Trust, and distrust, of Ebola Treatment Centers: A case-study from Sierra Leone

Autoři: Paul Richards aff001;  Esther Mokuwa aff002;  Pleun Welmers aff003;  Harro Maat aff003;  Ulrike Beisel aff004
Působiště autorů: Directorate of Research and Planning, Njala University, Makonde, Sierra Leone aff001;  Development Economics group, Wageningen University, Wageningen, The Netherlands aff002;  Knowledge, Technology and Innovation Group, Wageningen University, Wageningen, The Netherlands aff003;  Department of Anthropology, University of Bayreuth, Bayreuth, Germany aff004
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article


The paper considers local responses to the introduction of an Ebola Treatment Centre in eastern Sierra Leone during the West African epidemic of 2014–15. Our study used qualitative methods consisting of focus groups and interviews, to gather responses from patients, members of the families of survivors and deceased victims of the disease, social liaison workers from the centre, and members of the general public. The data indicate that scepticism and resistance were widespread at the outset, but that misconceptions were replaced, in the minds of those directly affected by the disease, by more positive later assessments. Social workers, and social contacts of families with workers in the centre, helped reshape these perceptions, but a major factor was direct experience of the disease. This is apparent in the positive endorsements by survivors and families who had members taken to the facility. Even relatives of deceased victims agreed that the case-handling centre was valuable. However, we also present evidence of continuing scepticism in the minds of members of the general public, who continue to suspect that Ebola was a crisis manufactured for external benefit. Our conclusions stress the importance of better connectivity between communities and Ebola facilities to facilitate experiential learning. There is also a need to address the wider cognitive shock caused by a well-funded Ebola health initiative arriving in communities with a long history of inadequate health care. Restoring trust in medicine requires Ebola Virus Disease to be re-contextualized within a broader framework of concern for the health of all citizens.

Klíčová slova:

Ambulances – Blood – Ebola hemorrhagic fever – Ebola virus – Human families – Human learning – Sierra Leone – Quarantines


1. Richards P. Ebola: how a people’s science helped end an epidemic, London: Zed Books;2016.

2. Mas L. Ebola centres attacked in DR Congo as conspiracy theories circulate. France 24 Observers [Internet]. 2019 March [cited 2019 Apr 4]. Available from

3. Vinck P, Pham PN, Bindu KK, Bedford J, Nilles EJ. Institutional trust and misinformation in the response to the 2018–19 Ebola outbreak in North Kivu, DR Congo: a population-based survey. The Lancet Infectious Diseases. 2019 March 27. doi: 10.1016/S1473-3099(19)30063-5

4. Nguyen V-K. An epidemic of suspicion—Ebola and Violence in the DRC, NEJM, 2019 March 6. doi: 10.1056/NEJMp1902682 30840790

5. Bardosh K, Gercama I, Bedford J. Social Science and Behavioural Data Compilation, DRC Ebola Outbreak, November 2018-February 2019. Social Science in Humanitarian Action [Internet]. 2019 Feb [cited 2019 Apr 4]. Available from

6. Boozary AS, Farmer PE, Jha AK. The Ebola Outbreak, Fragile Health Systems, and Quality as a Cure. JAMA. 2014;312(18):1859–60. doi: 10.1001/jama.2014.14387 25285459

7. Richards P, Amara J, Mokuwa E, Mokuwa A, Suluku R. Village Responses to Ebola Virus Disease in Rural Eastern Sierra Leone: Second Interim Report Programme. Ebola Response Anthropology Platform [Internet]. 2015 [cited 2019 Apr 4]. Available from:

8. Wilson D. Inside an Ebola Treatment Unit: A Nurse's Report, American Journal of Nursing AJN, American Journal of Nursing. 2015 Dec;115(12):28–38.

9. Bonwitt J, Dawson M, Kandeh M, Ansumana R, Sahrd F, Brown H et al. Unintended consequences of the “bushmeat ban” in West Africa during the 2013–2016 Ebola virus disease epidemic. Social Science & Medicine, 2008, March;200:166–73. doi: 10.1016/j.socscimed.2017.12.028 29421463

10. Fairhead J. Understanding social resistance to Ebola response in the forest region of the Republic of Guinea: an anthropological perspective. African Studies Review 2016 Dec;59(3):7–31. doi: 10.1017/asr.2016.87

11. Abramowitz S, McKune SL, Fallah M, Monger J, Tehoungue K, Omidian PA. The Opposite of Denial: Social Learning at the Onset of the Ebola Emergency in Liberia. J Health Commun. 2017;22(sup1):59–65. doi: 10.1080/10810730.2016.1209599 28854129.

12. Lave J. Apprenticeship in Critical Ethnographic Practice. Chicago: Univ. Chicago Press; 2011.

13. Lave J, Wenger E. Situated Learning: Legitimate Peripheral Participation. Cambridge: Cambridge Univ. Press; 1998.

14. Bandura A. Health promotion from the perspective of social cognitive theory. Psychology & Health. 1998;13(4):623–49. doi: 10.1080/08870449808407422

15. This remark was addressed to and recorded by Paul Richards, as a member of the Ebola Gbalu research project directed by Professor Susannah Mayhew of the London School of Hygiene and Tropical Medicine. Richards acknowledges the permission of Professor Mayhew to cite his fieldnotes.

16. White L. Speaking with Vampires: Rumour and History in East and Central Africa. Berkeley CA: Univ. Calif. Press;2000.

17. Freudenthal E. Ebola's lost blood: row over samples flown out of Africa as 'big pharma' set to cash in. The Telegraph [Internet]. 2019 Feb 6 [cited 2019 Apr 4] Available from

Článek vyšel v časopise


2019 Číslo 12
Nejčtenější tento týden