Life and Death Knowledge Management: Addresses and Ebola

Health personnel at the entrance of an isolation ward for patients suspected to have the Ebola virus in Bundibugyo District, Western Uganda. In the background is a shelter to hold the dead bodies of Ebola patients before they are taken for burial.

Image © 2007 Bizimungu Kisakye, Courtesy of Photoshare

I recently read an article about why Ebola containment has been so difficult. It’s certainly a complex problem. There are funeral practices to be accounted for, community health workers to teach, public health measures to be taken, already-fragile health systems to be shored up. There is fear, and denial, and misinformation that must be overcome. But behind all of these considerations is a simple knowledge management issue, something so fundamental to a society’s ability to fight an epidemic that it hardly gets discussed: Many people in West Africa don’t have reliable addresses, and even if they do, they aren't necessarily tracked or updated systematically.

In the 1990s, I was working as a paralegal at a small law firm that specialized in telecommunications law. One of the many responsibilities of we three paralegals was to keep the client, colleague, and vendor contact information updated. The contact management system was a decentralized tangle. If a client with multiple broadcast licenses (for example, AM radio, FM radio, and television) moved or changed telephone numbers, we had to update that information in at least eight and as many as eleven different places — client lists, licensee lists, accounting lists, partners’ Rolodexes.

Eleven different places. The most technologically advanced pieces of the puzzle were in word processing files—not even spreadsheets or tables, just lists. Other pieces had to be updated with a typewriter, or even a pen. Mistakes were made. I made one. Someone didn't get a letter they should have. I got yelled at. I yelled back, “You know what would help? A database!” I had asked for one before, but the partners didn't see the point. Now I had a concrete reason beyond just making my own work easier. I ranted about the value of being able to update an address once and accessing it for whatever kind of mailing we were generating, for whatever set of contacts we were trying to reach. A day or two later, new database software was on my desk.

Building that contacts database was one of my formative knowledge management experiences. It was my first taste of really loving what I was doing for a living—figuring out the different kinds of tables the system needed, how they related to each other, how they would get used. Solutions revealed themselves to me in dreams, in journal notes, in the shower. When it was finished, the new client and vendor database changed the firm. It wasn't very beautiful (I still had a lot to learn about layout and usability), but it was effective. It turned some three-day tasks into three-hour tasks. It made our work easier for us, and more accurate and successful for our clients. It made me into a knowledge management advocate and practitioner.

Now, back to the Ebola epidemic, and the specific article about why it was so difficult to contain. The tracing process that is so crucial to stopping the spread of contagion is straightforward: Identify the “contacts”—the people who had close contact with infected people. Find those contacts, and track them for three weeks. If they get sick, repeat the process—find their contacts, and track them. In the case of the Ebola epidemic, said the article, “Many contacts’ addresses were missing or were vague like ‘down by the farm road.’ In all, only 20% to 30% of the contacts in the database had a usable address.

The project I work on is called Knowledge for Health. It’s about managing knowledge—gathering it, caring for it, sharing it—so that it can inform public health programs and help healthcare workers do their jobs better. Sometimes that knowledge can only be gained through years of experience, or from broad-based studies and evaluations. Other times, it can come from an effective contacts database—a relatively simple solution, but one that needs people to see the need for it, make demands, and get it built.

An earlier draft of this post was originally published at on September 30, 2014.

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