebola epidemic has demonstrated that the existing range of medical a... more Background
The West African Ebola epidemic has demonstrated that the existing range of medical and epidemiological responses to emerging disease outbreaks is insufficient, especially in post-conflict contexts with exceedingly poor healthcare infrastructures. In this context, community-based responses have proven vital for containing Ebola virus disease (EVD) and shifting the epidemic curve. Despite a surge in interest in local innovations that effectively contained the epidemic, the mechanisms for community-based response remain unclear. This study provides baseline information on community-based epidemic control priorities and identifies innovative local strategies for containing EVD in Liberia.
Methodology/Principal Findings
This study was conducted in September 2014 in 15 communities in Monrovia and Montserrado County, Liberia – one of the epicenters of the Ebola outbreak. Findings from 15 focus group discussions with 386 community leaders identified strategies being undertaken and recommendations for what a community-based response to Ebola should look like under then-existing conditions. Data were collected on the following topics: prevention, surveillance, care-giving, community-based treatment and support, networks and hotlines, response teams, Ebola treatment units (ETUs) and hospitals, the management of corpses, quarantine and isolation, orphans, memorialization, and the need for community-based training and education. Findings have been presented as community-based strategies and recommendations for (1) prevention, (2) treatment and response, and (3) community sequelae and recovery. Several models for community-based management of the current Ebola outbreak were proposed. Additional findings indicate positive attitudes towards early Ebola survivors, and the need for community-based psychosocial support.
Conclusions/Significance
Local communities’ strategies and recommendations give insight into how urban Liberian communities contained the EVD outbreak while navigating the systemic failures of the initial state and international response. Communities in urban Liberia adapted to the epidemic using multiple coping strategies. In the absence of health, infrastructural and material supports, local people engaged in self-reliance in order to contain the epidemic at the micro-social level. These innovations were regarded as necessary, but as less desirable than a well-supported health-systems based response; and were seen as involving considerable individual, social, and public health costs, including heightened vulnerability to infection.
In recent years, anthropologists have become increasingly present in medical humanitarian situati... more In recent years, anthropologists have become increasingly present in medical humanitarian situations as scholars, consultants, and humanitarian practitioners and have acquired insight into medical humanitarian policy and practice. In 2012, we implemented a poll on anthropology, health, and humanitarian practice in which 75 anthropologists discussed their experiences in medical humanitarianism. Our goal was to move beyond the existing anarchy of individual voices in anthropological writing and gain an aggregate view of the perspective of anthropologists working in medical humanitarian contexts. Responses lead to six inductively derived thematic priorities. The findings illustrate how anthropologists perceive medical humanitarian practice; which aspects of medical humanitarianism should be seen as priorities for anthropological research; and how anthropologists use ethnography in humanitarian contexts.
UMI, ProQuest ® Dissertations & Theses. The world's most comprehensive c... more UMI, ProQuest ® Dissertations & Theses. The world's most comprehensive collection of dissertations and theses. Learn more... ProQuest, Psychosocial Liberia: Managing suffering in post-conflict life. by Abramowitz, Sharon Alane ...
This study analyzes findings from a rapid-response community-based qualitative research initiativ... more This study analyzes findings from a rapid-response community-based qualitative research initiative to study the content of Ebola-related communications and the transmission of Ebola-related behaviors and practices through mass media communications and social learning in Monrovia, Liberia during August–September 2014. Thirteen neighborhoods in the common Monrovia media market were studied to appraise the reach of health communications and outreach regarding Ebola prevention and response measures. A World Health Organization (WHO) research team collected data on social learning and Ebola knowledge, attitudes, and practices through focus group–based discussions and key informant interviews over a 14-day period to assess the spread of information during a period of rapidly escalating crisis. Findings show that during a 2- week period, Monrovia neighborhood residents demonstrated rapid changes in beliefs about the source of Ebola, modes of contagion, and infection prevention and control (IPC) practices, discarding incorrect information. Changes in practices tended to lag behind the acquisition of learning. Findings also show that many continued to support conspiracy theories even as correct information was acquired. The implications for community engagement are substantial: (1) Under conditions of accelerating mortality, communities rapidly assimilate health information and abandon incorrect information; (2) Behavior change is likely to lag behind changes in beliefs due to local physical, structural, sociocultural, and institutional constraints; (3) Reports of “resistance” in Monrovia during the Ebola response were overstated and based on a limited number of incidents, and failed to account for specific local conditions and constraints.
