How Social Media is destroying Ebola disaster response support - Part II

The Ebola crisis affecting West Africa has created new challenges in how to respond. Governments and Disaster response agencies are not in uncharted territory. This is not the first time Ebola has impacted the region and likely not the last. What is new is the speed in which information and demands are now placed upon them to act in a 7/24/365 social media hungry environment.

Social media's power to distribute a specific or broad message is indisputable. It is the lowest cost distribution method and mechanism available anywhere in the world. It is a proven network. Social media has achievements in and around disaster environments span across the globe from Haiti to New Zealand. From New York to Tacloban City. Internet connected platforms have enabled multiple types of social media applications to support and aid in the recovery during disaster.

In Sierra Leone, Liberia and Guinea, each government has pushed forward with policies to invest in public safety programs. All three nations are under-developed with high rates of illiteracy, significant levels of corruption, fragile economies, civil war, ethnic conflicts and distrust of the west and everyone else outside of the continent. Social media's use inside all three of these countries is limited and only beginning to be understood.

No two epidemics act alike because of terrain, ethnic composition, population densities and cultural acceptance of warnings and alerts. As a result, policies and risk analysis vary, both in terms of disaster preparedness and capabilities to respond with local awareness and acceptance. As we repeatedly stated, those looking to technology to be the solution and answer are in for a rude awakening. To defeat Ebola, the effort becomes one of direct intervention and does not paint a bright picture of success from any perspective. But it can be done as Nigeria has proven.

Use of Technology and social media's during a disaster has evolved over the past 5 years, playing an important role in detection, response and recovery. But there are limitations. In some cases, coordination of social media sensors can support potential detection models across a wide area. But if sensors such as tweets, facebook posts and Simple Message Service (SMS) are not widely available, detection using analytics proves to be difficult implement.

Internet access and its use by the public in the affected region is not as widespread as people think it is. 85% of the population in the region lives on less than $1.00 a day. The populations in all three affected countries do not own mobile phones or have access the internet for information. It is true that infrastructure is improving in all three nations (Guinea in particular), the reality remains, usage is dramatically lower than most understand or recognize. As we mentioned (and linked) in our previous article, the infrastructure is also limited by the total bandwidth available.

There are three important areas we often find significant obstacles. Policy, services and education. Disaster management is a complex, yet elegantly simple organization. In West Africa, the management of resources and assets, is frequently limited or in some cases, not well understood as to their effectiveness and value. Preparedness policy begins at the community level. But such policies are only possible when the community is willing to adopt them. Liberia and Guinea in particular have suffered through decades of civil unrest and war. These historical scars cannot be understated. The impact on communities and the cultural impact in all of them are open wounds that have not yet healed.

The measurement of how well a community is trained and capable of responding varies is rarely publicly disclosed for review. Each village has taken care of their own people for generations without interference or concern. It only when a mysterious disease flares up that the community is stunned in disbelief as shock hits the community with catastrophic consequences. This epidemic will be one of the longest in recent African history, marking the one year anniversary this coming December (2) when a young boy, Emile Ouamouno died in Gueckedou Prefecture in Guinea died along with 20 others in the same village. News of this was never reported on Social Media. And when it did begin to publish references, it reported that the first cases were first detected in March, 3 months after it actually hit. It would be another 7 months before social media would make Ebola a household word around the world. But when it did, it exploded everywhere else around the world but not West Africa.

New England Journal of Medicine presentation tracing Ebola index patient in Guinea.

International news media outlets are not out on the front lines outside of the capital cities Monrovia, Freetown or Conakry every day. Those journalist that venture out into the country including the BBC, do not risk staying for long periods of time reporting eye witness accounts. The result is limited information with few facts. Local media in some areas is non-existent and television is a luxury outside of the capital cities.

Filling the news and information vacuum to varying degrees are the NGO's and UN agencies. But their news accounts are not receiving the same attention as CBC, CNN, BBC and other internationally recognized broadcast organizations. They must also respect local laws and regulations, often limiting the level of details they can release. Most NGO's have maintained their focus on helping those affected. Given the nature of this disaster, the World Health Organization has done a remarkable job in ensuring information is freely available to any agency or organization that needs it. Real-time information sharing and distribution on the ground remains a challenging problem to overcome.

