{"id":6134,"date":"2014-11-05T06:00:00","date_gmt":"2014-11-05T06:00:00","guid":{"rendered":"https:\/\/africaresearchinstitute.org\/wordpress\/?p=6134"},"modified":"2016-03-11T14:08:50","modified_gmt":"2016-03-11T14:08:50","slug":"ebola-stigma","status":"publish","type":"post","link":"https:\/\/africaresearchinstitute.org\/wordpress\/ebola-stigma\/","title":{"rendered":"Ebola in Sierra Leone: Stigmatisation"},"content":{"rendered":"
In the third of a series of blogs about the impact and consequences of Ebola in Sierra Leone, ARI researcher\u00a0Jamie Hitchen<\/a>, recently back from a year spent working in the country, focuses on stigma.\u00a0You can read the first blog, on health care, here<\/a>. The second blog, on the economic hardships caused by Ebola can be found here<\/a>.\u00a0<\/em><\/address>\n
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Nurse Belkisu survived the virus and now works on the Ebola ward at Connaught; King’s Sierra Leone Partnership<\/p><\/div>\n

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\u201cThe Ebola virus has divided families, societies and has created boundaries within the country.\u00a0 Certain regions within the country have been quarantined\u2026.the social, economic and cultural impact this has is immense.\u201d \u2013 Reverend George Buannie, in conversation with the author, September 2014<\/strong><\/p>\n

The Government of Sierra Leone\u2019s official figures for 29 October 2014 record 786 survivors of Ebola. As the death toll rises, so does the number of survivors \u2013 a group that is quickly becoming ostracised. This post reflects on the stigma that has accompanied the virus at the individual, national and international level.<\/p>\n

Individual<\/strong><\/p>\n

Ebola survivors, health workers and family members of victims all suffer from related stigma.\u00a0 Re-integrating the mounting numbers of Ebola orphans<\/a> into family structures is proving difficult.\u00a0 Fear, is the major problem, caused in the main by poor public health communications from government officials and misinformation spread by rumours within communities.\u00a0 The fear<\/a> is causing individuals to stay at home, rather than report for testing at the limited number of medical facilities which remain open and staffed, thereby undermining efforts to treat patients. Early intervention is important for improved outcomes. When people avoid hospitals, prevention also becomes more difficult as the infected put their family members at risk.<\/p>\n

Addressing stigma should be an indispensable component of the response to Ebola.\u00a0 Lessons can be learned from stigma reduction strategies<\/a> that were developed in response to HIV\/AIDS. The dissemination of messages which communicate the key features of the virus to at-risk communities in order to improve their understanding of transmission and symptoms could play an important role in neutralising the impact of fear.\u00a0\u00a0 Traditional and religious leaders have a vital role to play in conveying these messages, but communities must also be able to ask questions and share concerns.\u00a0 Their voices have not yet been sufficiently heard, and the absence of a mechanism for sharing concerns risks exacerbating tensions.<\/p>\n

National<\/strong><\/p>\n

The emergence of the Ebola virus in Kailahun district, in the remote south-east of the country, where civil war began in 1991, provided ammunition to those seeking further evidence of the\u00a0north-south political divide<\/a>\u00a0that has existed in Sierra Leone since independence.\u00a0 President Koroma\u2019s All People\u2019s Congress (APC) has its support base in the country\u2019s northern districts while the opposition Sierra Leone Peoples Party (SLPP) draws its support base from southern districts.<\/p>\n

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Sierra Leone Presidential Election 2007; ElectoralGeography.com<\/p><\/div>\n

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An underlying perception, in some quarters, of a north-south, fractured and politicised response to the crisis has returned in recent weeks.\u00a0 Although numbers of recorded Ebola cases have decreased in Kailahun the main treatment centres were established there, and in neighbouring Kenema.\u00a0 New centres are being established in Freetown as the number of cases increase, but many patients are still being transported to the southern districts for care.<\/p>\n

According to a former colleague of mine at VSO, Edward Koroma, this is perceived as \u201cputting the communities at risk by continuing to bring infected patients into the districts and, consequently, fostering local resentment\u201d.\u00a0 For now the country remains united in its fight against the virus, but stigmatising whole districts as \u201cEbola centres\u201d has negative social, economic and ultimately, political ramifications.<\/p>\n

International<\/strong><\/p>\n

The stigma extends beyond national boundaries.\u00a0 Some Sierra Leoneans feel abandoned by other African states that have closed their borders<\/a> in response to the threat, hampering the relief effort, and are resentful of the African Union<\/a> \u2013 whose officials only visited for the first time on 23 October and left after just a few hours.<\/p>\n

Ghanaian President John Mahama reflected on this on his return from a visit to Guinea, Liberia and Sierra Leone. In a speech delivered in the UK, in October, he described how Liberia, Guinea and Sierra Leone feel \u201cisolated and ostracised\u201d.<\/p>\n

Africa, as an imagined whole, is being increasingly stigmatised as Ebola cases are treated in Spain and the USA.\u00a0 Further travel bans have been introduced by Canada and Australia, passenger screening is taking place, and examples of UK schools<\/a> cancelling trips to countries as distant from the outbreak as Tanzania characterises how panic and prejudice have trumped rationality.<\/p>\n

The stigma associated with Ebola has many facets, but the result is always the same: isolation and mounting, mutual distrust.<\/p>\n

Way Forward<\/strong><\/p>\n

Changing how Ebola survivors are perceived is critical for easing community tensions and effecting the eradication of Ebola. Given that survivors have immunity, once fully recovered they could work at treatment centres in a number of capacities. According to a clinical psychologist<\/em> <\/i>currently working in West Africa, who does not wish to be named, they could:<\/p>\n

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  1. Encourage and talk to patients<\/b><\/li>\n
  2. Advise those who run treatment centres on care and living environments, from a patient\u2019s point of view<\/b><\/li>\n
  3. Provide positive reinforcement for highly pressured healthcare workers <\/b><\/li>\n<\/ol>\n
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    At a global level, President Obama\u2019s public hug with Ebola survivor Nina Pham<\/a> was a deeply symbolic moment in tackling survivor stigma. By contrast, President Koroma avoided<\/a> physical contact with the survivors he met last month in Hastings. \u00a0It will be hard to shift community attitudes towards survivors unless senior officials lead by example.<\/p>\n

    by\u00a0Jamie Hitchen<\/a>, Policy Researcher, Africa Research Institute<\/em><\/p>\n

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    ARI Series: Ebola in Sierra Leone<\/div>\n
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