User:LBird BASc/sandbox/ATK/Seminar7/Jorge.Jana.Thomas

Introduction

The Ebola Virus Disease (EVD), first discovered in 1976 after outbreaks in the DRC and Sudan, has been responsible for many deadly epidemics with mortality rates as high as 90%. December 2013 marked the beginning of the largest West African Ebola epidemic in history, more specifically, in Liberia, Guinea, Mali, Sierra Leon, Nigeria and Senegal. (https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.html) The epidemic had devastating social, political and economic impacts on the countries concerned, destroying their healthcare systems and their often fragile post-civil war economies. The epidemic's duration and its important number of deaths (11,323 recorded in October 2015 and a total of 28 646 cases https://www.theguardian.com/world/2014/sep/25/-sp-ebola-crisis-briefing) cause us to question the methods used to resolve the outbreak. Different disciplines are relevant when studying an epidemic. The medical and biological sciences are needed to give a positive scientific explanation of the origin of the disease and expand research into finding a potential cure. In this perspective, medicine has historically been the primary response to EVD. Social considerations are also crucial because it is essential to understand the social practices causing the epidemic and preventing the full eradication of the disease in a given community. Hence, it is vital to integrate anthropological and sociological perspectives when treating EVD outbreaks. However, the history of these different disciplines poses an issue in treating Ebola. The scientific procedure has historically taken precedence over other approaches. This article will, therefore, explore different disciplinary approaches to the 2013-2016 Ebola epidemic and illustrate how an interdisciplinary approach would have been most beneficial and should be implemented to tackle current outbreaks such as the DRC Ebola pandemic, declared so on 1 August 2018 (https://www.who.int/emergencies/diseases/ebola/drc-2019). The social and cultural dynamics of the epidemic at the local, national and international level must be better understood to improve responses to potential future outbreaks.

condensed version:

The first outbreaks of the Ebola virus were in 1976 in the DRC and Sudan and subsequent epidemics reached death rates of 90%, between 2013 and 2016 in West Africa specifically Liberia, Guinea, Mali, Sierra Leon, Nigeria and Senegal. The epidemic had devastating social, political impacts on the countries’ economies and healthcare systems. The death toll, 11,323 in October 2015 https://www.theguardian.com/world/2014/sep/25/-sp-ebola-crisis-briefing) causes us to question methods used to end the outbreak. Medical and biological sciences are needed to explain the origin of diseases. Understanding cultural practices preventing disease eradication in a community requires an anthropological approach. However, the history of these different disciplines is problematic in tackling the crisis. Scientific procedure tends to take precedence. We will therefore explore different disciplinary approaches to the 2013-2016 Ebola crisis, illustrating the benefits of interdisciplinary thinking.

Biology and Virology

Ebola is one of the most virulent pathogens within the haemorrhagic fevers. The virus spreads through contact with bodily fluids, which makes the risk of contamination very high and puts health workers at risk. The incubation period is 21 days, during which the sufferer may inadvertently propagate the transmission chain. However, the risk of transmission is relatively low until symptoms develop. Symptoms are similar to other diseases found in West Africa such as malaria, Lassa fever and typhoid which results in frequent misdiagnosis.

Its genome consists of non-segmented, negative-sense, and single-stranded RNA molecule. The virus that caused the epidemic, Zaire Ebolavirus (ZEBOV), and four other species of EVs (BDBV, EBOV, RESTV, TAFV and SUDV) constitute the genus Ebolavirus of the Filoviridae family. (https://www.ncbi.nlm.nih.gov/pubmed/25694096). After contagion, the virus targets (trough the release of a vision) dendritic cells responsible for the antigen-mediated specific immune response and the activation of T-lymphocytes (memory, killer and cytotoxic). In a study published by Cell Host & Microbe, research found that the VP24 protein on Ebola competitively inhibits the activation and production of antibodies. The virus replicated uncontrollably in host cells and causes the inhibition of interferon protein, rendering a defective/impaired immune system. (https://www.sciencemag.org/news/2014/08/what-does-ebola-actually-do). The toxins released trigger inflammatory signalling proteins and nitric oxide, which damage the endothelial lining of blood vessels, causing repeated coagulation and reducing blood supply to organs. Inflammatory mediators and the loss of support signals from dendritic cells hinder adaptive immunity due to apoptosis of infected cells. (https://www.longdom.org/open-access/ebola-virus-disease-a-biological-and-epidemiological-perspective-of-avirulent-virus-jidd-1000103.pdf). The immune system is compromised, which often results in fatal organ failure.

