O2 ‘Free health/free die’: investigating women’s health in post-ebola rural sierra leone

Abstract

In 2014–2015, Sierra Leone suffered through the Ebola epidemic which claimed 3,9561 lives in Sierra Leone alone, led to near global pandemonium, and indirectly resulted in additional deaths for untreated conditions when the health system collapsed; more specifically, it resulted in an estimated 3,2972 additional maternal and neonatal deaths for a country that already has one of the highest maternal mortality rates in the world, 1,360/100,0003 live births. While, social research during the epidemic centered on understanding social and cultural traditions which would serve to reduce people’s movements and encourage their compliance with response efforts, the reasons for communities’ mistrust of the healthcare system went overlooked, and in practice military protocols and parallel health systems were commonly implemented. Since the post-Ebola recovery period, little attention has been paid to the social dynamics of the epidemic, which heavily contributed to its spread and impact, particularly in terms of relationships between community, state, and Development actors. In 2018, I conducted ethnographic research to study women’s relationship to the healthcare system, the social dynamics which impact women’s access to health, as well as social and cultural factors that could inform a future outbreak. I lived for 5 months with a community and conducted participant-observation, 11 focus groups, and 60 in-depth interviews, within the surrounding local communities and with district and national stakeholders, both native Sierra Leoneans and expatriates. Mistrust is still prevalent between communities and state healthcare system, but little has been done to address the relationship between the two. Government-run clinics have become a venue for rent-seeking behavior through the sale of private and public medical drugs, exacerbated by HCWs lack of integration within communities, as well as faults in HCW supervision. Additionally, responsibility and blame for health and illness is typically placed on communities, apparent in health strategies and language. References World Health Organization; March 2016 Ebola Situation Report: http://apps.who.int/ebola/ebola-situation-reports; accessed Sept. 24, 2018. UNFPA, ‘Rapid Assessment of Ebola Impact on reproductive health services and service seeking behavior in Sierra Leone’ March 2015. World Health Organization; 2015 Maternal Mortality Rate: http://apps.who.int/gho/data/node.country.country-SLE?lang=en; accessed Sept. 24, 2018.