Appendix B: Fear of Health Facilities and Ebola Treatment Units

Fear of Health Facilities and Ebola Treatment Units

Key Considerations

UNMEER/Martine Perret

Fear of health facilities and ETUs can lead to hiding Ebola victims and/or having them treated at home by untrained workers. These untrained workers can be individuals that the victims would normally turn to for help, such as traditional healers, and off-duty health facility workers (sometimes anyone who works for a health center is consulted, even if that person is in maintenance). Often, they will not wear protective clothing.

When addressing the avoidance of ETUs and health facilities, consider the following:

Collaborate with health systems strengthening teams and agencies that work in MNCH, HIV/AIDS or other health areas to promote safe usage of health facilities.

Address communities before ETUs are built and hold dialogues with community members; ensure that communities understand what the ETUs are and what they do, and why HWs wear PPEs; and make sure that community members have a role.

Always communicate clear steps that community members can take when they or someone they know is ill, such as informing a community leader, calling a hotline, etc.

Important people to involve in your communication efforts

Ebola survivors, HWs, CHWs and volunteers, Ebola task forces, district health teams, local champions, community leaders, mass media

Common Causes/ Contributing Factors	Sample Message Response	Sample Activities and Implementation
High death rates and lack of trust in foreign- or government-led facilities Lack of respect or information to communities and the family of victims Misunderstandings/lack of information about incoming ETUs and PPEs in communities, and lack of community buy-in Misunderstandings about survival rates; lack of information of whether health centers are safe places to go when sick All of these contribute to the perception that ETUs are places where people go to die and health facilities are places where you can catch Ebola	Consider messages that reflect how we are “in this together,” giving the community the real sense they have a role to play in ending Ebola. They could include messages about what to do or where to go when sick with an illness that is not Ebola, and the benefits of doing so. Governments and agencies need to work with community leaders and other members to communicate about incoming ETUs and PPEs to communities so they do not inflame panic. Messages need to focus on how early treatment can increase the chances of survival. Some examples include: ETUs are special and safe health centers that give the best care for Ebola. HWs in the ETU can give treatment for the signs and symptoms of Ebola. Early treatment for the signs and symptoms of Ebola can help the person to survive—right now, there is no special cure. Many new ETUs are being built so that sick people can get the care that they need to keep families and communities safe. The HWs in ETUs wear special protective clothing called PPE (overhaul suits) to keep them safe while they are taking care of the sick people. At the ETU, people that are tested who are known to have Ebola are kept in their own area so the Ebola does not spread to anyone else. The HWs in the ETU take good care of Ebola patients. Sick people get plenty of food, water and medicine to take care of pain when they are in ETU. Remember, if anyone is sick, call XXX (or see X) so they can advise you on the best health services and send the help you need. While you can’t visit your sick friend/family member in the isolation part of the center (red zone), you will be called for you to know how he/she doing OR you can still go to the center and discuss with the staff who take care of him/her	Radio dramas and radio discussions with HWs and trusted leaders who dispel rumors and explain the purpose of the ETUs, HWs wearing PPEs and the safety of health facilities Promote information on what to do when sick with something other than Ebola and provide clear benefits in mass media, with stories of community members who have been treated Create community-level activities that promote dialogues about visiting ETUs or health facilities, prompting discussion and reflection; incorporate survivor stories Ensure community ownership of ETUs and other treatment or health facilities; hold dialogues with communities to get their input and communicate agreed-upon safe burial practices back to the community Promote stories about survivors and others who are stigmatized (e.g., HWs, burial teams) through mass media, videos and community events Try to organize visits for communities or families to ETUs to help demystify them. Alternatively, create short videos of the ETUs and show them to alleviate fears Provide a bridge between the patient and his/her family and community—this might include establishing a cadre of community health volunteers who can guide community members to services when they are ill and interface with staff and the family for patient visits or calls

Common Causes/ Contributing Factors

Sample Message Response

Sample Activities and Implementation

High death rates and lack of trust in foreign- or government-led facilities

Lack of respect or information to communities and the family of victims

Misunderstandings/lack of information about incoming ETUs and PPEs in communities, and lack of community buy-in

Misunderstandings about survival rates; lack of information of whether health centers are safe places to go when sick

All of these contribute to the perception that ETUs are places where people go to die and health facilities are places where you can catch Ebola

Consider messages that reflect how we are “in this together,” giving the community the real sense they have a role to play in ending Ebola. They could include messages about what to do or where to go when sick with an illness that is not Ebola, and the benefits of doing so. Governments and agencies need to work with community leaders and other members to communicate about incoming ETUs and PPEs to communities so they do not inflame panic.

Messages need to focus on how early treatment can increase the chances of survival. Some examples include:

ETUs are special and safe health centers that give the best care for Ebola.
HWs in the ETU can give treatment for the signs and symptoms of Ebola. Early treatment for the signs and symptoms of Ebola can help the person to survive—right now, there is no special cure.
Many new ETUs are being built so that sick people can get the care that they need to keep families and communities safe.
The HWs in ETUs wear special protective clothing called PPE (overhaul suits) to keep them safe while they are taking care of the sick people.
At the ETU, people that are tested who are known to have Ebola are kept in their own area so the Ebola does not spread to anyone else.
The HWs in the ETU take good care of Ebola patients. Sick people get plenty of food, water and medicine to take care of pain when they are in ETU.

Remember, if anyone is sick, call XXX (or see X) so they can advise you on the best health services and send the help you need.

While you can’t visit your sick friend/family member in the isolation part of the center (red zone), you will be called for you to know how he/she doing OR you can still go to the center and discuss with the staff who take care of him/her

Radio dramas and radio discussions with HWs and trusted leaders who dispel rumors and explain the purpose of the ETUs, HWs wearing PPEs and the safety of health facilities

Promote information on what to do when sick with something other than Ebola and provide clear benefits in mass media, with stories of community members who have been treated

Create community-level activities that promote dialogues about visiting ETUs or health facilities, prompting discussion and reflection; incorporate survivor stories

Ensure community ownership of ETUs and other treatment or health facilities; hold dialogues with communities to get their input and communicate agreed-upon safe burial practices back to the community

Promote stories about survivors and others who are stigmatized (e.g., HWs, burial teams) through mass media, videos and community events

Try to organize visits for communities or families to ETUs to help demystify them. Alternatively, create short videos of the ETUs and show them to alleviate fears

Provide a bridge between the patient and his/her family and community—this might include establishing a cadre of community health volunteers who can guide community members to services when they are ill and interface with staff and the family for patient visits or calls

Back to Appendix B

Next: Ebola Stigma