Paper short abstract:

Survivors had very diverse experiences during the outbreak but they have vey similar needs. When implementing support mechanisms it will be necessary to consider the psycho-social impact of the disease and include those who are currently “invisible”.

Paper long abstract:

In Liberia there are an estimated 1500 Ebola survivors. Many of them have lost family members, colleagues and friends and had to watch others die in the Ebola Treatment Centers (ETU). Most have lost their personal belongings - cloths, matrasses and mobile phones, that were either burned or otherwise destroyed. One of the major challenges during the peak of the outbreak was that families were rarely informed on the status and condition of their loved ones or even had contact to them while they were sick, which created a lot of resistance among affected communities.

In November and December 2014 WHO did a rapid qualitative assessment on the psycho-social situation of survivors in Liberia. We conducted semi-structured interviews and focus-group discussions with 62 survivors in Montserrado, Bomi and Margibi counties. We were specifically interested in their illness narratives, the reactions of family and community when they came home, their resilience strategies and their needs. Survivors had very diverse experiences of family and community reception, but they have very similar needs. They need basic and specialized medical and psychosocial support but don't want to be singled out for fear of stigmatization. When implementing support mechanisms it will be necessary to consider the psycho-social impact of the disease and include those who are currently "invisible".

Paper short abstract:

As new lessons emerge on the response to the Ebola outbreak in the West African Region, it is becoming increasingly clear that community engagement is critical in the rolling out of any public health intervention. Due to the overwhelmingly high number of cases reported at the height of the epidemic, several facilities had to be reconfigured to admit, isolate and treat patients. Many such facilities were constructed in existing hospitals, schools or buildings that provided other functions prior to the outbreak. New facilities were also constructed to deal with the epidemic.

Paper long abstract:

As Liberia makes significant progress in halting the Ebola Outbreak that ravaged the West African region, efforts are now geared towards rebuilding and strengthening the very weak health systems. Strategies are now being put in place to scale down the activities and bed capacities in the Ebola care facilities. The closure of such facilities or repurposing for other use not related to the treatment of Ebola should follow standard operating procedures while respecting the social and psychological impact of the affected population.

In the post Ebola phase. there are many emerging issues coming out the communities which is still causing distrust between community health care workers and community members. While an assessment is yet to determine and unpack the key issues surrounding distrust between these two groups, several reports have highlighted that communities are reluctant to visit health care facilities for fear of stigma and discrimination and community health workers neglect patient that present with non –Ebola related cases. In light of this critical concern, the WHO Decommissioning guidelines clearly recommend community engagement in the decommissioning of Ebola care facilities as well as any public health intervention.

This abstract seeks to present the concerns and issues raised in one of the community dialogues held prior to the decommissioning exercise and points out key steps taken in the entire process while also taking note of individual perceptions and ensuring that the right message is being conveyed.

The process further indicates the discussions that ensued, the opinions of community members on the exercise, the safety and health of the community and environment and its role in supporting safe decommissioning of the facility and alternatives to the initial plan.

Paper short abstract:

Liberia was declared Ebola-free on the 9th May 2015, but new cases emerged. People reacted differently on this fact. Often, their reactions were coined by mistrust due to events during the first outbreak and the declaration of the end of the outbreak. Locally appropriate strategies for dealing with new outbreaks despite the weak health care system need to be developed together with the local communities. This paper focuses on some of the reactions on the new cases and reflects on the attempts to assure a long-term awareness even after the new outbreak is declared over.

Paper long abstract:

In Liberia, international organisations continued to engage medical anthropologists after the country was declared free of Ebola on the 9th of May 2015. This paper bases on experiences made during fieldwork immediately afterwards, from the beginning of June to the end of August 2015. Under these circumstances, the medical anthropological task was to deal with “cultural” issues in the aftermath of the epidemic. Many organisations involved in the international Ebola response efforts continued to be confronted with various issues: e.g. the stigmatization of health care workers involved in care during the epidemic as well as of Ebola survivors, or diverse circulating narratives concerning vaccination programmes which had negative effects in the community. After Ebola, clearly for many a time of grief, it becomes possible to ask the following questions: What are the narratives on and about the disease in Liberia after the epidemic? How do people, in immediate retrospective, explain the epidemic with regard to its “origins,” its course and ending, as well as concerning the virus as future threat? And how do these explanations affect the usage and delivery of health care in Liberia, both negatively and positively? From asking these questions, many lessons useful for an immediate (clinical) application in Liberia as well as for future epidemics can be learned. In this case, medical anthropology can be a powerful tool to help rebuilding health care and in re-establishing trust in the population. This paper offers first insights from the field.

