Health promotion is dependent upon sharing information with local populations and adapting health-care services to make them more acceptable, and is an essential part of any Ebola intervention. Listening to the concerns of local communities and engaging them as active participants ensures that health promotion messages are relevant, acceptable and understandable as well as culturally appropriate. Ebola is associated with fear and death, thus understanding the significance and meanings of life, death, disease and sickness for the Kissi of Guinea Forestière (Guinea) is essential for ensuring acceptable health services. Community engagement was essential for this research to gain the trust of the Kissi and to facilitate the sharing of knowledge and information to reduce the transmission of the Ebola virus. This technical account is based on three periods of ethnographic fieldwork and health promotion activities conducted in Guinea between May 2014 and February 2015.
Adapting Health-promotion Messages to Incorporate Local Meanings in Guinée Forestière
Maria Cristina Manca
Case Studies from West Africa
Emilie Venables and Umberto Pellecchia
The articles in this special issue demonstrate, through ethnographic fieldwork and observations, how anthropologists and the methodological tools of their discipline became a means of understanding the Ebola outbreak in West Africa during 2014 and 2015. The examples, from Liberia, Guinea and Sierra Leone, show how anthropologists were involved in the Ebola outbreak at different points during the crisis and the contributions their work made. Discussing issues including health promotion, gender, quarantine and Ebola survivors, the authors show the diverse roles played by anthropologists and the different ways in which they made use of the tools of their discipline. The case studies draw upon the ethical, methodological and logistical challenges of conducting fieldwork during a crisis such as this one and offer reflections upon the role of anthropology in this context.
Working at the nexus of medical anthropology and the anthropology of childhood, this article challenges three assumptions often embedded in child health policy: (1) children are the passive recipients of healthcare; (2) children’s knowledge of illness and their body can be assumed based on adult understandings; and (3) children’s healthcare can be isolated from their social relations. I explore these themes through the case study of a 2011 New Zealand government initiative to reduce the rates of rheumatic fever affecting low-income Māori and Pasifika children. Drawing on fieldwork with around 80 children at an Auckland primary school, I show how the ‘sore throat’ programme does not merely treat streptococcus A infections, but plays an active role in constituting children’s experiences and understandings of their bodies and illness, and in shaping healthcare practices in ways unintended by policy-makers.
William W. Darrow
Public health in the United States has lost its edge. It made a significant impact on human well-being, capacities, and potential in the late nineteenth and early twentieth centuries. Now it takes a backseat to biomedical research and therapeutic medicine. Population health with its traditional emphasis on preventing harm has been displaced by an exorbitantly expensive and continually expanding medical care system devoted almost exclusively to restoring or rehabilitating the health of patients – no matter the cost. The failure to control the spread of human immunodeficiency virus (HIV) in the United States can be attributed to adherence to an inadequate biomedical model that ignores the social. Social quality theory, designed to further social justice, solidarity, equal value, and human dignity, can contribute to identifying and correcting deficiencies in biomedical approaches to HIV prevention and other public health problems that continue to plague the people of the United States.
The Identity and Stigmatisation of Ebola Survivors
Survivors of the Ebola virus have been widely profiled as the success stories of the outbreak, yet they still face challenges relating to their identity and reintegration. A survivor’s body takes on new meanings aft er experiencing Ebola, and the label ‘survivor’ is as problematic as it is celebratory. Using data conducted during fieldwork in Monrovia, Liberia, this article discusses the complex identities of Ebola survivors. In Monrovia, most of the stigma and discrimination relating to survivors was directed towards men, who were considered ‘atomic bombs’ because of concerns that they could transmit Ebola through sexual intercourse. Health promotion messages around sexual transmission were often misunderstood, and communities requested the quarantine of men to reduce what they felt was a threat to the wider community. Understanding the meanings and sources of such stigmatisation is necessary to be able to work with and support survivors through psychosocial care and health promotion activities.
Arts-based approaches have been used to engage youth in health promotion activism and research in both local and international contexts. The application of art to research as a mode of inquiry has been a means of actively engaging marginalized communities such as youth in the research process in a way that allows them to creatively represent their thoughts and lives, while negotiating their power within the research environment (Wright et al. 2010). In representing their lived experiences, youth are able to name their worlds and challenge dominant culture (including the ways the media represents them) and its inherent power relations (Barndt 2008; Bagnoli 2009). Using art to do this becomes a catalyst for diff erent kinds of knowledge and knowing (Barndt 2008).
Health, Justice and the Persistence of the Sacred
James R. Cochrane
The essay refers to a concern for social justice in the origins of public health, borne in part by religious commitments, and to more recent expressions of a similar concern in debates about health equity. Equity, moreover, is affected by discursive power relations (dominant/hegemonic versus local/suppressed), which are discussed in relation to current research in the African Religious Health Assets Programme on the interaction of particular 'healthworlds' (a conceptual innovation) that shape the choices and behaviour of health-seekers. Two background theoretical positions guide the argument: Amartya Sen's claim that development is linked to freedom (including religious freedom); and, building on Sen's and Martha Nussbaum's human capabilities theory, an asset-based community approach to the building or reconstruction of public health systems. On this basis, it is argued that health systems and health interventions are just to the extent that they mediate between the necessary leadership or polity from 'above' (techné) and the experience and wisdom (métis) of those who are 'below', taking into account the asymmetries of power that this equation represents. Because difference and diversity are so often expressed in what we might reasonably call 'religious' terms, I specifically emphasize the continuing persistence of religion and, hence, the importance of accounting for its pertinence in social theory generally, and in relation to discourses of health and justice in the African context specifically. Acknowledging the ambiguities of religion, I nevertheless argue that an appreciative alignment between public health systems and religious or faith-based initiatives in health promotion, prevention and care is crucial to sustainable and just health systems in Africa.