Training local volunteers is the top priority by NGO's and the World Health Organization. The International Medical Corp, Gates Foundation, and local medical agencies are continually upgrading and themselves learning how to effectively train local medical aid workers. This cannot be achieved using the internet or even locally based cloud services and distributing it across the national wireless networks because of limited bandwidth and device access costs. The required training to use such services is also a significant obstacle. Knowledge transfer (train the trainer) is not always easily conveyed in a classroom. In some remote villages, it is ignored or considered a low priority or worse, not spoken of. The process that has proved most effective in the education of the locals has been to go into the field and educate directly one on one, a time consuming task that proved successful in neighboring Nigeria that traced and investigated every case early in the Ebola outbreak. Social media tools or other internet services did not play a role.

Social media and access to the Internet is currently not worth the investment to spend significant resources and efforts as local preparedness capabilities, management and planning is not possible without other essential services being implemented. When the outbreak was first detected, there continued to be the belief that communities could survive the Ebola outbreak because community leaders and the population were not equipped to understand the impacts or the implications to their families or those that live nearby. Prior to support by W.H.O. involvement, disaster planning and education was not recognized as a critical element in any phase of the Ebola outbreak. Complicating matters further are local conditions including asphalt paved roads and lack of capable airport facilities (storage, hangers, security) and the use of aircraft to support emergency operations and associated logistics in remote areas.

Early emergency response operations throughout West Africa were entirely ad-hoc. Access and use of local health clinics was limited and not widely trusted after years of civil war and local ethnic conflicts. It should be clear that the use of social media would not have made a difference when the Ebola outbreak first occurred given the current state of each country's communications capabilities. Social media would face significant resistance even if it was widely available with propaganda denouncing it. Today in all three countries, each has responded with improved Ebola response plans, dramatically improving the odds of the epidemic being contained. It is going to take a sustained on the ground approach to defeat Ebola. It will require a significant increase in medical support staff willing to volunteer and go to West Africa with the necessary support teams to back them up. Funding this will cost hundreds of millions of dollars. This is where the international community can leverage Social Media and play a key role as it did during Typhoon Haiyan.

Social media combined with wireless communications for emergency response programs are an important tool in Africa's future. Together they can deliver critical knowledge covering a spectrum of a diverse cultural audience. There is acknowledgement that there will be technical and fiscal deployment limitations. Liberia's average literacy rate is 60%, Sierra Leone; 35.1% and finally Guinea at 41%. In a strange twist of fate, despite a better literacy rate, Liberia has more cases of Ebola than Sierra Leone or Guinea.

With so many health workers initially infected and dying, a thorough review was initiated. It was discovered that workers were not following procedures. Masks and gloves were not always were being handled (removed) in the correct sequence by healthcare workers resulting in contact with the virus as some workers would touch their faces while still wearing their gloves. Such transparency has improved accountability and retraining. Governments recognized that in implementing transparency, trust is built and does not negatively affect them long term. Social media's reaction was swift as this information was tweeted and retweeted and posted on Facebook and Reddit around the world. Because of the lack of local internet availability, the criticism and hype was not read and did not affect morale like it did when a similar accident occurred in the Thomas Eric Duncan case in Dallas Texas. As news broke and criticized the medical team including the nursing staff, the response by the nursing union was swift and blasted the Texas Health Presbyterrian Hospital and CDC. It only got worse as two nurses were infected, one of them being allowed to travel. Social media wars broke out (especially on Reddit, Quora and Twitter) with nobody winning and more than a few losing both credibility and trust.

It has been suggested the news has not negatively affected the sums of money and supplies being donated and if anything, increased. We have noted several spikes in social media on the subject of the need for increased donations of reusable rubber gloves. As we posted in our previous article, social media has tweeted about these mistakes and errors and it has not helped improve conditions and the need for additional health care volunteers.  The spread of fear has drowned out several initiatives asking for increased medical volunteer support. We did not imply in our article that emergency disaster relief will not improve or should be halted, Social media users have. By retweeting news of quarantines, visa cancellations and the suspension of humanitarian aid, often adding (requoting) negative commentary (i.e. that it should become policy, or agree with total ban, quarantine or worse in some cases), the kind of publicity and information spreading around the globe has not been one of positive support and response. Reddit posts fill gigabytes of data center space with rumors and false information. Australia's Attorney General's Department of Emergency Management has raised similar concerns when using Social Media and published a white paper on the subject that is appropriately titled 'All that I'm hearing from you is white noise' (Social Media aggregation in emergency response)

