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Monday, August 3, 2015

A Social Anthropologist’s take on Ebola: Conversations with Cheikh Niang’

Between June 1 and June 12 2014, the Receptor team had the privilege of hosting Professor Cheikh Ibrahima Niang’, a social anthropologist at Cheikh Anta Diop University in Dakar, Senegal. Apart from the official engagements that Cheikh (as he preferred to be called) had at Utrecht, he also had occasion to talk about some topical issues about the continent of Africa in general. Among the topics covered in these conversations were: the role and history of women leadership in Africa; the role of traditional social institutions such as the Dimba women’s group in promoting maternal and sexual health especially among marginalized categories of women; the clash between modern legal institutions and traditional cultural and social values, and many more. Most important, however, were conversations relating to Ebola, which has since developed into an international disaster. The following paragraphs highlight some of the issues covered by Cheikh on the question of Ebola. These accounts, created from my notes from the conversations, are intended to provoke further discussion and research by students and researchers on these very interesting topics about Africa, and do not by any means purport to accurately represent Cheikh’s position on the topics. All errors are mine.

A brief biography of Cheikh Niang’

Cheikh Ibrahima Niang, a medical and social anthropologist, is Professor of anthropology at the Institut des Sciences de l’Environnement, Faculté des Sciences et Techniques, Université Cheikh Anta Diop, Dakar, Sénégal, where he teaches social science research methods and medical and social anthropology. He is also a member of the World health Organization (WHO) Advisory Group on the Ebola Virus Disease Response and is currently conducting ethnographic field research in several locations in Sierra Leone, Guinea and Mali that have been highly affected by Ebola virus disease. He has conducted anthropological and gender studies on HIV/AIDS, sexuality, homosexuality, gender-based violence and reproductive health, and has overseen many multi-site studies on anthropological and social aspects of health issues sponsored by the UN and other international agencies. Professor Niang is widely published in matters relating to culture, health, sexuality, reproductive health, education and behaviour.

Professor Cheikh Niang’

Main points on the conversations with Cheikh:

On the social aspects of the Ebola epidemic

Of course there is a biological process involved in the transmission of the Ebola virus from its natural hosts to humans. However, to create an epidemic of the proportions that we have seen in West Africa takes more than the appearance of a virus on the scene: it is the product of a particular social, historical, cultural and political process whose outcomes are very predictable. As a matter of fact, a close look at all the countries seriously affected by Ebola reveals certain common social patterns: a history of exploitation, subjugation, marginalisation, social injustice, and abject poverty, creating conditions of fear and mistrust, which are compounded by structural inabilities to cope. In this sense, then, we see that epidemics like Ebola are really manifestations of certain social and political processes.

On the role of fear in driving the momentum of the disease

Fear played a big role in the propagation of the epidemic. Fear, combined with lack of confidence in the system, led to a breakdown in communication between the care providers and the victims. Fear led to the stigmatization of those already infected. Fear led to irrational behaviour in the form of denial and rumours, but these should also be understood in their own context as forms of resistance. Denial, in a metaphorical sense, is a coping mechanism and the expression of denial should not be taken literally but recognised as such. Similarly, rumours thrive in situations where there is no transparency, such as when bodies are taken away without a clear explanation of what the process of disposal entails, or when blood samples are taken but results not appropriately transmitted back to the patients or their families, etc. etc.

On the necessity of a holistic approach to the management of Ebola

Without a doubt, clinical management of the virus is a crucial element, but so are peoples’ perceptions about the disease if successful health interventions are to be developed. It is true that certain cultural practices involving contact encourage the spread of Ebola, but at the same time there exists within cultures resources that can be successfully deployed to complement clinical measures. For instance family and kinship ties can be utilised so that the interaction between the sick and their kin are not just opportunities for further infection but resources for the transmission of knowledge and evidence about Ebola. One important aspect of the intervention is tracing, and this can be made easier by following known kinship trees and networks. Here, Griots are particularly well suited because apart from the genealogical knowledge they possess, they can use their social position to motivate others to fight for life while invoking positive values associated with the family lineages, such as resilience and bravery in the face of terror. In this example, Griots can be incorporated in a counselling role and in this way Ebola can be tackled by a combination of clinical and socio-anthropological approaches.

