📢 New editorial out in @GlobalHealthBMJ: 'Stuck in ‘the field’: why applied epidemiology needs to go home’.👞🏠🧪. Reflections from my work participating in transnationanl outbreak investigations and reviewing other peoples' TL;DR below.👇 .

New paper out!.

Effective emerging infectious disease control, especially with rare or unfamiliar pathogens, requires a flexible, reactive system. Palliative practical norms help to provide this in the kinds of resource-limited settings mostly to see zoonotic emergence. Check out the paper!.

Yup, it's one of those, "Ah ha! Postcolonial racism stifling effective public health again!" kinds of things. Anyway, in summary. .

This is extra unfair as when Western outbreak responders, operating in the same challenging settings on the same tricky emerging pathogens, act outside of official protocols it is often celebrated as being creative, ingenious or even heroic.

Often, deviations from official protocols by African public health professionals are treated as being borne out of incompetence, laziness, or corruption, rather than their commitment to service delivery whilst working in a flawed official system in a resource-limited setting.

I suspect it’s because such feats are quixotic if you won't or can’t acknowledge the capacity and agency of the African professionals on the ground. A lot of global health discourse seems to imagine a dearth of such talents or abilities in African national health systems.

With practical norms so widespread, explicit, and clearly integral to effective African EID control systems, why aren't they mentioned more in global health discourse around transnational strengthening of emerging infectious disease control systems?.

Senior national officials explicitly seed and modify practical norms shore up or shape certain parts of the system. And, where helpful, translate them into official protocols and more stable structures sometimes. Which begs the question. .

it was these clashing visions that likely prematurely collapsed the transnational investigations and responses. Back to the main thread though!.

In the main case study, the foreign outbreak responders appeared to be guided by a few different visions of disease control. Some religious, some of a more heroic humanitarian flavour, and others foreign biosecurity. None of them featured a sovereign Ghanaian state though, and. .

This shared vision or ethos oriented the work of everyone from the district officer working in the community to the virologist in the specialist lab in Accra. There are other visions though - those belonging to the foreign clinicians and researchers that get involved.

So how are these unofficial practices coordinated?.They are coordinated (I think) by this sort of shared vision. In the case of the Ghanaian outbreak responders, it appeared to be this (apolitical and postcolonial) vision of the state providing disease control for the citizenry.

. most official. Across West Africa, "local" outbreak responders have to navigate a mess of overlapping and frequently conflicting "official" guidelines, being generated by a complex and ever-changing landscape of would-be public health authorities (MoH, WHO, INGOs, NADMO etc.).

For many of the outbreaks responders it was unclear which practices were "official" and which were unofficial - just some local pocket of practices. At the time, 80% of Ghana's district health offices didn't have access to a copy of the official (IDSR) guidelines. Well. .

These unofficial practices weren't random or ad hoc. They were fairly well-established professional practices. What anthropologist Jean-Pierre Olivier de Sardan would call 'palliative practical norms.' . In fact. .

These unofficial practices incl things like a local official jumping on a bus with patient samples to get them to an acquittance's lab miles away - bypassing all kinds of official reporting and testing protocols - and the virologist at the lab actually taking and testing them.

The paper looks at the responses to various zoonotic outbreaks in Ghana/West Africa (Ebola, B virus, avian flu etc). It’s an ethnography, so we gathered up lots of primary documents from the time, interviewed everyone involved, and generally hung out (participant observation).

By looking at outbreak responses actually happen – not how we think they should - we learn a lot about the problem of emerging infectious diseases and how we can better stop them. The link is here, but as always I've done a thread summarising it below👇.

🚨NEW PAPER🚨.How outbreaks are ACTUALLY responded to 🦠👞🔎. It's about informal practices in outbreak investigations and response. Those that stray (or completely abandon) official protocols. Often treated as deviant or detrimental, but are they actually key?.

RT @ThandekaCochran: Fully funded PhD position in Amsterdam on hospital ethnography.