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Dibba Y, Kachimanga C, Gassimu J, Kulinkina AV, Bukhman G, Gilbert HN, Adler AJ, Mukherjee JS. Non-communicable disease care in Sierra Leone: a mixed-methods study of the drivers and barriers to retention in care for hypertension. BMJ Open 2024; 14:e077326. [PMID: 38346892 PMCID: PMC10862328 DOI: 10.1136/bmjopen-2023-077326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 01/11/2024] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVE To retrospectively analyse routinely collected data on the drivers and barriers to retention in chronic care for patients with hypertension in the Kono District of Sierra Leone. DESIGN Convergent mixed-methods study. SETTING Koidu Government Hospital, a secondary-level hospital in Kono District. PARTICIPANTS We conducted a descriptive analysis of key variables for 1628 patients with hypertension attending the non-communicable disease (NCD) clinic between February 2018 and August 2019 and qualitative interviews with 21 patients and 7 staff to assess factors shaping patients' retention in care at the clinic. OUTCOMES Three mutually exclusive outcomes were defined for the study period: adherence to the treatment protocol (attending >80% of scheduled visits); loss-to-follow-up (LTFU) (consecutive 6 months of missed appointments) and engaged in (but not fully adherent) with treatment (<80% attendance). RESULTS 57% of patients were adherent, 20% were engaged in treatment and 22% were LTFU. At enrolment, in the unadjusted variables, patients with higher systolic and diastolic blood pressures had better adherence than those with lower blood pressures (OR 1.005, 95% CI 1.002 to 1.009, p=0.004 and OR 1.008, 95% CI 1.004 to 1.012, p<0.001, respectively). After adjustment, there were 14% lower odds of adherence to appointments associated with a 1 month increase in duration in care (OR 0.862, 95% CI 0.801 to 0.927, p<0.001). Qualitative findings highlighted the following drivers for retention in care: high-quality education sessions, free medications and good interpersonal interactions. Challenges to seeking care included long wait times, transport costs and misunderstanding of the long-term requirement for hypertension care. CONCLUSION Free medications, high-quality services and health education may be effective ways of helping NCD patients stay engaged in care. Facility and socioeconomic factors can pose challenges to retention in care.
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Affiliation(s)
- Yusupha Dibba
- Clinical, Partners In Health, Freetown, Kono, Sierra Leone
- Harvard Medical School Blavatnik Institute, Boston, Massachusetts, USA
| | | | - Joseph Gassimu
- Clinical, Partners In Health, Freetown, Kono, Sierra Leone
| | - Alexandra V Kulinkina
- Clinical, Partners In Health, Freetown, Kono, Sierra Leone
- Swiss Tropical and Public Health Institute, Allschwil Switzerland, Basel, Switzerland
| | - Gene Bukhman
- Harvard Medical School Blavatnik Institute, Boston, Massachusetts, USA
- Center for Integration Science, Brigham and Women's Hospital, Boston, MA, USA
| | - Hannah N Gilbert
- Harvard Medical School Blavatnik Institute, Boston, Massachusetts, USA
| | - Alma J Adler
- Harvard Medical School Blavatnik Institute, Boston, Massachusetts, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Joia S Mukherjee
- Harvard Medical School Blavatnik Institute, Boston, Massachusetts, USA
- Clinical, Partners In Health, Boston, Massachusetts, USA
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Frankfurter R, Malik M, Kpakiwa SD, McGinnis T, Malik MM, Chitre S, Barrie MB, Dibba Y, Mulalu L, Baldwinson R, Fallah M, Rashid I, Kelly JD, Richardson ET. Representations of an Ebola 'outbreak' through Story Technologies. BMJ Glob Health 2024; 9:e013210. [PMID: 38341190 PMCID: PMC10862337 DOI: 10.1136/bmjgh-2023-013210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/14/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Attempts to understand biosocial phenomena using scientific methods are often presented as value-neutral and objective; however, when used to reduce the complexity of open systems such as epidemics, these forms of inquiry necessarily entail normative considerations and are therefore fashioned by political worldviews (ideologies). From the standpoint of poststructural theory, the character of these representations is at most limited and partial. In addition, these modes of representation (as stories) do work (as technologies) in the service of, or in resistance to, power. METHODS We focus on a single Ebola case cluster from the 2013-2016 outbreak in West Africa and examine how different disciplinary forms of knowledge production (including outbreak forecasting, active epidemiological surveillance, post-outbreak serosurveys, political economic analyses, and ethnography) function as Story Technologies. We then explore how these technologies are used to curate 'data,' analysing the erasures, values, and imperatives evoked by each. RESULTS We call attention to the instrumental-in addition to the descriptive-role Story Technologies play in ordering contingencies and establishing relationships in the wake of health crises. DISCUSSION By connecting each type of knowledge production with the systems of power it reinforces or disrupts, we illustrate how Story Technologies do ideological work. These findings encourage research from pluriversal perspectives and advocacy for measures that promote more inclusive modes of knowledge production.