Transparency does not indicate that all contingencies can be solved immediately or accepted by the public using social media. The messaging has been clear and more support is needed. But it will not be effective in West Africa. Even if it was, it is drowned out by all the negative media attention. In fact, there is evidence that social media usage by the global community eliminates the positive messages being published. Reddit's Ebola's posts are in the thousands. An early session tried to educate the world about Ebola using Reddit. It was positively received, tweeted and engaged. For every one positive post, hundreds cast doubt on U.S. policy and trust of government agencies, including the CDC. It can be an effective tool to educate the public and challenges a local community face. It certainly is not helpful to those in West Africa.  If social media was widely accepted and available in the Mano River Union (MRU basin, it could convey information quickly in its own cultural ways and customs;

• Ebola's 5 W's; Who, when, where, why and what
• Public Support initiatives
• Improved detection and response
• Distribute knowledge in real-time
• Spread support instead of fear

Local Sierra Leone Poster: more powerful than a Tweet: Photo Credit: BBC (http://www.bbc.com/news/magazine-28583051)

Most of the social media activity has occurred outside West Africa. We stated in our previous post that some governments are now halting humanitarian aid resources and services (Israel and Australia) to West Africa and reviewing (Canada) immigration visa's. It has been suggested that we were;

• Blaming Social media creating fear
• Social media influences foreign policy

In fact we did not suggest that this was the case at all. We left out of the article, on purpose, specific details and what these implications could be. Social media is a world of information that cascades in all forms edited to 30 second sound bytes or less than 140 characters. Users of social media increasingly use it learn about global news and events. What we have said was that social media user tweeted about these news stories in millions of tweets. User reactions to events then followed one of three courses of action:

1) Repost to their friends and followers

2) Add opinion and commentary (true and false stories)

3) Do nothing at all 

Social media can be a useful tool to gauge public opinion and sentiment. It is also an important platform governments and agencies use to debate and react  - if they wish to do so. We did not implicitly imply that Australia, Canada, Israel or any other nation have made foreign policy decisions regarding support for Ebola by analyzing social media behavior. We certainly left the door open to suggest it was possible, however unlikely. But it should not be automatically discounted that such activity is not being heard by politicians and making an impact. Chances are, it is. What we don't know for certain is the level of influence and what specific trends and events tip the scales one way or the other. Imagine how easy it is to make that assertion in 140 characters using Twitter. The millions of tweets, blogs, Reddit posts are influencing other users of social media. There have been past cases where political leaders and its members, agencies and private organizations have made decisions based on social media blowback and reversed course.

All we had to do in our article was clearly state our opinion on how social media could impact government policy. We decided, intentionally, not to do so and gauge reaction. It did not take long and was short and to the point. Responses ranged from "hogwash or it is a stretch". Emails included that we had lost all sense of reality. Others posted in response that social media is very effective in West Africa and pointed out that wireless services were available everywhere and all that was required was to used it more and could turn the tide. Using Topsy's analytical tool is one of many available to analyze social media behavior and the potential impact in West Africa.

Users post news about Canada's halting of Visa applications from West Africa

News of Canada's shipment of experimental Ebola Vaccine to World Health Organization did not gain wide acceptance or distribution. 

Ebola Quarantine news spreads faster and over a longer period of time

Public finally spreads some good news as Facebook announces Ebola Donation program and only 800 tweets, drops like a cliff soon after. Other users tweet announcement (5-18,000) Facebook's Twitter account fails to even mention the announcement on the day it was released.

Social media's usage since the start of the Ebola outbreak has mainly been one of negative news. West Africa's exposure to the Internet is still in the early stages of adoption. It cannot yet effectively utilize its power compared to other countries. The populations of all three countries must improve access to education resources and technology to enable self determination and more importantly, the ability to be resilient in the face of disaster. Other regions across the continent prove West Africa can catch up with its neighbors as illustrated in this CNN report How Africa Tweets. 

