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Papers by Raphael Frankfurter

Open Forum Infectious Diseases, 2022

Background It remains unclear if there is a dose-dependent relationship between exposure risk to ... more Background It remains unclear if there is a dose-dependent relationship between exposure risk to Ebola virus (EBOV) and severity of illness. Methods From September 2016 to July 2017, we conducted a cross-sectional, community-based study of Ebola virus disease (EVD) cases and household contacts of several transmission chains in Kono District, Sierra Leone. We analyzed 154 quarantined households, comprising both reported EVD cases and their close contacts. We used epidemiological surveys and blood samples to define severity of illness as no infection, pauci-/asymptomatic infection, unrecognized EVD, reported EVD cases who survived, or reported EVD decedents. We determine seropositivity with the Filovirus Animal Nonclinical Group EBOV glycoprotein immunoglobulin G antibody test. We defined levels of exposure risk from 8 questions and considered contact with body fluid as maximum exposure risk. Results Our analysis included 76 reported EVD cases (both decedents and survivors) and 421 cl...

BMJ Global Health, 2021

This article brings the social science concept of ‘deservingness’ to bear on clinical cases of tr... more This article brings the social science concept of ‘deservingness’ to bear on clinical cases of transnational migrant patients. Based on the authors’ medical social science research, health delivery practice and clinical work from multiple locations in Africa. Europe and the Americas, the article describes three clinical cases in which assumptions of deservingness have significant implications for the morbidity and mortality of migrant patients. The concept of deservingness allows us to maintain a critical awareness of the often unspoken presumptions of which categories of patients are more or less deserving of access to and quality of care, regardless of their formal legal eligibility. Many transnational migrants with ambiguous legal status who rely on public healthcare experience exclusion from care or poor treatment based on notions of deservingness held by health clinic staff, clinicians and health system planners. The article proposes several implications for clinicians, health ...

Medical Anthropology, 2021

BMJ Global Health, 2021

IntroductionAs of 26 March 2021, the Africa Centres for Disease Control and Prevention had report... more IntroductionAs of 26 March 2021, the Africa Centres for Disease Control and Prevention had reported 4 159 055 cases of COVID-19 and 111 357 deaths among the 55 African Union member states; however, no country has published a nationally representative serosurvey as of October 2021. Such data are vital for understanding the pandemic’s progression on the continent, evaluating containment measures, and policy planning.MethodsWe conducted a cross-sectional, nationally representative, age-stratified serosurvey in Sierra Leone in March 2021 by randomly selecting 120 Enumeration Areas throughout the country and 10 randomly selected households in each of these. One to two persons per selected household were interviewed to collect information on sociodemographics, symptoms suggestive of COVID-19, exposure history to laboratory-confirmed COVID-19 cases, and history of COVID-19 illness. Capillary blood was collected by fingerstick, and blood samples were tested using the Hangzhou Biotest Biotec...

Global Public Health, 2020

New England Journal of Medicine, 2020

New England Journal of Medicine, 2019

Embracing Multiple Normals The parents of a deaf boy in India are advised to get him a cochlear i... more Embracing Multiple Normals The parents of a deaf boy in India are advised to get him a cochlear implant so he can live a “normal” life. When they can’t afford to maintain the device, he’s left with...

BMJ, 2018

After the west African Ebola outbreak of 2014-16, international agencies have helped to establish... more After the west African Ebola outbreak of 2014-16, international agencies have helped to establish disease surveillance operations in the region, find Mara Kardas-Nelson and Raphael Frankfurter, but Sierra Leone’s health security efforts may not be improving outcomes for patients

Medical Anthropology Quarterly, 2019

This article considers the increasing centrality of biosecurity and epidemiological surveillance ... more This article considers the increasing centrality of biosecurity and epidemiological surveillance as key priorities for the Sierra Leonean health care system after the 2014-2016 Ebola outbreak. Amid this broad shift from conceiving of clinics as sites primarily for the provision of therapeutics to instead sites for disease surveillance and threat mitigation, paperwork regimes have proliferated within remote facilities that are out of stock of nearly all supplies and unable to address even the most basic of infectious diseases. Drawing on fieldwork in one such clinic in the region in which Ebola first emerged, I describe one nurse whose endless paperwork tasks seem to have transformed into a type of magical therapeutic practice, resonant with other forms of local text-based healing. Thus, I reflect on the ways that the logics of the fetish-and the emergent ambiguities and perils therein-come to operate through paperwork for local healing practices and biosecuritization efforts alike. This article is protected by copyright. All rights reserved.

