What makes something or someone trustworthy?
The Oxford English dictionary defines it as ‘the ability to be relied upon as honest and reliable’. But in West African communities, amidst swirling rumours, conspiracies and misinformation, what governs this powerful unifier of people?
Response workers have faced strong and even violent resistance to Ebola interventions as a result of miscommunication and fear in communities. Similarly, ‘hidden’ Ebola cases, where suspected cases have avoided accessing the health centres or reporting to response teams, are consistently reported. These hidden cases, alongside a small but persistent numbers of traditional burial practices of suspected cases, have caused recurrent spikes number of cases, despite the overall downwards trend. These problems are fuelled by mistrust between the worst affected communities and the response effort – a key driver of the Ebola crisis .
The media has sometimes portrayed these as problems of local ignorance of biomedicine and as a result of persistent use of traditional medicine and cultural practices . However, as non-governmental organisations, international partners and governments reflect on their contribution to the international response to the epidemic, these problems should not be so easily dismissed. An understanding of the roots of this chronic mistrust is vital to informing the response to health crises and health systems strengthening more generally.
Peeling back the layers of mistrust between governments, response partners and communities across differing political, social and economic contexts in Guinea, Liberia and Sierra Leone is a complex task; with the array of large-scale, multi-actor response operations and approaches they employ.
Arguably, aspects of institutionalised mistrust preceded the Ebola crisis; from local divisions based on gender, ethnicity, land ownership and age; to distrust in the state and foreign involvement as legacies of historical ‘structural violence’ in the region . With this as a backdrop the containment strategies, including curfews, mass cremations, quarantines and the use of military force, are an obvious source of suspicion and resistance. The response to Ebola has been criticised for a lack of dialogue with local people and dismissal of community concerns around containment strategies that shatter many of the core social, religious and economic elements of daily life.
What were the underlying, and incident, causes of mistrust in the Ebola response? What were the barriers to successful engagement of communities in the Ebola response? Where has mistrust been successfully overcome through effective community collaboration and how can the actors in the Ebola response learn from and support these approaches?
Polygeia, in collaboration with the Africa All Party Parliamentary Group, are examining the current response to the Ebola crisis, and its wider implication for approaches to health provision and are currently gathering evidence from experts and the affected communities in West Africa in order to address these questions and more. You can find out more about our call for evidence on the Africa APPG site here: http://www.royalafricansociety.org/analysis/new-africa-appg-inquiry-call-written-evidence-community-led-health-systems-ebola-outbreak If you would like to submit evidence, please contact Hetty Bailey at the Africa APPG on firstname.lastname@example.org.
 A Wake Up Call; Lessons from Ebola for the worlds Health Systems. Save The Children (2015) http://www.savethechildren.org.uk/sites/default/files/images/A-Wake-Up-Call.pdf
 Africa APPG – Combating Ebola: has the media helped or hindered? http://www.royalafricansociety.org/analysis/africa-appg-combating-ebola-has-media-helped-or-hindered
 Oosterhoff, P. and Wilkinson, A. Local Engagement in Ebola Outbreaks and Beyond in Sierra Leone. Institute of Development Studies. http://www.ids.ac.uk/publication/local-engagement-in-ebola-outbreaks-and...
Rhys Wenlock is a 2nd year Medical Student with a particular interest is humanitarian medicine and how it can relate to health systems strengthening and community engagement.
Tom Hird is a 2nd year PhD student in the International Health Research Group (IHRG). His research focuses on the burden and aetiology of chronic diseases in sub-Saharan Africa and the implications for health systems in the region.
Photo credit: EU Humanitarian Aid and Civil Protection, Flickr.