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Affiliation(s)
| | - Maya Malik
- School of Social Work, McGill University, Montreal, Québec, Canada
| | | | - Timothy McGinnis
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Momin M Malik
- Center for Digital Health, Mayo Clinic, Rochester, Minnesota, USA
| | - Smit Chitre
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Lulwama Mulalu
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Raquel Baldwinson
- Department of English Language and Literatures, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mosoka Fallah
- Africa Centres for Disease Control and Prevention, African Union, Addis Ababa, Ethiopia
| | - Ismail Rashid
- Department of History, Vassar College, Poughkeepsie, New York, USA
| | - J Daniel Kelly
- Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Eugene T Richardson
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Joseph SA, Jerome JG, Boima F, Pognon PR, Fejfar D, Dibba Y, Lavalie D, Barrie MB, Oteju A, Sheku M, Mahmoud M, Mattia J, Barnhart DA. Attitudes toward COVID-19 Vaccination: Staff and Patient Perspectives at Six Health Facilities in Sierra Leone. Vaccines (Basel) 2023; 11:1385. [PMID: 37631953 PMCID: PMC10458439 DOI: 10.3390/vaccines11081385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 08/29/2023] Open
Abstract
Sierra Leone is a West African country with a population of over 8 million. With more than half of Sierra Leone's population living in rural areas, it is important to understand rural populations' access to and attitudes toward the COVID-19 vaccine. In November 2021, the rate of vaccination coverage in Sierra Leone was only 7% for one dose and 4% for two doses. Understanding perspectives of health facility staff and patients can help strengthen future vaccine campaigns. We conducted a cross-sectional study, between March 2022 and May 2022, of clinical staff, non-clinical staff, and adult (>18 years) patients/caregivers attending six Ministry of Health and Sanitation (MoHS) facilities supported by Partners In Health, four in the Kono district and two in the Western Urban Area district, the capital of Sierra Leone. We assessed the opportunity to vaccinate, vaccine uptake, and intention to vaccinate. Out of the 2015 participants, 11.4% were clinical staff, 18.8% were non-clinical staff, and 69.8% were patients/caregivers. Less than half of the patients/caregivers had the opportunity to be vaccinated (42%), and 22% of patients/caregivers were fully vaccinated. Among the unvaccinated population, 44% would refuse a vaccine if offered to them at no cost. Lack of access to COVID-19 vaccines and to official education messaging, especially for patients and caregivers, is still an underlying problem in Sierra Leone for vaccine uptake, rather than a lack of willingness to be vaccinated.
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Affiliation(s)
| | - Jean Gregory Jerome
- Partners In Health Sierra Leone (PIH-SL), Freetown, Sierra Leone; (J.G.J.); (F.B.); (P.R.P.); (Y.D.); (M.B.B.); (A.O.); (M.S.)
| | - Foday Boima
- Partners In Health Sierra Leone (PIH-SL), Freetown, Sierra Leone; (J.G.J.); (F.B.); (P.R.P.); (Y.D.); (M.B.B.); (A.O.); (M.S.)
| | - Pierre Ricard Pognon
- Partners In Health Sierra Leone (PIH-SL), Freetown, Sierra Leone; (J.G.J.); (F.B.); (P.R.P.); (Y.D.); (M.B.B.); (A.O.); (M.S.)
| | - Donald Fejfar
- Partners In Health (PIH), Boston, MA 02199, USA; (D.F.); (D.A.B.)
| | - Yusupha Dibba
- Partners In Health Sierra Leone (PIH-SL), Freetown, Sierra Leone; (J.G.J.); (F.B.); (P.R.P.); (Y.D.); (M.B.B.); (A.O.); (M.S.)
| | - Daniel Lavalie
- Ministry of Health and Sanitation, Freetown, Sierra Leone; (D.L.); (M.M.); (J.M.)
| | - Mohamed Bailor Barrie
- Partners In Health Sierra Leone (PIH-SL), Freetown, Sierra Leone; (J.G.J.); (F.B.); (P.R.P.); (Y.D.); (M.B.B.); (A.O.); (M.S.)