Review of African Political Economy, 2018

ABSTRACT This article explores the relationship between the 2014–2016 Ebola outbreak and the poli... more ABSTRACT This article explores the relationship between the 2014–2016 Ebola outbreak and the political economy of diamond mining in Kono District, Sierra Leone. The authors argue that foreign companies have recycled colonial strategies of indirect rule to facilitate the illicit flow of resources out of Sierra Leone. Drawing on field research conducted during the outbreak and in its aftermath, they show how this ‘indirect rule redux’ undermines democratic governance and the development of revenue-generation institutions. Finally, they consider the linkages between indirect rule and the Ebola outbreak, vis-à-vis the consequences of the region’s intentionally underdeveloped health care infrastructure and the scaffolding of outbreak containment onto the paramount chieftaincy system.

SAHARA J : journal of Social Aspects of HIV/AIDS Research Alliance, Dec 1, 2018

Evaluations of community-based antiretroviral therapy (ART) programmes have demonstrated positive... more Evaluations of community-based antiretroviral therapy (ART) programmes have demonstrated positive outcomes, but little is known about the impact of tapering community-based ART. The objective of this study was to assess 24-month HIV retention outcomes of a community-based ART programme and its tapered visit frequency in Koidu City, Sierra Leone. This retrospective, quasi-experimental study compared outcomes of 52 HIV-infected persons initiated on community-based ART against 91 HIV-infected persons receiving the standard of care from November 2009 to February 2013. The community-based ART pilot programme was designed to strengthen the standard of care through a comprehensive, patient-centred case management strategy. The strategy included medical, educational, psychological, social, and economic support. Starting in October 2011, the frequency of home visits was tapered from twice daily every day per week to once daily three days per week. Outcomes were retention in care at 12 and 24...

Social science & medicine (1982), Dec 1, 2017

Despite over 28,000 reported cases of Ebola virus disease (EVD) in the 2013-16 outbreak in West A... more Despite over 28,000 reported cases of Ebola virus disease (EVD) in the 2013-16 outbreak in West Africa, we are only beginning to trace the complex biosocial processes that have promoted its spread. Important questions remain, including the effects on survivors of clinical sequelae, loss of family and livelihood, and other psychological and social trauma. Another poorly understood question is what effect social protection and job creation programs have had on survivors' wellbeing. Several clinical and social protection programs have been developed to respond to the needs of EVD survivors; however, little in the way of impact evaluation has taken place. We enrolled 200 randomly selected EVD survivors from Port Loko, Kenema, and Kailahun districts in Sierra Leone and stratified them based on the amount of instrumental social protection received post-discharge from an Ebola Treatment Unit. We then conducted a survey and in-depth interviews to assess participants' wellbeing and f...

The Lancet Global Health, 2017

The Journal of infectious diseases, Oct 28, 2016

An epidemic of Ebola virus disease (EVD) beginning in 2013 has claimed an estimated 11 310 lives ... more An epidemic of Ebola virus disease (EVD) beginning in 2013 has claimed an estimated 11 310 lives in West Africa. As the EVD epidemic subsides, it is important for all who participated in the emergency Ebola response to reflect on strengths and weaknesses of the response. Such reflections should take into account perspectives not usually included in peer-reviewed publications and after-action reports, including those from the public sector, nongovernmental organizations (NGOs), survivors of Ebola, and Ebola-affected households and communities. In this article, we first describe how the international NGO Partners In Health (PIH) partnered with the Government of Sierra Leone and Wellbody Alliance (a local NGO) to respond to the EVD epidemic in 4 of the country's most Ebola-affected districts. We then describe how, in the aftermath of the epidemic, PIH is partnering with the public sector to strengthen the health system and resume delivery of regular health services. PIH's exper...

