Anthropology of Ebola: Transmission Dynamics and Outbreak Socialities

Lead Research Organisation: University of Exeter
Department Name: Sociology, Philosophy, Anthropology

Abstract

West Africa is currently experiencing its first and largest outbreak of Ebola haemorrhagic fever (EHF). This epidemic demands immediate public health action and critically, social science expertise. While conducting research in Guinea and neighbouring Sierra Leone on Lassa fever (a related, but endemic haemorragic fever) members of this team were invited by the Guinean Ministry of Environment, Water and Forest, and the Ministry of Health to support Ebola containment efforts, specifically by exploring the forms and social significance of human-animal contact and health systems responses. Over the past months, members of this team have worked closely with NGOs and Government actors, helping to illuminate the primary routes of infection and support efforts to reduce transmission.

This project would extend and deepen our initial observations, and allow us to investigate in situ the organisation of containment efforts and their impact on material culture, social practices and institutions. Through an expanded ethnographic frame on the everyday sociality of Ebola containment, we will pursue pressing questions about the cultural processes of disease transmission and curtailment including:

1) How has the epidemic affected livelihood strategies, including farming, hunting, modes of trading, and domestic economies?
2) What effect have public health interventions aimed at reducing primary transmission had on the human-animal interactions
3) How do people experience emergency care provided and how does this impact how they use public health care?

This urgent project builds together anthropological, epidemiological and public health expertise to understand the effect of the West African Ebola outbreak upon communities who are currently living through this unprecedented epidemic. Our primary aim is to document people's experiences of the wide-ranging public health and disease control interventions that are currently being implemented - e.g. hunting bans, case finding and contract tracing, emergency isolation, sensitization and clinical care, suspension of traditional burial rites, etc.

This empirical orientation constitutes a considerable departure from the conventional anthropological remit during an outbreak, which has generally been circumscribed to helping make public health policies more palatable for local populations. In contrast, our efforts to come to grips with the social impact of this epidemic will be grounded in an attention to the roles that objects, material practices, animals and environments have to play in shaping the trajectory of the outbreak and its social impact. An extended 'social' lens will offer greater purchase on the routes of transmission and the obstacles to containment, and could lay the basis for more comprehensive collaborations between social scientists and public health professionals. Ultimately, we believe that a finely-grained, real-time ethnographic account into the social dynamics triggered by this worst-ever Ebola outbreak can help refine public health interventions to more effectively contain future outbreaks.

Planned Impact

With case-fatalities up to 90%, Ebola is among the world's deadliest viruses. The outbreak in Guinea, Sierra Leone and Liberia (West-Africa) has far exceeded the previous most lethal (and first) outbreak in Yamboukou, Democratic Republic of the Congo, and the previously largest outbreak in Gulu, Uganda. Early onset of the disease entails diverse symptoms from high temperature, diarrhoea, lethargy, shivering and aches, respiratory, and gastric problems, a variability which poses diagnostic challenges. As infection progresses, symptoms become more dramatic-throat lesions, spontaneous internal and external bleeding-and treatment, in most cases, merely supportive.

Despite considerable media attention and national concern, the outbreak is as of yet not contained; public health interventions hinge on early detection and changing critically significant social practices such as care for the sick and funeral rites. Fear of hospitals, where many of their loved ones and health workers have died, and suspicion of government officials, medical personnel and foreign aid workers has prompted populations to hide their sick and run from or attack public health teams. Owing to the considerable challenges of conducting ethnographic during an outbreak, anthropological accounts of Ebola are few and tend to be circumscribed to the immediate demands of curtailment, leaving many dimensions of the public health experience and response unexplored.

Our project combines approaches from social and medical anthropology, epidemiology, and medical geography and brings together researchers from the UK, Spain and Berlin, all of whom have worked at the interface of scholarly research and health policy and who have benefited from considerable intellectual cross-fertilization through current work on Lassa fever. It strengthens analytical capacity and methodological rigour in understanding the social dynamics of zoonotic disease in relation to international health planning and health systems in Africa. Bringing an empirically-nuanced methodological lens to bear on questions of disease transmission and in particular on zoonoses, this project is innovative in seeking to develop methods which are at once sensitive to the demands of a public health emergency and the theoretical advances in the social sciences. It draws on Guinean expertise and seeks to enhance social scientific capacity, aiming to address questions which, due to logistical and financial obstacles, have until this point been almost impossible to pursue.