Paper short abstract:

Both UNESCO and Sierra Leone's University of Makeni have made responses to the Ebola Virus Disease epidemic of 2013 - 2015. Thematic comparison of documents produced by both organizations allows us to understand the role of culture in organizational responses to the crisis.

Paper long abstract:

In Sierra Leone, the Ebola Virus Disease epidemic of 2013 - 2015 brought into play not only traditional actors in the field of public health (such as the World Health Organization), but also new actors such as the private University of Makeni (UNIMAK), and the United Nations' Educational Scientific and Cultural Organization (UNESCO). This paper will begin the task of understanding this aspect of the crisis through textual analysis of documents produced by UNESCO and the University of Makeni, which are considered as artefacts of a global crisis produced in very local contexts. UNIMAK which made itself a centre of counter-Ebola efforts in the city of Makeni and the surrounding Northern Province. The community gathered around UNIMAK was directly involved in the fight against the virus, while UNESCO was not, though the latter organization did make efforts to intervene in the crisis. Comparison of the themes running through documents produced by these two organizations sheds more light on the complexity of the EVD crisis, and opens a new perspective on the relationship between culture and epidemics. Cultural approaches to the EVD crisis have focussed on the role of cultural practices at the level of local communities in providing a vector for the spread of EVD. This has led to a neglect of the cultural factor in the response of local and international organizations to the epidemic, a neglect which this paper will begin to rectify.

Paper short abstract:

This paper demonstrates how an Ebola affected community utilized local information resources to construct an alternative understanding of the outbreak. An ongoing follow-up community-led intervention to promote primary health has adopted some elements of the identified local communication resource.

Paper long abstract:

Reports of affected communities defying official healthcare messages during Ebola outbreaks have persisted since the first outbreak in 1976 yet minimal anthropological research is conducted to address the disconnect between grassroots and global health communication strategy. During my ethnographic fieldwork in Luwero district in Uganda, I documented how local information resources constructed an alternative understanding of Ebola that influenced the affected community to question official communication.

Using participant observation, individual interviews and focus group discussions with key informants and community members, I obtained an emic understanding of how the affected community perceived credible information. The local information resource included elders, peer networks and clan hierarchies. Informal social spaces like gardens, bars, market stalls, video halls and returning residents with news from outside the community were instrumental in fuelling the grapevine network Radio Katwe that subtly influenced community opinion. Influence of informal resources was enhanced by their embeddedness in socialization processes including spiritualized rituals. We adopted some elements of the local information resource in an ongoing intervention to promote primary healthcare in one of the villages of Luwero district.

Community members believed and identified with informal explanations even when they were biomedically inaccurate. Official edicts were resented for insensitivity to local treatment, care and burial rituals. This study underscores the role of ethnographic studies in identifying local sensibilities and facilitating localization of global health communication strategies.

Paper short abstract:

Some reports suggest that ebola has ‘helped’ eradicate FGC/M in Liberia. The ebola crisis, I hypothesise, is likely to exacerbate rather than relieve tensions between institutions contesting FGC/M.

Paper long abstract:

Political participation of women, recognition of indigenous leadership including female leadership, and stopping gender- based violence are three worthy goals that have been highlights of Liberia's postconflict project. My existing research demonstrates that these goals are not always mutually supporting. At times, they come into direct conflict. The lack of a longstanding, collaborative, formal history between Sande leaders and the Liberian government is partly to blame for the conflicts and antagonism specifically over women's issues: who has the responsibility to define and punish sexual violence, whether or not bush school is legitimate, and how marital relations are socially and legally sanctioned.

The 2014 Ebola crisis complexified this contested set of relations even further. The ebola crisis in Liberia transformed donor and governmental priorities, caused corollary health and livelihood crises that are sharply gendered in nature, and deepened distrust between citizens and state.Some pilot reports are suggesting that ebola has 'helped' eradicate female genital cutting because it caused the suspension of initiation practices. These hypotheses are based only on superficial reporting of events and National Traditional Council edicts, rather than in-depth research. As a researcher with a longstanding ethnographic engagement with gender issues in Monrovia, I argue that this issue cannot be understood in alienation from corollary matters of indigenous sovereignty, settler/native cleavages, and liberal humanitarian dilemmas, of which there are many.

Drawing upon participant observation and interviews, I argue that the ebola crisis is likely to exacerbate rather than relieve tensions between institutions addressing FGC/M.