Anthropology's response to the West African Ebola epidemic was one of the most rapid and expansiv... more Anthropology's response to the West African Ebola epidemic was one of the most rapid and expansive anthropological interventions to a global health emergency in the discipline's history. This article sets forth the size and scale of the anthropological response and describes the protagonists, interventions , and priorities for anthropological engagement. It takes an inclusive approach to anthropological praxis by engaging with the work of nonanthro-pologist " allies, " including qualitative researchers, social workers, and allied experts. The article narrates how the concept of " anthropology " came to serve as a semantic marker of solidarity with local populations, respect for customary practices and local sociopolitical realities, and an avowed belief in the capacities of local populations to lead localized epidemic prevention and response efforts. Of particular consideration is the range of complementary and conflicting epistemological, professional, and critical engagements held by anthropologists. The article also discusses how to assess anthropological " impact " in epidemics. 421
The 2014 West African Ebola epidemic prompted reconsideration of West African health systems’ res... more The 2014 West African Ebola epidemic prompted reconsideration of West African health systems’ resilience to external shocks. To understand the post-conflict histories of West Africa’s health systems reconstruction, it is necessary to understand the health systems in place when the epidemic emerged. This paper recounts the debates that shaped Liberia’s post- conflict health sector from 2003 to 2014, with particular attention to 2006–2008, when two Med́ecinsSansFrontier̀es(MSF)unitswithdrew,andWorldVisionclosedclinicsacross Liberia, prompting a national healthcare crisis. These debates highlighted medical non- governmental organizations’ (NGOs’) obligations to provide health care to vulnerable post- conflict populations; the restricted support available for health care in low-income post- conflict countries; and the demand for Liberian sovereignty over the national healthcare sector. They juxtaposed financial, bureaucratic, and logistical demands against public health, political, and post-conflict security risks. Through interviews with insiders in the Liberian government, medical NGOs, and Liberian healthcare providers, this paper presents a narrative of post- conflict health sector transition that reveals how post-conflict transitions create moral, bureaucratic, and procedural dilemmas requiring ad hoc responses from humanitarian and national government actors. Although funding for the Liberian health sector was ultimately obtained, the surveillance, coordination, testing, and social mobilization vulnerabilities then in place set the stage for the 2014 Ebola epidemic.
(2016): Community-based reports of morbidity, mortality, and health-seeking behaviours in four Mo... more (2016): Community-based reports of morbidity, mortality, and health-seeking behaviours in four Monrovia communities during the West African Ebola epidemic, Global Public Health,
Medical humanitarianism—medical and other health-related initiatives undertaken in conditions bor... more Medical humanitarianism—medical and other health-related initiatives undertaken in conditions born of conflict, neglect, or disaster —has a prominent and growing presence in international development, global health, and human security interventions. Medical Humanitarianism: Ethnographies of Practice features twelve essays that fold back the curtains on the individual experiences, institutional practices, and cultural forces that shape humanitarian practice.
