The Acholi people called it gemo — a bad spirit that arrived suddenly, like an ill wind — and they had strict protocols to deal with the deadly sickness that followed. Patients were quarantined at home and cared for by a gemo survivor. Two poles of elephant grass were erected outside, as a warning to other villagers to stay away. Dancing, arguing and sex were forbidden, rotten meat was to be scrupulously avoided and those recovering had to remain isolated for a lunar month. Those who succumbed were buried at the edge of the village.
It took the skills of a trailblazing anthropologist, Professor Barry Hewlett from Washington State University, to discover that the Acholi, an ethnic group in northern Uganda, had their own rather effective method of dealing with Ebola. He inveigled his way into a World Health Organisation team tackling an Ebola outbreak in 2000, furnishing the first, in-depth anthropological analysis of how communities regard this killer in their midst. Ebola may be classed as an emerging disease, but the Acholi, he found, may well have been battling it for a century.
Recently, Professor Hewlett revealed his dismay at how the current outbreaks in Guinea, Liberia and Sierra Leone were being handled by the international fraternity, whose urgent, well-meaning containment efforts were leaving scant room for the beliefs, customs and sensitivities of locals. Others in his field have voiced similar concerns. Professor Melissa Leach, from Sussex University, has pointed out that remote communities associate past epidemics with the sudden arrival of masked white foreigners bearing syringes and body bags.
Strangers in space suits came to take the blood of sick children — then the children died. Corpses were zipped up, kept behind curtains and then burnt before relatives could check that their loved ones were passing intact to the afterlife. Lurid rumours arose of a western trade in body parts; efforts at disinfecting villages were misconstrued as deliberate contamination.
Cultural norms
Such misunderstandings explain why Ebola containment teams, lacking the peace offering of a cure, have been met with hostility — and worse. Tragically, eight health care workers, officials and journalists were murdered a fortnight ago in Guinea, their bodies thrown into a septic tank. Even when outsiders are welcomed, a slender grasp of cultural norms can lead to perilous knowledge gaps. The Acholi, for example, refer to certain cousins on the father’s side as “brothers”, a factor that is crucial to tracing contacts of the infected. Meanwhile, the epidemic grinds on in exponential abandon, thriving in the chaos caused by panic, fear, shattered domestic health infrastructure and a laggardly international response. The number of cases is expected to surpass a million by the end of this year.
We have now reached a point where it is very hard to envisage every infected person — at least those in the three most ravaged countries — being treated solely in hospitals or clinics.
While the first response has understandably focused on the scientific, social engagement now needs to be stepped up. Containment will rely on securing the goodwill of terrified communities; indigenous healers, sometimes labelled witch doctors, may need to be courted for their influence rather than sidelined for their superstitions.
This social dimension is especially important as the likelihood of military involvement ramps up. It is becoming clear that only armies have the logistical capability of erecting field hospitals at anywhere near the rate that patients are filling them. If medics in space suits inspire dread, then imagine the fear stoked by the arrival of foreigners with guns. We must hope that medical anthropologists, an unseen and un-heralded battalion in disease containment, will now make the difference as we try to chase away the gemo.
— Financial Times
Anjana Ahuja is a science commentator.
