Re: Why Anthropologists Join An Ebola Outbreak Team
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Ebola: Anthropologists key component of the response
The management of Ebola outbreak in Guinea provides a perfect illustration of the situation. When the epidemic was declared in March, the attitude of the local population fluctuated between disbelief and suspicion.
On one hand, there were those who did not believe at all in the existence of Ebola.
On the other, there were those who were convinced that if it was real, the disease had been imported by the agents of humanitarian organizations operating there, hence the great distrust fueled toward Doctors Without Borders (MSF ) and the World Health Organization (WHO).
This distrust in turn transformed into resistance, source of many incidents between the public and non-governmental organizations.
Marc Poncin, biologist at Doctors Without Borders, explained to SciDev.Net that in Conakry, the capital, "families have concealed patients and in some villages, people are resisting and prevent humanitarian organizations to do their work. The contamination has thus continued in communities and because control measures have not been implemented, it has contributed to the resurgence of the epidemic. "
Resistance
This observation is confirmed by Amadou Sall, scientific director of the Pasteur Institute of Dakar, for whom "one of the main problems is the cooperation of the communities."
"When people do not cooperate and we can not identify patients or their contacts, transmission chains are perpetuated and this is done in total unawareness from teams charged to monitor the epidemic," said Amadou Sall.
Faced with this situation, international organizations operating in Guinea had to call to anthropologists in the sub-region, to encourage people to cooperate to stem the epidemic.
Sylvain Landry Faye, head of the sociology department at the University Cheikh Anta Diop in Dakar and health anthropologist , is part of the group of experts who support the medical personnel in the field.
"When we talk about Ebola, we talk about disease and disease has often been considered to fall within the medical specialty," he said in an interview with SciDev.Net.
"However, the researcher believes that if the disease is an absence of a moral, physical and social well-being, then from that point of view it is a question of humanity and society and anthropology has a fundamental role to play in this context. "
Sylvain Landry Faye notes, in support of his argument that "doctors have always referred to the disease in a medical paradigm, taking care of viruses, prions, sick body and but not individuals."
He said the medical failures helped to realize that people suffer with their families, their societies and their cultures and the healing therefore falls not only to the physical organ affected.
Social metaphor
For Sylvain Landry Faye, the disease is a "social metaphor"; it "involves a society and a culture, and if we want to manage it, these parameters must be taken into account," hence the important role played by the anthropologist, specializing in issues associated with society and culture.
Regarding the case of Guinea, although medical teams knew exactly what was to be done to help the people, Sylvain Landry Faye notes that the implementation of their response plan was met with a poor collaboration of communities.
"The teams were beaten, humanitarian NGOs have died and have not been able to go to the villages to implement the protocols."
"Our tool is understanding the dynamics and logic of communities to help medical teams to adapt their practices to the socio-cultural realities."
The fact is that the transmission of Ebola virus is not understood as a biological phenomenon in rural areas of the country, where traditional beliefs, including witchcraft, take precedence over scientific facts.
In addition, the low literacy rate in Guinea, in the order of 25%, and inadequate information channels play an unfavorable role in efforts to fight against the epidemic.
Thus, SMS messages relayed repeatedly in the population have at a time circulated a rumor that a Guinean researcher based in Senegal had developed a cure against Ebola, based on hot chocolate, milk, sugar and onions.
It did not take long for these products to become scarce in a few hours in some shops in the country, including the capital, Conakry ...
Anthropologists have a specific mandate to play a role as educators, mediators and facilitators for the population to allow a flexible implementation of the response plan.
"As part of the management of the Ebola outbreak, we talk about death, contamination, soiling, funeral rites, we are talking about mankind and society", explains Professor Faye.
The role of anthropologists in controlling the Ebola epidemic in Guinea today is so crucial that they are seen as a central element of the response, to the extent that without their intervention, the medical staff would struggle to do his work.