Contributors offer vivid and often dramatic insights into the experiences of local humanitarian workers in the Afghan-Pakistan border areas, national doctors coping with influxes of foreign humanitarian volunteers in Haiti, military doctors working for the British Army in Iraq and Afghanistan, and human rights-oriented volunteers within the Israeli medical bureaucracy. They analyze our contested understanding of lethal violence in Darfur, food crises responses in Niger, humanitarian knowledge in Ugandan IDP camps, and humanitarian departures in Liberia. They depict the local dynamics of healthcare delivery work to alleviate human suffering in Somali areas of Ethiopia, the emergency metaphors of global health campaigns from Ghana to war-torn Sudan, the fraught negotiations of humanitarians with strong state institutions in Indonesia, and the ambiguous character of research ethics espoused by missions in Sierra Leone. In providing well-grounded case studies, Medical Humanitarianism will engage both scholars and practitioners working at the interface of humanitarian medicine, global health interventions, and the social sciences. They challenge the reader to reach a more critical and compassionate understanding of humanitarian assistance.
Contributors: Sharon Abramowitz, Tim Allen, Ilil Benjamin, Lauren Carruth, Mary Jo DelVecchio-Good, Alex de Waal, Byron J. Good, Stuart Gordon, Jesse Hession Grayman, Jean-Hervé Jézéquel, Peter Locke, Amy Moran-Thomas, Patricia Omidian, Catherine Panter-Brick, Peter Piot, Peter Redfield, Laura Wagner
Sharon Abramowitz is Associate Professor of Anthropology and Africa Studies at the University of Florida and author of Searching for Normal in the Wake of the Liberian War, also available from the University of Pennsylvania Press.
Catherine Panter-Brick is Professor of Anthropology, Health, and Global Affairs at Yale University, and Director of the MacMillan Program on Conflict, Resilience, and Health. She has coedited six books, most recently Pathways to Peace.
Medicine Anthropology Theory seeks to ‘open up’ medical anthropology by ‘embracing the concept of... more Medicine Anthropology Theory seeks to ‘open up’ medical anthropology by ‘embracing the concept of open access’ (Moyer and Nguyen 2014). The hope is that making all content free and easily accessible on the MAT website will engage broader publics, including scholars at international institutes who are unable to afford the access fees of for-profit journals; scholars without a formal affiliation to a library, such as underemployed academics and recent graduates on the job market; and practitioners and advocates in the communities where we work.
As a journal focused on health and medicine, there are, however, a number of ethically and politically complex concerns raised by the widespread dissemination of MAT’s contents. The imperative of ‘openness’, which resonates with efforts to make data ‘open’ within biomedical sciences (and related institutions that fund, publish, or grant ethical approval), can raise problems for medical anthropologists who work in communities where patient anonymity and vulnerability is a concern, as well as those working in places where indigenous property rights destabilize ‘the good’ of democratic distribution. Since navigating the nuances of openness and access is central to the practice of carrying out social science in the fields of health and medicine, we have gathered together six scholars who have worked in medical settings, and asked them to discuss frictions surrounding the dissemination of knowledge they have encountered in their research.
A word about the ‘we’ here. This conversation was initiated by Emily Yates-Doerr, and curated in collaboration with Jenna Grant (Reviews Editor at MAT). We have asked the contributors to reflect on how ‘open access’ – in the broadest sense of the term – plays out in their research and writing. Our hope is that this collectively written document will enrich the open-access conversation, as it unfolds both within and beyond the field of medical anthropology. The aim is not to critique the current momentum of open access as much as it is to raise and think through some of its complexities.
Background
The West African Ebola epidemic has demonstrated that the existing range of medical a... more Background
The West African Ebola epidemic has demonstrated that the existing range of medical and epidemiological responses to emerging disease outbreaks is insufficient, especially in post-conflict contexts with exceedingly poor healthcare infrastructures. In this context, community-based responses have proven vital for containing Ebola virus disease (EVD) and shifting the epidemic curve. Despite a surge in interest in local innovations that effectively contained the epidemic, the mechanisms for community-based response remain unclear. This study provides baseline information on community-based epidemic control priorities and identifies innovative local strategies for containing EVD in Liberia.
