Information to fight the Ebola epidemic

September 14, 2014

Reflective Blog Post #1 for Crisis Informatics

Developing countries have enormous challenges in health care, with lack of trained health care workers, up to date equipment, and medicine and other supplies. Epidemics like the current Ebola crisis are particularly difficult and, as seen in Liberia, can threaten to overwhelm an already fragile system.
The Ebola virus seems to have its own special fear factor. The fatality rate is high,  there is no  vaccine, and the cure is only in the experimental stage (used, famously, on two US missionaries who contracted the disease). Fear and a great deal of misinformation spread with the disease. People look for hope in false cures (such as drinking salt water, which has already killed two people in Nigeria). Some believe that health care workers who have come to help are actually spreading the disease.
Many of the West African communities affected by Ebola are rural, with few or no TVs or radios, and rely on traditional oral systems of disseminating information. MSF’s Dr. Marc Forget told CNN that “we need to go to the thousands of small villages and repeat the message on and on … It has to be one by one contact that needs to be done through the chiefs, the local authorities, the youth. It is time-consuming and very difficult.”
It is also critical. Okware, et al, state in their study of the 2000 outbreak in Uganda that “past experience in epidemic management has shown that in the absence of regular provision of information to the public, there are bound to be deleterious rumours.” They found that, in the successful management of the 2000 outbreak in Uganda, “rumour was managed by frank and open discussion of the epidemic, providing daily updates, fact sheets and press releases. Information was regularly disseminated to communities through mass media and press conferences. Thus all levels of the community spontaneously demonstrated solidarity and response to public health interventions.”
On the flip side of the crisis, local health care workers need better information. Dr. Margaret Mungherera, President of the World Medical Association and HIFA2015 member, says that in addition to adequate supplies and medicine, health care workers must be given training on infection prevention, proper protocols, etc.
Specially trained people from around the world are coming to West Africa to support local health care workers and fight the epidemic, but they can find themselves stymied by lack of information. For example, Rachel Levine of the US Public Health Service is ready to do contact tracing to contain the outbreak. (Contact tracing is finding all the people that an infected person had contact with, all the people they had contact with, and so on.) But contact tracing doesn’t work, because the addresses in the database Levine was given are often missing, or so vague as to be useless. She even found that the format of the information was not very usable — an “unwieldy Excel spreadsheet.” She brought special CDC software to help manage the workload. Uganda used an app called mTrac  that lets health workers use SMS on ordinary mobile phones (no smartphone needed) to report suspected cases.
As Guinea, Liberia and others struggle to contain and eliminate Ebola, they may be able to use some lessons learned from Uganda.
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Okware, S. I., et al. (2002, December). An outbreak of Ebola in Uganda. Tropical Medicine & International Health (7)12, 1068–1075. DOI: 10.1046/j.1365-3156.2002.00944.x

4 Responses to “Information to fight the Ebola epidemic”

  1. A great post Robin. It is very interesting to hear how Ebola was successfully managed in the 2000 Ugandan outbreak in and the information challenges that you mentioned. Do you think the organization of information in ways in which it can easily be retrieved and be useful “on the ground” is given sufficient recognition?

  2. Hi Robin,

    I found your post very interesting. You make a very good point about the difficulties of tracing contacts due to vague addresses–they don’t exactly have a 911 system in place there. And mTrac sounds like a great app to have. Enjoyed your post!

  3. Very interesting post! I’ve seen mentions that one of the difficulties now, as opposed to Uganda, is population increases, and the fact that this has spread to cities – so information has to get to so many more people.

  4. Chris, not nearly enough recognition! That’s why I found the CNN article about the contact tracer so fascinating. It’s something I never even thought about before.

    Emily, good point about the more concentrated populations of cites. Unfortunately, government efforts to create lockdowns and quarantines have not helped foster trust between citizens and emergency workers …