(This tool was developed in early 2015 and used it in numbers of occasions in various outbreaks)
An epidemiologist can use this and their standard epidemiological tool to have a preliminary snapshot of the cultural practices, which may have a negative or positive impact on the outbreak control. The perception and cultural practices for the same symptoms or illnesses will be diverse in different countries. If we trained some of our epidemiologists with these basic tools, we might address some barriers for controlling disease outbreaks due to cultural practices. This is not the purpose of making epidemiologist an expert in medical anthropology. This tool doesn’t replace the standard anthropological tools. A trained medical anthropologist should carry out detail evaluation to generalize.
This can help epidemiologists in developing control programs and evidence to seek medical anthropologist assistance if required. This tool is field-tested, and it takes around 15-30 minutes to get information from an informant, and if it is in the group, it takes about 1 hour at the maximum. Within this time frame, we can collect some additional information, which can help epidemiologists.
A. What is community perception of sickness and response to the followings?
|Symptoms||Community Perception||Where they go first (who treat them first)||In how many days||How are they treated?||When they visit the health facility|
|Fever*||Due to bad or sorcery||Witchcraft||2 days||The body is painted with some kind of anointing substances and asked to do them*||If not cured (number of days)|
|Bleeding (per rectum)|
|Bleeding (skin) rashes|
|Flu-like illnesses||Due to the insertion of bad air in the body||Traditional healers||3 days||Traditional healers ask them to stay in a separate room but not well ventilated|
|Add other symptoms relevant to the outbreak.|
Example 1 (Fever): The treatment of fever by anointing needs an additional person, and it put that person of getting infection too.
Example 2 (Flu-like illnesses): Ask to stay in a separate room might be a good practice, but the room ventilation is not adequate.
These examples may lead to a lot of follow up questions, and epidemiologists may not have enough time. Let the anthropologist take the rest of the follow-up questions. For the immediate control measures like Ebola, the epidemiologist can communicate risks of the practice of anointing.
B. Funeral/Burial Practices
- What do they do with the dead bodies?
- What are the rituals?
- How do they bury the dead bodies?
Note: This information provides hints to harmful practices such as putting favourite drinks in the mouth of dead bodies and drinking it. Rationale: The epidemiologist can identify these risky practices, and addressing them can significantly impact disease control.
Immediately we can risk communicating about this practice to the community through social mobilizers.
C. Caring for a sick person (current illness)
- Who takes care of sick people?
- Hand washing practices (request to demonstrate)
- Cultural practices – using traditional medicines, taking care by faith healers or traditional healers, etc.
- Nutrition of sick person (what kind of food)
D. The belief/trust in the local health system
- Where is the nearest health facility?
- Who treats them?
- Their perception of health service providers?
E. Stigma assessment
- Is there any stigma attached to this illness?
- What are the practices?