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.
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| 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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