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Are you paying attention?: Women Present Differently and Die at a Higher Rate

In all of these communities women have little power, are subject to abuse but remain the caretakers of families. In addition, as women, they present differently and are made differently than men. A must read for all healthcare providers: (Thank you Chen Reis JD, MPH for the link) http://www.wpro.who.int/topics/gender_issues/Takingsexandgenderintoaccount.pdf AND: http://www.foreignpolicy.com/articles/2014/08/20/why_are_so_many_women_dying_from_ebola "But as an outbreak progresses, women tend to be disproportionately affected. Women account for 55 to 60 percent of the deceased in the current epidemic in Liberia, Guinea and Sierra Leone, according to UNICEF." See newest article: https://www.opendemocracy.net/5050/tooni-akanni/

Photo of Lynn Lawry
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Women's health is a field of medicine that is generally boiled down to gender based violence in disasters and maternal care. In the case of Ebola or any hemmoragic disease it is important to remember that abnormal vaginal bleeding and miscarriage may be the first sign of infection but ignored by the woman who is caring for other sick family members. It would be interesting to know the demographic breakdown of current patients at field sites and if the numbers are not consistent with census data then a community program is needed to inform women and girls that they may present differently and need to access care immmediately. Currently, if there are women in healthcare centers it would be good to ask the about prior vaginal bleeding or miscarriage prior to symptoms just to get a handle (poor man's pilot study) to see if more information is needed. While interviewing in Sierra Leone in March I was told by both men and women that women have no choice in whether they will have sex or not; a Paramount Chief told me that " the man paid the dowry and has the right to have what he bought".  Since women have little control over sexual rights, this in itself is a risk if the husband is infected or if the woman is infected and cannot say no. We need much more information on this issue alone to ensure gender is included in this disaster. Just as in my Trust and Belief study, these questions can be added to the survey to find out how women are integrated into this epidemic, their roles (forced or not) and what they feel what community issues hinder access to care.

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Photo of Ludmilla Bade

WHO http://www.who.int/mediacentre/factsheets/fs103/en/ , under "Transmission" last para, lists men having ebola in sperm up to 7 weeks.

Photo of Lynn Lawry

Yes Ludmilla, like all research, there are always varying views. Since WHO is usually a summary of research, I tend to look at peer-reviewed literature over UN reports who notoriously use phrases and statistics that are not vetted. There are studies that say 7 weeks, 90 days and more. I think safety is the issue and using a condom for up to 90-120 days should be enough to protect the women in the family.

Photo of Katherine Rubin

Lynn, I am interested in finding true stats. Can you give me a head start on where to begin? ...considering doing a MPH capstone project on ebola. It would be great if any data sets are available which I can did into using SAS analysis. I am now beginning investigating where to focus.

Photo of Lynn Lawry

Katherine, great idea but stats are going to be a bit biased or modeled (WHO). The Ministry of Health of each country may have an excel spreadsheet of stats. https://www.facebook.com/brimaabdulai.sheriff/posts/10152436108195418?fref=nf&pnref=story on facebook posts stats but it is not clear to me whether he is getting true rural numbers. You can friend him and he sends out a report on FB frequently (for Sierra Leone). Keep in mind that Sierra Leone and Liberia have problems getting information from rural areas. Having mentored 2 capstone projects, I would suggest picking either Liberia or Sierra Leone to focus on and just be transparent about your limitations and compare them to the WHO modeling in which the Minister of Health of Sierra Leone actually disputed on BBC. See: https://www.opendemocracy.net/5050/tooni-akanni/confronting-ebola-in-liberia-gendered-realities-0

Photo of Lynn Lawry

Katherine, if you decide to focus on Sierra Leone, let me know, I have contacts there from my last trip in April that might be able to help. One in particular is in Kenema working for DFID but is from Sierra Leone and has been there since the war. She worked for IRC before moving over to DFID. She was helpful for my work on SGBV.

Photo of Lynn Lawry

See: https://www.opendemocracy.net/5050/tooni-akanni/confronting-ebola-in-liberia-gendered-realities-0

Photo of Lynn Lawry

Jab, I can only find vague references to this with a recommendation that men use condoms for up to 90 days. However, this is not something that is common or accepted in Africa in general and women have little control over their bodies especially when it comes to sex. I find this frightening and another piece to the puzzle of Ebola as to why it spreads. We need to speak to survivors to see if they are 1) told to use condoms and 2) to women of survivor men to see if they are using condoms or know that this is a risk for them.

Photo of Alex Haagaard

Thanks for raising this important issue. Are there any precedents for particularly successful sexual education/STD prevention campaigns in the area that a new Ebola-specific campaign could be modeled on?

Photo of Lynn Lawry

Sierra Leone has a huge gender based violence program that now could add this to their radio and billboard campaigns.

Photo of Lynn Lawry

Ebola radio and communication messages need to inform women and men that despite males who have survived are still infectious and sex must not happen without a condom or not all for 90 days.

Photo of Jab Thorn

If we get a vaccine women should be highly targeted as first recipients. Men who survive can carry active virus in their semen for months.

Photo of Lynn Lawry

Jab, thank you for the comment. Do you have a reference for this? Lynn