The goals of our impact strategy are to generate knowledge on the following:
1)Existing public health responses to manage Ebola and how these are perceived by those who are involved in them
2)The long term impact of emergency public health interventions on everyday social life and economic strategies
3)The social dimensions of human-animal relationships and how these might shape transmission dynamics

Beneficiaries of this research therefore include people at risk of contracting Ebola; service users of health systems in Guinea and other countries currently experiencing the outbreak; health workers, policy makers and health managers of Ebola (and VHF); non governmental organisations involved in interventions around Ebola (e.g. MSF, WHO, Red Cross). By building awareness and ownership among a key stakeholders and including them in refining research questions and dissemination activities to co-produce knowledge, this urgent research will be better received and will generate more relevant knowledge. More specifically, benefits should be realised in guiding improved public health delivery in emergency contexts, and heightening attention to the unforeseen consequences of public health interventions and the contingency aspects and ethical parameters in future planning.

Publications

10 25 50
 
Description Key findings: Research for on the impact of the ebola outbreak and response on local communities is ongoing. However, several key findings have emerged.

A central objective of this project was to explore the impact of the outbreak and response on human-animal interactions in the afflicted communities. Preventing a zoonotic outbreak, such as Ebola, in the first instance hinges upon reducing the possibility for viral spill-over and thus limiting the occasions whereby wildlife and humans come into contact. One early response measure taken by countries was to place a ban on the sale and hunting of bushmeat. Through ethnographic research with communities in rural Guinea and Sierra Leone, we found that not only had the ban had considerable negative consequences both for the livelihoods of effected communities and for the effectiveness of the response, including: 1) Hunters have been proposed as target for risk-based surveillance and sensitisation for zoonotic diseases. Our research suggests that hunting is a routine activity, integrated in domestic life, undertaken by men and women of all ages. Indeed, our research emphasised the central role of children in the capture and consumption of animals. 2) The bushmeat ban attempted to abruptly end a behaviour that was both highly routinised in rural communities and that was important for livelihoods with no offer of alternatives. In addition the ban placed an unreasonable stress on population in a time of crisis with unintended consequences: driving the economy underground with a change in risk along the value chain and social relations. 3) As communities had spent years hunting without suffering any illness from the practice, the ban fed into suspicions that the outbreak was a hoax or worse, a conspiracy of white conservationists and the government. People were less likely to listen to considerably more important messaging regarding preventing human-to-human contact.

A second key objective of this project was to elaborate experiences with public health care. Ebola outbreaks bring an influx of disease managers, volunteers, and clinicians from various international and national locations into contact with socio-political systems often burdened by histories of civil conflict with weak health systems infrastructure. The resistance and violence that confronted Ebola responders underscored the importance of understanding the different ways in which people perceive and engage with health services during a time of crisis.

Our research with contract-tracers, volunteer grave diggers, local health workers has yielded a number of relevant insights for future outbreak control and preparedness.Key points include: 1) Several local health workers described their participation in the response both in terms of a desire to 'help their country' and also the opportunity to learn new skills in a time of job scarcity. Critically, even those unconvinced about the origins and even reality of Ebola, spoke highly of the experience and training offered by the outbreak. 2) Local health workers experienced high levels of stigma and even violence from their communities. They described the importance of reorganise domestic life-e.g. new sleeping arrangements, partaking in meals-in assuaging fears. 3) Local health workers and community volunteers pointed to the critical role played by the local media, particularly the radio, in spreading awareness and in providing 'psychosocial support.' Journalists were identified for their positive impact on their work and on reducing stigma. 4) Mobile health technologies with were key to ensuring payment of health workers was received on time. There are clear avenues to explore and adapt low-cost open source technology to track future outbreaks and to help enhance the community response. 5) Contact-tracers pointed to key problems in international collaboration; many complained that the WHO workers were not willing to take risks to quarantine resistant communities. 6) Survivors recognised their continuing importance to research initiatives and question how their contribution is being valued. Survivors associations--which differ regionally in their political power--are hoping to extend their influence over the direction of clinical trials and the role in the rebuilding of the health care system; critically many who describe themselves as 'local scientists' have become quite knowledgable about transmission and hope to extend this knowledge through training. For future outbreaks, survivors suggested that they could be deployed as frontline workers, but need to be given the appropriate training in advance of the emergency. While the president has committed to providing free health care to the survivors, that commitment is under threat as funds from DFID will no longer be available. Another concern is with the destination and afterlife of plasma, whether these will remain in country in the advent of an outbreak or be taken out for further research. 7) Distinct priorities are emerging for post-ebola system; one area of some concern and development is around laboratory services and diagnostic capacities, equipment such as GeneXpert and plasmapheresis machines have been donated but questions remains as to how these can be put to use. Critically, while international research partners have a strong interest in collecting, sampling and analysing new pathogens, local actors point to the need to improve basic diagnostic services around malaria, HIV and haematology.
Exploitation Route Our findings could be taken forward in two key ways.

