If you ever read Laurie Garrett’s book, The Coming Plague or saw the Hollywood movie, Hot Zone, you are already familiar with the potential horrors of highly infectious and deadly disease pandemics in our interconnected 21st century world. Scientists like Ms. Garrett have been warning us for a few decades that we are losing the war on infectious diseases and to illustrate her point she includes a detailed discussion of the Ebola virus, one of the scarier microbes out there.
If you have also been paying attention to recent news reports, you are well aware that the deadliest outbreak of the notorious Ebola virus is unfolding right now in Africa. Yesterday, the World Health Organization (WHO) released the most up-to-date body count – and tragically, it nears 900. The outbreak is so out-of-control that people across West Africa are starting to panic and tempers are flaring. A couple weeks ago, Monrovia resident Edward Deline set fire to Liberia’s Health Ministry in protest over the death of his 14-year-old brother, who recently succumbed to the virus.
Part of the reason why tempers are so hot and hysteria rampant is that there is great mistrust by many West Africans of not only foreigners (especially from the West) but also of their own local government. With threadbare trust intermingling with the stench of death, rumors and conspiracy theories are running amok through city streets and village networks, according to reports. So much so, that many people are refusing to abide by the potentially life-saving edicts of government authorities and foreign health workers.
For example, health workers are imploring people to not treat Ebola victims at home, but instead get them to the hospital or local clinic to help stem the spread of this very contagious disease. But, many people abhor the idea of surrendering sick loved ones, especially in their time of great need. Media reports abound of families refusing to hand over the ill and deceased to officials, of violent roadblocks staged by communities to halt ambulances and of spontaneous protests being held outside hospitals and clinics. Marc Poncin, emergency coordinator for medical charity Medecins Sans Frontieres in Guinea, told Reuters, “We are seeing a lot of mistrust, intimidation and hostility from part of the population.”
While this might seem nonsensical to those of us with access to excellent medical care and a reasonable trust in authorities, in West Africa on the heels of colonialism, multiple civil wars and government corruption, their decision to hide those fallen ill makes a lot of sense.
First, most clinics and even hospitals in West Africa are woefully understaffed and lacking in basic supplies, so many people have more faith in shamans and community healers than in institutionalized medicine. As Susan Shepler, a professor at American University who conducts field work in the region writes:
Hospitals in this part of the world have notoriously poor service. Families routinely have to prepare meals and bring them to patients. Families have to go to local pharmacies to buy drugs and even gloves or needles from India or Nigeria because hospital storerooms are routinely not stocked. People’s apprehensions about the failings of the healthcare system come from experience, not from ignorance.
Second, as Professor Shepler reasonably points out:
When someone has the symptoms—fever, vomiting, diarrhea—they are supposed to report to the health center, where they will be taken away from family, and if they die, be buried by men in protective gear with no family present. You can see why people might be loath to turn over their loved ones. Really who among us would want to turn a sick loved one over to a hospital staffed with foreigners, knowing we might never see them again?
Even patients who are admitted to a health facility are sometimes later freed by anxious relatives. On Facebook, Sierra Leone’s special assistant to the President, Dr. Slyvia Blyden, describes one such case:
Esteemed members of SIERRA LEONE ISSUES… Tonight, credible reports are that a suspected Ebola patient has escaped from Isolation at PCMH Cottage [Hospital], Fourah Bay Rd. in Freetown with help of her friends and family. She was reportedly admitted in isolation whilst waiting for her test results from Ebola lab in Kenema. Well, to cut a long story short, she was forcibly removed from the Isolation room and then, was put onboard an okada motorbike and whisked off to her residence somewhere in Freetown. One of the nurses on duty was seriously slapped for attempting to stop the escape.
Indeed, this reaction is completely understandable based on the fact that the Ebola victims taken away by outsiders are rarely seen again alive – or even dead. No body is returned to the family for customary burial due to the virulent nature of the disease. Loved ones just disappear. Not surprisingly, when people just disappear, rumors and conspiracy theories rapidly appear. It certainly does not help that those escorting (sometimes forcefully) loved ones away are often foreigners and covered head-to-toe in otherworldly space gear.
Recently, an angry mob numbering thousands gathered outside one of the the main Ebola treatment hospitals in Sierra Leone, threatening to burn it down and remove the patients. According to Reuters, “the protest was sparked by a former nurse who had told a crowd at a nearby fish market that Ebola was unreal and a gimmick aimed at carrying out cannibalistic rituals.” Police were forced to use tear gas to disperse the crowds.
