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MSF health promotion session on hygiene and health in Walikale, North Kivu, DRC, in 2017.

Democratic Republic of Congo 2017 © Gwenn Dubourthoumieu


Let's Talk COVID-19: Fighting Misinformation

MSF health promotion session on hygiene and health in Walikale, North Kivu, DRC, in 2017.

Democratic Republic of Congo 2017 © Gwenn Dubourthoumieu

August 20, 2020

1:00PM-1:45PM ET

Event type: Live online

Sandrine Tiller:

Hi, everyone, and welcome. Thanks for joining for our series, Let's Talk COVID-19. Today's episode is focusing on fighting misinformation. I'm Sandrine Tiller, your guest host this week. I'm the lead for a Doctors Without Borders project on misinformation and disinformation. I'm actually based in London. Some of you might know us by our French name, Médecins Sans Frontières, so you'll probably hear us saying MSF throughout the conversation, but it just means Doctors Without Borders.

So, today, we're going to be talking about the shifting online environment, and the explosive growth of misinformation and disinformation about public health issues. The COVID-19 pandemic has triggered a surge of public interest in health care, but also massive confusion as people are flooded with unverified news in social media. The World Health Organization has called this epidemic of bad information an infodemic. It's putting people's health and lives at risk.

So, today, we're going to be talking to MSF aid workers and experts about the impacts on local communities from Haiti to the Democratic Republic of Congo to West Africa and beyond. Before we continue, I have a little housekeeping to take care of. This discussion is going to run for 45 minutes. Wherever you're joining from today, you can submit questions for the panelists. If you're watching on Zoom, send questions using the Q&A option at the bottom of your screen. If you're joining on YouTube live, Facebook live or Twitch, send questions in the comments or chat section. We'll prioritize questions directly related to today's discussion.

So, joining me today are Luz Saavedra. She is the head of mission for MSF in Haiti. Hi, Luz. We've also got Thiaba Anais Fame. She is the MSF regional advisor for community engagement based in Dakar in Senegal. Hi, Thiaba. We have Sabrina Rubli. She's the health promotion manager for MSF in North Kivu, Democratic Republic of Congo. She is in a place called Walikale, which is pretty far into North Kivu, and so her connection isn't great. So, that's why you're seeing a photo of her, and she's on the phone, so that she doesn't break out.

Right. So, we're going to be waiting for your questions, but I'm just going to start off by asking Thiaba to kick us off by looking at the language that we're using. What is the difference, Thiaba, between misinformation, disinformation and rumor?

Thiaba Anais Fame:

Thanks, Sandrine. Hi, everyone. So, here in MSF, we take information as it comes, and every kind of information is extremely important but we... just for the sake of better understanding what is being said. In MSF, what we call misinformation is pretty much a collection of untruthful information. So, it's not always scientifically based, and really nobody really knows where it's from. The sources are sometimes a little blurry. We don't know how it was created. But it's just a couple of information that sounds true, but deep down you know that they are. So they're a little itchy, let's say.

Sandrine Tiller:


Thiaba Anais Fame:

Disinformation, however, is a collection of inaccurate information. So, disinformation are usually shared with a more malicious purpose. They tend to be... to refer, for example, to abuse or attacks towards patient or health workers. Sometimes, they can be related to economics, or they can be sometimes politically motivated. So bottom line is they are meant to deceive the population and they're meant to hurt.

Rumors are a mix of myth and hearsay and feedback from the community, so they can be true and sometimes they can be inaccurate. So, the thing is that with rumors, we tend to focus and to talk a lot more about rumors and feedback. We'll talk a little more about that later on. But one thing that we need to remember is that we take all this information very seriously. We tend to address them as quickly as possible because they can have some real damaging impact on our staff, our activities, our reputation, and most importantly, on the health of the population. So, yeah.

Sandrine Tiller:

Right. So, earlier when we talked to you, you mentioned to me that it's important not to dismiss rumors or think that rumors are only bad. So, tell me a bit more about that idea.

