Ebola, Cultural Responses, and the Funding Gap

A few weeks ago I linked to a handful of academic works on Ebola outbreaks past and present. This week, as I round out my job as a high school teacher, I ran my sophomores through a couple of days on the virus and ongoing outbreak. In looking for accessible readings that deal with the cultural and political aspects of the West African Ebola outbreak, I’ve found Amy Maxmen’s reportage at National Geographic really interesting. In particular, I assigned excerpts from two of her articles that are worth highlighting here, if only to quote them in contrast to the Hewlett and Amola piece I linked to before about locally-rooted traditional responses in Uganda that contained the 2000 outbreak there effectively.

The first piece is from March and depicts the challenges of contact tracing in towns where people don’t want to be kept in isolation or taken to clinics from which they may not return. The second, from January, gives a thorough overview of how cultural traditions in the affected countries have enabled Ebola to spread, and outlines efforts to find culturally acceptable burial methods in order to help contain the outbreak:

In the three countries hit hardest by Ebola, preparations for burial typically are carried out by community members who handle the dead with bare hands, rather than by doctors, morticians, and funeral home directors. People were unwilling to have those practices casually tossed aside. That worked in Ebola’s favor. As death approaches, virus levels peak. Anyone who touches a droplet of sweat, blood, or saliva from someone about to die or just deceased is at high risk of contracting the disease.

To health authorities, the solution was simple. With so much at stake, science eclipses religion: Risky rituals must end.

“People were expected to go from one end of the spectrum to the other; from washing the bodies by hand, dressing them, and holding elaborate ceremonies, to having a corpse in a body bag and no goodbye,” says Fiona McLysaght, the Sierra Leone country director for a humanitarian organization called Concern Worldwide.

Of particular interest to me was the flexibility of such rituals, to which many who have done fieldwork can attest. As Paul Richards says in the article, “burial rituals were flexible… the spirits are totally practical!” The lede to the article is a story about a family that is trying to bury a pregnant woman who died – they want to remove the fetus according to tradition, but healthcare workers won’t have it. The solution? They found a ritualist who said that a reparation ritual would correct any problems caused by burying the woman without following customary rituals.

The idea of flexibility in ritual has been around for a while. Many rituals were only recent codified, and so many “requirements” and “customs” can be molded to fit what’s needed and what’s available. In my own line of work, Tim Allen’s argument that the traditionalist response to the ICC intervention in northern Uganda essentially invented universal Acholi reconciliation rituals where there hadn’t really been any before comes to mind.

Anyways, digression over. Back to Ebola.

After assigning these articles and discussing them with my students, yesterday I saw another article by Maxmen on the topic of Ebola, this time on the wide gap between money being donated to the cause and money being paid to frontline medical personnel. From Newsweek:

Hundreds, if not thousands, of nurses and other frontline staff fighting Ebola have been underpaid throughout the outbreak – and many remain so today. The lack of pay is not simply a matter of corrupt officials stealing donor money, because so-called “hazard pay” was issued through direct payments to frontline workers starting in November, then electronic payments to bank accounts and mobile phones beginning in December. The problems appear to be twofold: first, Sierra Leone’s national health system has been so underfunded for so long, that it was a monumental challenge to document all of the country’s care workers and set up payment distribution channels to them. Second, it turns out that relatively little money was set aside for local frontline staff within Sierra Leone’s health system in the first place. In fact, less than 2% of €2.9bn ($3.3bn) in donations to fight Ebola in West Africa were earmarked for them. Instead, the vast majority of money, donated from the taxpayers of the UK, the US and two-dozen other countries, went directly to Western agencies, more than 100 non-governmental organisations (NGOs), and to the UN.

[…]

When I visited Kenema Hospital in February, graffiti on one wall of the Ebola isolation area read: “Please pay us.” By then, nurse Kabba had cared for more than 420 Ebola patients, and had lost several friends. She had not received most of the €80 ($92) weekly allowance she’d been promised since September. Nurses around the country were in similar positions. “We hear about money pouring in, but it is not getting to us,” Kabba said. “People are eating the money, people who do not come here. We are pleading nationwide, we have sacrificed our lives.”

When I spoke with Kabba’s boss, District Medical Officer Mohamed Vandi, he acknowledged that his health force had been sorely neglected. “I am not hopeful for the future,” he said. As Ebola ebbed, world leaders had begun to make promises about improving fragile African health systems. Vandi looked on sceptically. “If we could not get support when the virus was here, I wonder how we could get it when the virus is gone?”

The whole article is well-worth reading, as it outlines how international agencies tried to implement payment programs isolated from corrupt government officials, but also bypassed numerous nurses. There’s also a strong critique of international NGOs’ tendency to do everything on their own rather than improve the state’s existing (and weak) healthcare infrastructure. For those studying aid, development, and public health, there’s worthwhile stuff here.

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