The first would be on stressing the limitations of a reactive policy such as a ban on the sale and consumption of bushmeat during an outbreak. It is clear that public health sensitisation messages regarding the risk of wildlife took the focus away from the priority of human-to-human transmission control measures and placed an additional stress on populations. In general our findings raise the question on the communication of emerging health threats that are complex, biomedical uncertain, and go against habits that have been pervasive since generations. For future outbreaks policy-makers should aim to first develop a solid understanding of the widespread, complex and important interactions between humans and animals before devising prevention strategies, as these may have unintended consequences.

Our findings regarding the experiences of local-health workers underscored the critical importance of community buy-in to bringing an end to the outbreak. While the tragic deaths of loved ones and experiences of quarantine has eroded local trust for health care system and engendered fear of formal providers, the extensive local participation in the response and the desire for continued training, suggests that there are deep community-based resources for which national health policy makers can draw. Critically, we see a role for survivors in future preparedness planning and in extending health care services through systems task-sharing at the local level.

Our experience working with local and international researchers pointed to the need to take into account the impact of different projects on local health systems. Because of the nature of the emergency, the sheer number of possible and yet untested interventions, exceptionally difficult to prioritise research projects. One point raised by our collaborators was the importance of considering approaches that were context-appropriate--as one national health official put it: research that we could lead and implement--or to quote a survivor, 'African solutions for african problems.' In general the ethical guidance for emergency research needs further reflection, survivors in particular felt that the premium placed on confidentiality only entrenched views that they were involved in 'secret' activities and missed an opportunity to recognise and even celebrate their contribution in the response.

In addition to national health systems more broadly, laboratory services need attention. The PI's experience serving on the SAGE Working Group on Ebola Vaccines and Vaccination highlighted that even with a potentially effective vaccine, diagnostic services to quickly identify contacts and thereby be able to vaccinate in a ring-fashion was critical. The outbreak exposed a number of more chronic emergencies--HIV, AMR, MDR TB, and Malaria. In extending surveillance capacities to new and emerging biosecurity threats, it is critical that these public health problems are foregrounded.
Sectors Agriculture, Food and Drink,Healthcare

 
Description Drawing together anthropological, veterinary, clinical and public health expertise, this research has fed into efforts to respond to the Ebola Outbreak on a variety of domains and among diverse stakeholders. The risks of conducting fieldwork during the Ebola outbreak delayed in-country research for several months while securing necessary insurance from the university. Thus, while the project did not formally begin until January 2015, the collaborations established during the course of setting up and designing the project and the visibility of the team and the relevance of its expertise to the response efforts, meant that impact from the project began to materialise in 2014, when team members were asked to contribute to policy discussions. Owing to that delay and, further, to the maternity leave of the PI in late 2015, Research is ongoing and the dissemination of results has yet to occur. However, at this stage, four key areas of impact can be identified: Registering Local Impact: A key aim of this project was to illuminate the response to, and impact of, hunting bans on local communities. Ethnographic evidence regarding the rejection of the 'spillover' hypothesis by communities and the delirious effects of the ban on food security has been fed back to members of the Ministry of Health and Ministries of Defence. Members of this team (Bonwitt, Kelly) worked closely with national (Guinea, Sierra Leone) and international branches of the Food and Agricultural Organisation to design research into human-animal interactions and helping to set up community-based animal health committees, which can identify outbreaks early on and help form the basis of a more sustainable and locally acceptable outbreak response. Roland Sokulu a research partner who is completing his PhD with the support of Bonwitt and Kelly continues to feed into FAO policy around animal surveillance systems. Global Health Policy: Insights into the experience of international and national contact tracers, local health workers, volunteer burial teams fed into recommendations regarding immunisation As an invited member of the World Health Organisation SAGE Working Group on Ebola Vaccination, the PI (Kelly) stressed the importance of informal health providers and engaging survivor networks for enhancing acceptability of programs (http://www.who.int/immunization/sage/meetings/2015/april/Ebola_vaccine_Draft_framework_final.pdf). In the most recent meeting, Kelly also flagged the importance of empowering local regulatory boards to oversee emergence and expanded use applications, and giving further sociological depth to the category of 'health worker' in the case of a targeted vaccination policy during an outbreak. Clinical Response: During the course of this project, members of this team (Brown, Borchert, Mari-Saez) collaborated with the International Rescue Committee and Médecins Sans Frontières to set up Ebola Treatment Units and to provide insight into barriers in the training of biosafety practice to local health workers. Their experience of working on the impacts of the response enhanced their efforts to ensure the acceptability of the response. Clinical Research: This projects engagement with local health workers and research into the role of media and broadcasting fed into discussions of the Scientific Committee for the therapeutic investigation of Favipavir (JIKI) trial to point to the importance of outreach and iterative communication with communities beyond local leadership. Team members (Mari-Saez, Kelly) anthropological contributions to Convalescent Blood and Plasma Investigations in Guinea and Sierra Leone, drew from research conducted with survivors networks suggesting the importance of providing continual clinical support for participants and the concerns facing survivors in communicating results about their plasma. At the conclusion of these projects, we organised participatory workshop to facilitate an open exchange between researchers, participants, coordinators, implementers. The insights from that work will feed into a report we plan to publish for the Wellcome Trust Bulletin and provide the basis for a survivors statement on research participation. Outbreak control and future preparedness: Finally, this grant led to the creation and running of the UK Ebola Response Anthropology Platform (ERAP) (www.ebola-anthropology.net), an initiative jointly funded by the Wellcome Trust and DFID to assist in current efforts against the ongoing outbreak, for which Kelly was a Steering Member. ERAP remit was to deliver rapid, real-time advice to policy and practice around emergent issues such as identification and diagnostics, funeral practices, home care, clinical trials, communications, community engagement and 'resistance'. The relevance of its work has been extensively recognised, receiving the ESRC award for Outstanding International Impact.
First Year Of Impact 2015
Sector Healthcare
Impact Types Cultural,Societal,Economic,Policy & public services