The rVSV-ZEBOV vaccine, developed in 2016, was found to be 70-100% effective and has been administered to more than 100, 000 people as of 2019.

Responses

1. Medical

The main objectives of medical groups that were implemented are summarised by the Pacific Journal of Medical Sciences "to provide information about the causative agent of the Ebola pandemic and present the views of experts about the complexity and challenges of dealing with this highly pathogenic virus". (https://journals.sagepub.com/doi/full/10.1177/0049085717743832). In this case, the primary aim of medical practitioners was to interrupt chains of transmission by rapidly isolating and quarantining patients. (https://www.who.int/csr/disease/ebola/one-year-report/factors/en/). The EVD response, like much of contemporary medicine, unequivocally privileged the health system experts, natural scientists and often overlooked the social relations and constructs important in other perspectives. These responses included enforced quarantines (from observational temporal quarantine to guarded home confinement), movement prohibition, imposed testing, traveller test points, and mandated cremation, which all contributed to the increased condemnation by the community as well as creating serious socio-economic distress (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4674104/). Medics' sublime messages that the disease was seriously contagious, whilst intending to promote protective behaviours, bore the opposite effect. Leading to mistrust, fear and mass hysteria within the local community. In Liberia, this was linked to the development of clandestine family rituals and burials that avoided the vehemently stigmatised disease. (https://www.who.int/csr/disease/ebola/one-year-report/factors/en/) (https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3071-4#ref-CR4)

Western medicine, often imposed by neoliberal policies, has throughout history delegitimised African social relations and unfairly branded them as superstitious. Consequently, there were numerous cases in which western medical experts were viewed as being the ones propagating the disease. To overcome such a mismatch of expertise, the medical system must turn to anthropologists to fully understand the underlying cultural realities and not just empirically scratch the surface of the problem through the high individualist approach.  (https://journals.sagepub.com/doi/full/10.1177/0049085717743832). Amid the outbreak, the consequential high status placed on health systems and their methods resulted in the deflection of attention from social alienation and family pressures. Many of the communities leaders, drew similarities to colonial responses, which continuously fails to prioritise social ties and does not account for the complex diversity of African societies. Thus, this slowed down the containment of EVD (https://journals.sagepub.com/doi/full/10.1177/0049085717743832).

At the time of the outbreak, there were no approved drugs to treat EVD the only care possible was supportive. Finding a cure was not the main objective of the doctors deployed in the area so much as using treatment centres are elaborate isolation places to disrupt contagion chains, an approach justified by the fact that quick action is perceived to be the most effective way of avoiding the risk of an epidemic.

condensed:

The primary aim of medical practitioners was to interrupt transmission chains by quarantining patients. The EVD response, privileged the work of scientists often overlooking social and cultural factors. The medical responses included enforced quarantines, movement prohibition, imposed testing, traveller test points, and mandated cremation. This created stigmatization by the community as well as creating serious socio-economic distress. Medical practitioners used IgM ELISA tests, RT-PCR tests, biopsy samples and viral cultures in definitive diagnosis. To this day, there are no approved treatments to treat EVD the only care possible was supportive. The CDC recommended: oral rehydration therapy (balancing electrolytes), intravenous fluids, oxygen therapy, treating other infections if they occurred, and disinfecting surfaces with (>70%) alcohol wipes. Conventional medicine was used to aid the symptoms (blood pressure, reduce vomiting, diarrhoea, fever and pain). Experimental treatment included the use of immune serums, antiviral drugs and possible blood transfusions. The doctors deployed in the infected areas main objective was to provide relief by setting up treatment and isolation centres rather than the search for a cure. Putting an end to the spread of the virus was the main concern meaning that medical action was often unquestioned. The medical approach was highly individualistic, meaning only the patient and the disease mattered and not the community or family. However, an anthropological perspective was needed for health workers to understand the important cultural dynamics sometimes prohibiting the containment of EVD.

