Ebola communication: What we've learned so far

In mid-October, a World Health Organization infectious diseases expert reported the death rate due to Ebola in West Africa had climbed to 70 percent, higher than previous estimates. And by December, new cases were predicted to hit 10,000 a week. For front-line medical workers, the projections couldn’t have been grimmer. They were overwhelmed and their numbers dwindling — Médecins Sans Frontières had already lost nine staff members to the epidemic — but reinforcements remained sparse. For organizations involved in communication and awareness-raising campaigns, meanwhile, this situation meant they needed to be more aggressive and robust, and their messaging fool-proof. Many of them were on the ground, conducting door-to-door campaigns and spot radio announcements, putting up posters and distributing pamphlets to inform communities about the disease. Some had even resorted to using megaphones to reach people who choose to remain indoors, conduct skits in schools and communities via youth drama troupes. A few aid groups were even considering perceived viral forms of communication like music and video messaging led by former football player and now UNICEF ambassador David Beckham. But are these campaigns actually working? Will the new plans be effective? It’s hard to tell at this point. Monitoring and evaluation activities, given the severity of the crisis, are rare, and most organizations lack the bandwidth to incorporate M&E in their daily workflow in West Africa. Despite the chaos, there are a few lessons learned, which officials from different groups involved in social mobilization efforts to stem the spread of Ebola shared with Devex. What works — and doesn’t One relative surprise is that mobile messaging services did not make as much impact as expected. Ombretta Baggio, senior health communications officer at the International Federation of Red Cross and Red Crescent Societies, explained text messages were not viewed in communities as trusted sources of information. Another detrimental factor is the high illiteracy rate in Guinea, Liberia and Sierra Leone. In Sierra Leone, Concern Worldwide found Ebola awareness paraphernalia, like posters that were being used to disseminate information about the virus and how it can be prevented, were “too graphic for children,” and decided to start developing a radio education program that would carry more “kid-friendly Ebola messages.” Africare noticed in Liberia that keeping patients’ family members and loved ones in the “communication loop” dispels suspicions and mistrust in the system and health workers. “We realized that while individuals with suspected cases were being collected from their home communities and taken to Ebola treatment units, updates or status reports about the patients' progress were not getting back to their families and loved ones,” Ernest Gaie, Africare country director in Monrovia, told Devex. Collaboration among stakeholders and repeated messaging, organizations agree, are also crucial. “Constant reinforcement of the messages and checking in with community volunteers have been key to making sure the messages stay real and at the forefront of everyone's thoughts and day-to-day activities,” Richard Parker, vice president for marketing and communications with U.S.-based nonprofit Project Concern International, told Devex. One must be persistent as well, according to Ishmeal Charles, Healey International Relief Foundation’s program manager in Sierra Leone. “In communities we've already provided some awareness programs, we need to tell them, tell them again, tell them, and tell them again, because this has to do with behavioral change, and changing people's behavior has to be on a constant engagement basis,” Charles told Devex. “Advocacy is a process. So to get people to follow the rules and change the practices we've been doing since we were born, it's a whole process of engaging them continuously.” Targeted messaging matters One of the first rules in journalism is: Know your audience. And a seasoned radio broadcaster who is currently station manager at a leading regional radio platform in Senegal argues this can also be applied to the Ebola outbreak. Souleymane Niang, station manager at West Africa Democracy Radio, regrets how some communication efforts being done in the present crisis are “too one-size-fits-all,” like not eating bush meat, which is not relevant in the case of Senegal. This approach runs the risk of a particular message losing relevance or being set aside by a community that does not share the same customs, beliefs or practices. “If you try to give one-size-fits-all to these communities, then you may mislead or even kill credibility of what you’re doing. Because people would say they, [for example in Senegal], ‘we are not concerned,’” Niang told Devex. “If Ebola is transmitted via bush meat, and we don’t eat bush meat, then Ebola won’t come in Senegal … It’s a mistake.” Some aid groups have already realized the importance of targeted messaging. PCI, for example, has identified women as among those with a higher risk of contracting the disease given their traditional roles in communities as caregivers and in charge of burials in Liberia, and therefore is targeting them with prevention messages. The organization is also working with tribal leaders and chiefs to ensure the messages it disseminates are “culturally and age-appropriate.” Concern, meanwhile, has come up with educational activities and has set up hand-washing stations at passenger pick-up locations for “Pen-Pen” motorcycle taxi drivers to lower their risk of infection. “There’s a big unemployment crisis in Liberia, especially with youth, and many have taken to driving motorcycle taxis as a way to survive,” Crystal Wells, senior