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Global Public Health
An International Journal for Research, Policy and Practice
Volume 18, 2023 - Issue 1
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Research Article

Continuity and Rupture in Crisis: from Ebola to COVID-19 in Sierra Leone and the eastern Democratic Republic of the Congo

Myfanwy Jamesa London School of Economics and Political Science, London, UKCorrespondence[email protected]
View further author information
,
Anthony Mansarayb London School of Hygiene and Tropical Medicine, London, UKView further author information
,
Frederic Omega Thigec Institut National de Recherche Biomédicale, Goma, Democratic Republic of the CongoView further author information
,
Mabel Mafindad College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra LeoneView further author information
,
Kennedy Kambale Kasoniab London School of Hygiene and Tropical Medicine, London, UKView further author information
,
Joel Kahehero Palukuc Institut National de Recherche Biomédicale, Goma, Democratic Republic of the CongoView further author information
,
Alie D. Timbod College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra LeoneView further author information
,
Lina Karenzic Institut National de Recherche Biomédicale, Goma, Democratic Republic of the CongoView further author information
,
Ferdinand Ntabalac Institut National de Recherche Biomédicale, Goma, Democratic Republic of the CongoView further author information
,
Daniel Tindanbilb London School of Hygiene and Tropical Medicine, London, UKView further author information
,
Bailah Leighd College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra LeoneView further author information
,
Hugo Kavunga-Memboc Institut National de Recherche Biomédicale, Goma, Democratic Republic of the CongoView further author information
,
Deborah Watson-Jonesb London School of Hygiene and Tropical Medicine, London, UKView further author information
,
Katherine Gallagherb London School of Hygiene and Tropical Medicine, London, UKView further author information
&
Luisa Enriab London School of Hygiene and Tropical Medicine, London, UKView further author information
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Article: 2259959 | Received 06 Oct 2022, Accepted 12 Sep 2023, Published online: 03 Oct 2023
 
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ABSTRACT

This article examines the experience of healthcare professionals working in primary healthcare provision during the first wave of the COVID-19 pandemic in North Kivu, the Democratic Republic of the Congo, and in Kambia District, Sierra Leone. Drawing on ethnographic observation, interviews and focus groups, we explore everyday narratives of ‘crisis’ in these two regions which had recently seen Ebola epidemics. In describing the impact of COVID-19 on their life, work, and relationships with patients, healthcare workers made sense of the pandemic in relation to broader experiences of structural economic and political crisis, as well as differing experiences of recent Ebola epidemics. There were contradictory experiences of rupture and continuity: whilst COVID-19 disrupted routine health provision and exacerbated tensions with patients, the pandemic was also described as continuity, interacting with broader structural problems and longer-term experiences of ‘crisis’. In effect, healthcare workers experienced the COVID-19 pandemic at the crossroads between the exceptional and the everyday, where states of exception brought by emergency measures shed new light on long-standing tensions and structural crisis.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 All participants provided written informed consent. Interviews were recorded and transcribed, and subsequently thematically analysed.