Our goal was to ignite discussion around a series of issues

• Social media can have an impact, individually and globally. 
• Headlines published in social media have limits
• Africa's use of social media is in an early stage of development
• Social media still has significant hurdles to overcome
• It cannot easily integrate into all disaster scenarios
• Still lacks adoption and acceptance of SMEM standards

Is our Headline accurate or inaccurate? 

The answer is both. Key indicators are missing and likely never to be made public, including data sets which track detailed donation information allowing it to be compared it to social media behavior. It might illustrate and correlate positive and negative affects. The United Nations Office for Coordination of Humanitarian Affairs (UNOCHA) has donation data, but only publishes totals contributed by each nation or organization and does not break out by dates when donations are made and by what regions. The same applies to Red Cross Agency the world. Most do not publish total funds raised for specific initiatives until year audits are completed. Nor do they publish fund raising and break out the financials into daily, weekly or monthly statements. The Red Cross is not required to do so in any jurisdiction we are aware of. Such statistics would be a key piece of evidence to determine social media's influence. Marketing and advertising 101 suggest positive messages help and negative ones do not. Sometimes both help, regardless of its message.

Augmenting financial donations in support of a conclusion are volunteers and professionals who registered to help. Tracking stats; when they applied, when hired, processed, deployed and returned home. Inconsistent messaging or negative news stories posted are not going to help. When there is a conflict or disagreement in policy on the international stage, it is going to attract social media attention and spread. It not only gets notice, but acted upon. Reaction may not have the same initial explosion social media distribution like a Category 5 Typhoon. Some stories are very subtle in comparison.

U.S. United Nations Ambassador Samantha Power made that clear in October how the U.S. feels about the lack of international response to support the Ebola crisis in West Africa, in condemning the current levels of response. The BBC story version was tweeted 194 times on the day of the story and disappeared. Or so one might believe. The story of Ambassador Power's condemnation was distributed by over 300,000 different news media outlets, blogs and social media sites, then again tweeted using various different headlines. Politicians and their use and interaction with social media should not be under estimated. Political parties routinely use polling data, whom in turn analyze social media every hour of the day, week and month. Social media's influence is rising, particularly when joined at the hip with news organization editorials and links. It often becomes an explosive combination winding up on the front page of the New York Times, (article tweeted 100,710 times) American Press (Obama Authorizes for Ebola the call up of the National Guard Reserves if necessary: tweeted 1,247,695 times), Wall Street Journal (WSJ / NBC Poll finds wide support for Quarantining Health Workers). 

Do we not think people answering these polls are not influenced by what they read using social media stories and commentary, let alone what they tweet in response? Should we also believe that politicians are never influenced by opinion polls? 

Listed below are some answers to both sides of the question. In the end, the goal is engage you the reader, to determine how social media can be used more effectively and the challenges that lay ahead.

Yes, headline is true:

• Social Media is a measurable barometer of public opinion
• Negative Social Media messaging outweighs positive messages hurting participation in support of the region
• Facts are often diluted, inaccurate or not fully explained
• Negative sentiment tends to detract on the ability to support response and delay urgently needed resources
• Resources directed to counteract false information
• Negative and repeated news stigmatizes West Africa today and in the future

No, headline is false:

• Social Media cannot be held responsible in the court of public opinion
• What you cannot access, cannot influence
• Leaders are not directly influenced (.....except when....)
• Fear, Uncertainty and Doubt are not quantitative with sufficient evidence
• Social Media trends change daily, weekly and monthly; the crisis is forgotten

In conclusion, you have to decide if social media is affecting the Ebola crisis and response and what changes (if any) should be made.

We invite you to follow our archives of curated articles collected from most major media outlets from around the world about the Ebola crisis in our CDM magazine powered by Flipboard. All of the links used above are in our magazine. Learn more about Ebola, technology and social media services used in Crisis and Disaster Management. We welcome your comments and thoughts below and not just on the websites that link to this article. 

In Part III of our Ebola coverage, we will look at how Social Media has impacted U.S. public opinion, where there is a strong belief, that a clear and present danger to the country's National Security exists because of one death in Dallas, Texas. We will try to avoid using a sensational headline. 

A challenge that may be difficult to resist.

To read Part I of this series, click HERE.