EAN News Newsletter of the EPIET Alumni Network
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EAN News Newsletter of the EPIET Alumni Network www.epietalum.net Special issue: Ebola February 2015 Winter newsletter ‘P(PE)raying Circle’, by Nadine Zeitlmann (C2013) Editorial Board Dear EAN members, experiences of setting up a mobile President lab in Guinea; Sophie Newitt (UK Happy New Year! We begin this year’s FETP C2013) and Jorge del Diego Naomi Boxall EAN newsletter series with a special share a New Year’s wish with us from issue focussing on the Ebola outbreak the field; and Appi Epi features useful Vice-President in West Africa (already over a year Ebola-related online resources. Ricardo Mexia since the first case!). Also in this issue: intros from our Chikwe Ihekweazu (EPIET C9) gives two new board members, Ricardo Treasurer a longer term perspective on how and Katherina; “Where Are You Katherina Zakikhany best to respond to the outbreak. Now?” features from three recently Anthropologist Annie Wilkinson graduated C2012 fellows; ESCAIDE introduces the Ebola Response experiences from this year’s EAN Treasurer Anthropology Platform, an online travel grant awardees – and last but Javiera Rebolledo resource for field responders to help not least, an introduction to the better understand and utilise the brand new EAN website! Secretary cultural contexts where they are working to improve control measures. Enjoy the read and all the best for Georgia Ladbury 2015, C2013 fellows recently back from The EAN Board Secretary missions reflect on their experiences and Maria Keramarou both in the field and returning home; Zuzana Klochanova & Suzan Trienekens Zoltan Kis (EUPHEM C2013) shares his Editor & Designer Page 1 Beyond epicurves - Chikwe Ihekweazu Do we have a broader responsibility to Back in Geneva for a de-brief with WHO, I tried public health as field epidemiologists? to ask more experienced colleagues how they managed to deal with the pain of leaving I remember the adrenaline rush when the first outbreak situations when the outbreak was opportunity to participate in an Ebola outbreak controlled. It was clear to me that while we came my way in 2004, as an EPIET fellow. A more may have helped put out one fire; we had not experienced colleague who had been chosen influenced the circumstances that led to the for the mission had to cancel at the last minute fire. Very early in my career, I felt the limitations for personal reasons and the opportunity came of the scope of field epidemiology. I thought: my way. It was the first of several missions that There must be more that we can do. I undertook for the World Health Organisation’s (WHO) Global Outbreak Alert and Response Ten years later, I am in Liberia as part of the Network. The outbreak was in Yambio, South huge response to the largest Ebola outbreak Sudan, one of the poorest countries in the world ever. As always there are many competent which was then just coming out of a protracted and well-meaning experts, which is exactly crisis. The location of the outbreak was not far what the situation has been calling for. Almost from the site where the first Ebola outbreak was every international NGO is in Liberia, Guinea reported in 1976. and Sierra Leone. For the first time, in the early weeks of 2015, the epicurve is beginning to I was lucky to work with an extremely head south. experienced and supportive team from the WHO, the US Centers for Disease Control (CDC) While the outbreak is by no means over, there and Medecins Sans Frontieres (MSF). I learnt is a feeling in the field that we are beginning to a lot from these colleagues in an intensive get the scale of response that is commensurate outbreak response that lasted about four with the size of this large outbreak. Over dinner weeks. Luckily, the outbreak was controlled; and coffee, I can’t help but listen to some of we ended up with a total of 17 cases, including the conversations. There is a growing feeling of seven deaths. quiet optimism, and when the outbreak is over there will be many more colleagues that will in At the end of that outbreak, WHO said, in a the next few months add an important line to statement still on their website (http://www. their resumes. who.int/mediacentre/news/releases/2004/ Yes, I am confident that if we continue working pr54/en) that: “The lessons we learned in as hard as we are at the moment, we will Yambio from this outbreak will strengthen eventually control this outbreak. Then, most of our responses to future outbreaks,” ... “The us will go home. Some of us will proceed to the Yambio experience has proven the value next crisis and others will go back to some of of rapid outbreak detection, local response those old-school, less glamorous public health capacities, active community involvement, and challenges like tuberculosis. Don’t expect an the