2. Anthropological approach

An epidemic is defined as “a widespread occurrence of an infectious disease in a community at a particular time” (ref: Oxford English Dictionary). By this we understand that the study of the “community” involved plays a central role in the resolution of an epidemic. Anthropological research illustrates that social and cultural factors contributed to the biological transmission of the Ebola virus and interfered with the medical response to the 2013 epidemic in West Africa. Many of the countries touched by this epidemic suffer from poverty, and economies destroyed by wars (Guinea, Liberia, Sierra Leone were involved in recent civil wars) which account for deficient health care systems and a lack of physicians. The impact of these factors on health is reflected in the low life expectancy rates in these countries (for example it is of 59 years in Guinea) (ref: https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC5953523/). Consequently, isolation of patients, public alerts and calls for help were delayed or ineffective increasing the number of the contaminated. (ref: https://www.who.int/csr/disease/ebola/one-year-report/factors/en/).

Understanding cultural practices in the infected regions is also central to the effective treatment of the outbreak. One of the main problems in dealing with the EVD epidemic was the cultural conflicts between health practitioners and locals. A retrospective analysis of the beginning of the outbreak done by the WHO showed that locals feared the virus and its treatment which opposed traditional practices in dealing with the dying and the deceased. (ref: https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC5953523/ )Ancestral funeral rites such as sleeping next to an infectious deceased member of the community and bathing in water used to rinse the corpses were responsible for cases of virus transmission. In Sierra Leon the WHO estimates that 80% of cases were linked to such rites (ref: https://www.who.int/csr/disease/ebola/one-year-report/factors/en/). The danger of these unsafe burials and the fear of the disease created stigmatization of the infected which led their families to hide them resulting in the contamination of whole households. Furthermore, the tradition of returning to one’s native village to die meant infectious patients travelled, thus further increasing transmission risks. (ref: https://www.who.int/csr/disease/ebola/one-year-report/factors/en/). Fear of health workers was another barrier to the eradication of the Ebola virus in the region. In Guinea in August 2014, rumours that health workers disinfecting a market were contaminating people led to riots. This proves that health care responses only work if there is communication and understanding between medical practitioners and the natives. (https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3071-4#ref-CR4) Moreover, a post-colonial approach to the outbreak associates the western response as an extension of imperialistic thinking which justifies intervention with disregard to customs. The locals' apprehension to Western medicine is often seen by doctors as backwards tradition and the work of well-respected African healers is often disregarded. This lack of acceptance stems from insufficient cultural awareness (ref: Gibson, N.C. (2003) Fanon: The postcolonial imagination. Cambridge: Polity Pres). Anthropological research makes it clear that biology does not provide a complete explanation for the EVD epidemic. An anthropological approach to treatment is needed in order to provide accepted aid to contaminated areas.

2. Psychological approach

EVD entails psychological effects at individual, community and international levels (ref: https://www.who.int/bulletin/volumes/94/3/15-158543/en/). Patients experience the trauma of deadly illness, extreme physical pain, isolation and stigmatization. In addition to this, survivors suffer from “post-Ebola syndrome” which includes neuropsychological problems and symptoms related to traumatic stress disorder. (ref: https://aricjournal.biomedcentral.com/articles/10.1186/s13756-016-0112-9). Reintegrating the community after quarantine also poses psychological hardship on both sides. Ebola survivors face ostracization as people still fear they are infectious. They sometimes return to abandoned villages and must face the death of family and friends. The Ebola outbreak also takes a psychological toll on communities as they must learn to rebuild after the loss of many members and the experience of prolonged distress. Health workers also need support to maintain their mental wellbeing whilst being exposed to death and fear. The countries the most affected by the epidemic did not have the resources to provide psychological rehabilitation which can partly explain the gravity of the outbreak. (ref: https://aricjournal.biomedcentral.com/articles/10.1186/s13756-016-0112-9 ). Therefore, psychologists are necessary regarding the EVD epidemic and its consequences. Medicine historically does not always leave place to psychology as it is seen as a “pseudo-science”, not as important in understanding an individual's health. However, the Ebola crisis depicts the necessity for interdisciplinary work as it requires psychologists and physicians.

research

Anthropological:

The World Trade Organisation states that they were, occasionally, met with violence and from a fearful population. Fear, and the hostility that it can derive, lead fleeing surveillance systems, regular testing and families hiding symptomatic relatives. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5953523/) (https://www.who.int/csr/disease/ebola/overview-august-2014/en/)

