(Re)arranging "systems of care" in the early Ebola response in Sierra Leone: An interdisciplinary analysis.
(Re)arranging "systems of care" in the early Ebola response in Sierra Leone: An interdisciplinary analysis.
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在塞拉利昂早期埃博拉应对中（重新）安排“护理系统”：跨学科分析。
DOI：
10.1016/j.socscimed.2021.114209
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发表时间：
2022-05
影响因子：
5.4
通讯作者：
Richards, Paul
中科院分区：
文献类型：
--
作者：
Mayhew, Susannah H.;Balabanova, Dina;Vandi, Ahmed;Mokuwa, Gelejimah Alfred;Hanson, Tommy;Parker, Melissa;Richards, Paul
关键词：
尽管关于埃博拉应对的文献越来越多，但很少有研究详细说明或反映不同护理系统的应对措施。关于如何、为什么或以何种方式在地方制定健康不良管理战略，卫生系统的权力、权威和等级制度如何被感知和质疑，或其他社会制度、机构和关系如何影响应对措施，人们知之甚少。本文对塞拉利昂两个早期受影响地区的当地反应进行了跨学科分析。利用社会秩序和组合的人类学理论，我们对来自博和莫扬巴地区的三个扩展案例进行了对比感染链的分析。以前的学术研究将地方行动理解为对国家埃博拉应对措施的反应性（支持或阻碍），与之相反，我们表明，地方安排领导和塑造了应对措施。我们的案例显示了多重、纠缠、动态和共存的护理系统如何影响这些反应。一些个人和社区在报告和隔离等措施上与卫生当局合作，另一些人则积极反对这些措施，或发挥中介作用。正式的卫生系统行为体、地方当局和普通公民共同谈判并制定了新的安排。这些安排包括妥协，有时权力被重新配置。它们还受到更广泛的政治和历史背景以及正规医疗资源的可用性或缺位的影响。我们的研究表明，了解参与医疗保健的机构和人员如何制定各种“护理系统”，从而影响埃博拉应对措施，至关重要。最重要的是，我们的工作强调需要在正式卫生系统与家庭和社区层面更广泛的社会、文化、政治和经济组织形式之间保持一致，以改善危机应对并促进可持续护理。特别是，卫生系统响应者需要在一线医疗系统中确定关键的中间人或安排者并与他们接触，与他们可以实现相互接受和有效的医疗重新配置。多重、动态、共存的护理系统形成了塞拉利昂的埃博拉应对措施。政治/历史背景、资源、冲突和妥协都影响了护理系统。不同的地方行动者协商关系，重新配置医疗保健安排。正是地方安排在分散的层面上主导和塑造了危机应对。卫生系统需要与“安排者”合作，重新配置符合当地需求的医疗服务。
Despite an expanding literature on Ebola-response, few studies detail or reflect on the responses of diverse systems of care. Little is known about how, why or in what ways, strategies of ill-health management were enacted locally, how health-systems power, authority and hierarchy were perceived and contested, or how other social systems, institutions and relationships shaped the response. This paper presents an interdisciplinary analysis of local responses in two early affected districts in Sierra Leone. Drawing on anthropological theories of social ordering and assemblage, we present an analysis of contrasting infection chains in three extended case studies from Bo and Moyamba districts. In contrast to previous scholarship which has understood local actions as being reactive (supporting or obstructing) to a national Ebola response, we show that local arrangements lead and shape responses. Our cases show how multiple, entangled, dynamic and co-existing systems of care influence these responses. Some individuals and communities collaborated with health authorities on measures like reporting and quarantine, others actively opposed them, or played an intermediary role. Collectively, formal health systems actors, local authorities and ordinary citizens negotiated and enacted new arrangements. These arrangements involved compromise and sometimes power was reconfigured. They were also shaped by wider political and historical contexts and by availability or absence of formal healthcare resources. Our research shows the critical importance of understanding how institutions and people involved in healthcare enact diverse “systems of care” and thereby shape Ebola response. Most importantly, our work underlines the need for alignment between formal health-systems and wider social, cultural, political and economic forms of organisation at family and community levels to improve crisis-response and promote sustainable care. In particular, health systems responders need to identify and engage with key brokers – or arrangers – in frontline care systems, with whom mutually acceptable, and effective, reconfigurations of care can be achieved. Multiple, dynamic, co-existing systems of care shaped Sierra Leone's Ebola response. Political/historic context, resources, conflict and compromise all shaped care systems. Diverse local actors negotiated relationships to reconfigure healthcare arrangements. It is local arrangements that lead and shape crisis-response at the decentralised level. Health systems need to engage with “arrangers” to reconfigure locally responsive care.
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影响因子：
8.1
作者：
Martineau, Tim;McPake, Barbara;Witter, Sophie
通讯作者：
Witter, Sophie
影响因子：
3.2
作者：
Hanefeld J;Mayhew S;Legido-Quigley H;Martineau F;Karanikolos M;Blanchet K;Liverani M;Yei Mokuwa E;McKay G;Balabanova D
通讯作者：
Balabanova D
DOI：
10.1177/1043659605278935
发表时间：
2005-10-01
期刊：
Journal of transcultural nursing : official journal of the Transcultural Nursing Society
影响因子：
--
作者：
Hewlett, Bonnie L;Hewlett, Barry S
通讯作者：
Hewlett, Barry S
DOI：
10.15171/ijhpm.2017.36
发表时间：
2017-08-01
影响因子：
3.5
作者：
Blanchet, Karl;Nam, Sara L.;Pozo-Martin, Francisco
通讯作者：
Pozo-Martin, Francisco
DOI：
10.1093/infdis/jiw345
发表时间：
2016-10-15
期刊：
The Journal of infectious diseases
影响因子：
--
作者：
Cancedda C;Davis SM;Dierberg KL;Lascher J;Kelly JD;Barrie MB;Koroma AP;George P;Kamara AA;Marsh R;Sumbuya MS;Nutt CT;Scott KW;Thomas E;Bollbach K;Sesay A;Barrie A;Barrera E;Barron K;Welch J;Bhadelia N;Frankfurter RG;Dahl OM;Das S;Rollins RE;Eustis B;Schwartz A;Pertile P;Pavlopoulos I;Mayfield A;Marsh RH;Dibba Y;Kloepper D;Hall A;Huster K;Grady M;Spray K;Walton DA;Daboh F;Nally C;James S;Warren GS;Chang J;Drasher M;Lamin G;Bangura S;Miller AC;Michaelis AP;McBain R;Broadhurst MJ;Murray M;Richardson ET;Philip T;Gottlieb GL;Mukherjee JS;Farmer PE
通讯作者：
Farmer PE