Humanitarian Health Lessons Learned: Ebola

Online learning around Ebola so far

Reda Sadki Global public health

This is the third in a series of five blog posts reflecting on what is at stake in how we learn lessons from the Ebola crisis that erupted in 2014 and continued in 2015. A new blog post will be published each morning this week (subscribe here).

“The responsible use of technology in humanitarian action offers concrete ways to make assistance more effective and accountable, and to reduce vulnerability and strengthen resilience. Distance learning and online education are good examples of technology supporting these goals” (World Disasters Report 2013:10).

There have been a number of online courses organized by humanitarian organizations as well as by higher education institutions. International organizations have developed e-learning courses such as MSF’s Ebola ebriefing and WHO’s Health Security Learning Platform, or leveraged existing online training packages such as IFRC’s scenario-based simulation modules on public health in emergencies.

Some of the transmissive online courses around Ebola

Some of the transmissive online courses around Ebola

American, British, Dutch, and Swiss universities are amongst those who have produced open online courses distributed on MOOC (Massive Open Online Course) platforms such as Coursera (Ebola Virus Disease: An Evolving Epidemic), Futurelearn (Ebola: Essential Knowledge for Health Professionals), and France Université Numérique (Ebola: Vaincre Ensemble!). All of these have focused on the transmission of information about the Ebola virus disease for general and/or specialist audiences, including those based in the field and in affected communities.

MSF’s Keri Cohn, writing from the Bo-Ebola Treatment Center in Sierra Leone, provided an account of the challenges she faced in using one such course due to access difficulties.

As an expat doctor, I have found your course […] to be excellent. Our national staff, who are local Sierra Leone nurses and clinical officers, have enrolled in the course on their mobile phone. However, because Internet is poor or not available, they have been unable to attend the course or [view videos]. In turn, with the help of MSF, I have been able to download [the content] and, together, in a group of around forty people, we have completed your course.

This is remarkable testimony with respect to the potential (as well as technical limitations) of online learning to disseminate reliable information to health workers, the ability of organizations to overcome technological barriers in the face of urgent need for information, and the high level of motivation of field-based health workers to acquire new knowledge.

But why should learning be a one-way street? What of the knowledge developed by Sierra Leone nurses and clinical officers through collaboration and engagement with people from the affected communities, peers from neighboring countries, and international staff? There is undoubtedly a massive amount of deep, continual learning happening in such a group through practice and experience, not to mention human bonds of friendship and solidarity, forged in the face of adversity. Learning – whatever the medium – cannot be reduced to the one-way transmission of information.

Many of the online learning technologies of the recent past have been modeled after top-down, legacy training systems. In their basic approach and use in practice, these are heavily weighted to the transmission of centralized knowledge from the center (headquarters, the capital city) to the periphery (the community, village, or clinic). They are frequently ineffective, as the transmitted knowledge is often abstract and decontextualized, while the value of existing local knowledge, practices and understanding is not recognized or incorporated into the learning experience.

Transmissive learning

Transmissive learning

Transmissive learning remains the dominant mode of formal learning in the humanitarian context, even though everyone knows that such an approach is ineffective when it comes to teaching and learning the critical thinking skills that are needed to deliver results and, even more crucially, to see around the corner of the next challenge. The moral economy of such transmissive education and training demands unquestioning compliance in the face of authority, lack of critical autonomy, and an absence of responsibility. Learners are treated as passive knowledge consumers rather than active knowledge producers, clearly out of alignment with both the spirit and practical needs of a humanitarian health crisis and processes of human capacity building in local communities and institutions. Such approaches are unlikely to foster collaborative leadership and team work, provide experience, or confront the learner with holistic complexity of specific sites and cases. In other words, they fail the crucial test of grounded relevance to improved preparedness and performance.

What can education contribute?

What can education contribute to the shape of future global health crisis response? What is the role of technology, beyond improving the efficiency of the transmission of information? Education research in many fields, including humanitarian work, has shown that significant learning, even transformative learning, is usually grounded in and builds upon experience. The educator’s role is to scaffold self-understanding, and to facilitate expansion of that self-understanding.

In our volatile working environment, what we know (usually thought of as content-based knowledge) is replaced with how we are connected to others. That is how we stay current and informed. Learning nowadays is about navigation, discernment, induction and synthesis, more than memory and deduction. Memory has become less relevant in a world where so much knowledge is within reach within seconds. Networks are a powerful problem-solving resource that people naturally turn to when they need help. We rely on small, trusted networks to accelerate problem-solving (learning).

Many new learning practices – through both formal and informal networks – develop organically, in the face of sometimes extreme circumstances. Often, it is exceptional leadership qualities in individuals (and sometimes their organizations) that make up for gaps and limitations of existing learning methods. Nevertheless, although humanitarians may initiate and lead change through their own learning, organizations must create facilitative structures to support and capture learning in order to move toward their missions (Yang 2003:154).

In Thursday’s blog post, I’ll share the experience of a pilot course that sought to overcome the limitations of transmissive learning to support knowledge co-construction by people with experience in humanitarian operations.  

References

Stocking, Barbara. “Report of the Ebola Interim Assessment Panel.” Geneva: World Health Organization, July 2015. http://www.who.int/csr/resources/publications/ebola/ebola-panel-report/en/.

Sharples, Mike. “FutureLearn: Social Learning at Massive Scale.” presented at the Learning With MOOCs II (LWMOOCS), Columbia Teacher’s College, October 3, 2015. http://www.slideshare.net/sharplem/social-learning-at-massive-scale-lwmoocs-2015-slideshare.

Vinck, Patrick (Ed.). World Disasters Report: Focus on Technology and the Future of Humanitarian Action. Geneva, Switzerland: International Federation of Red Cross and Red Crescent Societies, 2013.

Yang, Baiyin. “Identifying Valid and Reliable Measures for Dimensions of a Learning Culture.” Advances in Developing Human Resources 5, no. 2 (May 1, 2003): 152–62. doi:10.1177/1523422303005002003.