 
Description Future Outbreak Response and Control
Geographic Reach Multiple continents/international 
Policy Influence Type Participation in a national consultation
Impact Jesse Bonwitt's drew from his work human-animal interactions in the wake of the outbreak to contribute to workshops in Rome held by the Food and Agricultural Organization of the United Nations. From this meeting, the FAO sought to identify key areas of research and guidance regarding assess and manage such outbreaks in the future, and critically how to promote collaboration and stronger surveillance and diagnostic networks.
URL http://www.fao.org/news/story/en/item/381255/icode/
 
Description Recommendations for the World Health Organisation SAGE Working Group on Ebola Vaccination
Geographic Reach Multiple continents/international 
Policy Influence Type Membership of a guideline committee
Impact As an invited member of the World Health Organisation SAGE Working Group on Ebola Vaccination, the PI (Kelly) contributed to the drafting of recommendations regarding the prioritzation of immunization against Ebola. In addition to the identification of vulnerable populations, we provided guidance on the design of trials and processes of community engagement.
URL http://www.who.int/immunization/policy/sage/sage_wg_ebola_nov14/en/
 
Description ERC Starting Grant
Amount £997,564 (GBP)
Funding ID 715450 
Organisation European Research Council (ERC) 
Sector Public
Country European Union (EU)
Start 05/2017 
End 04/2021
 
Description MRC-AHRC Global Public Health: Partnership Awards
Amount £248,657 (GBP)
Funding ID R/R024510/1 
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 02/2018 
End 01/2020
 
Description NIHR Global Health Unit
Amount £6,997,730 (GBP)
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 05/2017 
End 04/2021
 
Description Research for Health in Humanitarian Crises (R2HC) Programme
Amount £250,000 (GBP)
Organisation Wellcome Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 11/2014 
End 11/2016
 
Description Wellcome Trust Ethics and Society Small Grant
Amount $10,400 (USD)
Funding ID 204939/Z/16/Z 
Organisation Wellcome Trust 
Department Wellcome Trust-PHFI capacity building programme
Sector Public
Country India
Start 10/2016 
End 10/2017
 
Description Wellcome Trust Seed Funding
Amount £96,350 (GBP)
Funding ID 209921/Z/17/Z 
Organisation Wellcome Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 10/2018 
End 09/2019
 