communications officer, told Devex. Direct messaging campaigns though, Niang argued, are best left to those raising awareness on the ground. How to channel and deliver the right information Despite the lack of M&E right now in West Africa, one thing is clear: Who delivers the message is as important as the message being given out — and is becoming increasingly true as organizations engage more community leaders and seek their leadership both in disseminating information and immediately crushing false rumors that are not helping at all to contain the outbreak. In communities in Sierra Leone, for example, Rev. Peter Konteh of Caritas Freetown noted how religious leaders are helping explain to families that their dead are being prayed for even without their physical presence. Baggio emphasized the critical work being done by local radio stations, which they have learned are reaching far more people and helping crush rumors, and therefore, she said, should be capacitated for more long-term efforts. Many stations are struggling to keep afloat because of lack of funds. Some are being supported by organizations like PCI with fuel so they can stay on air for more time. Niang, however, differentiates Ebola information packaged as news from spot radio announcements. “People tend to think that you have to air sensitization spots, but sometimes it doesn’t work because people would say, ‘OK, [the West] have sent money to air these kinds of things.’ While when [radio] gives information [in the form of news], it is supposed to be verified, comes from professional journalists,” he explained. What WADR does — send a reporter to Kenema and Freetown in Sierra Leone to report and interview front-line health workers — is making people realize that “Ebola is a reality and there are people risking their lives to stem the outbreak.” “Let’s not just do communication for the sake of communication,” Niang said. He did admit that his staff didn’t know much about the virus on the onset, and they all had to dedicate time and energy and researching about it. “It’s not like cholera, which is endemic in West Africa. Everybody knows it’s preventable and our communications know how to deal with it. But Ebola, nobody knew,” Niang said. Communication dilemma Organizations working on Ebola communication efforts on the ground are also hampered by the lack of treatment and holding centers for infected people. According to Charles, they may be able to encourage people to get their sick to the hospital, but then there’s no guarantee they will be taken in. “We currently have almost 2,000 infected people in the country, and we do not have 1,000 in bed in treatment centers. MSF for instance has a standard of having at most 50 patients in a facility,” he said. “And the problem with that is if you have more than 50, it gets overwhelmed and medical staff would not be able to keep up with those numbers.” Battling stigma is another challenge. One of the strategies groups are holding onto is getting Ebola survivors to inform communities that being infected with the virus is not a death sentence. But Niang revealed that it’s been tough getting them to speak up, and fears that they may ask for money to do so in the future. “In these kinds of diseases … survivors at some point of time refrain from speaking because of stigma. Their family or neighbors would know, but they wouldn’t want the whole community to know,” he said. “Advocacy is a process. So to get people to follow the rules and change the practices we've been doing since we were born, it's a whole process of engaging them continuously.” --— Ishmeal Charles, Healey International Relief Foundation’s program manager in Sierra Leone Worse than war Konteh explained that in Sierra Leone they are now in the situation where people are “proud” to say they have HIV, but will deny they have Ebola. His colleague, Charles, also noted it only took four months for Ebola to kill this many people, and this is making people fear the disease even more than war in a much shorter period of time. “The devastation [Ebola] has caused is far more outrageous than the civil war [and] there are a lot of stigmatization … which [did not happen during] the civil war,” Charles said. He recalled how during the war, people would know Revolutionary United Front rebels had attacked a certain town, so they would just move to the next. But with the outbreak, “it just spreads wide and fast. You don't know in what place it's going to be in next.” Another difference is that the armed conflict didn’t prevent victims from fleeing the country, unlike now. “In the civil war, you have the opportunity to bury your loved ones, if you are able to skip the barrels. If people get sick, you can look for a cure for them. And you can hide. With civil war you are able to shake hands; you're able to hug loved ones. Even when you cry, you are able to put your hands together and compassionately with others,” Charles said. “With Ebola, people don't shake their hands. They don't hug. Even when your loved one is dying you can't hug them.” Many people, he added, don’t even get to see their loved ones for one last time after they die. When they perish in a hospital, the corpses are just put in a plastic bag, zipped up and taken away, a culturally unacceptable way that affected families must endure to not put themselves at risk of contracting the virus. “It’s far much more worse, psychologically,” Charles concluded. “In war, if they kill you, you die at once. They shoot you, you die. But with Ebola, you end up infecting the rest of your family.” Read more development aid news online, and subscribe to The Development Newswire to receive top international development headlines from the world’s leading donors, news sources and opinion leaders — emailed to you FREE every business day.