I'm here today with Kat Collet, a senior teaching fellow at Imperial. We're going to talk about the Ebola epidemic in 2015 when she was in Sierra Leone. Tell us a bit about how you started there and how it relates to our challenges today. Hi Helen. It's really great to be here to talk to you a little bit about the Ebola epidemic and how it similar to what's going on now all across the world. I arrived in Sierra Leone in 2015 towards the end of the epidemic. It's little bit different than what we're experiencing now when we all started socially isolating together and what not, but I think one of the interesting things that I've found is right when I got off the plane, already I was seeing the signs of what was going on in the country. So you had folks to greet you, health care workers to greet you in full PPE to give you a form where you filled out and did a small screening to check your temperature and to wash your hands. That's before you even made it through customs. The experience very much there was similar to what we're seeing now as you're going into the shopping center or the supermarkets and keeping two meters away from one another. I think at that time, folks had been social isolating for roughly nine months, and I think things were starting to open back up. We were able to start to go to work, but to all of the restaurants and what not were still closed as swell. We were getting to the points of flattening the curve as we're hearing often today. But it was really strange to go to work but not be able to go out to restaurants or to greet someone as you normally would. You would normally shake people's hands, but you weren't able to do that. So it was a very strange thing to settle into a country and that felt very much different than it otherwise would have. When the epidemic then subsided, how did things change? How did people get back to any normality? Yeah, I think that's a really good question. In the first instance, it was really awkward because we could go back to shaking people's hands, but you didn't want to push somebody too hard. I think people were really fearful. Do I go outside? Do I not? Do I shake your hands? Do I not? There were a lot of really awkward and encounters in the first instance, and then we slowly started to see the hand-washing stations go away and the temperature checks go away. It then very much felt like everything had returned to normal except for everywhere you looked there was still Ebola public health messages painted on the walls. I think one of the things that was really interesting working in public health at the time was to see the infection control measures that are really being uptaken at the hospitals. Even though all of us going into a regular office building were no longer washing our hands, the teams working at the hospitals in particular really wanted to keep infection control measures in place. It was really challenging to see these teams that had learned so much and have gotten very good at using preventative measures to then not have the tools that they needed to keep these things going. But I think it also provided an opportunity for some really innovative thinking outside of the box and setting up mobile hand washing stations, for instance, and having those continue to be present throughout the hospital, which is great for both staff but also for patients as well. I wanted to move on a little bit. You were involved in some research about community experiences during the epidemic. Can you tell us a bit more about that and how it relates to today? Yeah, absolutely. I worked with Dr. Theresa Betancourt and her team at Harvard University, as well as the team at Kerry toss Free Town. We conducted a study with roughly 1,000 people over the age of 18 in the Greater Free Town area. There were three waves of data collection that we did. One right at the beginning of the epidemic, one midway through, and one just at the end after everything started to settle down a little bit. The goal was to try and explore the community impacts of Ebola, and in particular around knowledge, attitudes, and behaviors. So we collected a really wide amounts of data on various different things. Thinking about exposure, and general health status, risk and preventative behaviors, mental health, focusing in particular on anxiety, depression, and PTSD, and hardships, trust in the government, those types of things. Tell us a little bit about what you found in this research. Yeah. Some of the information that we found the data suggested things that we already know. So exposure was one of those things, where we knew that if you had a close family member or a community member that had Ebola or potentially was at risk, you would have better knowledge about the disease itself as well as thinking you had less risky behavior. But some of the other things that were a little bit less well-known or where we were excited to see some of the results were around, for instance, having a friend that was diagnosed with Ebola and was the only predictor of uptaking preventative behavior. I think what we see from that is maybe that inside your house if someone was sick, you as a caring person you want to take care of them, and so you might then actually not take on some of those normal preventative behaviors that you would do if you maybe we're just working with a friend or thinking about a friend. I think that relates to young people now and we're seeing them stand side more, but this idea of risk perception I think is very important, and knowing who to target when we're putting out those messages. Maybe it's young people to young people rather than the government to young people for instance. You mentioned early about mental health. What were the main findings about that? So we found that the levels of mental health concerns were quite high amongst everybody and I think that doesn't sound uncommon given that almost everybody, every household was affected in some way and where folks were in doing self isolation for upwards of nine months and 10 months. So there was some loose correlations with risk around depression. But what we found is that preventative behaviors in particular were higher amongst people that were maybe a bit more anxious. I think that suggests that there's an association with vigilance and overall mental hardship was associated with less preventative behaviors. So I think that really tells us that it's important to keep up our mental health and really to practice self care, to meditate or do yoga or take a minute and sit outside if you can and take time off work to keep yourself going over this period of time so that you then don't slip into potentially bad habits. It's a very interesting point because we know that from HIV work in the past that a certain level of anxiety and concern and exposure to other people who've had the condition actually increases preventive behaviors, but then that has a knock-on effect in terms of your own mental health. So I think that's interesting. I'm sure we'll see that again with the coronavirus epidemic. So just tell us a little bit more about how the survey was developed. Yeah. So we had various tools that were used in different contexts and HIV actually is a perfect example of some of the tools that we ended up adapting to the Ebola context. I think it was quite interesting because this was new and novel and there's not always the scale that is in the literature that's been validated that fits exactly what you want to get at. So we also did some literature searches and went on to find what we could find that related, but we developed some of the tools as well. So some of the results were quite interesting when we thought about how we would develop the tools ourself. So for instance, everyone was experiencing hardships during the outbreak, and so we really wanted to still gather hardship data, but we knew that there might not be very much differentiation between the results because everyone was not going out, everyone was not going to church and those types of things. So I think that just really drives home the point that the scope of the outbreak the effect on everyone was really, really high. I think another interesting thing to note is that when we were looking at risk perception, we decided to add another section based on fear and to try and see how people were feeling overall about this experience. So we developed a tool ourself, where we all sat and talked together, thought about what might make you fearful or not fearful, specifically to the Ebola epidemic itself. So there were obviously the common ones where you feel fear of touching someone after the outbreak had ended. But we also added things like hearing sirens or I'm seeing people in full protective equipment. So I think the context is really important there. Being able to think about your own context with the tools that are out there and had been used in the past. But also how do we adapt them specifically to what's going on, whether it be in London or even in your own community, if you want to do some work in your own community. That's really interesting. Can I ask you one last question, which is, comes through and out of what you said, which is about trust. What you conclude about the relationship between response to the epidemic in the community and trust? Yeah, I think that's a really important question. Trust in the government is very important. But we saw it in Ebola, there was not as much trust in the government. I think this comes for a lot of different reasons. Firstly, that the information wasn't great at the beginning of the epidemic. So people did start to mistrust or hide concerns. I think in this current climate, we do see that perhaps people feel less trusting in some governments than others, especially with the way that the information is coming out. But what we did find is that it was really important to get good information. So what we actually saw is that the best information that people trusted the information from clinicians and from traditional healers. I think what that tells us for this epidemic and really thinking about our communities, is it really going to be important to reach out to those that are known and trusted and give them the right information? I think, thinking about the traditional healers, that maybe isn't a group that you would otherwise expect to give out really good information. But there was a lot of training that was done, a lot of sensitization with that group of folks so that they did have the right information and they could get it to the right people. I think it's really important also to note that there are many people who are more seldom heard voices that also need this information as well. Often the community is the best way to get it all the way down to those folks as well. Thanks very much, Kat. That's been really helpful for everybody. So thank you. Great. Thanks so much.