Medical Anthropology Quarterly, 2016

Medical Anthropology, 2021

Media Teaser: Chagas disease is not only found in endemic countries of Latin America; it is also ... more Media Teaser: Chagas disease is not only found in endemic countries of Latin America; it is also present in Europe and the United States. This collection explores Chagas and migration.

Medical Anthropology Quarterly, 2019

This article explores the relationship between the 2014-2016 Ebola outbreak and the political eco... more This article explores the relationship between the 2014-2016 Ebola outbreak and the political economy of diamond mining in Kono District, Sierra Leone. The authors argue that foreign companies have recycled colonial strategies of indirect rule to facilitate the illicit flow of resources out of Sierra Leone. Drawing on field research conducted during the outbreak and in its aftermath, they show how this 'indirect rule redux' undermines democratic governance and the development of revenue-generation institutions. Finally, they consider the linkages between indirect rule and the Ebola outbreak, vis-à-vis the consequences of the region's intentionally underdeveloped health care infrastructure and the scaffolding of outbreak containment onto the paramount chieftaincy system.

Open Forum Infectious Diseases, 2022

Background It remains unclear if there is a dose-dependent relationship between exposure risk to ... more Background It remains unclear if there is a dose-dependent relationship between exposure risk to Ebola virus (EBOV) and severity of illness. Methods From September 2016 to July 2017, we conducted a cross-sectional, community-based study of Ebola virus disease (EVD) cases and household contacts of several transmission chains in Kono District, Sierra Leone. We analyzed 154 quarantined households, comprising both reported EVD cases and their close contacts. We used epidemiological surveys and blood samples to define severity of illness as no infection, pauci-/asymptomatic infection, unrecognized EVD, reported EVD cases who survived, or reported EVD decedents. We determine seropositivity with the Filovirus Animal Nonclinical Group EBOV glycoprotein immunoglobulin G antibody test. We defined levels of exposure risk from 8 questions and considered contact with body fluid as maximum exposure risk. Results Our analysis included 76 reported EVD cases (both decedents and survivors) and 421 cl...

BMJ Global Health, 2021

This article brings the social science concept of ‘deservingness’ to bear on clinical cases of tr... more This article brings the social science concept of ‘deservingness’ to bear on clinical cases of transnational migrant patients. Based on the authors’ medical social science research, health delivery practice and clinical work from multiple locations in Africa. Europe and the Americas, the article describes three clinical cases in which assumptions of deservingness have significant implications for the morbidity and mortality of migrant patients. The concept of deservingness allows us to maintain a critical awareness of the often unspoken presumptions of which categories of patients are more or less deserving of access to and quality of care, regardless of their formal legal eligibility. Many transnational migrants with ambiguous legal status who rely on public healthcare experience exclusion from care or poor treatment based on notions of deservingness held by health clinic staff, clinicians and health system planners. The article proposes several implications for clinicians, health ...

Medical Anthropology, 2021

BMJ Global Health, 2021

IntroductionAs of 26 March 2021, the Africa Centres for Disease Control and Prevention had report... more IntroductionAs of 26 March 2021, the Africa Centres for Disease Control and Prevention had reported 4 159 055 cases of COVID-19 and 111 357 deaths among the 55 African Union member states; however, no country has published a nationally representative serosurvey as of October 2021. Such data are vital for understanding the pandemic’s progression on the continent, evaluating containment measures, and policy planning.MethodsWe conducted a cross-sectional, nationally representative, age-stratified serosurvey in Sierra Leone in March 2021 by randomly selecting 120 Enumeration Areas throughout the country and 10 randomly selected households in each of these. One to two persons per selected household were interviewed to collect information on sociodemographics, symptoms suggestive of COVID-19, exposure history to laboratory-confirmed COVID-19 cases, and history of COVID-19 illness. Capillary blood was collected by fingerstick, and blood samples were tested using the Hangzhou Biotest Biotec...

