Abstract: A Culture-Centered Exploration of Community Members’ Response to an Ebola Outbreak.

◆ Esi Thompson, Indiana University

Initial reports about the West African Ebola outbreak portrayed community members as ignorant, illiterate, and primitive. But the persistence of the on-going outbreak in the Democratic Republic of Congo suggests the need to understand the narratives of community members in response to disease outbreaks. Scholars have argued that health decision-making and response occurs within complex social structures that influence how people make sense of disease and what behaviors they enact guided by the material challenges in their lived realities. If infectious disease outbreaks can be counted on to occur in sub-Saharan contexts (Fenollar and Mediannikov, 2018), then understanding how community members made sense of the Ebola outbreak is worthy of investigation.

Purpose and relevance
The purpose of this paper was to explore Liberian community members’ interpretations of the Ebola outbreak as people who have lived through a deadly outbreak. I argue that differing community member responses reflect their differing and changing agency in addressing a novel outbreak and to sustain life within existing cultural and structural mechanisms. The study is meant to provide a conduit for grounding local interpretive frames within mainstream discourse about responses to disease outbreaks. The focus of this article is in reconstructing the response of community member in disease outbreaks to show how these reflect their agency and quest for survival and life sustenance.

Literature /theoretical underpinning
The study draws on culture-centered approach (Dutta, 2008; Sastry & Dutta, 2017) to analyze the narratives of community members to draw out culture, structure and agency and how these influenced the meanings of and responses to the Ebola outbreak in Liberia.

This exploratory study adopted a qualitative approach with three semi-structured focus group discussions of 10 participants each and 10 semi-structured in-depth interviews with community leaders in the Mamba Kabah district in Margibi County of Liberia. Multi-stage cluster sampling was used in selecting respondents from communities and towns within Dolotown health catchment area and the Unification Town health catchment area.

The study found that community members expressed their agency in the face of the Ebola outbreak in various ways including through the use of historical knowledge and experience, religious and spiritual rituals, and cultural and social organizing structures. These were expressed differently over the course of the outbreak. Though some of these forms of agency may be viewed as resistance, community members adopted negotiated and oppositional meanings in an effort to make sense of the outbreak in their daily lives.

The study highlights the need for health communication about epidemics to be mainstreamed into efforts to address health inequities and improved health systems. It also emphasizes the importance of understanding how religion and culture feature in the health seeking needs and behaviors of community members confronted with a novel outbreak. Finally, the study shows that marginalized communities have agency, existing structures, and knowledge economies about culture and health that need to be harnessed for health communication.