An­thro­po­lo­gists in­ves­ti­gate so­cial lo­gics of in­fec­tion itineraries in health­care fa­cil­i­ties

Medical anthropology is the largest international subdiscipline of anthropology. Anthropological approaches to global health focus on current challenges, including in low- and middle-income countries, and social and cultural factors shaping health-related structures and practices. The anthropology team at RKI’s Centre for International Health Protection (ZIG) collaborates on several projects of the Global Health Protection Programme (GHPP), for example by conducting research on infection prevention and control (IPC). Together with local anthropologists or other global health experts, RKI’s anthropologists reflect on existing public health capacities and possible capacity development, which is usually based on long-term ethnographic fieldwork and in-depth contextual analysis at healthcare facilities.

Point-of-view shot taken by an anthropologist during ethnographic fieldwork in a delivery room at a partner hospital in Côte d’Ivoire. Photo: RKI

While embedded in the daily social setting in partner countries, RKI’s anthropologists and colleagues from partner institutions observe healthcare workers, patients or other interacting people such as community members. Qualitative data for their fieldwork journals also derives from informal conversations and semi-structured interviews. On-site research could investigate infection itineraries by observing practices of wound treatment, viral and bacteriological surveillance or handling personal protective equipment and potentially infectious waste.

A member of ZIG’s anthropology team spent three months in Guinea and Côte d'Ivoire for ethnographic fieldwork in partner hospitals in autumn 2023. Together with colleagues from local research institutes, he addressed the research gap how protocols of infection prevention and control are designed and implemented in facilities and how these protocols are perceived by local workers in different hierarchical levels. In Côte d’Ivoire, where RKI collaborates on the “Public Health Actions for Côte d’Ivoire” project (PAcCI), the ethnographic fieldwork took place in the “Centre Hospitalier et Universitaire de Bouaké” (CHUB). The focus was on logics and practices of IPC in the departments of traumatology, intensive care and pediatrics. The fieldwork yielded IPC practices shared between healthcare workers, families and caregivers. For example, in the intensive care unit, healthcare workers rely on families and loved-ones to feed patients a nutrient- and energy-rich diet to increase the chances of recovery.

The second site of research was in the city of Faranah, located in central Guinea, as part of the “Partnership to Improve Patient Safety and Quality of Care” project (PASQUALE). The anthropologist affiliated to RKI investigated realities of infection prevention and control in maternal care. He studied social settings and medical procedures before, during and after caesarean sections. For example, he found healthcare workers rely on long stays at the hospital to prevent c-section infections without perceiving the risk of infection due to long hospitalisations. The period of research in autumn 2023 raised questions for upcoming data collection: How is the project going to set in place a research on the post-cesarean surgical site infections and how are the results going to be communicated to healthcare workers and patients? What are the perceptions of patients, families and midwives of these results and of the course of treatment in case an infection is identified?

The anthropological component from both projects includes partnerships with local research institutes: “La Chaire Unesco de Bioethique” in Côte d’Ivoire and the “Centre de Recherche et de Formation en Infectiologie de la Guinée” (CERFIG) in Guinea. Two researchers, affiliated to these two institutes, are working on their master's thesis in anthropology within the framework of the projects. The RKI promotes anthropological and IPC-related exchange between the researchers and institutes involved. A hybrid seminar in Conakry, Guinea, was set up for exchanging research protocols and preliminary results. At the last day of the seminar, invited stakeholders such as health authorities from the Faranah region and representatives of Guinea’s Ministry of Health shared thoughts to be included in upcoming applied components of the projects. Both projects are part of the Global Health Protection Programme which runs with the financial support of the German Federal Ministry of Health in accordance with a resolution passed by the German Bundestag.

Participants of an exchange on research on IPC anthropology and public health in Conakry, Guinea, in November 2023. Photo: RKI

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