Thiaba Anais Fame:

Sure. The thing is that rumors are not always necessarily harmful. Yes, it's true that they reinforce misconception, and they need to be tackled with accurate information. But I think what we really need to remember here is that sometimes when you think deeper and when you search deeper, sometimes, you realize that rumors reflect needs, emotional needs that are not necessarily addressed in the awareness sessions or the key messages that we share.

So, in MSF, we try as much as possible to treat rumors as an opportunity, an opportunity to understand the communities where we're working and to try to dig a little and understand better anxieties because they are legit, they're legitimate anxieties. We need to understand them, we need to acknowledge them, and we need to respond to them. There are a couple of things that can be done in order to respond to them. But really, what is really important and what I guess I want people to remember is that in order to understand rumors, we need to understand the inner drivers behind them and what are they hiding. Sometimes, they hide fear, sometimes they hide anxieties. By understanding that, then we can create the appropriate messages, the appropriate narrative to respond to them.

Sandrine Tiller:

Right, and start a dialogue.

Thiaba Anais Fame:


Sandrine Tiller:

Yeah, great. What about the real world consequences? I'm going to move over to Sabrina in the Democratic Republic of Congo. In your experience over there as a health promoter, have you seen some real-life consequences of misinformation and disinformation circulating online?

Sabrina Rubli:

So, we've definitely seen some consequences of all of the COVID misinformation and especially rumors here in the DRC. What's important to know is that COVID arrived in the DRC, specifically in North Kivu, just as the World Health Organization was declaring the last Ebola epidemic officially over. So, the last few patients were being discharged from the Ebola treatment centers just as COVID was coming in. So, the initial reaction of the community was one of great suspicion, where they, very quickly... They were very quick to say that, "Well, COVID is just another way for the government or for foreigners, white people, Chinese, anybody to kill us since Ebola didn't work."

Then, COVID treatment centers were very quickly being repurposed into COVID treatment centers. The checkpoints for hand washing and temperature that had been used during the Ebola epidemic were now being used for monitoring COVID. A lot of the ways that the government, NGOs, the World Health Organization was communicating about the disease to the community was just in the same way that they've communicated about Ebola. Ebola response had been really controversial. There was a lot of political, a lot of violence, sometimes even towards health centers, MSF included, up in the North. So, the suspicions that had lingered towards health care centers during Ebola transitioned into suspicion about COVID.

Then, because COVID did originate outside of Congo, from China, and then it spread across the entire world, and then finally made its way into Africa and into Congo and into even really tiny communities here, the assumption that white people or foreigners are trying to kill us became quite strong. So, we really had to focus our health promotion activities, and health promotion is where we engage with the communities, where we have medical intervention, so where we're supporting hospitals or health centers. Health promotion is how we communicate directly to the community. So, we did a lot of education surrounding all sorts of health issues.

One of our biggest challenges was integrating the COVID awareness, COVID education, and learning from them what their thoughts and ideas and opinions were about COVID into our existing health promotion activities. So, we didn't just want to stop talking about malaria prevention or malnutrition, or the importance of measles vaccinations because now we had a new epidemic, we had to fit it in into our existing programs, which was a challenge.

One of the biggest rumors that persists is the vaccine rumor. There is a lot of talk about how a COVID vaccine will be tested in Congo, or in Africa. They are very adamant that they will never ever, ever accept any COVID vaccination. So, we have to do a lot of work really telling the people, telling the communities where we're present that it's dangerous to accept any medication that's not verified by the government, by the OMS and even by MSF. That if there comes a day when the COVID vaccine is made available, it will not be tested on Congolese people. There's rigorous testing processes. So, that's a rumor that we can see having issues down the road. Already, we're unable to do vaccination campaigns, even right now because people are very suspicious of any sort of mass vaccination campaign. So, yeah, those are some of the real world consequences that we're facing right now.

Sandrine Tiller:

Yeah. That's really worrying. I think, what I'm reading from what you're telling me, or what I'm reading between the lines is really that it's establishing trust with the community. I'm just going to use that to jump over to Luz, who's in Haiti, and ask Luz a little bit to talk to us about the experience in Haiti. I know you guys have been doing a lot of work to build this trustful relationship. I'm just bringing in a question from Christina on Zoom. She was asking how we stop the spread of COVID misinformation. I think, for us, trust, building a trustful relationship is really key. So, tell us a bit about the situation in Haiti, Luz.

