This makes use of a card tracking system to allow conversational voices to be identified and placed in order of the flow of the conversation without compromising the anonymity of the speaker. The system also has the advantage that it allows patterns to be detected in focus-group interaction—for instance, if there are dominant voices in the conversation, if certain comments only emerge after crucial interventions e.
Sampling and data analysis The trust management dealing centers investigation of trust in the context of an Ebola case-handling facility ETC was intended to be an exemplary case-study, based on statements made in ten focus groups.
The focus groups were run by a team of locally-based research assistants earlier trained by one of the authors EYM for work on Trust management dealing centers in — The same tailor-made focus-group interview protocol used in the —15 study was again used in the research conducted in see supporting materials.
Focus group participants We identified participants in focus groups in the following manner. One of our research assistants had been employed in the case-handling facility inand helped us reach former employees, patients and their families. In all, fifty persons agreed to take part in our study, of which 28 were former employees of the case-handling facility, 10 were patients or members of families and affected communities, and six were members of the general public Table 1.
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All gave informed consent by signing or marking a letter read out them describing the interview process and asking whether they wished to take part voluntarily. The six persons representing the general public were selected randomly from urban neighbourhoods in Kenema.
Randomization for membership of this group was done by raffle, first to choose six neighbourhoods and a street within each neighbourhood, then to choose one house on that street, and finally to determine the gender of the adult person to be interviewed in that house.
All persons selected agreed to join the focus group. Five focus groups were organised for occupational groups of ETC employees and three for survivors and family members. All persons contacted were invited, though not all agreed to take part.
Statements made in the village focus group were compared with statements made in three focus groups for male elders, female elders, and younger people held in Decemberat the height of the epidemic. All statements made by participants in the focus groups were written down by a facilitator designated for this task, and then entered into XL spread sheets, referenced according trust management dealing centers the order in which trust management dealing centers were made.
The full set of statements is available in the on-line supporting materials. The authors classified statements by topic and used this as evidence for the points made in the paper. All adult subjects and signed or thumb-printed a letter read out to them telling them what the interview was about and what they should do if they felt uncomfortable.
Background to the case study The case-study ETC commenced activity in September and admitted its trust management dealing centers case in March It trust management dealing centers the first such centre to become operational in Sierra Leone. Any departure from this protocol was met with sanctions. Repeat offenders were dismissed, for having put the safety of other staff at risk. In what follows we report on the question of trust and distrust respectively, and how both conditions were emergent during the Ebola crisis.
We have further sought to trace what role moments of experiential learning played in establishing and disseminating trust through social feedback processes. The view from the outside: Views on the ETC from the general public In order to explore how the work in the ETC was seen from the general public surrounding the ETC, we interviewed a small group of residents of a mixed residential quarter in the nearby town Kenema, who were purposively selected on the basis of having lived in Kenema during the Ebola crisis but without having been directly affected by infection on a personal or family level.
The session facilitator offered various prompts, including a starting question about what members of the group thought were the causes of the Ebola outbreak. The explanation that the disease was spread through person-to-person contact was widely shared in the group. Nevertheless, most comments about the ETC itself were positive. Discussants had heard survivors speak, in person or over the radio, about the good care they received.
This replaced pessimism based on earlier messages that there was no cure for Ebola with a growing confidence that many people could pull through with ETC help. ETC staff were seen as bringing specialist knowledge, with benefits to patients, when compared to alternatives.
Several discussants purported to have noticed that patients discharged from the ETC had fewer long-term health problems than those discharged from the government hospital.
Two discussants even advocated for the ETC to be rebuilt, to cope with future infectious disease threats. Others, however, found the ETC premises a painful reminder of those they had lost, and were glad when it was dismantled. Thus, from the perspective ofthe ETC was generally seen in a positive light.
But some members of the group did not hide earlier doubts. Otherwise you were the last one they helped. I hated them so much.
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Survivors, families of survivors, and families of the deceased A rather different picture emerges from the comments supplied by focus group participants who were survivors, or members of families of survivors and the deceased.
Survivors and family members often had positive experiences of the ETC itself but suffered considerably from stigma and a lingering suspicion in their communities that the disease was fake. Constituting a group of survivors to form a focus group posed a logistic challenge due to the way the ETC had received cases.
Nganyahun ETC took a large trust management dealing centers of its patients from outside the district, because by the time it was built the Kenema outbreak was ending.
To follow up the group of survivors would have meant traveling to Freetown or Kono, the districts from which most patients came, and funds did not allow the team to travel, while so much of its other interview work was Kenema-based. Thus we had to locate a small group of Kenema-based survivors with experience of time spent in the ETC, and two of these agreed to discuss their experiences in depth.
They both reflected on their fears before being taken to the ETC, having how the TNT channel makes money information that there was no cure, and hearing rumours that the ETC was involved in sinister activities.
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To their surprise they found that things were otherwise; they were well cared for and their personal needs were met—e. Neither was told the result of their blood tests until discharge, and ambulance drivers and crew were castigated for rough driving and excessive spraying of chlorine. I feared to use those drugs [at that time]. That was a difficult situation.
Trust, and distrust, of Ebola Treatment Centers: A case-study from Sierra Leone
Both survivors report community alienation. We were not really expecting such, but [the] community still do not believe the existence of Ebola. Our relatives still [have] mixed feelings about us.
