Three Acts of Resistance during the 2014–16 West Africa Ebola Epidemic

Abstract Community engagement is commonly regarded as a crucial entry point for gaining access and securing trust during humanitarian emergencies. In this article, we present three case studies of community engagement encounters during the West African Ebola outbreak. They represent strategies commonly implemented by the humanitarian response to the epidemic: communication through comités de veille villageois in Guinea, engagement with NGO-affiliated community leadership structures in Liberia and indirect mediation to chiefs in Sierra Leone. These case studies are based on ethnographic fieldwork carried out before, during and after the outbreak by five anthropologists involved in the response to Ebola in diverse capacities. Our goal is to represent and conceptualise the Ebola response as a dynamic interaction between a response apparatus, local populations and intermediaries, with uncertain outcomes that were negotiated over time and in response to changing conditions. Our findings show that community engagement tactics that are based on fixed notions of legitimacy are unable to respond to the fluidity of community response environments during emergencies.</jats:p

Velocity Fluctuations in Dynamical Fracture: the Role of Microcracks

We address the velocity fluctuations of fastly moving cracks in stressed materials. One possible mechanism for such fluctuations is the interaction of the main crack with micro cracks (irrespective whether these are existing material defects or they form during the crack evolution). We analyze carefully the dynamics (in 2 space dimensions) of one macro and one micro crack, and demonstrate that their interaction results in a {\em large} and {\em rapid} velocity fluctuation, in qualitative correspondence with typical velocity fluctuations observed in experiments. In developing the theory of the dynamical interaction we invoke an approximation that affords a reduction in mathematical complexity to a simple set of ordinary differential equations for the positions of the cracks tips; we propose that this kind of approximation has a range of usefulness that exceeds the present context.Comment: 7 pages, 7 figure

The open question

The open question:&nbsp;Medical anthropology and open acces

Lessons From the West Africa Ebola Epidemic: A Systematic Review of Epidemiological and Social and Behavioral Science Research Priorities.

This systematic literature review compared the epidemiological (EPI) research and the qualitative social and behavioral science (SBS) research published during the West Africa Ebola virus disease (EVD) epidemic. Beginning with an initial capture of over 2000 articles, we extracted 236 EPI and 171 SBS studies to examine how disciplinary priorities affected research conducted during the EVD response, with implications for epidemic response effectiveness. Building on this research, we set forth a roadmap for the closer integration of EPI and SBS research in all aspects of epidemic preparedness and response that incorporates the lessons of the West Africa EVD outbreak. Key priorities include the following: (1) developing the capacity to systematically quantify qualitative sociocultural variables; (2) establishing interdisciplinary collaborations to improve "risk segmentation" practices; (3) creating and prepositioning qualitative indicators and composite sociocultural indexes for rapid deployment in outbreaks; (4) integrating novel systems with community resources; (5) developing new techniques for modeling social mobilization and community engagement; (6) prioritizing good data and complex analyses early in emergencies; and (7) learning from past experiences. Our findings support a program of action that situates data collection and analysis in real-time, recursive, integrated efforts to move community attitudes, behaviors, and responses into epidemiological research. We offer recommendations to improve coordinated, multidisciplinary approaches to health emergencies

Shape selection in non-Euclidean plates

We investigate isometric immersions of disks with constant negative curvature into $\mathbb{R}^3$, and the minimizers for the bending energy, i.e. the $L^2$ norm of the principal curvatures over the class of $W^{2,2}$ isometric immersions. We show the existence of smooth immersions of arbitrarily large geodesic balls in $\mathbb{H}^2$ into $\mathbb{R}^3$. In elucidating the connection between these immersions and the non-existence/singularity results of Hilbert and Amsler, we obtain a lower bound for the $L^\infty$ norm of the principal curvatures for such smooth isometric immersions. We also construct piecewise smooth isometric immersions that have a periodic profile, are globally $W^{2,2}$, and have a lower bending energy than their smooth counterparts. The number of periods in these configurations is set by the condition that the principal curvatures of the surface remain finite and grows approximately exponentially with the radius of the disc. We discuss the implications of our results on recent experiments on the mechanics of non-Euclidean plates

Community-Centered Responses to Ebola in Urban Liberia: The View from Below

The West African Ebola epidemic has demonstrated that the existing range of medical and epidemiological responses to emerging disease outbreaks is insufficient, especially in post-conflict contexts with exceedingly poor healthcare infrastructures. This study provides baseline information on community-based epidemic control priorities and identifies innovative local strategies for containing EVD in Liberia.In this study the authors analyzed data from the 2014 Ebola outbreak in Monrovia and Montserrado County, Liberia. The data were collected for the purposes of program design and evaluation by the World Health Organization (WHO) and the Government of Liberia (GOL), in order to identify: (1) local knowledge about EVD, (2) local responses to the outbreak, and (3) community based innovations to contain the virus. At the time of data collection, the international Ebola response had little insight into how much local Liberian communities knew about Ebola, and how communities managed the epidemic when they could not get access to care due to widespread hospital and clinic closures. Methods included 15 focus group discussions with community leaders from areas with active Ebola cases. Participants were asked about best practices and what they were currently doing to manage EVD in their respective communities, with the goal of developing conceptual models of local responses informed by local narratives. Findings reveal that communities responded to the outbreak in numerous ways that both supported and discouraged formal efforts to contain the spread of the disease. This research will inform global health policy for both this, and future, epidemic and pandemic responses

"Now he walks and walks, as if he didn't have a home where he could eat": food, healing, and hunger in Quechua narratives of madness

