Résumé
La surveillance des sujets contacts de personnes contaminées par le virus Ébola a pour objectif de contrôler les chaînes de transmission. Cette mesure soulève des questions d’éthique qui imposent de documenter ses modalités d’application et ses effets sociaux. L’étude a été menée au Sénégal sur la base d’entretiens approfondis auprès de 43 sujets contacts du cas survenu à Dakar d’une personne venue de Guinée contaminée par le virus Ébola, complétés par des observations. La surveillance avec confinement à domicile a été appliquée différemment aux co-résidents du malade et aux agents de santé. Les aides matérielles furent indispensables, la dimension relationnelle et la protection contre la stigmatisation étaient appréciées. Mais l’information a été insuffisante pour lever l’angoisse d’être contaminé ou de contaminer des proches, et certains ont éprouvé une souffrancemorale, la perte de leurs revenus et/ou de leur emploi. Les modalités de surveillance des sujets contacts devraient être plus acceptables et adaptées. Le rapport entre inconvénients et bénéfices reste à évaluer d’un point de vue de santé publique.
Mots clés: Ébola, Surveillance des sujets contacts, Suivi, Socio-anthropologie, Ethique, Dakar, Sénégal, Guinée, Afrique intertropicale
Abstract
Quarantine has been widely used during the Ebola outbreak in West Africa mainly to control transmission chains. This measure raises ethical issues that require documentation of the modalities of quarantine at the field level and its social effects for contact persons. In Senegal, 74 people were in contact with the Ebola case coming from Guinea in September 2014. Of these, 34 members of the case’s household were contained together at home and monitored by officers. The remaining 40 health care workers from two facilities were dispersed in their family households and monitored by telephone or during doctors’ visits. The study is based on in-depth interviews with 43 adult contacts about their experiences and perceptions, with additional observation for interpretation and contextualization.
Containment at home was applied differently to contacts who lived with patient zero than to professional health care contacts. No coercion was used at first since all contacts adhered to surveillance, but some of them did not fully comply with movement restrictions. Contacts found biosafety precautions stigmatizing, especially during the first days when health workers and contacts were feeling an acute fear of contagion. The material support that was provided—food and money—was necessary since contacts could not work nor get resources, but it was too limited and delayed. The relational support they received was appreciated, as well as the protection from stigmatization by the police and follow-up workers. But the information delivered to contacts was insufficient, and some of them, including health workers, had little knowledge about EVD and Ebola transmission, which caused anxiety and emotional suffering. Some contacts experienced the loss of their jobs and loss of income; several could not easily or fully return to their previous living routines.
Beyond its recommendations to enhance support measures, the study identifies the ethical stakes of quarantine in Senegal regarding informed consent and individual autonomy, non-maleficence and benevolence, and equity and adaptation to specific situations. Nevertheless, the balance between preventive benefits and individual inconveniences of quarantine should still be evaluated from a public health perspective.
Keywords: Ebola, Contact follow-up, Quarantine, Socio-anthropology, Ethics, Dakar, Senegal, Guinea, Sub-Saharan Africa
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