Unsafe burials. Anthropologists quickly identified the fact that how quickly the virus spread once it moved into urban settings and densely populated areas, which occurred in the capitals of the main three countries. They represented the epicentres of intense virus transmission. (https://www.who.int/csr/disease/ebola/one-year-report/factors/en/)

Anthropologists asserted that the traditional custom of ancestral burial, which is deeply rooted in many rural communities in Western Africa carries a especially high transmission risk. According to Guinea’s Ministry of Health and the WHO, the disregard of ancestral funeral rites was linked to around 60% and 80% of cases respectively (women, being the most common care-givers in many of these communities, were disproportionally affected). In many tribes, socially prominent members traditionally sleep near corpse for several nights in hope that this allows for the transfer of power between family members. This significantly increased the risk of transmission. (https://www.who.int/csr/disease/ebola/one-year-report/factors/en/)

The high mortality rates created the perception that health clinics and hospitals were linked to contagion and subsequently death. Stigmatisation of the disease by the media, lead in many cases to societal impacts linked to stigma and discrimination: the hiding of patients in family homes, secret traditional burials in order to avoid ostracism by the community. https://www.who.int/csr/disease/ebola/one-year-report/factors/en/

This stigmatisation prevented many sufferers from visiting clinics when experiencing early symptoms. There was intensive community resistance and rebuttal towards foreign physicians, which led to clandestine contact with the deceased, surrounded by social, religious, political and cultural conflicts. The conflict was exacerbated by community healers who preached against the use of westernised medicine, while many denied the western allegations that the origin of the virus was their ancestral home. (with special regard to Guinea)  (https://www.sciencedirect.com/science/article/pii/S2212109917300602)

Anthropologists argued that it is important to implement (known as CARE model) a protocol that aims maintaining culture beliefs and customs (including time for praying, singing and dancing rites when a community members is taken away) while allowing for the detailed description of risks associated with bodily contact. (https://aricjournal.biomedcentral.com/articles/10.1186/s13756-016-0112-9)

When in April 2014, a group of medics were deployed in an area of Guinea with almost 100% rate of mortality. Rumours that the MSF were the cause of the transmission of EVD, an anti-MSF demonstrated was subsequently planned. However, when an anthropologists intervened and urged community leaders to sensitise the population the central local governments leaders cancelled such demonstration. A clear example of how , escpecailly in rural areas, interdisciplinary teams of medics, anthropologists and sociologists must be constituted. (https://aricjournal.biomedcentral.com/articles/10.1186/s13756-016-0112-9)

Anthropologists aims, in contrast, were to establish confidence in the medical interventionists and hospitals by facilitating and implementing training for health workers. A Combination of health workers listening to the public’s concerns is needed.

Political/Sociological / Economical:

Global media multinationals intensified the stigmatisation and marginalisation of those linked with the outbreak. ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5953523/)

Sociologists draw a connection between the western medical interventional in modern Africa and police force and colonial suppression, which have led to the rejection of such practices by the communities. Heavily focused on individual exclusion and clinical facets of the person in question and failing to regard the consequences on the collective. Indeed, this may have lead to the international conclusion that western medical practice is superior and a complete disintegration of traditional African medicine. This gave rise to an unwillingness to comply with foreigners’ medical advice, infrequent visits to clinics and occasionally conflicting/ violent attitudes/tension towards international aid in many rural commmunties.

(In A Dying Colonialism, especially in the chapter on ‘Medicine and Colonialism’ (pp. 121–146), Fanon (1965b) (https://journals.sagepub.com/doi/full/10.1177/0049085717743832

Psychology:

The three countries most affected by the EVD outbreak had almost not psychologists with the necessary training to tackle the continued treatment and rehabilitation of the survivors.

->role that psychological considerations play in the treatment of sicknesses, not only a biological medical perspective needed but others also. issue of history here: a medic may not take the point of view of a psychologist as seriously here because historically, psychology has been seen as a "soft science" or "pseudoscience" whereas medicine is a "hard science". This differentiation between sciences and approaches to knowledge creates a clash between disciplines needing resolution through interdisciplinary.