In the Quechua-speaking peasant communities of southern Peru, mental disorder is understood less as individualized pathology and more as a disturbance in family and social relationships. For many Andeans, food and feeding are ontologically fundamental to such relationships. This paper uses data from interviews and participant observation in a rural province of Cuzco to explore the significance of food and hunger in local discussions of madness. Carers’ narratives, explanatory models, and theories of healing all draw heavily from idioms of food sharing and consumption in making sense of affliction, and these concepts structure understandings of madness that differ significantly from those assumed by formal mental health services. Greater awareness of the salience of these themes could strengthen the input of psychiatric and psychological care with this population and enhance knowledge of the alternative treatments that they use. Moreover, this case provides lessons for the global mental health movement on the importance of openness to the ways in which indigenous cultures may construct health, madness, and sociality. Such local meanings should be considered by mental health workers delivering services in order to provide care that can adjust to the alternative ontologies of sufferers and carers

A rapid qualitative methods assessment and reporting tool for epidemic response as the outcome of a rapid review and expert consultation

During the first year of the COVID-19 pandemic, the Methods Sub-Group of the WHO COVID-19 Social Science Research Roadmap Working Group conducted a rapid evidence review of rapid qualitative methods (RQMs) used during epidemics. The rapid review objectives were to (1) synthesize the development, implementation, and uses of RQMs, including the data collection tools, research questions, research capacities, analytical approaches, and strategies used to speed up data collection and analysis in their specific epidemic and institutional contexts; and (2) propose a tool for assessing and reporting RQMs in epidemics emergencies. The rapid review covered published RQMs used in articles and unpublished reports produced between 2015 and 2021 in five languages (English, Mandarin, French, Portuguese, and Spanish). We searched multiple databases in these five languages between December 2020 and January 31, 2021. Sources employing “rapid” (under 6 months from conception to reporting of results) qualitative methods for research related to epidemic emergencies were included. We included 126 published and unpublished sources, which were reviewed, coded, and classified by the research team. Intercoder reliability was found to be acceptable (Krippendorff’s α = 0.709). We employed thematic analysis to identify categories characterizing RQMs in epidemic emergencies. The review protocol was registered at PROSPERO (no. CRD42020223283) and Research Registry (no. reviewregistry1044). We developed an assessment and reporting tool of 13 criteria in three domains, to document RQMs used in response to epidemic emergencies. These include I. Design and Development (i. time frame, ii. Training, iii. Applicability to other populations, iv. Applicability to low resource settings, v. community engagement, vi. Available resources, vii. Ethical approvals, viii. Vulnerability, ix. Tool selection); II. Data Collection and Analysis (x. concurrent data collection and analysis, xi. Targeted populations and recruitment procedures); III. Restitution and Dissemination (xii. Restitution and dissemination of findings, xiii. Impact). Our rapid review and evaluation found a wide range of feasible and highly effective tools, analytical approaches and timely operational insights and recommendations during epidemic emergencies

Unmet needs and behaviour during the Ebola response in Sierra Leone: a retrospective, mixed-methods analysis of community feedback from the Social Mobilization Action Consortium

Background: The west African Ebola epidemic (2014–15) necessitated behaviour change in settings with prevalent and pre-existing unmet needs as well as extensive mechanisms for local community action. We aimed to assess spatial and temporal trends in community-reported needs and associations with behaviour change, community engagement, and the overall outbreak situation in Sierra Leone. Methods: We did a retrospective, mixed-methods study. Post-hoc analyses of data from 12 096 mobiliser visits as part of the Social Mobilization Action Consortium were used to describe the evolution of satisfied and unsatisfied needs (basic, security, autonomy, respect, and social support) between Nov 12, 2014, and Dec 18, 2015, and across 14 districts. Via Bayesian hierarchical regression modelling, we investigated associations between needs categories and behaviours (numbers of individuals referred to treatment within 24 h of symptom onset or deaths responded to with safe and dignified burials) and the role of community engagement programme status (initial vs follow-up visit) in the association between satisfied versus unsatisfied needs and behaviours. Findings: In general, significant associations were observed between unsatisfied needs categories and both prompt referrals to treatment and safe burials. Most notably, communities expressing unsatisfied capacity needs reported fewer safe burials (relative risk [RR] 0·86, 95% credible interval [CrI] 0·82–0·91) and fewer prompt referrals to treatment (RR 0·76, 0·70–0·83) than did those without unsatisfied capacity needs. The exception was expression of unsatisfied basic needs, which was associated with significantly fewer prompt referrals only (RR 0·86, 95% CrI 0·79–0·93). Compared with triggering visits by community mobilisers, follow-up visits were associated with higher numbers of prompt referrals (RR 1·40, 95% CrI 1·30–1·50) and safe burials (RR 1·08, 1·02–1·14). Interpretation: Community-based development of locally feasible, locally owned action plans, with the support of community mobilisers, has potential to address unmet needs for more sustained behaviour change in outbreak settings

Shocks and finite-time singularities in Hele-Shaw flow

Hele-Shaw flow at vanishing surface tension is ill-defined. In finite time, the flow develops cusp-like singularities. We show that the ill-defined problem admits a weak {\it dispersive} solution when singularities give rise to a graph of shock waves propagating in the viscous fluid. The graph of shocks grows and branches. Velocity and pressure jump across the shock. We formulate a few simple physical principles which single out the dispersive solution and interpret shocks as lines of decompressed fluid. We also formulate the dispersive weak solution in algebro-geometrical terms as an evolution of the Krichever-Boutroux complex curve. We study in detail the most generic (2,3) cusp singularity, which gives rise to an elementary branching event. This solution is self-similar and expressed in terms of elliptic functions.Comment: 24 pages, 11 figures; references added; figures change