Time to put Ebola in context - WHO

[Gert van der Hoek]

WHO

Time to put Ebola in context


Viruses that cause haemorrhagic fevers have been popularized by the media as fierce predators that threaten to devastate global populations. Professor Melissa Leach says there is much to learn from combining local and scientific knowledge in dealing with these deadly pathogens.

Courtesy of Professor Melissa Leach

Professor Melissa Leach is director of the STEPS (Social, Technological and Environmental Pathways to Sustainability) Centre and a professorial fellow at the Institute of Development Studies, Sussex, England. She has a Master of Arts in geography from the University of Cambridge and a Doctorate of Philosophy in social anthropology from the University of London. She also speaks four African languages: Mandinka and Kissi (Guinea), Mende and Krio (Sierra Leone). Over the past 25 years she has been closely involved both in ethnographic fieldwork and in research using historical, ecological and science and technological approaches. Her recent work has explored the politics of science and knowledge in policy processes linked to the environment and health, especially vaccination, medical research trials and epidemics.

A: Top-down, standardized responses and control measures have sometimes proved to be unsustainable, facing resistance from local populations. They may provoke local fears or feelings of injustice if people are restricted from moving or if they cannot bury their dead according to custom.

An example of this occurred in 2001 in Gabon, where European and American medical teams met armed resistance from local populations and had to leave. This was because villagers remembered the control measures they had used for an earlier outbreak in 1995–96 as deeply offensive.

Particularly troublesome was the prevention of customary burial practices. Sick and dead people were hidden behind tarpaulins in isolation units, which led people to suspect that their relative's body parts were being stolen. This interplayed with a broader distrust of international teams “parachuted” in from outside. To avoid such situations in future, we need to build inclusive, participatory approaches that combine local and scientific knowledge.

More:WHO


See also: Ebola: failures, flashpoints and focus

As the worst Ebola epidemic on record shows no signs of abating in West Africa, fear and ignorance are increasingly said to be playing a role in its continued spread. Meanwhile, local practices such as the consumption of bushmeat and deforestation are the go-to explanations for the epidemic's underlying causes.

However, decades of anthropological research in the region by STEPS Centre and Institute of Development Studies (IDS) researchers, indicates not only that this picture is an over-simplification, but that disease control policies based on these ideas may be unhelpful.

KNOTS - IDS

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[Gert van der Hoek]

Re: Time to put Ebola in context - WHO

Stefaan Anrys

5 augustus 2014

Mistakes in fighting Ebola repeated all over again, says pioneer

‘Médecins Sans Frontières is repeating the same mistakes from earlier Ebola outbreaks’. Prof. Barry Hewlett, the first anthropologist ever to be invited by the World Health Organization in fighting Ebola, has given an interview to the Belgian MO* Magazine.

In 2000 Barry Hewlett joined a mission to fight Ebola in Uganda. On this and other outbreaks, he wrote Ebola, Culture and Politics: The Anthropology of an Emerging Disease, a compulsory reading for medical anthropologists. In an interview with the Belgian MO* Magazine, Hewlett contends that medical teams are repeating the same mistakes all over again. With the death toll passing 700, this is the deadliest Ebola outbreak up to now.

Which major errors have been made, in your view, in fighting Ebola-outbreaks in Africa?

Barry Hewlett: Firstly the lack of culturally sensitive and appropriate control effort. There’s also a lack of incorporating local people’s knowledge into control efforts. If you take a look at my book, the problems described in all the previous outbreaks are taking place again. I am surprised that MSF-team members are not familiar with previous experiences, but I think they hire new people all the time.

During an outbreak of Marburg in Angola, mentioned in the WHO-toolkit, the family could not bury the deceased or even attend the funerals. Is this one of the biggest challenges today in West Africa?

Barry Hewlett: Read my book! People have indigenous systems that realize that it’s ok to alter burial practices during deadly outbreaks. But it is true that during any deadly outbreak, like smallpox and Spanish flu in the US, respectful burial practices are important.

The Angolan case revealed other challenges such as the little ownership of population in the disease control management.

Barry Hewlett: I see this as major issue. Local people need to be involved and take control of their own circumstances. This is as major a problem as with the current move to quarantine villages in West Africa.

Link to full article (English)

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