Luz Saavedra:

Thank you. I think that it's very interesting to see how there are certain commonalities between the context because we also have rumors and misinformation here that we are very concerned with because, as my colleagues were saying, it's affecting the health seeking behavior of people. When it comes to trust, I think, that it's important to contextualize where rumors come from.

Prior to the COVID epidemic arriving to Haiti, it's a country that was not in a great situation from the humanitarian perspective. We are talking about a country where more than 60% of the population was living with less than $2.4 a day, under the poverty line. If you compare it with the rest of Latin America and the Caribbean, the average life expectancy here is 10 years lower than in the rest of the countries, and so on and so forth. We can talk about food insecurity or the fact that, for example, something as simple as 50% of women are anemic.

So, I think that when we are contextualizing, we need to understand that COVID has act like a magnifying glass of all those existing vulnerabilities. But not only with regards to the vulnerability of people or what was the situation, I think that it's very important to highlight, and this is not something unique of Haiti, either. That is the uncertainty is related to the economic crisis that is affecting us globally. The political and insecurity stability, all these things have been generating a series of worries, anxieties, and people are basically tired to be fighting for survival. This is something that Thiaba was saying and Sabrina as well.

So, all these impacts, the levels of trust that people have in institutions, their own governmental institutions, but also INGOs like ours. So, we are extremely concerned about rumors and how we can create trust. We have been seriously affected by the epidemic on the way that we can work with people because before, for health promotion, we used to be able to gather a large number of people. Now, because of respecting the barrier measures, we need to change and adapt the way that we talk.

There has been a very interesting, and I would say, not necessarily expected side effect of this, which is that we have been forced to use other techniques to reach out to people. So, for example, to do what, here, we call porte à porte. So, we go to the houses of people with the barrier measures, masks and so forth. We can engage into much more one on one. This enables us not only to do the transmission of information, which is essential, but also to be listening and to understand better what are the pre-occupation kind of worries, what my colleague, Thiaba, was mentioning before and engaging to a communication that is much more on two senses.

Sandrine Tiller:

Interesting. Yeah. Actually, I'll bring in one of the questions that's just coming online. In your experience, Luz, have you been looking into certain rumor and then found that actually it's true? It may have seemed outlandish, but it's true.

Luz Saavedra:

As I was saying before, there's the issue around how you can trust. The fact that there has been declarations, internationally, and public declarations talking about what Sabrina was saying, the vaccination tests, do not help us. When it comes to rumors, there's some elements that were already present in the Haiti context with regards to, for example, injections. So it's very difficult to counteract something that people have the inertia of trusting in that sense. But then, when we see the impacts of these rumors, it's also interesting to see that it's not only direct impacts related to the epidemics in itself.

So for example, with the whole rumor around vaccination is not only because of the rumor that the frequentation of health centers for routine vaccination has gone down by more than 50%. It's also related to the fact that people don't know about this disease. This is an unknown disease, so there's fears associated to that and anxiety. People do not know whether if by going to the... There's fears of contamination. There's also impacts associated to the capacity of responding to the health needs of the population in the sense of functioning health instructors.

So, it's very difficult to understand certain things. At the same time, for example, in the Haitian context, there's a lot of people, given that 60% of the population live with $2.4 a day, there's a lot of people that trust on other ways to try to keep their immune system boosted through traditional medicine and so forth. So, it's very difficult to make the difference between these misinformations about you can cure the disease with just taking something and doing something for yourself with your own means. Of course, we try to be respectful and engage into this dialogue with communities.

Sandrine Tiller:

Right. Thiaba, I'm coming back to you with a question from Miriel about how MSF takes into account cultural sensitivity, and how we address rumors without offending communities?

Thiaba Anais Fame:

So, how we do that? Well, I was mentioning earlier that two things that we've been doing so far is a lot of rumor tracking and a lot of social listening. With that, we've realized what... I think COVID has made us collectively reflect on how we better ask community's perception in the sense that how people cope, how people grieve, how people react in adversity is something that we need to understand better so that in the way we adapt our messages and in the way we adapt our activities, we don't offend people.

