Conversation with an Expert
Sharon Abramowitz, Ph.D. is trained as an anthropologist, sociologist, and epidemiologist with credentials from Harvard University, Johns Hopkins - Bloomberg School of Public Health, Brandeis University, and Rutgers - The State University of New Jersey. She is presently a consultant at UNICEF, and is based in Brookline, Massachusetts.
She has authored and edited several books, including Searching for Normal in the Wake of the Liberian War (University of Pennsylvania Press, 2014), and Medical Humanitarianism: Ethnographies of Practice (University of Pennsylvania Press, 2015), as well as a wide range of articles in peer-reviewed scientific journals, professional reports, monitoring and evaluation activities, grey papers, and public media/journalism contributions.
Dr. Abramowitz, your work in Monrovia and Montserrado County in urban Liberia indicates that locally affected populations can govern themselves, by engaging in medical self-surveillance, self-management, and self-triage. You suggest that it is this self-governance by communities that effectively contained the Ebola epidemic given the absence of a coordinated response and substantial health infrastructure. What are the benefits and challenges of this approach to disease containment during an epidemic, and long-term epidemic prevention?
Your research highlighted some concerns inherent in overly relying on community-established and managed responses, including the potential for militarization and violence. Others pointed to the politicization of the epidemic, with political factions linked to certain ethnic groups blamed for the epidemic or poor epidemic management. How do you see these challenges influencing efforts to engage communities or the reliance of public health interventions on community-centered responses?
In your work you indicate that “community leaders argued that substantial investments in local infrastructure and systems were required to prevent the spread of the epidemic, recalling Paul Farmer’s much circulated call for ‘staff, stuff, and systems’” (Abramowitz, et al 2015). Dr. Farmer has argued that public health experts are frequently the ones perpetuating the idea that controlling disease is more important than treating the sick, believing it is too costly to provide routine quality care. He terms this “treatment nihilism,” which he views as a legacy of colonial rule and related sanitary policy. He suggested that to decolonize global health, we should provide the material and mundane things required for everyday health management that your participants referenced. Do you feel this is sufficient to address global health inequalities and how might it be achieved? Would this approach prevent hesitancy to international intervention in future disease outbreaks or epidemics?
Your work clearly involves close and longstanding engagements with community members. Given the importance of community collaborations in epidemic disease responses, what are some of the most effective strategies to develop trusting relationships and open dialogue quickly? Does establishing a relationship with respected locals within a community play a role?
In your study, you discuss how in the absence of healthcare, infrastructure, and material support, local people engaged in self-reliance in order to contain the epidemic at the micro-social level. These innovations were regarded as necessary, but as less desirable than a well-supported health-systems based response. In your eyes, what does a well-developed public health infrastructure look like at the state level and what can international organizations and local populations do to promote their development?
Finally, it appears that one of the greatest challenges for public health is managing multiple disease paradigms or beliefs. Could you share your thoughts on how best to balance validating beliefs, attitudes, and rituals with biomedical knowledge, particularly when these may be in conflict?