From an anthropological point of view, it must be remembered that intervention, even with the good intention of saving lives, is not only intrusive but interferes with the day to day management of social and political relations within families and society. When victims, their families and social networks are not consulted, intervention can be seen as taking over roles and upsetting the distribution of responsibilities and power. For instance, the duty of care is anonymously appropriated by masked agents of the state; the sociology of food is replaced by a by mechanical intravenous drip systems; valuable kin and family members are turned into dangerous agents of infection; societal management of death and grief is denied. All these apparent contradictions create a fertile ground for resistance, which, while addressed to the arbitrary appropriation of societal roles and power, may be manifested as resistance to potentially useful medical interventions.

Lessons from the current experience in Ebola management

A peculiar characteristic of the current epidemic across all the three most affected countries was the presentation of culture as a barrier to the effective management of Ebola. This, in the most part, can be attributed to a lack of understanding and empathy with the cultural constructions of the societies concerned. Participating in the death and decent send-off of their loved ones is an important obligation of the surviving family members and a right of the departed. It is quite possible to involve the families of victims in some way by incorporating them into the safe burial protocols. Similarly, there exists already in many cultures within the region, cultural pathways to deal with certain categories of abnormal deaths. For example death by lightning, death by drowning and suicide already fall into special categories in some cultures. Such deaths are therefore exempted from normal rituals. The challenge then will be to have Ebola classified in a similar category within this cultural idiom. In this way, rituals can be made safer. Prayer at a distance is culturally acceptable and in fact already done, and so is the practice of rituals that exclude touching but which are then excused by asking the departed for forgiveness. In future, therefore, there should be more willingness to explore similar cultural pathways of providing a holistic management protocol for Ebola.

Another problem that emerged was the lack of consultation with the local communities. Despite good intentions, paternalistic approaches that tended to exclude local communities were initially observed. However it is important to recognise that if the information is properly packaged, local communities have the capacity to understand the basic transmission process of Ebola and what needs to be done. Therefore, rather than take their power and roles away, they could be involved in the management process through identifying and understanding different roles and players and assigning complementary roles as appropriate.

Another factor to consider is how to minimise resistance from the target communities by recognising the important role of collective historical memories in defining people’s attitudes to interventions. In all the three countries concerned, both colonial and post-colonial rule has historically been associated with oppression, social injustice and poverty of the masses. Resistance, sometimes violent, played a role in decolonisation, and resistance is therefore seen as a legitimate option to deal with perceived threats. Furthermore, the use in colonial times of tactics such as well poisoning gives a very plausible ring to the possibility that the political powers that be might be intent on harming the population. This particular fear has seen youths displaying apparently irrational behaviour by guarding wells and water points for fear of contamination but considering the collective memory of well-poisoning, it actually makes sense.

Conclusion: avoiding the vicious cycle of fear

Political subjugation and social injustice define the key factors that lead to poverty and lack capacity to contain epidemics such as Ebola before they spiral out of control. Poverty breeds fear which creates a conducive atmosphere for resistance (sometimes manifested as denial and rumour) to thrive. Fear constitutes a break-down of trust and confidence among grass-root communities leading to increased risk and vulnerability during an epidemic. Lack of confidence leads to the incapacity of officialdom to interpret, understand and adequately respond to the discourses of grass-root communities. This is why one must amplify the voice of the grass-roots about its experience with the epidemic, and incorporate it in future responses. This is a process that requires the commitment to redress the root causes of social injustice and poverty, to eliminate fear by being transparent in any interventions, and to incorporate cultural resources in a holistic approach.

Guest Post by Dr. Michael Odhiambo (Michael is post doctoral researcher attached to the School of Human Rights Research and the Receptor Approach)

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