Jun 29, 2019 Volume 393Number 10191p2563-2654, e45
Responding to the Ebola virus disease outbreak in DR Congo: when will we learn from Sierra Leone?
The Ebola Gbalo Research Group
In Sierra Leone, we found that community-level distrust was related to the nature of the response and the distance to the locus of operational decision making. Large and distant Ebola treatment centres were distrusted because families could not follow sick relatives and monitor their progress; rather, patients were seen to be taken away by hazmat-suited strangers to die in unknown locations (many bodies were never returned, their graves unknown). Village-based community care centres were preferred as triage facilities because community members knew the staff and could see into the centres. 10 Burial teams and contact tracing worked best when the recruits were local. Panic and confusion were alleviated when home carers were given clear instructions about how to care for their loved ones safely while waiting for help to arrive. 11 Where local agents, including health personnel, government workers, and families, were strongly involved in planning and implementing the response it was more effective. Families were recognised as essential to the survival of their relatives, and local health personnel felt fully valued. Our findings suggest that in Bo and Moyamba districts the response succeeded when community and district leaders were fully engaged. The actors differed in each district; international responders need to work with district and traditional authorities, as well as health workers embedded in communities, to discover other local leaders and figures of influence, including women’s groups, secret societies and religious groups, traditional healers, citizen welfare groups, and youth organisations.