Description Convalescent Blood and Plasma Research Consortium 
Organisation Institute of Tropical Medicine Antwerp
Country Belgium 
Sector Academic/University 
PI Contribution We have helped provide anthropological insights into the design and implementation of research into the effectiveness of convalescent blood and plasma. Critical to our contribution was negotiating the participation of the survivors and providing a point of contact and communication between these participant groups and the research team. We concluded this work with a two day participatory workshop where survivors were able to feedback their concerns to researchers and trial implementers and all actors were able to identify core areas of concern and stumbling blocks in the research process. One of the key outcomes was to recognise the limitations of confidentiality as the ethical foundation of the project; survivors wanted their participation to be publicised as part of their contribution to the Ebola Response and national health more broadly.
Collaborator Contribution Our partners provided us insight into the challenges of conducting research during an outbreak, allowing us to interview them for the ESRC project and observe the day-to-day work of enrolling and informing participants, as well as negotiating the bureaucratic processes of clinical research in country and at the international level.
Impact This is a multi-disciplinary collaboration involving clinicians, virologists and anthropologists. The trial in Guinea has showed that convalescent blood and plasma is a promising therapeutic for the treatment of Ebola, while research in Sierra Leone has yet to be completed. Anthropological analysis regarding the experiences of the survivors in this projects is still in process.
Start Year 2015
 
Description Convalescent Blood and Plasma Research Consortium 
Organisation Ministry of Defence, Sierra Leone
Country Sierra Leone 
Sector Public 
PI Contribution We have helped provide anthropological insights into the design and implementation of research into the effectiveness of convalescent blood and plasma. Critical to our contribution was negotiating the participation of the survivors and providing a point of contact and communication between these participant groups and the research team. We concluded this work with a two day participatory workshop where survivors were able to feedback their concerns to researchers and trial implementers and all actors were able to identify core areas of concern and stumbling blocks in the research process. One of the key outcomes was to recognise the limitations of confidentiality as the ethical foundation of the project; survivors wanted their participation to be publicised as part of their contribution to the Ebola Response and national health more broadly.
Collaborator Contribution Our partners provided us insight into the challenges of conducting research during an outbreak, allowing us to interview them for the ESRC project and observe the day-to-day work of enrolling and informing participants, as well as negotiating the bureaucratic processes of clinical research in country and at the international level.
Impact This is a multi-disciplinary collaboration involving clinicians, virologists and anthropologists. The trial in Guinea has showed that convalescent blood and plasma is a promising therapeutic for the treatment of Ebola, while research in Sierra Leone has yet to be completed. Anthropological analysis regarding the experiences of the survivors in this projects is still in process.
Start Year 2015
 
Description Convalescent Blood and Plasma Research Consortium 
Organisation University of Liverpool
Country United Kingdom 
Sector Academic/University 
PI Contribution We have helped provide anthropological insights into the design and implementation of research into the effectiveness of convalescent blood and plasma. Critical to our contribution was negotiating the participation of the survivors and providing a point of contact and communication between these participant groups and the research team. We concluded this work with a two day participatory workshop where survivors were able to feedback their concerns to researchers and trial implementers and all actors were able to identify core areas of concern and stumbling blocks in the research process. One of the key outcomes was to recognise the limitations of confidentiality as the ethical foundation of the project; survivors wanted their participation to be publicised as part of their contribution to the Ebola Response and national health more broadly.
Collaborator Contribution Our partners provided us insight into the challenges of conducting research during an outbreak, allowing us to interview them for the ESRC project and observe the day-to-day work of enrolling and informing participants, as well as negotiating the bureaucratic processes of clinical research in country and at the international level.
Impact This is a multi-disciplinary collaboration involving clinicians, virologists and anthropologists. The trial in Guinea has showed that convalescent blood and plasma is a promising therapeutic for the treatment of Ebola, while research in Sierra Leone has yet to be completed. Anthropological analysis regarding the experiences of the survivors in this projects is still in process.
Start Year 2015
 
