Communicating in a Crisis like Ebola: Facts and Figures

"A critical look at the complications and experiences from the perspective of communications and social science holds lessons for future public health responses to infectious disease outbreaks."

In this article, Elizabeth Smout examines health communication in the context of the ongoing Ebola outbreak in West Africa, noting that "[t]he virus is transmitted through behaviours that represent the best of human nature - caring for the sick, showing reverence for the dead, showing affection..." She notes that the isolation and treatment of people infected, or suspected of being infected, with the Ebola virus has been at the forefront of efforts to tackle this epidemic - a strategy that has been influenced by social, cultural, and political dynamics. For example, the legacies of both colonial rule and post-colonial conflict have led many citizens to be suspicious of government motives and to dismiss public health messages in favour of their own interpretations of the Ebola outbreak's origins. Rumours and misinformation around Ebola became heavily politicised in Sierra Leone, for instance. Poor infrastructure that undermines communication and fluid population movement are contributing factors to a situation that Smout describes as follows: "Without an effective communication strategy to mobilise or marshal communities, local people may not seek treatment when an infection is suspected. Without effective communication between organisations working on the ground, resources will not be directed to where they are most needed. And unless governments share information, cross-border management of an outbreak will suffer."

Smout cites several examples of the ways in which communication is a vital ingredient in dealing with health emergencies. For instance, a study conducted in the United Kingdom during the flu pandemic of 2009 found that the uptake of protective behaviours against the virus, such as buying hand sanitisers, was clearly correlated with increased media coverage and messaging related to swine flu. However, there was resistance to official efforts to tell people about Ebola, resulting in outcomes such as the September 2014 killing of 8 local officials, healthcare workers, and journalists attempting to raise awareness about the disease. This is due in part to what Smout sees as a failure on the part of organisations involved in responding to Ebola to prioritise building relationships with affected communities from the outset. "Information sharing works best as a dialogue facilitated by trained local people acting as social mobilisers - because people known to the community are more able to engage others in conversation and be trusted with their concerns." She also points to the importance of dialogue between countries, as well as between local and national governments.

Coordination of communication on the part of all partners involved in response to an outbreak can minimise the risk of spreading false information and rumours. For that reason, materials produced to help non-governmental organisations (NGOs) and others inform communities about Ebola have to be approved by the relevant ministry in each country and partners with technical or scientific expertise such as the United Nations Children's Fund (UNICEF).

Various communication tools, such as radio, have been used to fight Ebola. Radio programmes in the region have incorporated short public service announcements (PSAs) about Ebola, panel discussion programmes where the public can call or text their questions into the show, and longer radio dramas. BBC Media Action, for example, has developed a radio drama, Mr Plan-Plan and the Pepo-oh, in an effort to counter the "what not to do" messages during the outbreak with a focus on what people could do to prepare, to stop the virus from spreading, and to respond if someone around them did get infected. (An audio file called "How radio dramas build health awareness - an interview with BBC Media Action" is available for download. Rachel Aveyard talks to Imogen Mathers about producing Mr Plan-Plan and why drama and radio are such important vehicles for making public health information accessible and applicable to people's everyday lives. She also outlines a few of the logistical barriers to delivering the show to hundreds of partner stations across countries where internet and transport networks are poor or non-existent.) Several Ebola songs have been written in an effort to spread messages, as tributes to victims, or as political statements. The Global Alliance to Immunise Against AIDS (GAIA) developed a storytelling cloth pattern designed to be worn by health workers talking with communities. Also, organisations such as UNICEF and IBM have developed systems where people can call or text to report concerns about the response and provide real-time information to the ministry of health and district response centres on where resources need to be directed. "Instant messaging services such as WhatsApp have also been enormously important tools for informal information sharing, with both helpful and damaging effects."

Despite these efforts, Smout argues that the information provided by various agencies does not always match the information needed by the people affected (e.g., practical information on how to manage the virus within a community). For example, information spreading through informal networks in Sierra Leone has gradually shifted focus from denying that Ebola is real and questioning the science, to rumours surrounding lockdowns and their impact on the general public. She reiterates the importance of community-level initiatives in the Ebola response, particularly in rural areas where traditional leadership structures dominate. There needs to be an understanding of social context and adaptation of practices so they become culturally sensitive. Box 4 in the document provides examples of community mobilisation against Ebola, such as an initiative in which social anthropologists invited community and opinion leaders from "resisting" villages in Guinea to a workshop with organisations involved in the response to ensure that people were heard and to developed a shared strategy. "Such initiatives need to be linked with district and national coordination systems, so that people's needs are represented at high-level discussions. This is particularly important in a situation where suspicion, stigma and misinformation are rife."

Smout concludes: "Only through open information sharing and dialogue at all levels can challenges be overcome, trust gained and epidemics as devastating as Ebola be stopped."