| | - Aramide Oteju
- Partners In Health Sierra Leone (PIH-SL), Freetown, Sierra Leone; (J.G.J.); (F.B.); (P.R.P.); (Y.D.); (M.B.B.); (A.O.); (M.S.)
| | - Mohamed Sheku
- Partners In Health Sierra Leone (PIH-SL), Freetown, Sierra Leone; (J.G.J.); (F.B.); (P.R.P.); (Y.D.); (M.B.B.); (A.O.); (M.S.)
| | - Mariama Mahmoud
- Ministry of Health and Sanitation, Freetown, Sierra Leone; (D.L.); (M.M.); (J.M.)
| | - Jusu Mattia
- Ministry of Health and Sanitation, Freetown, Sierra Leone; (D.L.); (M.M.); (J.M.)
| | - Dale A. Barnhart
- Partners In Health (PIH), Boston, MA 02199, USA; (D.F.); (D.A.B.)
- Harvard Medical School, Boston, MA 02115, USA
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Higgins J, JEROME JG, Boima F, Dally E, Krangar L, Boley EJ, Toussaint S, Dibba Y, Kachimanga C, Mhango M, Chung V, Watson S. Community and facility-level barriers to achieving UHC in Kono District, Sierra Leone and Maryland County, Liberia. PLOS Glob Public Health 2023; 3:e0002045. [PMID: 37363882 PMCID: PMC10292700 DOI: 10.1371/journal.pgph.0002045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/21/2023] [Indexed: 06/28/2023]
Abstract
Universal Health Coverage (UHC) is achieved when individuals and communities receive the health services they need without suffering financial hardship. However, many countries face barriers to building health systems that enable the availability of affordable, accessible care. The goal of this study was to present a model of local monitoring of barriers and to provide a roadmap for designing interventions that improve access to and use of healthcare delivery systems. We conducted household, individual, and health facility surveys in seven catchment areas in Sierra Leone and Liberia between December 2019 and March 2020. A two-stage cluster sampling method was used to sample households and individuals, and all health facilities were included. We divide access barriers into demand (patient-side care seeking behavior), supply (availability of facilities and services), and their intersection (affordability, spending, and use rates). Among the 2,576 respondents within our 1,051 surveyed households, the propensity to seek care when ill was reported at 90% in Sierra Leone (n = 1,283) and 70% in Liberia (n = 806). We estimated that 31% of households spent greater than 10% of their total expenditure on healthcare in a month, and that 14.5% of households spent greater than 25%. Overall, the general service readiness index mean score for all health centers was around 70%. The greatest hindrance to service readiness was the availability of essential medicines, with facilities reporting an average score of 32% in Sierra Leone and 63% in Liberia. Our evidence suggests that the cost of care is both a barrier to care-seeking and a persisting problem among care-seeking patients. Lack of service availability (essential equipment and medicines), poses a risk to high-quality care. The research team recommends deploying interventions (visit cost subsidies, supply chain improvements) targeted at resolving these issues in order to advance the goal of achieving UHC.
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Affiliation(s)
- Julia Higgins
- Partners In Health, Boston, Massachusetts, United States of America
| | | | - Foday Boima
- Partners In Health—Sierra Leone, Kono District, Sierra Leone
| | - Emily Dally
- Partners In Health, Boston, Massachusetts, United States of America
| | | | - Emma Jean Boley
- Partners In Health—Liberia, Harper, Liberia
- Partners In Health—United States, Boston, Massachusetts, United States of America
| | | | - Yusupha Dibba
- Partners In Health—Sierra Leone, Kono District, Sierra Leone
| | - Chiyembekezo Kachimanga
- Partners In Health—Sierra Leone, Kono District, Sierra Leone
- Partners In Health—Malawi, Neno, Malawi
| | - Michael Mhango
- Partners In Health—Sierra Leone, Kono District, Sierra Leone
| | - Vivian Chung
- Partners In Health, Boston, Massachusetts, United States of America
| | - Samuel Watson
- Institute of Applied Health Research, University of Birmingham, Birmingham, England
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Holmes SM, Castañeda E, Geeraert J, Castaneda H, Probst U, Zeldes N, Willen SS, Dibba Y, Frankfurter R, Lie AK, Askjer JF, Fjeld H. Deservingness: migration and health in social context. BMJ Glob Health 2021; 6:e005107. [PMID: 33827795 PMCID: PMC8031028 DOI: 10.1136/bmjgh-2021-005107] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 01/30/2021] [Indexed: 12/28/2022] Open
Abstract
This article brings the social science concept of 'deservingness' to bear on clinical cases of transnational migrant patients. Based on the authors' medical social science research, health delivery practice and clinical work from multiple locations in Africa. Europe and the Americas, the article describes three clinical cases in which assumptions of deservingness have significant implications for the morbidity and mortality of migrant patients. The concept of deservingness allows us to maintain a critical awareness of the often unspoken presumptions of which categories of patients are more or less deserving of access to and quality of care, regardless of their formal legal eligibility. Many transnational migrants with ambiguous legal status who rely on public healthcare experience exclusion from care or poor treatment based on notions of deservingness held by health clinic staff, clinicians and health system planners. The article proposes several implications for clinicians, health professional education, policymaking and advocacy. A critical lens on deservingness can help global health professionals, systems and policymakers confront and change entrenched patterns of unequal access to and differential quality of care for migrant patients. In this way, health professionals can work more effectively for global health equity.
