LOST IN TRANSLATION?
The Ebola outbreak of 201416 was a reminder that what works to control an epidemic in one region may make things worse in another. Valuable lessons for India from a health summit in Sweden
Did you know that talking about ‘goat plague’ did more to stop the spread of Ebola in West Africa than all the public service messages about not eating infected monkeys and bats?
While science and data must drive global health policies, making the messages relatable is equally vital.
India, which is facing its own communication challenges when dealing with health threats, needs lessons in cultural contextualisation. Well-meaning public health officials, for example, use the term ‘kangaroo care’ when teaching women in rural India how to hold newborns, yet most of these women have never heard of the kangaroo, and cannot possibly understand its relevance to childcare. Instead, experts say, using a monkey as a metaphor would work far better in this context.
The Ebola virus outbreak of 2014 - 16 is a perfect example of just how damaging mixed messages can be to healthcare and disease containment efforts.
When the virus first began to spread in Guinea, Liberia and Sierra Leone — it would eventually claim 11,000 people in the biggest such outbreak so far — global responders used lessons from past outbreaks in isolated parts of rural Ce Africa, ignoring the regional
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Dr Paul Richards (above), a British anthropologist, speaking at the Uppsala Health Summit on Tackling Infectious Diseases, held in Sweden last week.
The summit saw experts across sectors recommend collaborative policies that could be adapted by countries and communities to quickly report and contain potential outbreaks.
Since Ebola is infectious but not contagious — it doesn’t spread through air like the flu epidemic — no one expected it to spread as quickly as it did. Then, as tens of thousands became infected, experts grimly predicted millions would be infected and thousands would die within months. They were wrong on both counts.
Once responders got the message right, incidence began to plummet and the infection did not spread to even 100,000.
TRUE OR FALSE?
The garbled messaging of the initial months of Ebola 2014 was in some cases outright dangerous, said Richards, a professor at Njala University in central Sierra Leone, who specialises in the Mano River region that was Ground Zero for the 2014-16 outbreak.
The message about bushmeat causing infection risk, for instance, backfired. “People thought, ‘I’m a Muslim, I don’t eat bushmeat or live near a forest, so I’m not at risk of Ebola’. But they were at risk if they were nursing a patient with Ebola who they thought had malaria or Lassa fever.”
Slow response was a big part of the problem too. The first case was traced back to December 2013, but the governments of Guinea, Liberia and Sierra Leone didn’t ially notify the WHO until May 2014. eclared it a ‘public health emernational concern’ on
. Ebola epidemic had mbing along for nine months before there was an international response and then everything came at once, which made people think that things were a lot worse than they really were,” said Richards. "Once the infection spread to Europe and North America, there was a whole new wave of panic fed... after which it was almost impossible to get any context back into the situation .”
REMEMBER THE GOATS?
The epidemic was finally contained by intensifying tried-and-tested methods and building on local knowledge.
“We talked to communities in rural areas about goat plague (peste des petits ruminants or PPR), which is a viral disease in goats that spreads through contact with
body fluids. Many people in Sierra Leone and Liberia had lost goats to PPR in the 1990s and knew how to protect healthy goats by quarantining sick animals,” said Dr Richards.
Once their experiences were used to illustrate the problem, people understood.
“They already had the tools to deal with Ebola once you got the right message. And the right message was talking about PPR rather than talking about monkeys and bats and all the rest of it.”
Once they saw the risks, villagers quickly started using quarantine and adapted their burial rituals to lower infection. “It takes six weeks to three months for a local community to understand the nature of the infection risks, to find local models,” said Dr Richards.
Community participation saw Ebola incidence fall fastest in rural south-east Sierra Leone, even though they got less aid. Motorbike taxis began ferrying blood samples, test results and, most crucially, data to help trained researchers do lastmile surveys and analyse information in real time from remote areas. “This helped us build the Ebola Response platform,” said Dr Richards, “and put true and reliable information online within 24 hours.”