Methodology/Principal Findings
This study was conducted in September 2014 in 15 communities in Monrovia and Montserrado County, Liberia – one of the epicenters of the Ebola outbreak. Findings from 15 focus group discussions with 386 community leaders identified strategies being undertaken and recommendations for what a community-based response to Ebola should look like under then-existing conditions. Data were collected on the following topics: prevention, surveillance, care-giving, community-based treatment and support, networks and hotlines, response teams, Ebola treatment units (ETUs) and hospitals, the management of corpses, quarantine and isolation, orphans, memorialization, and the need for community-based training and education. Findings have been presented as community-based strategies and recommendations for (1) prevention, (2) treatment and response, and (3) community sequelae and recovery. Several models for community-based management of the current Ebola outbreak were proposed. Additional findings indicate positive attitudes towards early Ebola survivors, and the need for community-based psychosocial support.
Conclusions/Significance
Local communities’ strategies and recommendations give insight into how urban Liberian communities contained the EVD outbreak while navigating the systemic failures of the initial state and international response. Communities in urban Liberia adapted to the epidemic using multiple coping strategies. In the absence of health, infrastructural and material supports, local people engaged in self-reliance in order to contain the epidemic at the micro-social level. These innovations were regarded as necessary, but as less desirable than a well-supported health-systems based response; and were seen as involving considerable individual, social, and public health costs, including heightened vulnerability to infection.
In recent years, anthropologists have become increasingly present in medical humanitarian situati... more In recent years, anthropologists have become increasingly present in medical humanitarian situations as scholars, consultants, and humanitarian practitioners and have acquired insight into medical humanitarian policy and practice. In 2012, we implemented a poll on anthropology, health, and humanitarian practice in which 75 anthropologists discussed their experiences in medical humanitarianism. Our goal was to move beyond the existing anarchy of individual voices in anthropological writing and gain an aggregate view of the perspective of anthropologists working in medical humanitarian contexts. Responses lead to six inductively derived thematic priorities. The findings illustrate how anthropologists perceive medical humanitarian practice; which aspects of medical humanitarianism should be seen as priorities for anthropological research; and how anthropologists use ethnography in humanitarian contexts.
UMI, ProQuest ® Dissertations & Theses. The world's most comprehensive c... more UMI, ProQuest ® Dissertations & Theses. The world's most comprehensive collection of dissertations and theses. Learn more... ProQuest, Psychosocial Liberia: Managing suffering in post-conflict life. by Abramowitz, Sharon Alane ...
Medical humanitarianism--medical and other health-related initiatives undertaken in conditions bo... more Medical humanitarianism--medical and other health-related initiatives undertaken in conditions born of conflict, neglect, or disaster --has a prominent and growing presence in international development, global health, and human security interventions. Medical Humanitarianism: Ethnographies of Practice features twelve essays that fold back the curtains on the individual experiences, institutional practices, and cultural forces that shape humanitarian practice.
Contributors offer vivid and often dramatic insights into the experiences of local humanitarian workers in the Afghan-Pakistan border areas, national doctors coping with influxes of foreign humanitarian volunteers in Haiti, military doctors working for the British Army in Iraq and Afghanistan, and human rights-oriented volunteers within the Israeli medical bureaucracy. They analyze our contested understanding of lethal violence in Darfur, food crises responses in Niger, humanitarian knowledge in Ugandan IDP camps, and humanitarian departures in Liberia. They depict the local dynamics of healthcare delivery work to alleviate human suffering in Somali areas of Ethiopia, the emergency metaphors of global health campaigns from Ghana to war-torn Sudan, the fraught negotiations of humanitarians with strong state institutions in Indonesia, and the ambiguous character of research ethics espoused by missions in Sierra Leone. In providing well-grounded case studies, Medical Humanitarianism will engage both scholars and practitioners working at the interface of humanitarian medicine, global health interventions, and the social sciences. They challenge the reader to reach a more critical and compassionate understanding of humanitarian assistance.