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Affiliation(s)
- Seth M Holmes
- Society and Environment, Medical Anthropology, and Public Health, University of California Berkeley, Berkeley, California, USA
- Humanities and Social Sciences, University of California San Francisco School of Medicine, San Francisco, California, USA
- Paoli Calmettes Chair, IMéRA Mediterranean Institute for Advanced Study, Marseille, France
| | | | - Jeremy Geeraert
- European Ethnology, Humboldt University of Berlin, Berlin, Germany
| | - Heide Castaneda
- Anthropology, University of South Florida, Tampa, Florida, USA
| | - Ursula Probst
- Institute for Social and Cultural Anthropology, Free University of Berlin, Berlin, Germany
| | - Nina Zeldes
- Institute for Social and Cultural Anthropology, Free University of Berlin, Berlin, Germany
| | - Sarah S Willen
- Anthropology, University of Connecticut, Storrs, Connecticut, USA
| | | | - Raphael Frankfurter
- School of Medicine, University of California San Francisco, San Francisco, California, USA
- Medical Anthropology, University of California Berkeley, Berkeley, California, USA
| | - Anne Kveim Lie
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | | | - Heidi Fjeld
- Institute of Health and Society, University of Oslo, Oslo, Norway
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Kachimanga C, Dibba Y, Patiño M, Gassimu JS, Lavallie D, Sesay S, Lado M, Kulinkina AV. Implementation of a non-communicable disease clinic in rural Sierra Leone: early experiences and lessons learned. J Public Health Policy 2021; 42:422-438. [PMID: 34497378 PMCID: PMC8452567 DOI: 10.1057/s41271-021-00304-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2021] [Indexed: 02/04/2023]
Abstract
This study is an evaluation of the first cohort of patients enrolled in an outpatient non-communicable disease clinic in Kono, Sierra Leone. In the first year, the clinic enrolled 916 patients. Eight months after the enrollment of the last patient, 53% were still active in care, 43% had been lost to follow-up (LTFU) and 4% had defaulted. Of the LTFU patients, 47% only came for the initial enrollment visit and never returned. Treatment outcomes of three patient groups [HTN only (n = 720), DM only (n = 51), and HTN/DM (n = 96)] were analyzed through a retrospective chart review. On average, all groups experienced reductions in blood pressure and/or blood glucose of approximately 10% and 20%, respectively. The proportions of patients with their condition controlled also increased. As NCDs remain underfunded and under-prioritized in low-income countries, the integrated program in Kono demonstrates the possibility of improving outpatient NCD care in Sierra Leone and similar settings.
