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Local Treatment in SL

Health seeking behaviour 

Social science research shows that across Africa decisions about where, when and from whom to seek help when a person is sick tend to involve groups of people, not just individuals.  Sometimes the person who is sick might have little say in health seeking decisions. Therapy management groups  can include family members, groups of peers and others such as religious or community leaders and friends. We also know that when health care is costly or health facilities are far away, people often delay seeking treatment or seek alternative remedies, including home-remedies, medicines from medicine vendors (in Nigeria known as patent medical vendors), pharmacies, traditional healers, prayer houses and healing homes. Health seeking behaviours and the use of remedies are also shaped by local understandings of disease aetiology, which may include biological and spiritual dimensions that do not map simply upon biomedical categories and understandings.    

During the Ebola and other viral haemorrhagic fever outbreaks, people often decided not to seek care because they were afraid of dying alone in treatment centres, which they associated with death. Misinformation and rumours also contributed towards avoidance of healthcare workers and treatment facilities during the height of the Ebola outbreak. Evidence from many contexts across sub-Saharan Africa also shows that even when treatment is available, people may prefer to stay at home if they think they are going to die, because this is cheaper for family members who worry about the expense of transporting a dead body. At home, people may have also have a better ‘social’ death, surrounded by loved ones who can care for them in and easily perform burial rituals. These factors can stop people from accessing formal medical care.

Merlin. 2002. 'Licking' Lassa: A strategic review. London.

The British relief agency Merlin carried out a Knowledge, Attitudes and Practices survey to inform a strategic review of Lassa fever in Sierra Leone during the 1990s. Although the material is dated, the reflections on health seeking behaviour in this document remain relevant. The review highlights that knowledge is not sufficient to change behaviour, particularly when people are faced with a poorly functioning, expensive health system that may be difficult to reach. The review also shows that health seeking for Lassa Fever is made more difficult because the disease is not easily distinguished from other infections.

Policy-relevant findings:

  • The informal and commercial medical sectors are often providing first line care. Any comprehensive outbreak monitoring and response system needs to involve informal and commercial providers
  • These providers also need to know how to stay safe when treating patients, and when and how to make referrals to the formal health system.
  • People living in Lassa endemic areas may benefit from a more nuanced public health messaging about treatment of fevers that is better attuned to local models of care.

 

Resources

Epidemics: Science, governance, and social justice

This book focuses on how different policy-makers, scientists, and local populations construct alternative narratives-accounts of the causes and appropriate responses to outbreaks- about epidemics at the global, national and local level. The contrast between emergency-oriented, top-down responses to what are perceived as potentially global outbreaks and longer-term approaches to diseases, such as AIDS, which may now be considered endemic, is highlighted.

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Emerging disease or emerging diagnosis?: Lassa fever and Ebola in Sierra Leone

This article looks beyond Ebola in 2014 to the history of efforts to control VHFs in the Mano River and challenges the idea that there was a vacuum of knowledge. Highlighted instead are politics of knowledge which have run through global health and which have prioritized particular forms of knowledge and ways of dealing with disease. Ethnographic research on the emergence of Lassa and the subsequent emergence of Ebola in West Africa is presented, focusing on the development of technologies and institutions to detect and manage both viruses.

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The process and practice of diagnosis: Innovations in diagnostics for Lassa fever in Sierra Leone

Chapter 5 of Annie Wilkinson’s PhD thesis, provides a detailed description of health seeking behaviours for Lassa Fever in rural Sierra Leone. In this context, people interpreted and managed Lassa Fever in light of their familiarity with a wide range of other diseases, some of which were viewed as dangerous and others less so; in contexts where sickness, health and treatment were marked by uncertainty; and where hospitals were not necessarily perceived to be sites of good care.  An important insight is that people differentiated ‘big sick’ or ‘hospital sick’ from an ordinary or ‘small’ sick and it was partly on the basis of this distinction that people would choose to access care.

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When the field is a ward or a clinic: Hospital ethnography

This resource attempts to demonstrate the value of deeply embedded hospital ethnography as a means to offer a new level of data with which to synthesise critical medical anthropology. The author uses this collection to showcase how hospital-based ethnographic work offers a collaborative approach in which the ethnographer, of necessity, must take into account a broader range of experiences in hospital encounters.

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Patients’ and healthcare providers’ perceptions and practices regarding hypertension, pharmacy-based care, and mHealth in Lagos, Nigeria

Although not focused on Lassa Fever, a recent publication on hypertension in Nigeria, provides a comprehensive review of contemporary health seeking behaviour in the country, underlining the important role that small-scale local pharmaceutical providers provide as the front line of medical care.  This study also describes what respondents call a ‘Nigerian Factor’; a reluctance to seek health care until very sick.

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