UCSF

This dissertation examines survivor health through media discourse, community trauma and health social movements in the aftermath of the 2014-16 West Africa Ebola epidemic. As the largest Ebola epidemic ever recorded, the 2014-16 Ebola epidemic in West Africa left approximately 15,000 Ebola survivors. While disciplines including public health and disaster science attended to understandings of Ebola survivorship during the height of the Ebola response, limited studies attend to the social-structural aspects of survivor health long after public health and humanitarian interventions ceased. Recognizing that there is a gap in structural analyses of the Ebola survivorship, this dissertation applies a sociological analysis to examine survivor health after the 2014-16 West Africa Ebola epidemic. Engaging disaster sociology, neo-colonialism, collective trauma and health social movement frameworks, I aim to understand the social constructions of survivorship in post-disaster phases. This dissertation project incorporates qualitative data from three datasets, a media discourse analysis (n=156), 20 semi-structured focus groups with Ebola survivors (n=100) in Sierra Leone and 15 in-depth interviews. Critical discourse analysis and grounded theory methods are used as tools for analysis in understanding the social and economic livelihood.

The three papers in this dissertation examine survivor health to understand how structural inequity takes shape in the aftermath of an epidemic. The first paper describes how survivorship discourse is constructed after an epidemic ends by analyzing media narratives. This analysis found that survivor discourse reinforced body surveillance of Ebola survivors and portrayed Ebola survivors as deceptively hiding the Ebola virus. Moreover, the media emphasized the utility of survivor's bodies through a biomedical lens for the purpose of scientific knowledge production. The second chapter uses Ebola survivor narratives to understand the lived experience of collective trauma post the 2014-16 Ebola outbreak. Themes elicited experiences of community trauma that impacted community cohesion, including Ebola stigma, access to economic opportunities and survivor benefits, and the use of survivors as biocapital for the biomedical research industry. The third paper aims to describe how survivor advocacy was used advocate for policies for post-disaster health care in Sierra Leone. Findings suggest that the Ebola survivor social movement to gain access to epidemic citizenship claims for their right to health was unsuccessful due to political corruption, shifts in global health priorities, and the social and inequities of who was impacted by the Ebola outbreak in Sierra Leone.

In conclusion, I center on survivor health as a social problem that requires social analyses and solutions. Various forms of community trauma emerge for survivors of epidemics, produced by a multitude of community discordances, including stigmatization, inequities in resource allocation, advocacy for health rights and ultimately the biomedicalization of survivorship. These forms of trauma reinforce inequalities for survivors in the afterlives of epidemics. I posit that a community trauma-informed recovery approach that centers health equity in post-disaster settings is needed to address the social and structural aspects of survivorship. I recommend that public health and biomedical research move beyond describing survivor health in solely pathogenic and epidemiological framings to describe the structural, social, and economic factors that impact the livelihood of Ebola survivors.