Marais Frederick, Minkler Meredith, Gibson Nancy, Mwau Baraka, Mehtar Shaheen, Ogunsola Folasade, Banya Sama S, Corburn Jason
Department of Health, Western Cape Government: Health, 8 Riebeek Street, Cape Town, South Africa Division of Community Health, Stellenbosch University, Tygerberg Campus, Cape Town, South Africa.
School of Public Health, University of California Berkeley, 50 University Hall, Berkeley, CA 94720-7360, USA
Health Promot Int. 2016 Jun;31(2):440-9. doi: 10.1093/heapro/dav003. Epub 2015 Feb 12.
The real missing link in Ebola control efforts to date may lie in the failure to apply core principles of health promotion: the early, active and sustained engagement of affected communities, their trusted leaders, networks and lay knowledge, to help inform what local control teams do, and how they may better do it, in partnership with communities. The predominant focus on viral transmission has inadvertently stigmatized and created fear-driven responses among affected individuals, families and communities. While rigorous adherence to standard infection prevention and control (IPC) precautions and safety standards for Ebola is critical, we may be more successful if we validate and combine local community knowledge and experiences with that of IPC medical teams. In an environment of trust, community partners can help us learn of modest adjustments that would not compromise safety but could improve community understanding of, and responses to, disease control protocol, so that it better reflects their 'community protocol' (local customs, beliefs, knowledge and practices) and concerns. Drawing on the experience of local experts in several African nations and of community-engaged health promotion leaders in the USA, Canada and WHO, we present an eight step model, from entering communities with cultural humility, though reciprocal learning and trust, multi-method communication, development of the joint protocol, to assessing progress and outcomes and building for sustainability. Using examples of changes that are culturally relevant yet maintain safety, we illustrate how often minor adjustments can help prevent and treat the most serious emerging infectious disease since HIV/AIDS.
迄今为止，埃博拉防控工作中真正缺失的环节可能在于未能应用健康促进的核心原则：让受影响社区、其受信任的领导人、网络以及民间知识尽早、积极且持续地参与进来，以帮助告知当地防控团队做什么以及如何与社区合作把事情做得更好。对病毒传播的主要关注无意中给受影响的个人、家庭和社区带来了污名化，并引发了基于恐惧的反应。虽然严格遵守埃博拉的标准感染预防与控制（IPC）预防措施和安全标准至关重要，但如果我们将当地社区的知识和经验与IPC医疗团队的知识和经验相结合，可能会更成功。在信任的环境中，社区伙伴可以帮助我们了解一些适度的调整，这些调整不会损害安全性，但可以提高社区对疾病控制方案的理解和应对能力，使其更好地反映他们的“社区方案”（当地习俗、信仰、知识和做法）以及关切。借鉴几个非洲国家当地专家以及美国、加拿大和世卫组织参与社区健康促进的领导人的经验，我们提出了一个八步模型，从以文化谦逊的态度进入社区，到相互学习与信任、多方法沟通、制定联合方案，再到评估进展和成果以及为可持续性建设奠定基础。通过列举与文化相关但仍保持安全的变化示例，我们说明了微小的调整往往如何有助于预防和治疗自艾滋病毒/艾滋病以来最严重的新发传染病。
