Caffeine and reflexivity

"I am going to try to explain part of my role as an anthropologist in an Ebola outbreak."

I have struggled to write this blog post, my first from Liberia, for the past few weeks. There are many unfinished drafts and half-written paragraphs sitting on my desktop waiting to be completed. But today, as I sit in an unfamiliar, sterile hotel waiting for a meeting to begin, I finally have the distance I need to be able to put (some) of my thoughts on paper. OK, on screen. (As much as anthropologists are famed for carrying around multiple notebooks, sometimes the romance of handwritten words needs to be replaced with something instant and legible).

I have been in Liberia for almost a month now, working as an anthropologist in Monrovia. During these last four weeks I have talked to endless people, asked question after question, scrawled down replies and queries and thoughts. I wake up in the night with the voices of the people I spoke to running through my head, thinking ‘I should really write this down’ before turning over and going back to dreaming about Serial (a recently discovered podcast which takes me to a very different world every Thursday evening).

So now I am going to try to write it down and explain part of my role as an anthropologist in an Ebola outbreak. One of my tasks has been to find out what people think about MSF’s Ebola treatment centre: what do people imagine happens inside and how MSF can help to demystify it? This is a work in progress – every time I find a new piece to the puzzle or a new research path to follow, I risk losing sight of the original objectives and need to stop and reel in my thoughts before they become too far from home.

If you have read any of the other MSF blogs about Ebola, you will have a vague if not vivid idea of what happens inside our centres. Strange alien bodies, unrecognisable beneath their protective layers, provide medical care and support to the sick in the best way that they can. Fences create clear divisions between the different areas: high risk versus low risk, suspect versus confirmed. Access is restricted. For someone who has not been inside an Ebola centre, who has not crossed the red fence – or even the entry gate – it can be a terrifying place.

My job takes me to the inside of the Ebola centre but also, more importantly, to the outside. What do people imagine takes place behind the fences?  What can they expect if they go there?  How can it be made more welcoming?  When the Ebola outbreak was at its peak – a time when I was not in the field, so something which I have pieced together using the words of those who were – neighbouring communities remember the bodies and the panic and the fear. They were scared about becoming infected with Ebola, terrified about what was happening to their friends and relatives on the other side of the gate.

Things are changing in Monrovia. People are still scared and they still fear Ebola, but there is more understanding about what happens ‘on the inside’. Education and information help people to understand that being admitted does not necessarily mean that you will die. Communities are more aware of the care they can expect, and are less scared of the treatment they will receive.

Yes, there are still rumours about Ebola which come through a lack of information and an all-encompassing fear.  I listen to these rumours, attempt to understand their root cause, try to help the wider MSF team to decipher them.  Sometimes this is frustrating – I am there as an impartial listener, not debating with my friends over a beer in the pub.  My voice is supposed to remain muted. Sometimes I push people harder than I should: “why would I want to kill you with the chlorine spray? Why reason would I have for doing that?” I questioned an elderly man who insisted that the chlorine used for decontamination purposes is actually what is killing people. He gave me a shrug in return.

I understand his perspective: I completely understand it. When a dead body is collected, a lot of chlorine is sprayed to disinfect the area and ensure that no-one else becomes infected. There is a clear link between death and chlorine, which, to the so-called ‘outsider’ who has not had access to enough information, easily becomes imagined as a causal one. In finding out these rumours, making sense of them and trying to find solutions and counter-arguments for them, new health promotion messages can be created and new information given to people to help demystify the chlorine spray and the virus in general.

I come back from some of these discussions drained, yet at the same time energised and excited to have a new piece of the puzzle. Every time someone tells me something different, or repeats an oft-heard rumour with a new twist, it becomes a little clearer. I understand that local (and not-so-local) communities are desperately trying to make sense of a virus that has destroyed every aspect of their lives: it has taken away their education, their livelihoods and their loved ones.  

When the outbreak began, before people had any information, they made sense of it using the frameworks and snippets of information that they had. I would do the same thing. In the same way that I Google my symptoms if I am sick, and try to out-smart and question my doctor with my own knowledge and proposed diagnosis (sorry, clinicians!), I would absorb every bit of information about Ebola that was available to me, whether its source was reputable or not.  

This is why health promotion and background understandings of Ebola are an essential part of responding to the outbreak. The more accurate, accessible information that can be given to communities, the more empowered they are and the more they can begin to make sense of (and prevent) Ebola.

Once again, this blog post comes fuelled by caffeine and reflexivity and may be slightly disjointed in its analysis. I struggle to articulate what I have seen and heard and this is by no means a final argument, but a partial reflection on life in the anthropological field. Next time: reflections upon stigma and how some of the things I have heard are very difficult to digest.