They have no trust in us about the existence of the virus. Even our former [friends who] we were with now isolate and stigmatize us.
All three discussants thought the Method binary options reviews trust management dealing centers necessary and were grateful that staff had made such efforts to help their loved ones, despite the risk to their own lives.
All three spoke movingly about the pain of farewells and having to cope with fear that they would never see their family member again. By the time one of the patients was admitted December the ETC had been operating for three months, and phones were now distributed to patients so that families could remain in touch. Even a certain amount of patient visiting seems to have been possible.
One wife learnt her husband was going to survive when he was visited by his brother, who apparently talked to the sick man from behind a barrier. One of the wives would have liked to help nurse her husband. The other recognized that because of the infection risk it was wiser to leave the task of nursing to skilled professionals. She, herself, was in quarantine, so had no opportunity to leave her house. All three talked about being shunned by neighbors and friends.
In one case neighbors even locked the local well so that it could not be used by the affected family. Experience of good care revised assessments of the ETC. They all saw the establishment of the ETC as a reason for hope, and had expected their family member to survive, only to have these expectations dashed. Even so, they praised the dedication of the staff. Another added that: I am always happy when I see them, even though my husband died, my daughter survived. I have mixed feelings.
I had to find another house to live in. I was marginalized by society. I was stigmatized.
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The only thing that I did was to wave at her in the ambulance. My [wife] said to me, please take care of my trust management dealing centers. I wept. I would have loved to [have] followed, but I was quarantined. They waved at me. I felt tears in my heart. Every step he took was disinfected.
I cried nearly to death. I cried my eyes out when I did not see my daughter. Registration on binary options gave him my phone number [and] he used to call me and reported the death of my daughter.
Because I was not close [by] to launder or cook for her. I could not give her anything. The ETC seemed not to have any systematic procedures for handling this. Much information was passed through informal channels by workers at the ETC. When she saw my daughter at the ETC she recognized her, so when she died, she informed me. Who knows how they were buried? In a mass grave and denied our traditional requirements for a decent burial? We never set eyes on the corpse nor even visited the burial of our loved ones.
We did not know there was such a ceremony. No, I did not see the corpse. I neither saw a picture of trust management dealing centers corpse or of the grave. I did trust management dealing centers know that there was a grave until [you told me] today. It sent bad signals to both patients and family members. ETC community liaison The arrival of the international community to help with response to EVD, a disease never before seen in Sierra Leone, required abundant local help.
Those with a good educational background found work as translators, case finders, data clerks and so forth. Some of these recruits were then trained as community liaison workers for the ETC. This group linked the facility with affected families and their communities, and also helped implement quarantine.
Three of these liaison workers took part in a focus group to discuss their experiences. First, they talked about their initial fears and general ignorance of the disease. But nobody knew much. By doing, we learnt [how to reduce] the death rate. One key thing I learnt is that when the outbreak occurred it was new and that we were not prepared, and that nobody [in the country] knew about the Ebola virus.
We spread messages that helped reduce the spread of Ebola. They did not believe in the disease. The only thing they believed is that if [Ebola] exist[ed], we had brought it to the community. They sympathized [with] us and [made] discharge[d] [patients] very welcome. They were anxious to get help.
Sometimes people went on [the] rampage and threw stones at our vehicle. To my dismay up to now some people do not believe there was Ebola. They thought we were betraying them. They saw us as spies. Some attacked us physically.
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They felt betrayed. In the end they had more trust [in the ETC] than in other health facilities. This was denied by villagers, who pointed out that their first cases dated back to Julytwo months before the ETC was opened.
A visit allowed us, however, to compare responses with the data collected in December A focus group of six three men and three women, five of whom described themselves as farmers was formed, and participants unfolded a straightforward story.
According to the earlier data file there were 29 deaths and 13 survivors so 42 cases of EVD in all. The first two persons to die were reportedly buried in the village, but the rest were interred in the graveyard attached to the Nganyahun ETC.
This distrust was connected to a more general climate of skepticism about the existence of Ebola as a disease. Much local reasoning supporting these negative attitudes is shared across widely separated epidemic locations in Africa. This places news from early that case-handling facilities in North Kivu have come under attack by armed militia in a significantly altered context.
Three major reasons can be identified for this lack of trust. The first reason is that Ebola in both Sierra Leone and North Kivu is a new disease, but it mimics the symptoms of many more familiar diseases, such as malaria and Trust management dealing centers Fever. EVD reveals its distinctiveness only in its later stages. Isolated rural communities rightly see virtue in high-quality domestic care for other diseases such as malaria and feel deprived when they cannot offer the same for EVD.
As the results trust management dealing centers our case study shows, in Sierra Leone it took time for evidence to become clear to care givers. This temporal dynamic can be seen with regards to the fact that bodily contact spreads EVD, that quarantine and isolation are unavoidable, and that ETCs provide good quality care and can improve outcomes for patients. Evidence was thus needed to support a change of attitudes in Sierra Leone.
This emerged in three stages. The first was when families began to recognize that those most involved in care for a patient were those most at risk of next being infected.
A steady flow of discharged survivors then changed perceptions that the ETC was a place where people went only to die. Families finally realized that patients had better survival chances in the ETC than those attending a regular hospital or kept at home.