Description Sierra Leone Capacity Building 
Organisation Kings Sierra Leone Partnership
Country Sierra Leone 
Sector Charity/Non Profit 
PI Contribution One of the central aims of this project was to bring social scientific insights to bare on the design of research and interventions into post-ebola health care capacity in Sierra Leone. We have helped develop proposals for to support the masters and doctoral research of members of the 34th Military, Njala university and have helped develop large-scale capacity building grants to Comic Relief and Horizon 2020. Members of our team have also worked with iDT labs, a tech company based in Freetown, to help design surveys to test platforms for the transfer of mobile money to healthcare workers. We are currently supporting a working group on antimicrobial resistance, including the pharmacy board, WHO (labs), MSH (Management Sciences for Health) to design standardised data collection tools for the surveillance of AMR to feed into a national strategy. We have supported the work of a doctoral student from Edinburgh to develop a plan for research to be conducted in collaboration with Mercy Hospital Research Laboratory to come to understand the impact of the Presidential Recovery Priority (PRP) implementation process in Bo district, Southern Sierra Leone.
Collaborator Contribution The Military 34th Hospital in Freetown provided an entry point to interview and work with Ebola survivors who are serviced by a dedicated clinic on its grounds. King's Sierra Leone Partnership, which played a central role in containing the Ebola outbreak in Freetown, provided links with health workers and staff in the city for this project's research into the impact of the response on the health system. The iDT labs offered an overview to the specific technical and communicative challenges of the outbreak and provided insights into innovative pathways to support health care workforce through mobile salary platforms. Njala university provided an academic partner for research conducted in the areas near Bo. Mercy Hospital Research Laboratories provided links with health workers in the region to come to grips with the impact of the post-ebola on district health systems.
Impact We have submitted two grants proposals, one to Horizon 2020, which while scored well did not receive funding. The second, currently under review, is to Comic Relief and will focus on implementing a system of malaria. We have supported three masters projects to completion and supported the successful application of one of these students, Tommy Hansen, to study for a PhD at the London School of Hygiene and Tropical Medicine with Profession Melissa Parker. We are in the process of applying for funding for Steven Sevalier, soon to be director of research at Military 34th Hospital, to pursue at PhD project under the supervision of Ann H. Kelly at King's College London. We have organised a survivors workshop to feedback concerns to researcher's coordinating the convalescent blood and plasma trial and finally, a series of village-level meetings to feed into FAO strategies to increase awareness of common infectious disease resevoirs in the region.
Start Year 2015
 
Description Sierra Leone Capacity Building 
Organisation Mercy Hospital
Department Mercy Hospital Research Lab
Country Sierra Leone 
Sector Hospitals 
PI Contribution One of the central aims of this project was to bring social scientific insights to bare on the design of research and interventions into post-ebola health care capacity in Sierra Leone. We have helped develop proposals for to support the masters and doctoral research of members of the 34th Military, Njala university and have helped develop large-scale capacity building grants to Comic Relief and Horizon 2020. Members of our team have also worked with iDT labs, a tech company based in Freetown, to help design surveys to test platforms for the transfer of mobile money to healthcare workers. We are currently supporting a working group on antimicrobial resistance, including the pharmacy board, WHO (labs), MSH (Management Sciences for Health) to design standardised data collection tools for the surveillance of AMR to feed into a national strategy. We have supported the work of a doctoral student from Edinburgh to develop a plan for research to be conducted in collaboration with Mercy Hospital Research Laboratory to come to understand the impact of the Presidential Recovery Priority (PRP) implementation process in Bo district, Southern Sierra Leone.
Collaborator Contribution The Military 34th Hospital in Freetown provided an entry point to interview and work with Ebola survivors who are serviced by a dedicated clinic on its grounds. King's Sierra Leone Partnership, which played a central role in containing the Ebola outbreak in Freetown, provided links with health workers and staff in the city for this project's research into the impact of the response on the health system. The iDT labs offered an overview to the specific technical and communicative challenges of the outbreak and provided insights into innovative pathways to support health care workforce through mobile salary platforms. Njala university provided an academic partner for research conducted in the areas near Bo. Mercy Hospital Research Laboratories provided links with health workers in the region to come to grips with the impact of the post-ebola on district health systems.
Impact We have submitted two grants proposals, one to Horizon 2020, which while scored well did not receive funding. The second, currently under review, is to Comic Relief and will focus on implementing a system of malaria. We have supported three masters projects to completion and supported the successful application of one of these students, Tommy Hansen, to study for a PhD at the London School of Hygiene and Tropical Medicine with Profession Melissa Parker. We are in the process of applying for funding for Steven Sevalier, soon to be director of research at Military 34th Hospital, to pursue at PhD project under the supervision of Ann H. Kelly at King's College London. We have organised a survivors workshop to feedback concerns to researcher's coordinating the convalescent blood and plasma trial and finally, a series of village-level meetings to feed into FAO strategies to increase awareness of common infectious disease resevoirs in the region.
Start Year 2015
 