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Affiliation(s)
| | - Yusupha Dibba
- Partners In Health, 25 Saquee Drive, Off Wilkinson Road, Freetown, Sierra Leone ,grid.38142.3c000000041936754XHarvard Medical School, 25 Shattuck Street, Boston, MA USA
| | - Marta Patiño
- Partners In Health, 25 Saquee Drive, Off Wilkinson Road, Freetown, Sierra Leone
| | - Joseph S. Gassimu
- Partners In Health, 25 Saquee Drive, Off Wilkinson Road, Freetown, Sierra Leone
| | - Daniel Lavallie
- grid.463455.5Ministry of Health and Sanitation, Wilkinson Road, Freetown, Sierra Leone
| | - Santigie Sesay
- grid.463455.5Ministry of Health and Sanitation, Wilkinson Road, Freetown, Sierra Leone
| | - Marta Lado
- Partners In Health, 25 Saquee Drive, Off Wilkinson Road, Freetown, Sierra Leone
| | - Alexandra V. Kulinkina
- Partners In Health, 25 Saquee Drive, Off Wilkinson Road, Freetown, Sierra Leone ,grid.416786.a0000 0004 0587 0574Swiss Tropical and Public Health Institute, Socinstrasse 57, Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Petersplatz 1, Basel, Switzerland
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Frankfurter R, Kardas-Nelson M, Benton A, Barrie B, Dibba Y, Farmer P, Richardson E. Indirect rule redux: the political economy of diamond mining and its relation to the Ebola outbreak in Kono District, Sierra Leone. Rev Afr Polit Econ 2019; 45:522-540. [PMID: 31772418 PMCID: PMC6879188 DOI: 10.1080/03056244.2018.1547188] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This article explores the relationship between the 2014-2016 Ebola outbreak and the political economy of diamond mining in Kono District, Sierra Leone. The authors argue that foreign companies have recycled colonial strategies of indirect rule to facilitate the illicit flow of resources out of Sierra Leone. Drawing on field research conducted during the outbreak and in its aftermath, they show how this 'indirect rule redux' undermines democratic governance and the development of revenue-generation institutions. Finally, they consider the linkages between indirect rule and the Ebola outbreak, vis-à-vis the consequences of the region's intentionally underdeveloped health care infrastructure and the scaffolding of outbreak containment onto the paramount chieftaincy system.
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Affiliation(s)
- Raphael Frankfurter
- Department of Anthropology History and Social Medicine, University of California, San Francisco, San Francisco, USA
| | - Mara Kardas-Nelson
- School of Public Health, University of California, Berkeley, Berkeley, USA
| | - Adia Benton
- Department of Anthropology, Northwestern University, Evanston, USA
| | | | | | - Paul Farmer
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | - Eugene Richardson
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
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Cancedda C, Davis SM, Dierberg KL, Lascher J, Kelly JD, Barrie MB, Koroma AP, George P, Kamara AA, Marsh R, Sumbuya MS, Nutt CT, Scott KW, Thomas E, Bollbach K, Sesay A, Barrie A, Barrera E, Barron K, Welch J, Bhadelia N, Frankfurter RG, Dahl OM, Das S, Rollins RE, Eustis B, Schwartz A, Pertile P, Pavlopoulos I, Mayfield A, Marsh RH, Dibba Y, Kloepper D, Hall A, Huster K, Grady M, Spray K, Walton DA, Daboh F, Nally C, James S, Warren GS, Chang J, Drasher M, Lamin G, Bangura S, Miller AC, Michaelis AP, McBain R, Broadhurst MJ, Murray M, Richardson ET, Philip T, Gottlieb GL, Mukherjee JS, Farmer PE. Strengthening Health Systems While Responding to a Health Crisis: Lessons Learned by a Nongovernmental Organization During the Ebola Virus Disease Epidemic in Sierra Leone. J Infect Dis 2016; 214:S153-S163. [PMID: 27688219 PMCID: PMC5050485 DOI: 10.1093/infdis/jiw345] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
An epidemic of Ebola virus disease (EVD) beginning in 2013 has claimed an estimated 11 310 lives in West Africa. As the EVD epidemic subsides, it is important for all who participated in the emergency Ebola response to reflect on strengths and weaknesses of the response. Such reflections should take into account perspectives not usually included in peer-reviewed publications and after-action reports, including those from the public sector, nongovernmental organizations (NGOs), survivors of Ebola, and Ebola-affected households and communities. In this article, we first describe how the international NGO Partners In Health (PIH) partnered with the Government of Sierra Leone and Wellbody Alliance (a local NGO) to respond to the EVD epidemic in 4 of the country's most Ebola-affected districts. We then describe how, in the aftermath of the epidemic, PIH is partnering with the public sector to strengthen the health system and resume delivery of regular health services. PIH's experience in Sierra Leone is one of multiple partnerships with different stakeholders. It is also one of rapid deployment of expatriate clinicians and logistics personnel in health facilities largely deprived of health professionals, medical supplies, and physical infrastructure required to deliver health services effectively and safely. Lessons learned by PIH and its partners in Sierra Leone can contribute to the ongoing discussion within the international community on how to ensure emergency preparedness and build resilient health systems in settings without either.
