Marginalised and mistrustful: listening to people who have few reasons to trust outsiders

The village of Alima, homes scattered around a large community hall, walls open to let the gentle breezes flow through, looks serene and welcoming.

However, this village, in a clearing deep in the forest in the health zone Mandima, between the towns of Beni and Butembo in North Kivu, eastern Democratic Republic of Congo (DRC), has endured years of conflict, deprivation and suffering, and is deeply mistrustful of outsiders.

And now yet another threat has landed in the heart of this community: Ebola. Although Alima is in a health zone that was one of the first to be infected in the largest outbreak ever experienced in the DRC, and the first outbreak to occur on the eastern side of this vast country, the people of Alima appear to have no knowledge of the disease or why it is now killing in their midst.

“Why are you bringing strangers into our village to tell us about this? The message should only be passed by our people," said the village Imam.

“Do you not pray in a foreign language? In Arabic?” responded Dr Ibrahima-Socé Fall, Assistant Director General for Emergencies, who is overseeing the Ebola response in the DRC. “Foreigners can bring important knowledge that we all need to use to train the local people.”

Dr Fall and a team of Ebola experts were in Alima to hold a community dialogue, to listen to the people’s concerns and provide them with the knowledge they need to protect themselves against contracting Ebola.

One of the lessons learned from both this Ebola outbreak and others is that simply providing messages is not enough. Every community needs to have a chance to voice their concerns, be listened to, and have information and action taken that meets their needs.

Initially shy, the women, all sitting on the benches at the back refused to ask questions when invited. Then finally, one stood up and declared: "I want to know why this disease is killing women. It is killing all the mothers. Why?"

All the women joined in a chorus of “Why, why, why?”

Although the mistrust of outsiders was clear, most of the questions asked showed a burning thirst for information about the disease and how people could protect themselves.

This was one of the multiple community dialogues being held by WHO, where technical experts and leaders of the response visit a village or group mistrustful or needing more information about Ebola and the actions being taken to prevent it.

Arranging such a dialogue involves understanding what the village or community group need and this is usually organised by socio-anthropologists and community engagement experts. Julienne Anoko, WHO lead socio-anthropologist rides a motorbike through torrential rain, mud and barely visible forest tracks to reach villages in this area, understand their concerns and organise community dialogues when needed.

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