Abstract
BackgroundA major challenge to outbreak control lies in early detection of viral haemorrhagic fevers (VHFs) in local community contexts during the critical initial stages of an epidemic, when risk of spreading is its highest (“the first mile”). In this paper we document how a major Ebola outbreak control effort in central Uganda in 2012 was experienced from the perspective of the community. We ask to what extent the community became a resource for early detection, and identify problems encountered with community health worker and social mobilization strategies.MethodsAnalysis is based on first-hand ethnographic data from the center of a small Ebola outbreak in Luwero Country, Uganda, in 2012. Three of this paper’s authors were engaged in an 18 month period of fieldwork on community health resources when the outbreak occurred. In total, 13 respondents from the outbreak site were interviewed, along with 21 key informants and 61 focus group respondents from nearby Kaguugo Parish. All informants were chosen through non-probability sampling sampling.ResultsOur data illustrate the lack of credibility, from an emic perspective, of biomedical explanations which ignore local understandings. These explanations were undermined by an insensitivity to local culture, a mismatch between information circulated and the local interpretative framework, and the inability of the emergency response team to take the time needed to listen and empathize with community needs. Stigmatization of the local community – in particular its belief in amayembe spirits – fuelled historical distrust of the external health system and engendered community-level resistance to early detection.ConclusionsGiven the available anthropological knowledge of a previous outbreak in Northern Uganda, it is surprising that so little serious effort was made this time round to take local sensibilities and culture into account. The “first mile” problem is not only a question of using local resources for early detection, but also of making use of the contextual cultural knowledge that has already been collected and is readily available. Despite remarkable technological innovations, outbreak control remains contingent upon human interaction and openness to cultural difference.
Highlights
A major challenge to outbreak control lies in early detection of viral haemorrhagic fevers (VHFs) in local community contexts during the critical initial stages of an epidemic, when risk of spreading is its highest (“the first mile”)
The first mile in disease outbreak control There is general agreement that community members have a key role to play in early detection of Viral Haemorrhagic Fevers (VHFs) such as Ebola
To solve the first mile problem, public health managers are quick to involve community health workers and social mobilization teams, ideally equipping them with smartphones to map the outbreak in real time
Summary
A major challenge to outbreak control lies in early detection of viral haemorrhagic fevers (VHFs) in local community contexts during the critical initial stages of an epidemic, when risk of spreading is its highest (“the first mile”). The first mile in disease outbreak control There is general agreement that community members have a key role to play in early detection of Viral Haemorrhagic Fevers (VHFs) such as Ebola. Detection in the community presents a major challenge due to the difficulty for community members of recognizing nonspecific and common early symptoms such as fever, nausea, vomiting, diarrhea, and weakness. This is exacerbated by a general lack of local knowledge about biomedical explanations and by competing indigenous explanatory frameworks. We suggest that the “first mile” of VHF outbreak control presents us with a comparable challenge in reverse: to try to capture timely information about an imminent outbreak from the community on the ground
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