Relatives of the ill think they are doing the right thing and it is extremely difficult to tell them otherwise. Especially, when rumors like cannibalism are spreading faster than the virus itself. However, trying to treat a relative stricken by the Ebola virus is like Russian roulette – you may or may not come out alive. This is one reason why the disease is spreading so fast.
Professor Shepler says it is not just the uneducated who mistrust their government and health care workers. She describes a conspiracy theory she heard from an educated friend in Sierra Leone:
A friend recounted a story that in one of the poor neighborhoods some group was giving vaccinations against Ebola (“But there is no vaccine,” I protest. “Doesn’t matter. People don’t know that,” he replies.) He says two babies died almost immediately after receiving the shots, and the medical team vanished afterwards, now no one knows who gave the shots. “Someone must have been poisoning the children to make it look like more Ebola deaths!” This is an unsubstantiated rumor, but the important thing is how the rumor was spread by average, even well educated, people like my friend. He said that people think it is someone in or near the government who is getting rich off of the money that is coming into the country to battle the epidemic, and wants the situation to continue to look dire.
When I sounded doubtful, my friend gave further evidence. He told me that the Chief Accountant at the Ministry of Health was preparing to make a report to the donors of how all the Ebola response money given to the government had been spent so far. The evening before the presentation he was badly beaten by thugs, and they took all the paperwork away from him and nothing else. Clearly, my friend argued, someone has something to hide!
Government officials getting rich off the aid pouring in from around the world is just one of the theories circulating among West African communities. Other rumors and conspiracy theories include:
- The disease itself was brought to Africa by white foreigners.
- Organs are being stolen from the dying and deceased to be sold on the international market.
- Ebola is a bioweapon being spread through water.
- Ebola is not a virus, but witchcraft.
- A multi-national pharmaceutical company has created a new strain of Ebola in order to financially benefit from the magic bullet cure they have also created.
- Corpses are being wrapped in plastic bags unseen to the public because body parts have been removed for witchcraft.
- Doctors are intentionally infecting West Africans with the virus so they can test experimental drugs on unsuspecting victims.
- Ebola is really caused by an evil snake that if you look at it, you will die (before you scoff, the virus magnified really does look snake-like – see below).
Jon Lee, author of “An Epidemic of Rumors: How Stories Shape Our Perception of Disease” studies the folklore, rumors and conspiracy theories that rage along side various disease outbreaks. He examines not only at the affected groups but also how the news media narrates the story. He argues that these rumors do not start maliciously in an effort to spread the disease or undermine outsiders, yet the rumors can easily exacerbate the situation. Benjamin Radford elaborates on Discover Online: “they [the stories] emerge from people trying to make sense of the death that’s going on around them – and a misunderstanding of science. Standard Western medical procedures designed to stop the spread of the virus — something as simple as strangers sealing a deceased victim’s body in plastic and taking it away to be examined or buried in isolation – conflict with traditional customs and practices.” And are also very scary.
Consequently, managing Ebola only from a medical perspective will only go so far. As any Medical Anthropology student knows, local rumors and conspiracy theories must be addressed in a deadly outbreak such as this, regardless of how outlandish and outrageous as they might be. Arguably, one of the best ways to do so, is to treat people with the respect they deserve, whether rural or urban, educated or uneducated – and to understand that many of the rumors do often embody a thread of truth.
Furthermore, contempt is not easily disguised and the current discourse inside and outside of West Africa is that ignorant rural people are the biggest part of the problem. International aid agencies along with local government agencies must see the people of West Africa as intelligent partners, not ignorant enemies, in combating this deadly disease.
CDC spokesman Stephan Monroe admits that ”there’s a fair amount of distrust in the government in general and of the messages that are being delivered. What we’re focusing on now is trying to identify in each one of the communities that are affected by this outbreak the trusted source — whether it be a village elder or a religious leader — somebody who we can work with to teach them first what the appropriate messages are, so that people can then accept the messages.”
Melissa Leach, who has spent a good part of her career in West Africa, says this is the right approach, “Education is important, but needs to be undertaken sensitively and involving trusted local figures. The cultural practices that outbreak control teams try to modify — especially those involved with funerals and burial — lie at the heart of local social life. Challenges to these practices are also challenges to local society and authority — so, understandably resented.”
Hopefully, now that West African governments along with international aid teams have done some soul-seaching about what they have done wrong in spite of trying to do right during the past four months of this pandemic, they can partner with the very people being most ravaged and together claim victory not only over fear and mistrust, but also most importantly, the virus itself.
* Photo above of Dr. Kent Brantly treating an Ebola patient was taken by Samaritan’s Purse, one of the international aid groups on the front lines. A few weeks after this photo was taken of Dr. Brantly, he came down with the disease himself. He is currently fighting for his own life as the virus rages on in West Africa.