[This article was first posted on Medium on March 27, 2015. This article is an account of the project I managed as a Country Director in Liberia during the Ebola crisis]
When misinformation is a case of life or death, aid workers and communities need an ear to the ground.
The rumor began with a fever. On March 4th, 2015 in a public school in rural northern Liberia on the border with Guinea, a child was diagnosed with a high fever. Following protocol in a region where Ebola cases remained a concern, the school called an ambulance to take the child for treatment. But when the ambulance arrived, students began to panic and flee the campus. Parents began to frantically connect by phone and a rumor quickly spread to the larger town of Sanniquellie, 35 km to the south.
“People are vaccinating children in schools and the vaccinated children are then taken by ambulance and hospitalized.”
Within the hour, parents throughout the region were rushing to local schools and removing their children.
Luckily, in this case the rumor was short-lived. Information about the panic was quickly communicated to local radio stations who set the record straight, calming the anxious population. The broadcasts were followed up by local health teams who made school visits. The rumor was stopped before it reached the highly populated Ganta school system, another 35 km south of Sanniquellie.
Replicating this system to refute future rumors is not so simple. Rumors spread quickly and generally through word of mouth, SMS and social media — channels that are hard to track and monitor. Rumors that start far from the capital, where most aid organizations are based, can grow out of control very quickly.
Rumors can kill
What is now clear to healthcare organizations working on the ground in West Africa is that the Ebola epidemic has been driven as much by misinformation and rumors as by weaknesses in the health system. It is common sense that information is a critical element in combatting disease, particularly when contagion from common social practices, such as bathing the corpses of the deceased, were central to so much of the early spread of the disease. But in the context of a massive disease outbreak, when hundreds of international organizations and billions of dollars flood into a region whose fragile infrastructure has been damaged by years of civil war, information dissemination becomes a powerful challenge.
In the Ebola outbreak, the international community quickly created a series of wide-scale social behavior change communication campaigns, a typical approach in humanitarian aid. The result was that local populations were bombarded with massive but poorly-coordinated blasts of messaging on billboards, in print, on radio and TV, through health outreach workers and community organizations, via SMS and call-in hotlines.
One thing that was routinely missed in this chaotic information environment was that one size does not fit all.
Local beliefs and attitudes were in some cases a serious impediment to people acting on the messages. Some communities believed, for example, that the bleach sprayed by health workers to sanitize the environment was the government spraying the virus and spreading disease. In other cases, people believed the disease was the result of black magic. In this context, misinformation could spread quickly and along with it, infection and death.
Even for those communities where generic messaging was absorbed, or where there was hope that Ebola was contained, significant challenges remain. People needed ongoing information about Ebola prevention and preparedness for future epidemics. They were hungry to hear about situations on the borders and the resumption of trade and commerce. Many parents were fearful of sending their children to schools that were once used as Ebola holding centers and were resisting regular vaccination schedules for measles or polio because they feared Ebola vaccinations.
In this complex environment, aid workers were grappling with how to get a better handle on rumors, and how to refute them quickly. In partnership with the Liberian National Red Cross Society, UNICEF and Project Concern International, Internews developed a simple but critical new tool. DeySay SMS (“Dey Say” refers to how people speak about rumors in Liberian English), to detect and manage rumors in as close to real-time as possible.
DeySay began with an SMS short code, provided by UNICEF free of charge to hundreds of health workers, NGOs and volunteers on the ground throughout Liberia. When anyone connected to the system becomes aware of a rumor, they texted it via the short code to a central coordination hub in Monrovia.
The information was then collected, analyzed for trends, and disseminated to local media partners in the field with details about the rumor so they could stop its spread. Once the system was fully functional, aid workers and social mobilizers in the relevant regions were put on alert so they could go door-to-door to calm anxieties and correct misinformation.
In conjunction with the rapid response system, DeySay also produced a weekly newsletter for local media throughout the country and partners on the ground. The newsletter highlighted trends in rumors and their geographic locations, and helped identify the most critical rumors at any given time. The newsletter also offered insights for local media into information gaps and challenges around Ebola and health reporting.
DeySay SMS offered both rapid response to rumors and, over time, collect and housed valuable data that could be analyzed and used to train media and health workers so they could be more prepared the next time the region experiences a crisis. Knowing which areas were prone to rumors, where the pockets of resistance are and how to truly communicate in ways that people could understand was critical not only for combating epidemics but for creating a healthy recovery.
The DeySay project was an Internews project in collaboration with UNICEF, Liberian National Red Cross Society and Project Concern International. The project is funded by USAID under the Health Communication Capacity Collaborative (HC3) project.