(This tool was developed in early 2015 and used it in numbers of occasions in various outbreaks)
An epidemiologist can use this in addition to 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 kinds of basic tools, then we may address some barriers for controlling disease outbreak 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. Detail evaluation should be carried out by a trained medical anthropologist to generalize.
Some of the key information, which can help epidemiologist on developing control programs and also provide evidence on seeking immediate medical anthropologist assistance to address issues. This tool is field tested for the requirement of time, and it takes around 15-30 minutes to get information from an informant, and if it is in the group, it takes around 1 hour at maximum. Within this time frame, we can collect some additional information, which can help epidemiologist.
A. What is the community perception of sickness and response to followings?
|Symptoms||Community Perception||Where they go first (who treat them first)||In how many days||How they are treated?||When they visit health facility|
|Fever*||Due to bad evil or sorcery||Witch craft||2 days||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 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 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 the separate room might be good practice but the room ventilation is not adequate.
On both of these examples may lead to a lot of follow up questions and epidemiologist may not have enough time. Let the anthropologist take rest of the follow-up questions. However, for the immediate control measures like Ebola (we can communicate community the risk practice of anointing).
B. Funeral/Burial Practices
- What they do with dead bodies
- What are the rituals
- How they bury
Note: this gives hints to harmful practices like (a practice of putting favorite drinks in the mouth of dead bodies and drinking them). Rationale: This can be identified by investigating epidemiologist, and this knowledge will have huge impact on addressing these practices.
Immediately we can risk communicate this practice to the community and social mobilizers.
C. Caring of a sick person (the current illness or outbreak disease)
- Who cares the sick
- Hand washing practices (can ask to demonstrate)
- Cultural practices – using traditional medicines, taking care to faith healers or traditional healers etc
- Nutrition of sick person (what kind of food)
D. The Belief of the existing health system
- Where is the nearest health facility
- Who treats them
- Their perception of service providers
E. Stigma assessment
- Is there any stigma attached to this illness?
- What are the practices?