“The gas coming from the healthcare worker’s truck is exterminating our entire village.” “Our village is being punished by a witch’s curse.” “The government has made up this disease so that we go to hospitals, where they will inject poison into us.” Believe it or not, these statements are not just shouted at crowds by radical local leaders and witchdoctors; they are deep-seated beliefs held by the majority of the population in Liberia, West Africa, and Sierra Leone, where the deadliest Ebola outbreak in history is occurring.
Ebola viral disease (EVD), which kills 9 out of 10 people it affects, is initially transmitted from wild animals, fruit bats, the primates, or the natural host. However, the vomiting, diarrhea, and intense weakness, among other symptoms, are easily mistaken for a slew of other illnesses prevalent in Africa such as malaria and typhoid fever, making identification of EVD exceptionally difficult. Additionally, the incubation period, or the time interval from infection to display of symptoms, is 2 to 21 days, worsening the already problematic struggle to quarantine affected individuals. A greater mobilization of the population, due to an increase in industrialization, becomes an uncontrollable hazard in transmission of contagious diseases. This is, in part, the reason for Ebola’s rapid spread. The main cause, however, is the region’s cultural beliefs, rituals, and stigmas.
Although the Ebola virus, transmitted through direct or indirect contact with blood, secretions, or bodily fluids of an affected individual, is not particularly easy to spread, the population’s ignorance about the virus and absolute adherence to their cultural beliefs heightens its effect. The rural habit of consuming uncooked or partially cooked meat and burial rituals involving direct contact with the deceased are two customs that pose the greatest threat in terms of transmission. People are also unlikely to seek treatment in these regions: not only does the society mistrust outside help, largely due to their entrenched and relentless suspicion of their governments, but there is also a familial duty to care for a family’s sick members. However, some villages attach a stigma to sick individuals, which causes these individuals to escape to other villages or urban areas and spread the virus to these new areas.
Every tradition, however dissimilar, that causes harm to the individual’s health and well-being can be reduced to one word: mistrust. When foreign doctors and charity workers attempt to convert villagers into Westerners, using unfamiliar language, wearing strange clothing, and bringing their slightly offensive norms, the villagers only despise the Westerners more. The villages fail to trust the authority of the Western healthcare workers, so there is no chance that the population will be receptive to the radio shows and images set forth by these organizations. Unable to physically see the Ebola virus using their family members as hosts, they have an extremely difficult time adapting to the ideas of modern medicine. How can a villager, versed in the jargon of magical remedies and evil presences, be expected to understand that a non-living entity inserts its DNA into a host cell to be replicated, when they have not even learned the basics of the scientific method? Expectedly and understandably, they, instead of believing in and trying to understand the completely foreign ideas of strangers, turn to their village leaders and local healers, who perpetuate their provincial mindset. And while we, dangerously approaching the identification of “humanitarian colonists,” try to impose our Western culture on these underdeveloped societies, their members only respond violently to our efforts. In April, a crowd attacked a Doctors Without Borders clinic in Guinea, and the Red Cross operations in a certain Guinean town were suspended due to gang threats. As Dr. Peter Piot, the scientist who first discovered the Ebola virus, stated, “fear of the virus, and the lack of trust in the government, in the health system, is as bad as the actual virus.” And this overwhelming fear, although highlighted and intensified by the Ebola outbreak, is most certainly not exclusive to it.
It is extremely frustrating to healthcare workers and officials, already coping with the obstacles that the disease itself presents, contend with ingrained beliefs and an age-old mistrust of outside authority. This seems to be the crux of the problem in global health: how do we justify aiding a population when they so vehemently oppose it? Of course, in cases of extreme outbreaks, we cannot simply, as a global community, allow the inept and corrupt governments of the region deal with the problem themselves. Recently, an emergency meeting of eleven West African states was called to deal with the EVD issue. Several precautions have been taken to prevent the spread of this disease, including Ugandan screening of travelers, better reporting of cases, a sub-regional control center of the World Health Organization in Guinea, and an effort to increase awareness among the population. Meetings like these – although they mostly treat the symptoms rather than solve the problem itself – are largely beneficial and effective.
However, we have the mentality that any help, even if it is from inexperienced undergraduates who have not even entered medical school, is entirely beneficial. This is not necessarily true. There have been several cases of first-year medical students performing Caesarean sections for the first time on pregnant women in third world countries and of NGOs leaving areas worse than they found it, teasing the natives with the wonder of modern medicine without the ability to provide these resources. Also, many organizations, including Doctors Without Borders, focus primarily on the immediate need for alleviation of suffering and neglect the long-term issues of poor infrastructure, corruption, and lack of education. As global citizens, we are responsible for the sustainable growth and betterment of less fortunate societies while still preserving their cultural identity. For example, in the case of the recent Ebola outbreak, the most effective way that doctors developed confidence in the system was actually by accepting the native way. Instead of trying to force treatment and simply knitting their eyebrows at the society’s refusal to take help, some healthcare workers gave items like soap and chlorine as precautionary measures. It is relatively easy to find individuals willing to teach the science behind Ebola and benefits of modern medicine, but the true obstacle is overcoming the hostility of the natives. However, by giving respect to a population’s customs and local leaders, we gradually knock down the barriers and move away from our perceived alien identity. After gaining societal trust, these organizations can then begin to repair defunct aspects of the area while maintaining their respect for the local traditions and culture.
Ebola Epidemic: Global Responsibility? Perf. Mike Hanna, Dr. Michel Van Herp, Dr. Ben Neuman. Aljazeera News, 4 July 2014. Web. 8 July 2014.
“Ebola Virus Disease.” WHO. WHO, Apr. 2014. Web. 07 July 2014.
Elgot, Jessica. “Africa Needs More Than A Witch Doctor To Stop ‘Out Of Control’ Ebola Outbreak.” The Huffington Post UK. AOL (UK), 7 Apr. 2014. Web. 08 July 2014.
“West Africa Can’t Manage the Ebola Outbreak.” Washington Post. The Washington Post, 29 June 2014. Web. 05 July 2014.