"We had reached a situation where people would not listen to anything we told them", explains Sylvain Landry Faye.
In such a difficult context, anthropologists are responsible for making recommendations to find a balance between the fear and resistance of the population and the need to control the epidemic.
Mediation
That is how they recommended to medical staff to give up the name of "isolation center" to refer to reception centers for patients preferring the more reassuring name of "treatment center."
According to Amadou Sall, of the Pasteur Institute of Dakar, "treatment centers had become at some point, synonymous with the death chamber. Populations refused to go there, saying that when you enter, you can dont get out alive "- referring to the high mortality rate of around 90% in patients with Ebola.
Sylvain Landry Faye notes for his part additional difficulties due to local beliefs and cites several examples.
"In societies where death is accompanied by a set of traditional rituals including the preparation of the body and the summoning of spirits before the funeral, when you explain to people that they should not be touched the bodies of Ebola victims , they do not understand. From the point of view of traditions, one must submit to interrogation rites of the body to determine the cause of death, to know whether the person died of natural causes or "witchcraft" death. . "You must therefore touch the body."
Yet in this context, given the virulence of Ebola, it is recommended not to touch the dead body of the disease people.
For Professor Faye, "we are dealing here with an immutable epidemiological protocol, for reasons we understand, but we still had to find a solution to save the essentials: humain lives. ."
"In this case, anthropologists have had to initiate a discussion with the community to explain the medical risks incurred."
For Sylvain Landry Faye, the key question was: "At what price could we manage the social risk of not to bury the dead according to tradition?"
"We had to find a balance, which was at least to allow people to see the body and throw objects in the body bag before burial. This, at least, soothes the hearts and avoids contaminating populations in series. This is how the principle of secure burials was accepted. "
Another illustration of the difficulties facing response teams to contain the epidemic: after the death, a few months ago, of a pregnant woman, they were met with opposition from the populations concerning the conditions of her burial .
It should be noted that among the Kissi, in Forest Guinea, where the incident occurred, it is forbidden to bury a woman with a baby in her abdomen.
Tradition states that the fetus has to be extracted, so that the baby and mother may be buried separately.
But amid Ebola outbreak, it would have been suicidal to conduct surgery on the young woman who died , in order to separate her from her baby.
In the absence of an agreement between the medical staff and the public, the young woman could not be buried immediately and her body had begun to decompose, with the key to many health risks.
The team of anthropologists of Professor Faye intervened again to discuss with the people, understand their reluctance and find a solution.
"There is a principle in anthropology who said that every time there is a standard, there is an exception," says Faye.
"That left us only to find this exception in the specific context of the Kissi society. After discussions with village elders of the young woman, we reached an agreement. Overall, if it was impossible for one reason or another, to extract the fetus from the womb of the mother, it was necessary to sacrifice to remedy, including offerings and various ceremonies. So we asked the WHO to pay the rite of repairs and thus the burial took place. "
But the most serious incidents that required the use of mediation from anthropologists, took place in the town of Ti?kolo, in the sub-prefecture of Gu?ck?dougou where notables coming to raise awareness had been beaten by young people and where humanitarian vehicles were damaged.
Agents of MSF had also been kidnapped and sages of the sub-prefecture who accompanied them had been abused, in Kolobengou and Wabengou in the same prefecture.
Called in as reinforcements, anthropologists have provided mediation and have sought to understand the reasons for the attitude of the gang of youths.
They had in fact decided to protect themselves against Ebola by living withdraw from society and feared by their own explanations, that the sages and the humanitarian teams were coming to transmit the virus.
...
"Our job is to understand the mechanisms of these behaviors and their motivation to respond appropriately and with a sense of touch that takes into account the sensitivity of the population, but also the urgent need to put an end to the suffering caused by disease ", says Sylvain Landry Faye.
http://www.scidev.net/afrique-sub-s...thropologues-composante-cl-de-la-riposte.html