2 Data from Division Provinciale de la Santé du Nord-Kivu, Goma.

3 Community Focus Group, Goma, 23.10.2020.

4 DR-CS1-KII-HCW-04, Goma, 02.02.2021.

5 DR-C13-KII-HCW-07, Goma, 04.02.2021.

6 DR-CS11-KII-HCW-01, Goma, 02.02.2021.

7 Healthcare workers Focus Group, Goma, 15.02.2021.

8 DR-C13-KII-HCW-07, Goma, 04.02.2021.

9 DR-CS15-KII-HCW-02, Goma, 02.02.2021.

10 HCWINT_HF4_Kambia 17.02.2021.

11 HCWINT_HF21_Kambia 22.02.2021.

12 HCWINT_HF24_Kambia 24.02.2021.

13 HCWINT_HF19_Kambia 19.02.2021.

14 FGD_HCW_HCW02 Kambia, 30.04.2021.

15 HCWINT_HF1_Kambia 12.03.2021.

16 HCWINT_HF29_Kambia 24.03.2021.

17 DR-CS10-KII-HCW-03, Goma, 02.02.2021

18 DR-CS11-KII-HCW-01, Goma, 02.02.2021.

19 DR-CS14-KII-HCW-10, Goma, 02.02.21.

20 DR-CS4-KII-HCW-08, Goma, 05.02.21.

21 DR-CS11-KII-HCW-01, Goma, 02.02.2021.

22 DR-CS4-KII-HCW-08, Goma, 05.02.21.

23 Healthcare workers Focus Group, Goma, 15.02.2021.

24 Community Focus Group, Goma, 01.04.2021.

25 DR-CS16-KII-HCW-11, Goma, 09.02.2021.

26 DR-CS16-KII-HCW-11, Goma, 09.02.2021.

27 DR-CS15-KII-HCW-02, Goma, 02.02.2021.

28 DR-CS3-KII-HCW-12, Goma, 10.02.2021; DR-CS14-KII-HCW-10, Goma, 02.02.2021.

29 DR-CS2-KII-HCW-09, Goma, 08.02.2021; DR-CS15-KII-HCW-02, Goma, 02.02.2021.

30 DR-CS12-KII-HCW-06, Goma, 04.02.2021.

31 HCWINT_HF8_Kambia 11.04.2021.

32 HCWINT_HF12_Kambia 03.03.2021

33 HCWINT_HF21_Kambia 22.02.2021.

34 HCWINT_HF28_Kambia 15.04.2021.

35 HCWINT_HF22_Kambia 12.04.2021.

36 HCWINT_HF12_Kambia 03.03.2021.

37 FGD_HCW_HCW05 Kambia, 30.04.2021.

38 FGD_HCW_HCW01 Kambia, 30.04.2021.

39 HCWINT_HF22_Kambia 12.04.2021.

40 HCWINT_HF22_Kambia 12.04.2021.

41 Community Focus Group, Goma, 01.04.2021.

42 Community Focus Group, Goma, 01.04.2021.

43 DR-C13-KII-HCW-07, Goma, 04.02.2021.

44 DR-CS12-KII-HCW-06, Goma, 04.02.2021.

45 Healthcare workers Focus Group, Goma, 15.02.2021.

46 DR-CS4-KII-HCW-08, Goma, 05.02.21.

47 DR-CS16-KII-HCW-11, Goma, 09.02.2021

48 DR-C13-KII-HCW-07, Goma, 04.02.2021.

49 Community Focus Group, Goma, 01.04.2021.

50 DR-CS10-KII-HCW-03, Goma, 02.02.2021

51 Healthcare workers Focus Group, Goma, 15.02.2021.

52 HCWINT_HF21_Kambia 22.02.2021.

53 HCWINT_HF22_Kambia 12.04.2021.

54 FGD_HCW_HCW07 Kambia, 30.04.2021.

55 FGD_HCW_HCW05 Kambia, 30.04.2021.

56 HCWINT_HF6_Kambia 14.04.2021.

57 HCWINT_HF29_Kambia 24.03.2021.

58 HCWINT_HF6_Kambia 14.04.2021.

59 HCWINT_HF29_Kambia 24.03.2021.

60 DR-CS3-KII-HCW-12, Goma, 10.02.2021; DR-C13-KII-HCW-07, Goma, 04.02.2021.

61 DR-CS10-KII-HCW-03, Goma, 02.02.2021

62 DR-CS10-KII-HCW-03, Goma, 02.02.2021

63 Healthcare workers Focus Group, Goma, 15.02.2021.

64 DR-CS11-KII-HCW-01, Goma, 02.02.2021.

65 DR-CS1-KII-HCW-04, Goma, 02.02.2021.

66 DR-CS14-KII-HCW-10, Goma, 02.02.21.

67 DR-CS1-KII-HCW-04, Goma, 02.02.2021.

68 DR-CS14-KII-HCW-10, Goma, 02.02.21.

69 Healthcare workers Focus Group, Goma, 15.02.2021.

70 DR-CS10-KII-HCW-03, Goma, 02.02.2021

71 HCWINT_HF1_Kambia 12.03.2021.

72 HCWINT_HF28_Kambia 11.04.2021.

73 HCWINT_HF13_Kambia 10.04.2021.

74 HCWINT_HF12_Kambia 03.03.2021.

Additional information

Funding

This work was supported by UK Research and Innovation.
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