Global Public Health, 2020

New England Journal of Medicine, 2020

New England Journal of Medicine, 2019

Embracing Multiple Normals The parents of a deaf boy in India are advised to get him a cochlear i... more Embracing Multiple Normals The parents of a deaf boy in India are advised to get him a cochlear implant so he can live a “normal” life. When they can’t afford to maintain the device, he’s left with...

BMJ, 2018

After the west African Ebola outbreak of 2014-16, international agencies have helped to establish... more After the west African Ebola outbreak of 2014-16, international agencies have helped to establish disease surveillance operations in the region, find Mara Kardas-Nelson and Raphael Frankfurter, but Sierra Leone’s health security efforts may not be improving outcomes for patients

Medical Anthropology Quarterly, 2019

This article considers the increasing centrality of biosecurity and epidemiological surveillance ... more This article considers the increasing centrality of biosecurity and epidemiological surveillance as key priorities for the Sierra Leonean health care system after the 2014-2016 Ebola outbreak. Amid this broad shift from conceiving of clinics as sites primarily for the provision of therapeutics to instead sites for disease surveillance and threat mitigation, paperwork regimes have proliferated within remote facilities that are out of stock of nearly all supplies and unable to address even the most basic of infectious diseases. Drawing on fieldwork in one such clinic in the region in which Ebola first emerged, I describe one nurse whose endless paperwork tasks seem to have transformed into a type of magical therapeutic practice, resonant with other forms of local text-based healing. Thus, I reflect on the ways that the logics of the fetish-and the emergent ambiguities and perils therein-come to operate through paperwork for local healing practices and biosecuritization efforts alike. This article is protected by copyright. All rights reserved.

Review of African Political Economy, 2018

ABSTRACT This article explores the relationship between the 2014–2016 Ebola outbreak and the poli... more ABSTRACT This article explores the relationship between the 2014–2016 Ebola outbreak and the political economy of diamond mining in Kono District, Sierra Leone. The authors argue that foreign companies have recycled colonial strategies of indirect rule to facilitate the illicit flow of resources out of Sierra Leone. Drawing on field research conducted during the outbreak and in its aftermath, they show how this ‘indirect rule redux’ undermines democratic governance and the development of revenue-generation institutions. Finally, they consider the linkages between indirect rule and the Ebola outbreak, vis-à-vis the consequences of the region’s intentionally underdeveloped health care infrastructure and the scaffolding of outbreak containment onto the paramount chieftaincy system.

SAHARA J : journal of Social Aspects of HIV/AIDS Research Alliance, Dec 1, 2018

Evaluations of community-based antiretroviral therapy (ART) programmes have demonstrated positive... more Evaluations of community-based antiretroviral therapy (ART) programmes have demonstrated positive outcomes, but little is known about the impact of tapering community-based ART. The objective of this study was to assess 24-month HIV retention outcomes of a community-based ART programme and its tapered visit frequency in Koidu City, Sierra Leone. This retrospective, quasi-experimental study compared outcomes of 52 HIV-infected persons initiated on community-based ART against 91 HIV-infected persons receiving the standard of care from November 2009 to February 2013. The community-based ART pilot programme was designed to strengthen the standard of care through a comprehensive, patient-centred case management strategy. The strategy included medical, educational, psychological, social, and economic support. Starting in October 2011, the frequency of home visits was tapered from twice daily every day per week to once daily three days per week. Outcomes were retention in care at 12 and 24...

Social science & medicine (1982), Dec 1, 2017

Despite over 28,000 reported cases of Ebola virus disease (EVD) in the 2013-16 outbreak in West A... more Despite over 28,000 reported cases of Ebola virus disease (EVD) in the 2013-16 outbreak in West Africa, we are only beginning to trace the complex biosocial processes that have promoted its spread. Important questions remain, including the effects on survivors of clinical sequelae, loss of family and livelihood, and other psychological and social trauma. Another poorly understood question is what effect social protection and job creation programs have had on survivors' wellbeing. Several clinical and social protection programs have been developed to respond to the needs of EVD survivors; however, little in the way of impact evaluation has taken place. We enrolled 200 randomly selected EVD survivors from Port Loko, Kenema, and Kailahun districts in Sierra Leone and stratified them based on the amount of instrumental social protection received post-discharge from an Ebola Treatment Unit. We then conducted a survey and in-depth interviews to assess participants' wellbeing and f...