Contributors: Sharon Abramowitz, Tim Allen, Ilil Benjamin, Lauren Carruth, Mary Jo DelVecchio-Good, Alex de Waal, Byron J. Good, Stuart Gordon, Jesse Hession Grayman, Jean-Hervé Jézéquel, Peter Locke, Amy Moran-Thomas, Patricia Omidian, Catherine Panter-Brick, Peter Piot, Peter Redfield, Laura Wagner
The Ebola response shows the need for new global mechanisms to be established that can rapidly m... more The Ebola response shows the need for new global mechanisms to be established that can rapidly mobilise all experts who can bring relevant local contextual, medical, epidemiological, and political information on global health emergencies. Now is the time to consider how to bring social science into the centre of future pandemic surveillance, response, community preparedness, and health system strengthening.
This paper presents a hypothesis for understanding how Ebolavirus disease (EVD) has moved differe... more This paper presents a hypothesis for understanding how Ebolavirus disease (EVD) has moved differentially through Guinea, Liberia, and Sierra Leone, following culturally and socially distinctive patterns of transmission. This document sythesizes research conducted by recent research in Sierra Leone (Richards et al. 2015), expert observations and analyses regarding state distrust and instability in Guinea (James Fairhead, informal communication; McGovern 2004, 2012), and a preliminary analysis of 2014 WHO data on the local cotext of Ebola transmission in Monrovia, Liberia (Abramowitz et al. 2015). The conceptual premise of this document is that current capacity of Ebola response is fundamentally constrained by existing inefficiencies of the case tracking and case reporting system.
Objective: The objective of this study was to identify the pace of Ebola-related social learning ... more Objective: The objective of this study was to identify the pace of Ebola-related social learning in urban and peri-urban areas around Monrovia, Liberia during August 2014, the onset of the emergency phase of the epidemic. Data: Research teams collected data in 13 discrete neighborhood sites over fourteen consecutive days via focus groups, community discussions, and key informant interviews for the purpose of program development. Data was de-identified and shared with research partners for analysis. Findings: The study’s findings indicate that within a two-week period, community members demonstrated rapid social learning of correct information about the source of the Ebolavirus and methods for prevention, as well as the rapid dismissal of of incorrect information about the virus. The data also suggest that a critical moment for a shift in social learning took place after the research midpoint, during days 7-10 (of a total of 14). Conclusion: The research demonstrates that under conditions of accelerating health crises, low income and low-resource communities can rapidly assimilate correct health information and dispel incorrect information, even in a context of heightened instability, suspicion, and misinformation.
The objective of this study was to identify epidemic control priorities among 15 communities in M... more The objective of this study was to identify epidemic control priorities among 15 communities in Monrovia and Montserrado County, Liberia – one of the hardest hit areas by the current Ebola outbreak. Findings from 15 focus group discussions with 386 community leaders identified specific strategies currently being undertaken and “ideal-typical” representations of what a community-based response to Ebola should look like. Data were collected on the following topics: prevention, surveillance, care-giving, community-based treatment and support, networking/hotlines/calling response teams and referrals, management of corpses, quarantine and isolation, orphans, memorialization, and the need for community-based training and education. Findings have been presented as recommendations for (1) Prevention, (2) Treatment and Response, and (3) Sequelae. The study also reviewed issues of fear and stigma towards Ebola victims and survivors, examined communities could draw upon survivors as resources in the outbreak, and studied how communities could provide psychosocial support to those who have been affected by Ebola. The findings provide several models that can inform international and governmental support for community-based management of the current Ebola outbreak.
