Ebola: limitations of correcting misinformation
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Published Online: 18 December 2014
Article Info
Communication
and social mobilisation strategies to raise awareness about Ebola virus
disease and the risk factors for its transmission are central elements
in the response to the current Ebola outbreak in west Africa.1
A principle underpinning these efforts is to change risky “behaviour”
related to “traditional” practices and “misinformation”. Populations at
risk of contracting Ebola virus disease have been exhorted to “put
aside, tradition, culture and whatever family rites they have and do the
right thing”.2 Messages designed to correct perceived misunderstandings3 include: “Ebola is caused by a virus. Ebola is not caused by a curse or by withcraft”;4 “science and medicine are our only hope”;5 and “traditions kill”.5
Such
messages follow logically from clinical and epidemiological framings of
contagion. They pay little attention, however, to the historical,
political, economic, and social contexts in which they are delivered.
Furthermore, they reinforce external perceptions that local beliefs and
practices are barriers to be overcome through persuasion or
counterbalanced with incentives.6 Such characterisations have been counterproductive in previous Ebola outbreaks.7 We propose four questions to scrutinise some of the assumptions about current Ebola social mobilisation strategies.
First,
will improving people's biomedical knowledge of Ebola lead to desired
behaviour changes? Efforts to change what people do through biomedical
information alone can be ineffective. Communicating knowledge about why
people should wash their hands with soap, sleep under a bednet, or
change their sexual practices is known to be insufficient to induce
behavioural changes in practice,8, 9 usually because of people's other priorities. The situation with regard to Ebola seems to be following suit.10
Biomedical information on risk might hold limited relevance to people
when trying to care for sick loved ones or attend to the dead. Other
approaches that start by addressing people's priorities need to be
considered when attempting to influence health-related activities.
Second,
should local activities be regarded as “exotic behaviour”? Caring for
the sick is an intensely practical endeavour. Public health framings of
Ebola, however, often portray caring practices as irrational and
immutable traditions.11
This perception reflects a lack of genuine engagement in the material,
social, or spiritual implications of changing social practices. In many
parts of Sierra Leone, Liberia, and Guinea, burial practices often
incorporate procedures to distribute inheritance and ensure the deceased
an afterlife. Failing to conduct funerals appropriately may cast family
members as negligent, or foster suspicion of malicious causes of death;
these concerns can override health considerations.12
To disregard such concerns and take an inflexible stance in negotiating
mutually acceptable courses of action precludes any genuine
demonstration of respect or empathy for that person's situation.
Third,
how helpful is the message that biomedicine is the most effective way
to understand and respond to Ebola? The idea of trying to shift people's
framings away from so-called traditional beliefs is embedded in the
public health view of biomedicine as the only valid way to understand
and respond to illness. 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.14
Health
workers from Sierra Leone's Red Cross Society Burial Team talk with
community members before removing a body from a house in Freetown
Francisco Leong/Staff
Fourth,
are standardised messages and modes of delivery for public health
information about Ebola appropriate? Public health framings generally
assume that standardised protocols that deliver “correct” health
information through the “right” medium are needed to change behaviour.
Protocols are typically developed at national or international levels
rather than collaboratively with the people who are expected to change
their behaviour. When rolled out rapidly at scale, the standardisation
of messages is treated as paramount in country plans; an operational
logic that hinges on the use of mass media and rote training of
community liaison workers. Such a standardised approach discourages
adaptation, prohibits engagement with local social realities, and
ignores how people will interpret public health messages according to
specific local political and social circumstances.
Engagement
across communities with flexible protocols that communicate problems,
request help in developing local solutions, and enable their
implementation are likely to be more effective in changing high risk
practices than standardised approaches. As households and communities
have made clear when given the chance, what they would like is practical
information about risk factors for Ebola transmission and, crucially,
how to reduce risks when caring for the sick and burying the dead, as
well as the material resources necessary to put this advice into
practice.7, 15
As members of the Ebola Response Anthropology Platform,
we call on all organisations involved in the response to the Ebola
outbreak to question the assumption that biomedicine must correct local
logics and concerns, and the effectiveness of using standardised advice
for non-standardised situations. Those tasked with asking people to
change practices and activities associated with Ebola transmission
should be allowed the time and flexibility to negotiate mutually agreed
changes that are locally practical, socially acceptable, as well as
epidemiologically appropriate. Resulting approaches to managing the
crisis are likely to be diverse but locally sustainable, provided they
are developed with respect for local people and their priorities and
resourced appropriately. Otherwise, we warn that a focus on correcting
“misinformation” could do more harm than good.
We declare no competing interests.
References
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- Forrester, JD, Hunter, JC, Pillai, SK et al. Cluster of Ebola cases among Liberian and US health care workers in an ebola treatment unit and adjacent hospital—Liberia, 2014. MMWR Morb Mortal Wkly Rep. 2014; 63: 925–929
- Leach, MA, Fairhead, JR, Millimouno, D, and Diallo, AA. New therapeutic landscapes in Africa: parental categories and practices in seeking infant health in the Republic of Guinea. Soc Sci Med. 2008; 66: 2157–2167
- Anoko, JN. Communication with rebellious communities during an outbreak of Ebola virus disease in Guinea: an anthropological approach. http://www.ebola-anthropology.net/case_studies/communication-with-rebellious-communities-during-an-outbreak-of-ebola-virus-disease-in-guinea-an-anthropological-approach/; 2014. ((accessed Dec 11, 2014).)
