• Rumours complicate the fight

    War on Ebola

    Imagine seeing someone for the first time in years without being able to hug them or even shake hands. That was one of the many challenges that Kars de Bruijne dealt with in Sierra Leone, where Ebola remains a threat.
    in short

    Kars de Bruijne, a RUG PhD candidate in the department of International Relations and International Organisations, travelled to Sierra Leone in March to contribute to the fight against Ebola.

    He had been to the African country already in 2012, but last month, he returned as part of a team to find out how the communication with the people about Ebola can be improved.

    During interviews with 180 people, De Bruijne learned that part of the population doesn’t believe that Ebola actually exists;  others suspect it is a man-made illness.

    Many don’t trust medical personnel or government authorities, so De Bruijne’s team choose a more grassroots approach to communication.

    For example, one way to take away the fear of ambulances is by showing the people what actually happens after the ambulance is called, so they can familiarize themselves with the procedure.

    full version

    Reading time: 8 min. (1,297 words)

    During the first days of his trip, the 31-year-old tried to stick to the recommended rules to avoid becoming infected: he never touched anyone, always wore long sleeve shirts and disinfected his hands regularly. But he soon realized that wearing so much clothing in the southern hemisphere and trying to avoid making physical contact with anyone was impossible.

    He had been to the African country already in 2012, but last month, he returned as part of a team to find out how the communication with the people about Ebola can be improved.

    The RUG PhD student was not afraid that he might be infected with Ebola during his three week stay, though. De Bruijne knew that Ebola patients are only contagious at certain times: when they show symptoms, shortly before they die, and after they die. He was also aware that family members or health workers are more at risk because they’re in direct contact with the patients.

    ‘The chances of getting hit by a car in Sierra Leone are much higher’, explains De Bruijne.

    Scared of ambulances

    ‘Ebola doesn’t exist’, a former child soldier and friend of De Bruijne’s from Sierra Leone explained during one of the interviews. He believed the disease was manmade and that it may actually be malaria, but that the authorities call it Ebola instead.

    During De Bruijne’s fieldwork, he also went to a cannabis farm to interview people working there. Several told him things like, ‘the whites kill the black man’ – they were also convinced Ebola was artificial.

    This disbelief complicates the fight against Ebola, but it’s not the only problem De Bruijne came across.

    ‘Many people are scared of ambulances’, says De Bruijne. They are noisy, big and they tend to speed, which is why some people hesitate to call for one. Additionally, some people refuse to call the emergency phone number ‘117’ out of fear they might be killed on purpose in the hospital.

    This was one of the major issues the PhD candidate identified during his talks with Sierra Leoneans. But De Bruijne also found out that some people do not seem to be taking the situation seriously: ‘A lot of calls to the emergency number are just prank calls’, he says.

    The project

    De Bruijne went to Sierra Leone as part of a Research for Health in Humanitarian Crises (R2HC) project, which was funded by DFID and the Welcome Trust. They worked together with the Swedish Umeå University, Medical Research Centre (MRC), Centre for Health Research and Training in Sierra Leone (CHaRT-SL) to examine communication models that are used to decrease the spread of Ebola. He is part of the school of Global Studies at the University of Sussex and is also a lecturer and PhD student at the International Relations and International Organizations department of the RUG.

    ‘From the beginning of January 2015, we interviewed over 180 people about Ebola’, De Bruijne explains. During the first ten days of his trip in March, he did additional interviews to fill in gaps from the previous interviews, he says.

    The rest of his stay was focused on the development of specific messaging methods to prompt people to seek treatment. By speaking with people in eight different communities, what De Bruijne found out was crucial for the fight against Ebola.

    On the other hand, the team discovered that those who actually call the emergency number for help are often not aware of the necessary steps to take until the ambulance arrives. In other words: if someone dies of Ebola, those around the victim don’t know what should be done to avoid infection.

    In another village he visited, some were convinced that the disease was made up to kill people and that someone in charge would sell the body parts of the dead.

    While rumours have always been persistent in Sierra Leone, it became apparent that there were more misconceptions floating around than currently acknowledged by specialists. It was then De Bruijne’s task to develop messages that would encourage people to seek treatment.


    The governments or authorities that are in charge of certain communities already addressed these issues, but the rumours are persistent. ‘The people harbour a degree of mistrust of different layers of authorities, be it right or wrong’, De Bruijne says.

    Sending messages to communities to encourage treatment-seeking behaviour is crucial, he says. But considering the level of mistrust in the country, how can it be changed?

    ‘We knew from research that people from within the communities are most trusted. Many of our informants pointed in the same direction. We therefore opted for a grassroots approach to spread the messages’, De Bruijne says, describing the outcome of the project.

    Locals are asked to inform each other about Ebola and share books and posters for educational purposes. The direct demonstration of work procedures is also a way to make people believe that Ebola is real.

    For example, one way to take away the fear of ambulances is by showing the people what actually happens after the ambulance is called, so they can familiarize themselves with the procedure. That way, rumours are implicitly addressed, he says.

    ‘Another problem is that some people are also afraid of chlorine’, De Bruijne adds. Since people are aware that it is used in the ambulances, some Sierra Leoneans assumed that chlorine must have killed people. Hence, they developed messages aiming to give a friendlier face to chlorine, he says.

    A sign held by a man in Sierra Leone reveals the distrust some have about seeking medical treatment for Ebola.

    The National Ebola Response Center (NERC), which is responsible for Sierra Leone, and the UN Mission for Ebola Emergency Response (UNMEER) requested that the messages were fast tracked into operation.

    ‘While our research assistants are currently field-testing more than 30 of the communicational messages, some of our people are working on their implementation with the relevant authorities, including the social mobilization pillar of the ministry of health’, De Bruijne says.

    Challenging experience

    De Bruijne explains that these problems are not only due to a lack of knowledge; anthropologists often interpret rumours as a form of protest against authorities. As real protests and riots are sometimes seen as dangerous, citizens have developed other ways to have their voices heard, De Bruijne says.

    ‘I spoke to a pastor working in a community where over 40 people had died’, he explains. As a consequence of this form of protest, the pastor concluded that 30 out of 100 people in Sierra Leone believe Ebola was developed to kill the African people. Another 30 out of 100 people believe the rumour that the disease is not real. ‘While the actual numbers are hard to ascertain, the persistence of these beliefs is a major problem’, he says.

    De Bruijne actually didn’t expect these kinds of findings – in previous academic research, similar results were not present.

    De Bruijne also had to cope with the emotional aspect of his trip: ‘In Sierra Leone, you cannot escape seeing the personal toll the disease has taken’, he explains. He encountered many devastated people who have lost loved ones.

    Others haven’t seen their family in a while because they had to remain where they were due to the travel ban when Ebola began to spread. ‘Small children who were born since the start of Ebola have never left their house’, De Bruijne explains.

    Some progress is already visible in the fight against the dangerous disease, De Bruijne says. The health workers in Sierra Leone have already improved tracking movements – back in December, the infection rate was much higher, partly due to the difficulty of tracking down the previous contacts of an infected patient, he explains.

    De Bruijne definitely plans to go back to Sierra Leone after he has finished his PhD. If the messages succeed in encouraging more people to get treatment, he just might be able to hug his friends the next time he arrives.