Description Sierra Leone Capacity Building 
Organisation Ministry of Defence, Sierra Leone
Country Sierra Leone 
Sector Public 
PI Contribution One of the central aims of this project was to bring social scientific insights to bare on the design of research and interventions into post-ebola health care capacity in Sierra Leone. We have helped develop proposals for to support the masters and doctoral research of members of the 34th Military, Njala university and have helped develop large-scale capacity building grants to Comic Relief and Horizon 2020. Members of our team have also worked with iDT labs, a tech company based in Freetown, to help design surveys to test platforms for the transfer of mobile money to healthcare workers. We are currently supporting a working group on antimicrobial resistance, including the pharmacy board, WHO (labs), MSH (Management Sciences for Health) to design standardised data collection tools for the surveillance of AMR to feed into a national strategy. We have supported the work of a doctoral student from Edinburgh to develop a plan for research to be conducted in collaboration with Mercy Hospital Research Laboratory to come to understand the impact of the Presidential Recovery Priority (PRP) implementation process in Bo district, Southern Sierra Leone.
Collaborator Contribution The Military 34th Hospital in Freetown provided an entry point to interview and work with Ebola survivors who are serviced by a dedicated clinic on its grounds. King's Sierra Leone Partnership, which played a central role in containing the Ebola outbreak in Freetown, provided links with health workers and staff in the city for this project's research into the impact of the response on the health system. The iDT labs offered an overview to the specific technical and communicative challenges of the outbreak and provided insights into innovative pathways to support health care workforce through mobile salary platforms. Njala university provided an academic partner for research conducted in the areas near Bo. Mercy Hospital Research Laboratories provided links with health workers in the region to come to grips with the impact of the post-ebola on district health systems.
Impact We have submitted two grants proposals, one to Horizon 2020, which while scored well did not receive funding. The second, currently under review, is to Comic Relief and will focus on implementing a system of malaria. We have supported three masters projects to completion and supported the successful application of one of these students, Tommy Hansen, to study for a PhD at the London School of Hygiene and Tropical Medicine with Profession Melissa Parker. We are in the process of applying for funding for Steven Sevalier, soon to be director of research at Military 34th Hospital, to pursue at PhD project under the supervision of Ann H. Kelly at King's College London. We have organised a survivors workshop to feedback concerns to researcher's coordinating the convalescent blood and plasma trial and finally, a series of village-level meetings to feed into FAO strategies to increase awareness of common infectious disease resevoirs in the region.
Start Year 2015
 
Description Sierra Leone Capacity Building 
Organisation Njala University, Sierra Leone
Country Sierra Leone 
Sector Academic/University 
PI Contribution One of the central aims of this project was to bring social scientific insights to bare on the design of research and interventions into post-ebola health care capacity in Sierra Leone. We have helped develop proposals for to support the masters and doctoral research of members of the 34th Military, Njala university and have helped develop large-scale capacity building grants to Comic Relief and Horizon 2020. Members of our team have also worked with iDT labs, a tech company based in Freetown, to help design surveys to test platforms for the transfer of mobile money to healthcare workers. We are currently supporting a working group on antimicrobial resistance, including the pharmacy board, WHO (labs), MSH (Management Sciences for Health) to design standardised data collection tools for the surveillance of AMR to feed into a national strategy. We have supported the work of a doctoral student from Edinburgh to develop a plan for research to be conducted in collaboration with Mercy Hospital Research Laboratory to come to understand the impact of the Presidential Recovery Priority (PRP) implementation process in Bo district, Southern Sierra Leone.
Collaborator Contribution The Military 34th Hospital in Freetown provided an entry point to interview and work with Ebola survivors who are serviced by a dedicated clinic on its grounds. King's Sierra Leone Partnership, which played a central role in containing the Ebola outbreak in Freetown, provided links with health workers and staff in the city for this project's research into the impact of the response on the health system. The iDT labs offered an overview to the specific technical and communicative challenges of the outbreak and provided insights into innovative pathways to support health care workforce through mobile salary platforms. Njala university provided an academic partner for research conducted in the areas near Bo. Mercy Hospital Research Laboratories provided links with health workers in the region to come to grips with the impact of the post-ebola on district health systems.
Impact We have submitted two grants proposals, one to Horizon 2020, which while scored well did not receive funding. The second, currently under review, is to Comic Relief and will focus on implementing a system of malaria. We have supported three masters projects to completion and supported the successful application of one of these students, Tommy Hansen, to study for a PhD at the London School of Hygiene and Tropical Medicine with Profession Melissa Parker. We are in the process of applying for funding for Steven Sevalier, soon to be director of research at Military 34th Hospital, to pursue at PhD project under the supervision of Ann H. Kelly at King's College London. We have organised a survivors workshop to feedback concerns to researcher's coordinating the convalescent blood and plasma trial and finally, a series of village-level meetings to feed into FAO strategies to increase awareness of common infectious disease resevoirs in the region.
Start Year 2015
 