We did a couple of relative assessment at the beginning of the pandemic. We realized that religion played a tremendous role in how people perceive the pandemic and how people perceive the virus. Our role here is not to tell people that praying is not going to help them protect themselves and protect their families. What we're trying to do though is two things. First of all, tell them that, "Well, praying is the way you've chosen to address the virus or to protect yourself from new virus, that's up to you. However, we would like to encourage you in the presence of this symptom and that symptom…”.

So, it starts by acknowledging culture and acknowledging that people will address, and people will face the adversity and face the virus the way they see fit. But it's also a manner of collaborating with the people that the community trust the most. So in Cameroon, in Congo, in Mali, in Niger, we've been working hand in hand. It has been hard, but we've been working very closely with religious leaders, with gatekeepers, with traditional healers, with people that when they speak, well, people will pay more attention. So, again, I think it's a matter of how we approach the message. Also, most importantly, it's about acknowledging that people or communities will run back to culture, run back to what makes them feel safe. It is not our place to ... How do we say that? Okay. I have the word in French.

Sandrine Tiller:

To insert ourselves.

Thiaba Anais Fame:

Thank you. Sorry. Sorry about that.

Sandrine Tiller:

Yeah. To put ourselves in the way. Yeah.

Thiaba Anais Fame:

Exactly. To put ourselves in the way, sorry. That's what I was going to say. So, yes. So, definitely, our colleagues, Luz and Sabrina has been talking a lot about trust, and trust is something that you built, you built systematically. You built by asking question, by listening, and by reflecting on who make decisions when it comes to health behavior, who people trust the most. How do we make sure that what we're trying to say and what the message that we're trying to convey does not flush away a little bit what people beliefs are, I guess.

Sandrine Tiller:

Great. Okay. Luz, I can see you wanted to make a point as well. I know this is a big topic for you in Haiti. I know you've been working also on engaging with traditional leaders. So, tell us a bit about that.

Luz Saavedra:

Yeah. In fact, one of the very interesting adaptations that we have to do with regards to COVID was to limit the number of people. So, as I was saying before, that enable us to have more one-on-one discussions and to create that element of listening and respecting and trust. One of the activities that was really successful was working precisely with community leaders.

I would say that it was not necessarily, again, not only transmission of information. Of course, that was part of it. But also understanding how they interact with their community and understanding their role as spokesperson, if you want, of the community. So, with the tracking of rumors, as Thiaba was saying, super interesting to see how certain things start to form a trend so you can adopt your messages better. I would say that normally, we would say training of traditional leaders, but in fact, this was quite a two-way street because we were learning as much from them as we were transmitting information.

I think in that sense and given that we have a US audience, I always say to the teams, a quote from Maya Angelou, that is a fantastic Afro-American writer. She says that people forget what you say, and people even forget what you do, but people never forget how you make them feel. We have been learning so much. As it's a new disease, we are all in our high-learning curve about trying to be more in the listening side of things, and how to do that respecting in that sense.

Sandrine Tiller:

Yeah. I think that's a really important point. Actually, I want to bring in Sabina here because I know that what you described in terms of the mood in the Democratic Republic of Congo, while they've just gone through a very serious epidemic with Ebola, which is, of course, incredibly scary and absolutely deadly, and then now, they have COVID. Then on top of that, they have all these other illnesses that are prevalent in those areas, malaria and measles. There's a huge outbreak of measles last year in DRC.

So, I think, tell us a bit, Sabrina, maybe also just from the point of view, the people you've met in our health centers. Where's their head up? How are we making this emotional connection with their feelings because it's much more than just saying, "Here are the facts." It's about understanding where people are.

Sabrina Rubli:

Yeah, absolutely. I think one of the first things that we noticed... Well, actually, one of the first activities that we did in our COVID response was at all of the hospitals and health centers that MSF supports, we set up a little triage stations and so any patient or visitor that comes has to have their temperature taken and wash their hands. Then, if they have a fever, they go to the side, and the temperature is taken again after a few minutes. Then, if they're deemed to be a suspect case or at risk, then they speak to a doctor who asked them a few more questions. So, there's a whole process that goes on.

