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埃博拉治疗中心的信任与不信任:来自塞拉利昂的案例研究。

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

机构信息

Directorate of Research and Planning, Njala University, Makonde, Sierra Leone.

Development Economics group, Wageningen University, Wageningen, The Netherlands.

出版信息

PLoS One. 2019 Dec 2;14(12):e0224511. doi: 10.1371/journal.pone.0224511. eCollection 2019.

Abstract

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.

摘要

本文探讨了 2014-2015 年西非埃博拉疫情期间,在塞拉利昂东部设立埃博拉治疗中心后当地的反应。我们的研究采用了定性方法,包括焦点小组和访谈,从患者、疾病幸存者和死亡患者的家属、中心的社会联络人员以及公众中收集反应。数据表明,一开始普遍存在怀疑和抵制,但在疾病直接影响者的心目中,误解被后来更积极的评估所取代。社会工作者以及中心工作人员家属的社会接触者帮助改变了这些看法,但一个主要因素是直接接触疾病。这在幸存者和有成员被送往该设施的家庭的积极支持中显而易见。即使是死亡患者的亲属也同意处理中心是有价值的。然而,我们也提供了公众中持续怀疑的证据,他们仍然怀疑埃博拉是为了外部利益而制造的危机。我们的结论强调了社区和埃博拉设施之间更好连接的重要性,以促进体验式学习。还需要解决由于资金充足的埃博拉卫生倡议进入长期医疗保健不足的社区而引起的更广泛的认知冲击。要恢复对医学的信任,就需要将埃博拉病毒病重新置于关注所有公民健康的更广泛框架内。

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