Curated by Emily Yates-Doerr, Jenna Grant
Contributors: Emma Kowal, Todd Meyers, Eugene Raikhel, ... more Curated by Emily Yates-Doerr, Jenna Grant Contributors: Emma Kowal, Todd Meyers, Eugene Raikhel, Peter Redfield, Sharon Abramowitz, Barbara Andersen, and Eileen Moyer
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Papers by Sharon Abramowitz
Contributors offer vivid and often dramatic insights into the experiences of local humanitarian workers in the Afghan-Pakistan border areas, national doctors coping with influxes of foreign humanitarian volunteers in Haiti, military doctors working for the British Army in Iraq and Afghanistan, and human rights-oriented volunteers within the Israeli medical bureaucracy. They analyze our contested understanding of lethal violence in Darfur, food crises responses in Niger, humanitarian knowledge in Ugandan IDP camps, and humanitarian departures in Liberia. They depict the local dynamics of healthcare delivery work to alleviate human suffering in Somali areas of Ethiopia, the emergency metaphors of global health campaigns from Ghana to war-torn Sudan, the fraught negotiations of humanitarians with strong state institutions in Indonesia, and the ambiguous character of research ethics espoused by missions in Sierra Leone. In providing well-grounded case studies, Medical Humanitarianism will engage both scholars and practitioners working at the interface of humanitarian medicine, global health interventions, and the social sciences. They challenge the reader to reach a more critical and compassionate understanding of humanitarian assistance.
Contributors: Sharon Abramowitz, Tim Allen, Ilil Benjamin, Lauren Carruth, Mary Jo DelVecchio-Good, Alex de Waal, Byron J. Good, Stuart Gordon, Jesse Hession Grayman, Jean-Hervé Jézéquel, Peter Locke, Amy Moran-Thomas, Patricia Omidian, Catherine Panter-Brick, Peter Piot, Peter Redfield, Laura Wagner
Sharon Abramowitz is Associate Professor of Anthropology and Africa Studies at the University of Florida and author of Searching for Normal in the Wake of the Liberian War, also available from the University of Pennsylvania Press.
Catherine Panter-Brick is Professor of Anthropology, Health, and Global Affairs at Yale University, and Director of the MacMillan Program on Conflict, Resilience, and Health. She has coedited six books, most recently Pathways to Peace.
As a journal focused on health and medicine, there are, however, a number of ethically and politically complex concerns raised by the widespread dissemination of MAT’s contents. The imperative of ‘openness’, which resonates with efforts to make data ‘open’ within biomedical sciences (and related institutions that fund, publish, or grant ethical approval), can raise problems for medical anthropologists who work in communities where patient anonymity and vulnerability is a concern, as well as those working in places where indigenous property rights destabilize ‘the good’ of democratic distribution. Since navigating the nuances of openness and access is central to the practice of carrying out social science in the fields of health and medicine, we have gathered together six scholars who have worked in medical settings, and asked them to discuss frictions surrounding the dissemination of knowledge they have encountered in their research.
A word about the ‘we’ here. This conversation was initiated by Emily Yates-Doerr, and curated in collaboration with Jenna Grant (Reviews Editor at MAT). We have asked the contributors to reflect on how ‘open access’ – in the broadest sense of the term – plays out in their research and writing. Our hope is that this collectively written document will enrich the open-access conversation, as it unfolds both within and beyond the field of medical anthropology. The aim is not to critique the current momentum of open access as much as it is to raise and think through some of its complexities.
The West African Ebola epidemic has demonstrated that the existing range of medical and epidemiological responses to emerging disease outbreaks is insufficient, especially in post-conflict contexts with exceedingly poor healthcare infrastructures. In this context, community-based responses have proven vital for containing Ebola virus disease (EVD) and shifting the epidemic curve. Despite a surge in interest in local innovations that effectively contained the epidemic, the mechanisms for community-based response remain unclear. This study provides baseline information on community-based epidemic control priorities and identifies innovative local strategies for containing EVD in Liberia.
Methodology/Principal Findings
This study was conducted in September 2014 in 15 communities in Monrovia and Montserrado County, Liberia – one of the epicenters of the Ebola outbreak. Findings from 15 focus group discussions with 386 community leaders identified strategies being undertaken and recommendations for what a community-based response to Ebola should look like under then-existing conditions. Data were collected on the following topics: prevention, surveillance, care-giving, community-based treatment and support, networks and hotlines, response teams, Ebola treatment units (ETUs) and hospitals, the management of corpses, quarantine and isolation, orphans, memorialization, and the need for community-based training and education. Findings have been presented as community-based strategies and recommendations for (1) prevention, (2) treatment and response, and (3) community sequelae and recovery. Several models for community-based management of the current Ebola outbreak were proposed. Additional findings indicate positive attitudes towards early Ebola survivors, and the need for community-based psychosocial support.