One of the quickest reactions to us installing those triage was that we noticed the community no longer wanted to go to MSF health structures. So, that would be a very, very, very serious thing because, obviously, the health care system in DRC, specifically, where MSF works, I mean, in Walikale, here, there's no other actors working, there's no other NGOs. The access to health care is MSF.

So, very quickly, we have to manage that fear, and we have to really understand it. So, why were people afraid of going to MSF health centers? Was it because they thought they would catch COVID? No, not necessarily. They thought they would just, automatically, be put into quarantine. So then of course, we had to tell them and do a lot of focus groups and a lot of discussions and a lot of sensitization, going door to door, telling people and explaining the process, and just what does it mean to be a suspect case.

The fact that, no, if you have a fever and you go to seek health care, you will not automatically be put into quarantine or isolation. That was the fear that they would just be taken and held for 14 days and then released, which was not the case. So, we really had to explain to them that, no, that's not the case. If you have a fever, you will be treated for your symptoms, you will receive a malaria test. If you have other underlying issues, you will be treated. You won't just get put into this corner and left for 14 days.

So, I think for us as the health promotion team, it's all about talking to people. I think, as Thiaba mentioned, it's not about looking at the rumors at face value, but it's looking at as to why people believe that and what their underlying concerns are and what their fears are, and going a little bit deeper. So, focus groups for us have been a really great tool to understand more and more what people are thinking and what people are feeling. For example, one of the things that's come out is that a lot of people really believe that there's... We mentioned churches. Of course, churches here are really important part of the community. But because churches have been closed for so long, and schools as well, but the bars have stayed open, there was a very quick link to be made to, "Well, this is the devil's disease because the churches are closed, so we can't pray, but we can drink and we can take alcohol and all these other things that come along with that."

So again, we have to really manage that, as Thiaba said, very carefully and not say like, "No, you're wrong”. Prayer is a way for a lot of people to find comfort and support, and that's great, but COVID is not, to my knowledge, anyway the devil's disease. So, yeah, it's a lot of talking to people, understanding where their fears are coming from, and how that creates rumors. If we understand where they're coming from, then we can understand how we can manage them and not necessarily dismiss them or get rid of them, but just manage them. So, they exist, but they're not destructive, and they're not causing people to stop accessing health care, and they're not causing people to avoid the hospital and avoid the health centers, but just understand what is happening in their community.

Sandrine Tiller:

Right, right. I think it's a good opportunity to say that we have this environment. Also, in all of the countries where we are, in the UK, and I'm sure in the US as well, there's so much uncertainty right now. The science isn't giving us exactly precise answers. Some people are making up their own theories of why this and why that, what's safe and what's not. I've seen it happen even in my own family.

So, I think it's not a us and them situation. I think it's definitely, in every community, you have this phenomenon of feeling a need to explain what's going on.

Sabrina Rubli:

Exactly. Sorry. Just acknowledging the fact that COVID is really scary, not just for people in Congo, but around the world. It's a new pandemic. Nobody really knows what's going on. Everyone is uncomfortable with this. So, just acknowledging that, yeah, this is a really strange and scary and unknown situation, I think, is also really important.

Sandrine Tiller:

Right, right. Have the people that you've met in DRC, have they... This is a question from Mona in Zoom. Are they aware of the high cases in the US? Are you American, Sabrina?

Sabrina Rubli:

I'm Canadian.

Sandrine Tiller:

Oh, sorry. Well, they might be asking you. Are they asking you about what's happening in Canada or in the US?

Sabrina Rubli:

Definitely. People know that it's a pandemic, and there's massive numbers of cases and mortality around the world. I also bring that up. I give the example of what my own family is going through back home in Canada, where they've been in quarantine for months, and friends as well that are quarantined by themselves for months. I think it's almost like camaraderie, like we're in this together, we're all in an unknown situation. Yeah. People here have access. They know what's going on in the world, a lot of people. So, yeah. It's interesting to see their reactions to that as well.