coordination of specialized international international mobilisation for that. assistance to the outbreak’s containment”. So, would we have completed our jobs as field After that outbreak, the team felt a sense epidemiologists when this outbreak is finally of accomplishment, which I shared. We had under control? Since most of us as are not part probably helped save hundreds if not thousands of the decision making processes that relate to of lives. But I could not get South Sudan off my economic development in countries like Liberia, mind. I met a young man during that outbreak the natural answer would be “yes”. But can we – a “survivor”, with whom I kept in touch for a continue with this same paradigm in 2015? Can while. He had joined our social mobilization we really afford to go back to work – and forget team and supported our response. I felt obliged Liberia? Can we leave it to the bureaucrats at to help him get back to a “normal” life, and I did the World Bank or IMF as has been the case in this for a while. But, with time, I “let go”. the past? Page 2 Beyond epicurves - Chikwe Ihekweazu This time, things have to be different – we just from the HIV/AIDS global epidemic that robust cannot afford to casually go back to the status health systems are critical in mounting and quo. We have to raise our collective voices sustaining a vigorous response to an emerging about the situation in the clinics that we visited disease threat. This 2014 Ebola outbreak for “assessments” and the conditions in the provides a unique opportunity to rebuild schools from which we recruited teachers as and strengthen health systems and should “social mobilisers”. The conditions in the slums serve as an instigator for a much more robust that we drove past in our white jeeps are not investment in public health. “normal” for Liberia! They cannot be “normal” in any country. It really does not matter how Being part of this response is a rare privilege. much airport screening we do, humanity stands It is not one that can be completed with a no chance against viruses if people live in the “mission report”. If the over 1000 international squalor of West Point. colleagues that have participated in this response change their views on public health More than ever before there is a possibility that as our collective responsibility, we may have we can engage the attention of the world to a small chance of really changing the way we call for collective action to force the change think about intervention field epidemiology. that needs to happen in places like Liberia, The one thing that we can be absolutely sure which the outbreak has brought to the world’s of is that there will be another large outbreak attention. As epidemiologists that have spent somewhere in the world in the next few years. months in the field, we have a moral obligation It really is our collective choice to either learn to lend our voices to the broader struggle. We from history or to keep doing things the cannot and should not look away. same way we always have. Granted, working in partnership for development is a lot more We must raise our voices and share our complicated than “outbreak control” – but this experience and call our governments to action. really is the only sustainable way forward. We have a responsibility to try to influence the broader public health agenda beyond the The choice is ours. technical aspects of our work. We have learnt The Ebola Response Anthropology Platform Annie Wilkinson is a social anthropologist at on the ‘ignorance’ and ‘superstition’ of local the UK Institute of Development Studies and populations, supposedly evidenced by member of the Ebola Response Anthropol- Ebola denial and preference for ‘traditional’ treatments and burials. Relationships between ogy Platform. Her current research focuses local populations and response partners were on health systems, after a PhD investigating clearly problematic. However, such ‘culturalist’ health seeking and diagnosis of Lassa fever in interpretations are misleading as they deny Sierra Leone. the validity of local people’s logics and perspectives, including those rooted in the The Ebola Response Anthropology Platform experience of inadequate health systems and was set up out of a concern that the social of governments proven not to act in people’s and political dimensions of the West African interest. In addition, the top-down and Ebola epidemic were being overlooked and medicalised approaches which have dominated misunderstood. From early on, conventional the response to date have too often excluded tools of containment for Ebola were failing as local people from meaningful involvement in public health teams were met with fear and efforts managing the epidemic and from decisions over to isolate patients, quarantine households their health, or the burial of family members.