Description Sierra Leone Capacity Building 
Organisation iDT labs
Country Sierra Leone 
Sector Private 
PI Contribution One of the central aims of this project was to bring social scientific insights to bare on the design of research and interventions into post-ebola health care capacity in Sierra Leone. We have helped develop proposals for to support the masters and doctoral research of members of the 34th Military, Njala university and have helped develop large-scale capacity building grants to Comic Relief and Horizon 2020. Members of our team have also worked with iDT labs, a tech company based in Freetown, to help design surveys to test platforms for the transfer of mobile money to healthcare workers. We are currently supporting a working group on antimicrobial resistance, including the pharmacy board, WHO (labs), MSH (Management Sciences for Health) to design standardised data collection tools for the surveillance of AMR to feed into a national strategy. We have supported the work of a doctoral student from Edinburgh to develop a plan for research to be conducted in collaboration with Mercy Hospital Research Laboratory to come to understand the impact of the Presidential Recovery Priority (PRP) implementation process in Bo district, Southern Sierra Leone.
Collaborator Contribution The Military 34th Hospital in Freetown provided an entry point to interview and work with Ebola survivors who are serviced by a dedicated clinic on its grounds. King's Sierra Leone Partnership, which played a central role in containing the Ebola outbreak in Freetown, provided links with health workers and staff in the city for this project's research into the impact of the response on the health system. The iDT labs offered an overview to the specific technical and communicative challenges of the outbreak and provided insights into innovative pathways to support health care workforce through mobile salary platforms. Njala university provided an academic partner for research conducted in the areas near Bo. Mercy Hospital Research Laboratories provided links with health workers in the region to come to grips with the impact of the post-ebola on district health systems.
Impact We have submitted two grants proposals, one to Horizon 2020, which while scored well did not receive funding. The second, currently under review, is to Comic Relief and will focus on implementing a system of malaria. We have supported three masters projects to completion and supported the successful application of one of these students, Tommy Hansen, to study for a PhD at the London School of Hygiene and Tropical Medicine with Profession Melissa Parker. We are in the process of applying for funding for Steven Sevalier, soon to be director of research at Military 34th Hospital, to pursue at PhD project under the supervision of Ann H. Kelly at King's College London. We have organised a survivors workshop to feedback concerns to researcher's coordinating the convalescent blood and plasma trial and finally, a series of village-level meetings to feed into FAO strategies to increase awareness of common infectious disease resevoirs in the region.
Start Year 2015
 
Description Zoonotic Spillover 
Organisation Food and Agricultural Organisation (FAO)
Country Italy 
Sector Charity/Non Profit 
PI Contribution Jesse Bonwit has contributed to FAO response to the outbreak on national and local levels, providing key insights into how publics in Guinea and Sierra Leone perceive the public health risk animals pose, how they react and response to surveillance systems and the impact of the bushmeat ban. I helped support the design of research into the effectiveness of national animal health surveillance systems and Roland Sukulu, a research partner and doctoral candidate, is currently help develop local veterinary committees to help encourage local ownership of public health measures to prevent and control zoonotic disease and to make best use of local knowledge of the health of reservoir species.
Collaborator Contribution FAO has helped provide an platform to investigate the interests and perspectives of governmental officials involved in animal wildlife health at the ministierial provial level (Ministory of Education, Ministry of Agriculture, Forestry and Food Security and National Parks).
Impact During their secondment to the FAO, Jesse Bonwitt and Julien Gavelle have helped craft institutional policies regarding public health messaging about Ebola and regional surevillance policies.
Start Year 2014
 
Description Coordinated a 2 day workshop with Ebola survivors in Freetown, Sierra Leone 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact We coordinated a workshop with the Sierra Leone Survivors Association to bring together survivors with researches involved in the investigation of the therapeutic potential of convalescent blood and plasma. In addition to discussing the experiences and challenges involved in this particular clinical trial, our audience included survivors who were not participants to reflect more broadly on the impact of medical research during a time of emergency and the role survivors might plan in crafting future investigations into their condition and policy for ebola preparedness. Researchers found the activity enormously helpful in identifying the stumbling blocks their project faced and helped to understand the core concerns of survivors.
Year(s) Of Engagement Activity 2017
 
Description Workshop and Roundtable at Durham University 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This two-day workshop brought together anthropologists, historians and specialists from other disciplines who have engaged with ethnographic perspectives to extend their study of emerging and re(emerging) diseases across the tropics. It seeks to answer three overarching questions. (1) How should scientists engage with the question of emergence and historicity in the context of global health? (2) What are the theoretical potentials of working as social scientists and historians on zoonotic and vector borne disease and (3) What are the ethnographic challenges of engaging with the past of global health as we move to an uncertain future. The first day was largely consisted of academic presentations while the second involved a roundtable discussion and debate with practitioners from the developing and developed world around the question of the value of the one health concept, the history of its impact on policy and its future relevance.
Year(s) Of Engagement Activity 2015
URL https://www.youtube.com/watch?v=nYgVnId1BYk