Sandrine Tiller:

Right, right. Well, let me move to a question from Lily on Zoom. She's asking, and I'll hand this one to Thiaba because I think you're the one who's probably got this in mind. She's asking, "When there's so much information out there, and it evolves quickly and from different sources, what's the best way of keeping track of everything at different levels? So, community level, medical staff, health providers, the authority." How do we manage that, Thiaba? How do you help our teams in the field to manage all these different sources of information, and how to understand what's going on?

Thiaba Anais Fame:

So, at regional level, what we did is that we focus a lot, and by a lot, I mean a lot of energy on rumor tracking. I think when we talk about rumor tracking, people don't necessarily have the idea of how extensive this work is, but it's been super helpful, and it's been actually, one of the best way to make sure that we listen, we collect, we verify, we triangulate from different information, and we capture in one specific place, something that we call a log book, a rumor log book. That helped us analyze and respond to them and act upon them as quickly as possible.

We have to remember that we cannot, physically, react to every rumors. It's not possible. There's not enough of us. So, we have to prioritize them. One way to prioritize them is to see... Because some rumors are very well established and some rumors, in terms of impact or likelihood of happening, are kind of small. So, we don't spend as much energy on those rumors. So, we try to focus as much as possible on rumors that we deem dangerous. So, there are rumors, for example, about stigma, about violence against health workers or health staff, or rumors targeting foreigners, vulnerable groups, migrants, women.

In Niger, for example, we did have a lot of rumors targeting migrants. In one of our project in... I think, it was in Bangui, we had rumors targeting woman from a specific ethnicity that they were target, they were victims of violence, they were verbally and sometimes physically abused, et cetera. So, we tackle those as quickly as possible, obviously.

The thing is that rumor tracking has been... It's an extensive amount of work. But at regional level, what has really helped us well is that we have this working group within different agencies. So, you've got the UN, you've got the Red Cross, you've got MSF, you've got a bunch of people. That has been extremely important and extremely helpful in the sense that we shared and we discuss main trends, basically, what other agency sees on a weekly basis. We work together in terms of how do we improve the way we collect and the way we document this feedback. By working together and working quickly together, we've been able to focus on the feedback itself instead of trying to harmonize our approaches. How the UN works, it's their way of working, that's fine. How the Red Cross work, it is what it is.

So, really, I think that has been extremely helpful because what happens is that once we work all together, we try to extract recommendations from all the rumors that we see in Congo, in Niger, in Mali. We do it by region, and then we share these recommendations at different levels. So, these recommendations can help from a operational perspective. It can also help our teams at field level doing health promotion and community engagement. It can help the teams doing treatment, et cetera.

So, we've been able to maximize these resources and learn from each other and try to see red flags, and learn really from each other. I think that's another good example of how we've learned from past pandemics and past... like Ebola, et cetera. So, I think that has been extremely helpful. But rumor tracking is extensive, and it's systematic and it's regular. The reason why it works is because we listen, and we take these rumors seriously, and we act upon them as quickly as we can.

Sandrine Tiller:

Right, right. This is something, actually, in our little... This new project that we've just set up on misinformation and disinformation is we get to trial some rumor tracking software to see if we can have a more agile system. We don't know if it will work, but it's basically, also, to give people almost a kind of real-time view of rumors because, they move fast. I think it's a great initiative, what you're doing in West Africa because, yeah, we need to share that information and see them coming so that we can anticipate where it comes from.

Yeah. So, I wanted to actually go back to Luz on this topic, and just maybe start to zoom out a little bit about, I guess, maybe the complexity of misinformation in today's world. We've had a couple of questions about the role of government in promoting or disseminating misinformation and how we tackle that. There's different information coming from different authorities that maybe we can't openly say, "Yeah, that's wrong." I know Haiti is one of those contexts, where there's a lot of information coming from a lot of places. It's a place where we've been for many years, partly, because there's so much insecurity and so much contestation of the political space. So, I just thought you're the head of mission there, so maybe you can help us zoom out a bit and talk about maybe the more political angle on things.

Luz Saavedra:

Well, interestingly, Haiti, like many other countries, it's a country that depends a lot on remittances from migrant workers, from the country that are elsewhere. Some of the biggest communities are in the US and in Brazil, and in Chile, my own country, where unfortunately, what the authorities were saying was not necessarily matching what the authorities were saying here. This is an island that has two countries, the Dominican Republic and Haiti.