The Lancet Global Health, 2017

The Journal of infectious diseases, Oct 28, 2016

An epidemic of Ebola virus disease (EVD) beginning in 2013 has claimed an estimated 11 310 lives ... more An epidemic of Ebola virus disease (EVD) beginning in 2013 has claimed an estimated 11 310 lives in West Africa. As the EVD epidemic subsides, it is important for all who participated in the emergency Ebola response to reflect on strengths and weaknesses of the response. Such reflections should take into account perspectives not usually included in peer-reviewed publications and after-action reports, including those from the public sector, nongovernmental organizations (NGOs), survivors of Ebola, and Ebola-affected households and communities. In this article, we first describe how the international NGO Partners In Health (PIH) partnered with the Government of Sierra Leone and Wellbody Alliance (a local NGO) to respond to the EVD epidemic in 4 of the country's most Ebola-affected districts. We then describe how, in the aftermath of the epidemic, PIH is partnering with the public sector to strengthen the health system and resume delivery of regular health services. PIH's exper...

Medical Anthropology Quarterly, 2016

Medical Anthropology, 2021

Media Teaser: Chagas disease is not only found in endemic countries of Latin America; it is also ... more Media Teaser: Chagas disease is not only found in endemic countries of Latin America; it is also present in Europe and the United States. This collection explores Chagas and migration.

Medical Anthropology Quarterly, 2019

This article explores the relationship between the 2014-2016 Ebola outbreak and the political eco... more This article explores the relationship between the 2014-2016 Ebola outbreak and the political economy of diamond mining in Kono District, Sierra Leone. The authors argue that foreign companies have recycled colonial strategies of indirect rule to facilitate the illicit flow of resources out of Sierra Leone. Drawing on field research conducted during the outbreak and in its aftermath, they show how this 'indirect rule redux' undermines democratic governance and the development of revenue-generation institutions. Finally, they consider the linkages between indirect rule and the Ebola outbreak, vis-à-vis the consequences of the region's intentionally underdeveloped health care infrastructure and the scaffolding of outbreak containment onto the paramount chieftaincy system.

This thesis explores the way people engage with, depend on and live through transient global heal... more This thesis explores the way people engage with, depend on and live through transient global health interventions in Kono District, Sierra Leone. In a country that is often cast as in a constant state of health emergency by global health organizations and practitioners, I attempt to capture the realities of living with its burden of disease, and the ways in which people do not suffer passively but actively make their circumstances livable. Drawing on three years of ethnographic experience both in Sierra Leone and in the United States as a volunteer with “Ichende International,” a global health organization, I relate Ichende’s history and contextualize its recent maternal and child health project as a result of evolving ties with major global health institutions (such as Partners in Health) and broad trends in global public health. I describe the project’s unfolding in a landscape of care and healers: biomedical, “traditional,” local and transnational. While humanitarian global health projects come and go in their communities, I show how people actively “cope” and “make-do” with their illnesses, and the ways local healers enable this living-on. I argue that traditional medicine in Sierra Leone should be appreciated for its effects: as a type of palliation—and I conclude that this is an egregiously neglected field in global health. I end with a call for the field of global health to attend to, and respond to, this conflicted reality and the lives therein.

New England Journal of Medicine, 2020

Sent to a psychiatrist because of aggressive behavior and social withdrawal, a Brazilian teenager... more Sent to a psychiatrist because of aggressive behavior and social withdrawal, a Brazilian teenager is empowered by the doctor’s dialogic approach and addresses his anger and anxiety by working on the school council to change the conditions that led to his symptoms.