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Volume 9, Number 10—October 2003

Research

Cultural Contexts of Ebola in Northern Uganda

Barry S. Hewlett*Comments to Author  and Richard P. Amola†
Author affiliations: *Washington State University, Vancouver, Washington, USA; †Ministry of Health, Adjumani, Uganda

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Table 5

Beliefs and practices of the national and international healthcare professionals that enhanced and lowered health of some persons during Gulu Ebola hemorrhagic fever (EHF) outbreak

Health-enhancing beliefs and practices Health-lowering beliefs and practices
Most national government health workers and decision makers spoke local language and had an understanding of local cultures
Unintended consequences of WHOa health education video: burning of houses of survivors
Establishment of isolation unit and use of barrier nursing
Taking bodies to burial ground before family members could verify the death. This practice led to sick persons hiding from family and health workers; family members being afraid to take sick persons to hospital; persons running away from the ambulance; and stories of Europeans selling body parts
Providing gloves and bleach to local communities
Omitting traditional healers from control efforts; they were ready and willing as a group to help mobilize the community
Medical care of Ebola victims including rehydration, control of vomiting, other
drugs/medications
Early stages only: 1) nurses and healthcare nurses lacked training about barrier nursing, protective gear, and education about the transmission and nature of the disease; 2) lack of transport for sick patients; 3) international health workers not familiar with naming, kinship system, household organization of local communities
Multidimensional health education
Taking blood samples for research only or blood taken without reporting results back to persons or communities’ increased distrust of healthcare workers
Suspension of the following activities: handshaking upon greeting, cutting by traditional healers, schools, discos, public funerals, traditional beer drinking
International team members conducting EHF studies for research only. This diverted time and energy from control efforts
Diagnostic laboratories for Ebola

Ambulances to transport patients to hospital to isolate

Reallocation of tasks of health workers to focus on EHF

Use of mobile teams to follow all contacts and provide health education, support for survivors and impacted families

aWHO, World Health Organization; EHF, Ebola hemorrhagic fever.

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