So, sometimes, these contradictions between what the different governments are saying are quite telling, and they explode a lot into discussions, particularly, on social media. So, that's really interesting that you mentioned that because it has been sometimes, as Thiaba was saying, for us to follow up on the rumors and misinformation. It's a very, very work intensive-element. Talking about the context and the evaluation, it's also true that because we have been forced to be more on the listening side, given the unknown elements of this crisis. People talk to you about which are the barriers that they are having to access help. That is when you start going into more a slippery slope of evidently, in this country, like in many other countries, their financial barrier to access health care is a massive one.

There's elements that are related to security. So insecurity in certain areas, and you can see in the background, a map of Port-au-Prince, it's also a massive barrier, and how we communicate and how we interact with the different groups to ensure acceptance by all parties involved. It's really tricky from a political perspective as well. Then there's elements with regards to... it's not only understanding what MSF can do for you, but also how is the status of certain healthy structures. Are they functional or are they not? Until which point, sometimes the official version is there's X, Y, and Z, but then the reality can be different. So it's a really, really tricky one in that sense on how we communicate with people and how we ensure that our political awareness with regards to certain elements that are linked directly to the levels of social contestation in the country and to what I was referring before, in terms of people are tired, tired of fighting for their survival.

There are certain things with regards to the direct and indirect impacts of COVID, that we as MSF, as Doctor Without Borders, we are not going to say. But of course, I'm very happy to see absolutely, unbelievably, amazing civil society of the Haitian variety groups, activists, and so forth. They are the ones that are in the best position to make a political will of certain situations. A lot of what is happening is linked to a disease that we don't know much. But as I said before, COVID is a magnifying glass of all the structural problems that were there before and that we are seeing.

So for us, I insist, again, because it's really a very important point. We are learning so much, just by enlarging our scope of listening, not only to the populations, but to other colleagues of the local and solidarity networks and so forth that are doing an unbelievably brave work against all winds and tides. We are in hurricane season, so it's not just an expression that help us in that sense to bring the political to understand why needs are as they are and why the capacity of response has been massively impacted by these epidemics.

Sandrine Tiller:

Yeah, thanks. This is definitely my topic and my area, so I'm very interested in that and what you're saying. Certainly, these projects that we've just set up with MSF is to look at how maybe the more political dimensions of the effects of misinformation and disinformation, and how it is going to affect our society. I do think that it is going to have some really serious effects on trust in health providers. I think the example that Sabrina gave about the fact that people are really worried about the vaccines, this is not only in DRC, this is a global issue.

All the points you've just made, Luz, about the political dimensions of who manages truth and who's reality, I think these are really big challenges for us in the future. As a global society and as a global health factor, we really want to get ahead of that curve because I think the effects on health are going to be very serious.

So, we're just at the final minutes of our webinar. So, I'm just going to wrap up, if you allow me. I want to say a big thank you to Luz, Thiaba and Sabrina for a fascinating conversation and for taking the time to be with us today. Really appreciate your insights. I also just want to mention that we had a lot of fascinating questions on Zoom. Unfortunately, not all of them fit in the flow of conversation, but they were really, really interesting. Yeah, I'm still looking at some of them right now.

But I just want to close today. It's been a pleasure to be your host today. I had a little internet connection problem a minute ago. So, I hope that didn't affect you too much. MSF USA's Executive Director, Avril Benoît will be back in two weeks for the next and final episode of the summer series, Let's Talk COVID-19. Join us on Thursday, September 3rd, and we'll discuss the future course of the pandemic and the challenges that lie ahead. Thanks to all of you for joining us. If you have any questions, and you'd like to stay in touch with MSF, you can email us at Thank you very much. Goodbye.

Join Doctors Without Borders/Médecins Sans Frontières (MSF) for our online discussion series, Let’s Talk COVID-19, to learn how we’re responding to the global pandemic while maintaining essential medical services in more than 70 countries.

In this eight-part series we talk with MSF aid workers and experts to answer your questions about the humanitarian response to COVID-19.

