The latest issue of African Studies Review includes a commentary from Adia Benton and Kim Yi Dionne titled “International Political Economy and the 2014 West African Ebola Outbreak.” It’s available for download here for the next month, and I think it’s well worth a read. In the piece, Benton and Dionne outline the domestic and international response to the Ebola outbreak that has caused so much damage in Guinea, Liberia, and Sierra Leone, but they also place the outbreak is a much wider context, looking at the setting in which this outbreak is taking place and looking at the outbreak in relation to past events. They even lay out the relevance of problems in the region as recent as the Mano River War and structural adjustment and as far back as the slave trade and colonialism. With this background in mind, they state:
[W]e should expect that ordinary people navigating an epidemic would be suspicious of the motives and directives not just of their governments, but also of local agents implementing health interventions on behalf of their governments. It should not be surprising that these suspicions could further antagonism toward governments.
In describing the response to the outbreak, Benton and Dionne provide a survey of attempts and failures from the weak response of a broken healthcare infrastructure to the inaction of the international community – led by a dismissive WHO. What’s really important, though, is their emphasis on how the international community responded to the crisis only when it began to threaten the West itself. We all saw this when Ebola became huge news as it arrived in hospitals in Dallas and in the streets of Manhattan, and faded out of the news cycle once those threats abated. Discussing the UN’s decision to create an emergency committee to focus on the outbreak, the authors write that “the resolution adopted at the end of the emergency meeting stated that ‘the unprecedented extent of the Ebola outbreak in Africa constitutes a threat to international peace and security.’ The security paradigm—and particularly one in which threats from West Africa were spreading to the West— therefore colored U.S. and European responses to the ‘crisis.” Kim Yi Dionne gave a talk at Yale earlier this year in which she talked about and around the issues discussed in this article. One thing she brought up that I found fascinating that isn’t discussed in the article is the role of “culture” in spreading disease. In particular, how many stories cite West African burial practices, belief in witchcraft, or mistrust of outsiders as cultural reasons that Ebola has spread. In relation to this, Dionne referred to the work of Barry Hewlett and Richard Amola, whose report on the Ebola outbreak in northern Uganda in 2000-2001 outlined a very different role for culture to play:
In early October, residents began to realize that this outbreak was more than a regular kind of illness and began to classify it as two gemo (two [illness] gemo [epidemic])…Gemo is a bad spirit (type of jok that comes suddenly and causes a mysterious illness and death in many people within a very short period of time). Gemo reportedly comes like the wind in that it comes rapidly from a particular direction and affects many people, but the wind itself does not necessarily bring it…Once an illness is identified as gemo, a protocol for its prevention and control is implemented that is quite different from the treatment and control of other illnesses.
When an illness has been identified and categorized as a killer epidemic (gemo), the family is advised to do the following: 1) Quarantine or isolate the patient in a house at least 100 m from all other houses, with no visitors allowed. 2) A survivor of the epidemic should feed and care for the patient. If no survivors are available, an elderly woman or man should be the caregiver. 3) Houses with ill patients should be identified with two long poles of elephant grass, one on each side of the door. 4) Villages and households with ill patients should place two long poles with a pole across them to notify those approaching. 5) Everyone should limit their movements, that is, stay within their household and not move between villages. 6) No food from outsiders should be eaten. 7) Pregnant women and children should be especially careful to avoid patients. 8) Harmony should be increased within the household, that is, there should be no harsh words or conflicts within the family. 9) Sexual relations are to be avoided. 10) Dancing is not allowed. 11) Rotten or smoked meat may not be eaten, only eat fresh cattle meat. 12) Once the patient no longer has symptoms, he or she should remain in isolation for one full lunar cycle before moving freely in the village. 13) If the person dies, a person who has survived gemo or has taken care of several sick persons and not become ill, should bury the persons; the burial should take place at the edge of the village.
As they reflect, “From a biomedical perspective, this protocol constitutes a broad-spectrum approach to epidemic control.” The Acholi response to Ebola varies widely from other groups’, but it is a response rooted in both history and culture. There are a lot of facets to epidemics and responses that only emerge with on-the-ground research and observation with local interlocutors. Benton and Dionne’s call for more research into the Ebola outbreak and the response to it is an important one to heed.
Their commentary is just one of a number of academic attempts to understand the Ebola outbreak and call for more investigations and responses. One that I found really informative and interesting was Cultural Anthropology‘s collection on Ebola. Another one is the blog of a development worker in Liberia, Codex Lector (HT Rachel Strohm for this link).