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Affiliation(s)
- Corrado Cancedda
- Partners In Health Division of Global Health Equity Department of Global Health and Social Medicine, Harvard Medical School
| | | | | | | | - J Daniel Kelly
- Division of Global Health Equity Department of Medicine, University of California-San Francisco School of Medicine Wellbody Alliance
| | - Mohammed Bailor Barrie
- Partners In Health Department of Global Health and Social Medicine, Harvard Medical School Wellbody Alliance
| | | | - Peter George
- Port Loko Government Hospital, Port Loko, Sierra Leone
| | | | | | | | - Cameron T Nutt
- Partners In Health Department of Global Health and Social Medicine, Harvard Medical School
| | - Kirstin W Scott
- Department of Global Health and Social Medicine, Harvard Medical School
| | | | | | | | | | | | | | - John Welch
- Partners In Health Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital
| | - Nahid Bhadelia
- Partners In Health Division of Infectious Diseases, Boston University School of Medicine, Massachusetts
| | | | | | | | | | | | | | | | | | | | - Regan H Marsh
- Partners In Health Department of Emergency Medicine, Brigham and Women's Hospital Department of Global Health and Social Medicine, Harvard Medical School
| | | | | | | | - Karin Huster
- Partners In Health Department of Global Health at the University of Washington, Seattle
| | | | | | | | | | | | | | | | | | | | | | | | - Ann C Miller
- Department of Global Health and Social Medicine, Harvard Medical School
| | | | | | | | - Megan Murray
- Partners In Health Division of Global Health Equity Department of Global Health and Social Medicine, Harvard Medical School
| | - Eugene T Richardson
- Partners In Health Division of Global Health Equity Division of Infectious Diseases, Stanford University School of Medicine Department of Anthropology, Stanford University, Palo Alto, California
| | | | | | - Joia S Mukherjee
- Partners In Health Division of Global Health Equity Department of Global Health and Social Medicine, Harvard Medical School
| | - Paul E Farmer
- Partners In Health Division of Global Health Equity Department of Global Health and Social Medicine, Harvard Medical School
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Richardson ET, Barrie MB, Kelly JD, Dibba Y, Koedoyoma S, Farmer PE. Biosocial Approaches to the 2013-2016 Ebola Pandemic. Health Hum Rights 2016; 18:115-128. [PMID: 27781004 PMCID: PMC5070685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Despite more than 25 documented outbreaks of Ebola since 1976, our understanding of the disease is limited, in particular the social, political, ecological, and economic forces that promote (or limit) its spread. In the following study, we seek to provide new ways of understanding the 2013-2016 Ebola pandemic. We use the term, 'pandemic,' instead of 'epidemic,' so as not to elide the global forces that shape every localized outbreak of infectious disease. By situating life histories via a biosocial approach, the forces promoting or retarding Ebola transmission come into sharper focus. We conclude that biomedical and culturalist claims of causality have helped obscure the role of human rights failings (colonial legacies, structural adjustment, exploitative mining companies, enabled civil war, rural poverty, and the near absence of quality health care, to name but a few) in the genesis of the 2013-16 pandemic. From early 20th century smallpox and influenza outbreaks to 21st century Ebola, transnational relations of inequality continue to be embodied as viral disease in West Africa, resulting in the preventable deaths of hundreds of thousands of people.
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Affiliation(s)
- Eugene T. Richardson
- PhD Candidate in the Department of Anthropology at Stanford University,
Stanford, CA, USA; and a Research Scientist at Partners In Health, Freetown, Sierra
Leone
| | - Mohamed Bailor Barrie
- Co-founder of Wellbody Alliance, Koidu, Sierra Leone; an MMSc Candidate in
the Department of Global Health and Social Medicine at Harvard Medical School, Boston, MA,
USA; and Strategic Adviser to Partners In Health, Freetown, Sierra Leone
| | - J. Daniel Kelly
- Co-founder of Wellbody Alliance, Koidu, Sierra Leone; and a Lecturer in the
Division of Global Health Equity at Brigham and Women’s Hospital, Boston, MA,
USA
| | - Yusupha Dibba
- Medical Director of Wellbody Alliance, Koidu, Sierra Leone
| | - Songor Koedoyoma
- Chief of Staff of the Kono District Ebola Response Center (DERC), Koidu,
Sierra Leone
| | - Paul E. Farmer
- Co-founder of Partners In Health, Boston, MA, USA; Kolokotrones University
Professor of Global Health and Social Medicine at Harvard Medical School, Boston, MA, USA;
and Chief of the Division of Global Health Equity at Brigham and Women’s Hospital,
Boston, MA, USA. He is Editor-in-Chief of Health and Human Rights
Journal
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