As the COVID-19 pandemic rages on, Doctors Without Borders/Médecins Sans Frontières(MSF) teams are also confronting an “infodemic” of rumors, misinformation, and disinformation that adds to the dangers. In many of the places where we work around the world, we see false or misleading information deliberately circulated to cause harm and fuel confusion. Health workers have been stigmatized and attacked, and there is growing distrust of medical experts and scientific evidence. Amid the cacophony of news and social media, it can be difficult to discern the facts about the coronavirus. 

The viral spread of rumors and lies can have life-threatening consequences, especially during a pandemic, as people ignore safety measures, take phony cures for real illness, or avoid health centers altogether.   

Join us on Thursday, August 20, for a conversation about how MSF is working with communities to stop the spread of misinformation and protect public health. We’ll speak with Luz Saavedra, head of mission for MSF in Haiti; Thiaba Anais Fame, MSF health promoter and regional advisor for community engagement based in Dakar, Senegal; and Sabrina Rubli, health promotion manager for MSF in North Kivu, Democratic Republic of Congo. Our guest host for this episode is Sandrine Tiller, a program adviser for MSF UK who is leading a special organizational initiative focused on the threat of misinformation and disinformation.  

Speakers will answer your questions and discuss the unique challenges MSF teams face when fighting fiction with facts. 

*Your registration gives you access to all events in this free discussion series. After you register, you'll receive an email confirmation with the Zoom link to attend online and email reminders before each event (the link to join us online will be the same for all events). You'll also have the option to dial in by phone.



Sandrine Tiller is the lead for a new misinformation and disinformation project for Doctors Without Borders, based in London. She has extensive humanitarian field experience, having worked in Venezuela, Eritrea, Tanzania, Israel/Occupied Palestinian Territories, and Lebanon with grassroots organizations, the United Nations, the British Red Cross, and the International Committee of the Red Cross. She has been working with Médecins Sans Frontières since 2011, based in the UK office, undertaking short assignments to South Sudan, Democratic Republic of Congo (DRC), Jordan, the Philippines, and Ukraine. She is currently working on MSF reflection and analysis files, including Disinformation/Weaponization of information, Environmental Health, and the shrinking humanitarian space. 

Luz Saavedra is the head of mission for MSF in Haiti. A Chilean and Spanish dual citizen, Luz has been working with MSF as a humanitarian manager and researcher since 2000. With MSF and the Overseas Development Institute, she completed numerous assignments and research projects in Somalia, Palestine, Lebanon, Jordan, Democratic Republic of Congo (DRC), Sudan, Ethiopia, Burkina Fasso, Senegal, South Sudan, Kenya, Colombia, Mozambique, Central African Republic (CAR), Nepal, Morocco, and Niger. Luz studied Political Science at Universitat Autònoma de Barcelona and Sciences Po Paris, and holds a Masters in International and Comparative Law from SOAS University of London. 

Thiaba Anais Fame is MSF’s humanitarian anthropology, health promotion, and community engagement regional advisor based in Dakar, Senegal. She is currently working on a multiplatform communication campaign against disinformation about the COVID-19 virus and the stigmatization of people affected. Through a growing network of community champions, the campaign promotes systematic rumor tracking to better understand fears and respond to concerns and showcases dialogue and solidarity among communities. In Dakar, her team coordinates the West and Central Africa regional working group on rumor management and community feedback around COVID-19. The team actively contributes to the regional interagency group on Risk Communication and Community Engagement (CREC) along with 30 other organizations. Thiaba also has contributed to the regional online library on health promotion and community engagement tools,

Sabrina Rubli is the health promotion activity manager in North Kivu, Democratic Republic of Congo (DRC). She has been working to develop and implement community engagement strategies as part of MSF’s COVID-19 response, as well as developing educational tools to share with the population. Along with her team of health promoters, Sabrina is finding ways to incorporate COVID-19 education and community engagement alongside other existing issues the community is facing, such as malnutrition, sexual violence, cholera, and malaria, all within the volatile context of North Kivu. Hailing from Canada, Sabrina has completed MSF assignments in Haiti, Tanzania, and Kenya, specializing in women’s health and sexual and gender based violence (SGBV).