Habituating field scientists.

This article explores the sensory dimensions of scientific field research in the only region in the world where free-ranging bonobos ( Pan paniscus) can be studied in their natural environment; the equatorial rainforest of the Democratic Republic of Congo. If, as sensory anthropologists have argued, the senses are developed, grown and honed in a given cultural and environmental milieu, how is it that field scientists come to dwell among familiarity in a world which is, at first, unfamiliar? This article builds upon previous anthropological and philosophical engagements with habituation that have critically examined primatologists' attempts to become 'neutral objects in the environment' in order to habituate wild apes to their presence. It does so by tracing the somatic modes of attention developed by European and North American researchers as they follow bonobos in these forests. The argument is that as environments, beings and their elements become familiar, they do not become 'neutral', but rather, suffused with meaning.

Assessing routine health information system performance during the tenth outbreak of Ebola virus disease (2018-2020) in the Democratic Republic of the Congo: A qualitative study in North Kivu.

The Democratic Republic of Congo has implemented reforms to its national routine health information system (RHIS) to improve timeliness, completeness, and use of quality data. However, outbreaks can undermine efforts to strengthen it. We assessed the functioning of the RHIS during the 2018-2020 outbreak of Ebola Virus Disease (EVD) to identify opportunities for future development. We conducted a qualitative study in North Kivu, from March to May 2020. Semi-structured interviews were conducted with 34 key informants purposively selected from among the personnel involved in the production of RHIS data. The topics discussed included RHIS functioning, tools, compilation, validation, quality, sharing, and the use of data. Audio recordings were transcribed verbatim and thematic analysis was used to study the interviewees' lived experience. The RHIS retained its structure, tools, and flow during the outbreak. The need for other types of data to inform the EVD response created other parallel systems to the RHIS. This included data from Ebola treatment centers, vaccination against Ebola, points of entry surveillance, and safe and dignified burial. The informants indicated that the availability of weekly surveillance data had improved, while timeliness and quality of monthly RHIS reporting declined. The compilation of data was late and validation meetings were irregular. The upsurge of patients following the implementation of the free care policy, the departure of healthcare workers for better-paid jobs, and the high prioritization of the outbreak response over routine activities led to RHIS disruptions. Delays in decision-making were one of the consequences of the decline in data timeliness. Adequate allocation of human resources, equitable salary policy, coordination, and integration of the response with local structures are necessary to ensure optimal functioning of the RHIS during an outbreak. Future research should assess the scale of data quality changes during outbreaks.

Impact of a free care policy on the utilisation of health services during an Ebola outbreak in the Democratic Republic of Congo: an interrupted time-series analysis.

BACKGROUND: During past outbreaks of Ebola virus disease (EVD) and other infectious diseases, health service utilisation declined among the general public, delaying health seeking behaviour and affecting population health. From May to July 2018, the Democratic Republic of Congo experienced an outbreak of EVD in Equateur province. The Ministry of Public Health introduced a free care policy (FCP) in both affected and neighbouring health zones. We evaluated the impact of this policy on health service utilisation. METHODS: Using monthly data from the national Health Management Information System from January 2017 to January 2019, we examined rates of the use of nine health services at primary health facilities: total visits; first and fourth antenatal care visits; institutional deliveries; postnatal care visits; diphtheria, pertussis and tetanus (DTP) vaccinations and visits for uncomplicated malaria, pneumonia and diarrhoea. We used controlled interrupted time series analysis with a mixed effects model to estimate changes in the rates of services use during the policy (June-September 2018) and afterwards. FINDINGS: Overall, use of most services increased compared to control health zones, including EVD affected areas. Total visits and visits for pneumonia and diarrhoea initially increased more than two-fold relative to the control areas (p<0.001), while institutional deliveries and first antenatal care increased between 20% and 50% (p<0.01). Visits for DTP, fourth antenatal care visits and postnatal care visits were not significantly affected. During the FCP period, visit rates followed a downward trend. Most increases did not persist after the policy ended. INTERPRETATION: The FCP was effective at rapidly increasing the use of some health services both EVD affected and not affected health zones, but this effect was not sustained post FCP. Such policies may mitigate the adverse impact of infectious disease outbreaks on population health.

Rethinking Human-Nonhuman Primate Contact and Pathogenic Disease Spillover.

Zoonotic transmissions are a major global health risk, and human-animal contact is frequently raised as an important driver of transmission. A literature examining zooanthroponosis largely agrees that more human-animal contact leads to more risk. Yet the basis of this proposition, the term contact, has not been rigorously analyzed. To understand how contact is used to explain cross-species spillovers, we conducted a multi-disciplinary review of studies addressing human-nonhuman primate (NHP) engagements and pathogenic transmissions and employing the term contact. We find that although contact is frequently invoked, it is employed inconsistently and imprecisely across these studies, overlooking the range of pathogens and their transmission routes and directions. We also examine a related but more expansive approach focusing on human and NHP habitats and their spatial overlap, which can potentially facilitate pathogenic transmission. Contact and spatial overlap investigations cannot, however, explain the processes that bring together people, animals and pathogens. We therefore examine another approach that enhances our understanding of zoonotic spillovers: anthropological studies identifying such historical, social, environmental processes. Comparable to a One Health approach, our ongoing research in Cameroon draws contact, spatial overlap and anthropological-historical approaches into dialog to suggest where, when and how pathogenic transmissions between people and NHPs may occur. In conclusion, we call for zoonotic disease researchers to specify more precisely the human-animal contacts they investigate and to attend to how broader ecologies, societies and histories shape pathogen-human-animal interactions.

'If your husband doesn't humiliate you, other people won't': gendered attitudes towards sexual violence in eastern Democratic Republic of Congo.

More than a decade of fighting in the Democratic Republic of the Congo (DRC) has resulted in extensive human rights abuses, of which sexual and gender-based violence (SGBV) is one of the most salient and disturbing features. This paper uses qualitative data, based on 10 focus groups with 86 women and men to better understand gendered community perspectives on SGBV and its consequences in South Kivu. We conclude that for many survivors, rape has consequences far beyond the physiological and psychological trauma associated with the attack. Respondents say sexual violence has become a societal phenomenon, in which the community isolation and shame experienced as a result of the attack become as important as concerns about the attack itself. Male focus group participants explain their own feelings of shame and anger associated with knowing their female relatives were raped. These findings highlight the complexity of community reintegration for survivors and identify a number of programmatic and policy implications, such as the need for counselling for survivors of sexual violence with their families as well as individually; the importance of income-generating training; and the need for improved justice mechanisms to bring perpetrators to justice.