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
"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/
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.
Talking with women who in the Western area of Freetown April 2014. See: http://www.washingtonpost.com/national/health-science/2014/08/14/3e08d0c8-2312-11e4-8593-da634b334390_story.html
example of the Sierra Leone SGBV campaign
Another example of the GBV campaign in Sierra Leone.