Trust in medicine after the EVD epidemic: street-level health bureaucrats, the institutionalization of care, and the creation of preparedness in Sierra Leone, Uganda, and Ghana

西非国家EVD疫情的规模是前所未有的。科学文献、媒体报道和全球卫生话语中，对医学缺乏信任已被确定为主要因素之一，加速了埃博拉病毒病的传播，并对埃博拉应对措施构成了核心挑战。我们的项目调查的社会，医学和历史条件的信任在非洲的背景下医学的形成。以塞拉利昂的EVD疫情为经验起点，我们对塞拉利昂的医学信任进行了全面的案例研究，塞拉利昂是EVD长期流行和根本不安全的地方。这将得到在乌干达和加纳进行的研究的补充，这些研究评估了以往在短期埃博拉病毒病暴发（乌干达）方面的经验和最近在邻国（加纳）采取的防备干预措施。在这三个国家的案例研究中，我们分析了如何以及在何种程度上建立信任，提供保健服务。我们要问的是，EVD疫情是如何塑造信任关系的，EVD疫情发生后，在卫生服务提供方面是如何（重新）建立信任的，以及信任在多大程度上构成了疫情防范的社会基础。将塞拉利昂与乌干达和加纳的护理制度化的个人和集体经验进行比较，使我们能够在极端不安全和贫困的背景下对信任进行系统和深入的分析。迫切需要根据非洲国家的日常生活现实进行这种分析，以便制定文化上适当和当地接受的流行病防备措施。为了实现这些目标，我们结合联合收割机定量和定性的研究方法。我们的研究活动是嵌入在非洲科学能力建设的综合框架。

The scale of the EVD epidemic in the West African countries has been unprecedented. Lack of trust in medicine has been identified as one of the major factors in the scientific literature, in media reports, and global health discourses, which accelerated the spread of EVD and posed a central challenge to the Ebola response. Our project investigates the social, medical, and historical conditions of the formation of trust in medicine in Africa contexts. Taking the EVD outbreak in Sierra Leone as our empirical starting point, we conduct a comprehensive case study of trust in medicine in Sierra Leone, a site of prolonged EVD epidemic and radical insecurity. This will be complemented by studies in Uganda and Ghana, evaluating previous experiences of short-term EVD outbreaks (Uganda) and recent preparedness interventions in a neighbouring country (Ghana). In these three country case studies we analyse how and to what extent trust is built in health service delivery. We ask how trust relations have been shaped by the EVD outbreak, how trust is being (re)built in health service delivery after the EVD epidemic, and to what extent trust forms the social basis for epidemic preparedness. Comparing individual and collective experiences of the institutionalisation of care in Sierra Leone with Uganda and Ghana enables us to produce a systematic and in-depth analysis of trust in contexts of radical insecurity and poverty. Such an analysis grounded in the lived everyday realities in African countries is urgently needed in order to devise culturally appropriate and locally accepted epidemic preparedness measures. To achieve these goals we combine quantitative and qualitative research methods. Our research activities are embedded in a comprehensive framework of scientific capacity building in Africa.