Conclusions/Significance
Local communities’ strategies and recommendations give insight into how urban Liberian communities contained the EVD outbreak while navigating the systemic failures of the initial state and international response. Communities in urban Liberia adapted to the epidemic using multiple coping strategies. In the absence of health, infrastructural and material supports, local people engaged in self-reliance in order to contain the epidemic at the micro-social level. These innovations were regarded as necessary, but as less desirable than a well-supported health-systems based response; and were seen as involving considerable individual, social, and public health costs, including heightened vulnerability to infection.
thematic priorities. The findings illustrate how anthropologists perceive medical humanitarian
practice; which aspects of medical humanitarianism should be seen as priorities for anthropological research; and how anthropologists use ethnography
in humanitarian contexts.
Contributors offer vivid and often dramatic insights into the experiences of local humanitarian workers in the Afghan-Pakistan border areas, national doctors coping with influxes of foreign humanitarian volunteers in Haiti, military doctors working for the British Army in Iraq and Afghanistan, and human rights-oriented volunteers within the Israeli medical bureaucracy. They analyze our contested understanding of lethal violence in Darfur, food crises responses in Niger, humanitarian knowledge in Ugandan IDP camps, and humanitarian departures in Liberia. They depict the local dynamics of healthcare delivery work to alleviate human suffering in Somali areas of Ethiopia, the emergency metaphors of global health campaigns from Ghana to war-torn Sudan, the fraught negotiations of humanitarians with strong state institutions in Indonesia, and the ambiguous character of research ethics espoused by missions in Sierra Leone. In providing well-grounded case studies, Medical Humanitarianism will engage both scholars and practitioners working at the interface of humanitarian medicine, global health interventions, and the social sciences. They challenge the reader to reach a more critical and compassionate understanding of humanitarian assistance.
Contributors: Sharon Abramowitz, Tim Allen, Ilil Benjamin, Lauren Carruth, Mary Jo DelVecchio-Good, Alex de Waal, Byron J. Good, Stuart Gordon, Jesse Hession Grayman, Jean-Hervé Jézéquel, Peter Locke, Amy Moran-Thomas, Patricia Omidian, Catherine Panter-Brick, Peter Piot, Peter Redfield, Laura Wagner
Sharon Abramowitz is Associate Professor of Anthropology and Africa Studies at the University of Florida and author of Searching for Normal in the Wake of the Liberian War, also available from the University of Pennsylvania Press.
Catherine Panter-Brick is Professor of Anthropology, Health, and Global Affairs at Yale University, and Director of the MacMillan Program on Conflict, Resilience, and Health. She has coedited six books, most recently Pathways to Peace.
As a journal focused on health and medicine, there are, however, a number of ethically and politically complex concerns raised by the widespread dissemination of MAT’s contents. The imperative of ‘openness’, which resonates with efforts to make data ‘open’ within biomedical sciences (and related institutions that fund, publish, or grant ethical approval), can raise problems for medical anthropologists who work in communities where patient anonymity and vulnerability is a concern, as well as those working in places where indigenous property rights destabilize ‘the good’ of democratic distribution. Since navigating the nuances of openness and access is central to the practice of carrying out social science in the fields of health and medicine, we have gathered together six scholars who have worked in medical settings, and asked them to discuss frictions surrounding the dissemination of knowledge they have encountered in their research.
A word about the ‘we’ here. This conversation was initiated by Emily Yates-Doerr, and curated in collaboration with Jenna Grant (Reviews Editor at MAT). We have asked the contributors to reflect on how ‘open access’ – in the broadest sense of the term – plays out in their research and writing. Our hope is that this collectively written document will enrich the open-access conversation, as it unfolds both within and beyond the field of medical anthropology. The aim is not to critique the current momentum of open access as much as it is to raise and think through some of its complexities.
