Understanding lived experiences and contextual realities of Ebola outbreaks: A case studies approach in Western Uganda

Abstract

Ebola Virus Disease (EVD) is caused by a highly infectious and fatal filovirus of zoonotic origin among human and primate populations on the African continent. EVD is classified as a potential ?public health emergency of international concern? (PHEIC) under the revised International Health Regulations (2005). Actors and institutions governing global health perceive EVD in terms of an imminent threat to global health security. This influences response interventions focusing on surveillance and containment, more recently witnessed in the form of militarisation. Using two case studies, this research explores lived experiences and contextual realities of two communities in western Uganda, Bundibugyo and Kibaale, who experienced EVD outbreaks in 2007 and 2012 respectively. An inductive research approach following a constructionist epistemology and a phenomenological design was employed. Multiple qualitative methods including 25 in depth interviews, nonparticipant - observations and document analysis were used. Analysis employed an approach adopted from grounded theory technique. Five main themes emerged: A Behavior Blame Narrative; Structural Determinants of Delayed Diagnosis and Nosocomial Transmission; Social Realities; EVD Exceptionalisation and Empowerment. Findings demonstrate a local as well as global dichotomy in perceptions around EVD emergence and that current response interventions fail to support health system strengthening and prioritise ?global? security above the security and welfare of the individual in African contexts. This study contributes to existing knowledge in this area by providing a broader and deeper understanding of how globalisation processes impact on the social suffering of the individual. It also has important theoretical implications by conveying the importance of anthropological approaches to EVD outbreaks beyond a cultural epidemiology. This can demonstrate alternative perspectives to approaching EVD outbreaks and facilitate the local voice to emerge from beneath dominant narratives.