The West African Ebola epidemic has demonstrated that the existing range of medical and epidemiological responses to emerging disease outbreaks is insufficient, especially in post-conflict contexts with exceedingly poor healthcare infrastructures. In this context, community-based responses have proven vital for containing Ebola virus disease (EVD) and shifting the epidemic curve. Despite a surge in interest in local innovations that effectively contained the epidemic, the mechanisms for community-based response remain unclear. This study provides baseline information on community-based epidemic control priorities and identifies innovative local strategies for containing EVD in Liberia.
Methodology/Principal Findings
This study was conducted in September 2014 in 15 communities in Monrovia and Montserrado County, Liberia – one of the epicenters of the Ebola outbreak. Findings from 15 focus group discussions with 386 community leaders identified strategies being undertaken and recommendations for what a community-based response to Ebola should look like under then-existing conditions. Data were collected on the following topics: prevention, surveillance, care-giving, community-based treatment and support, networks and hotlines, response teams, Ebola treatment units (ETUs) and hospitals, the management of corpses, quarantine and isolation, orphans, memorialization, and the need for community-based training and education. Findings have been presented as community-based strategies and recommendations for (1) prevention, (2) treatment and response, and (3) community sequelae and recovery. Several models for community-based management of the current Ebola outbreak were proposed. Additional findings indicate positive attitudes towards early Ebola survivors, and the need for community-based psychosocial support.
Conclusions/Significance
Local communities’ strategies and recommendations give insight into how urban Liberian communities contained the EVD outbreak while navigating the systemic failures of the initial state and international response. Communities in urban Liberia adapted to the epidemic using multiple coping strategies. In the absence of health, infrastructural and material supports, local people engaged in self-reliance in order to contain the epidemic at the micro-social level. These innovations were regarded as necessary, but as less desirable than a well-supported health-systems based response; and were seen as involving considerable individual, social, and public health costs, including heightened vulnerability to infection.
thematic priorities. The findings illustrate how anthropologists perceive medical humanitarian
practice; which aspects of medical humanitarianism should be seen as priorities for anthropological research; and how anthropologists use ethnography
in humanitarian contexts.
Contributors offer vivid and often dramatic insights into the experiences of local humanitarian workers in the Afghan-Pakistan border areas, national doctors coping with influxes of foreign humanitarian volunteers in Haiti, military doctors working for the British Army in Iraq and Afghanistan, and human rights-oriented volunteers within the Israeli medical bureaucracy. They analyze our contested understanding of lethal violence in Darfur, food crises responses in Niger, humanitarian knowledge in Ugandan IDP camps, and humanitarian departures in Liberia. They depict the local dynamics of healthcare delivery work to alleviate human suffering in Somali areas of Ethiopia, the emergency metaphors of global health campaigns from Ghana to war-torn Sudan, the fraught negotiations of humanitarians with strong state institutions in Indonesia, and the ambiguous character of research ethics espoused by missions in Sierra Leone. In providing well-grounded case studies, Medical Humanitarianism will engage both scholars and practitioners working at the interface of humanitarian medicine, global health interventions, and the social sciences. They challenge the reader to reach a more critical and compassionate understanding of humanitarian assistance.
Contributors: Sharon Abramowitz, Tim Allen, Ilil Benjamin, Lauren Carruth, Mary Jo DelVecchio-Good, Alex de Waal, Byron J. Good, Stuart Gordon, Jesse Hession Grayman, Jean-Hervé Jézéquel, Peter Locke, Amy Moran-Thomas, Patricia Omidian, Catherine Panter-Brick, Peter Piot, Peter Redfield, Laura Wagner
misinformation.
Contributors: Emma Kowal, Todd Meyers, Eugene Raikhel, Peter Redfield, Sharon Abramowitz, Barbara Andersen, and Eileen Moyer