Theological perspective:

Due to the distinct paradigms of burial in biomedicine and theology, especially when biomedicine was largely developed in the global west, continents away from West Africa, a burial entails very distinct meanings in the disciplines. In biomedicine strongholds such as Western Europe, it is widely believed that contact with the infected, dead or alive, could spread epidemics, thus it is accepted and legally institutionalised that theological rituals comes second to disease quarrantine.

By contrast, African theological teachings presents itself as a window for insights into ailments. Per many West African religious beliefs, burials are an opportunity to inquire the cause of one’s death, the occasion for the deceased to pass onto the afterlife, and to join their ancestors; whereas failure would lead to the dead’s spirits taunting loved ones while lingering in the living realm, and correct rituals would turn the deceased into an ancestor that overlooks and protects the family. Thus, theological procedures to contact the deceased’s body are strictly adhered to. Bodies were cleansed and foetuses were removed for burial to uphold natural cycles and ensure the wellbeing of the living and the dead.

Since the meaning of burial diverges in biomedicine and West African theology, disagreements over how burials should be performed have arisen during the outbreak. In Guinea, this led to an incident where the burial was brought to a standstill, amidst disagreements between a Kissi family and the medical team on how the corpse should be handled. The body rotted as the dispute carries on, which risked further infections upon leakage.

Meanwhile, another team in Guinea substituted an old repatriation ritual for the foetus’ removal, and successfully buried the pregnant body to everybody involved’s satisfaction. This underpins the importance of theology in complementing biomedicine to understand, manage, and quell epidemics like ebola in West Africa.

Conclusion:

condensed:

The understanding of the 2013-2016 Ebola epidemic requires the attention of anthropologists, psychologists, physicians, biologists and many other discipline experts. It is an interdisciplinary issue. However, medical science dominates the response to the outbreak, often ignoring local customs which results in increased contamination and cultural conflicts (such as riots). This problem stems from an issue in the history of disciplines. Traditionally, disciplines have been separate, confined by their own language and boundaries (as we can see here, the anthropological approach does not explain the epidemic in the same way as the medical response does). The specialization of these disciplines is important to handling the outbreak (medicine is needed on its own to some extent in order to actually treat the patients). However, a mutual understanding between disciplines of the respective structures of one another is required in order to have respond in an effective interdisciplinary way to potential future EVD epidemic. There is a lack of awareness of local customs and social factors which contribute to the transmission of the virus in the medical response to the Ebola epidemic. Intervention must be more culturally sensitive, this can be achieved by health workers and social scientists working together.

A multimodal strategy that is rooted in local history and considers social customs is needed in the future, in order to reach a compromise between the needs of the local and healthcare priorities.  It is clear that the epidemic readiness must be addressed trough the strengthening of health systems both at community, national and international scopes. Undoubtedly, there is a strong lack of culturally sensitive approaches to medical intervention. Must be branded as response as supposed to intrusive intervention, designed and delivered by social scientists and medical professional working interdisciplinarity in social mobilisation and cooperation. There is a need for increased cultural congruence of the response in order to empower the local communities, vital for the success at containing future epidemics. A more interrogated and holistic approach is needed in order to better incorporate African practices into outbreak response. Response should extend beyond the health system to probing social complications which lie outside the medical field.

There is increasing recognition of the need for interdisciplinary research to examine the social dimensions of the epidemic, the policy response to it, the communities’ reactions to the repsonde and how these factors intersected with the biological transmission of the virus, physical containment measures and community medical treatment. Indentify response gaps and proirities from the perspectives of different groups – men, women, community leaders, health practitioners, traditional healers, and local and national government stakeholders.

Anthropological perspective: We can link the two anthropological sides together to make one based on the importance of understanding cultural practices in the treatment of ebola and the containment of the outbreak. In this perspective the exploration of the issue of history is interesting because we can discuss post-colonial theory (link with sociology) which is important to consider in the study of social sciences because it is part of its historical approach to knowledge. Post-colonial theory: study of cultural legacy of colonialism and imperialism, focusing on the human consequences of the control and exploitation of colonized people and their lands. ->Post-colonial theory is a critical theory (cf. quote Gandhi), it is written as a opposition to the empire 's episteme. The colonial considerations pivotal in the outbreak of ebola create an issue because they are often not taken into consideration by medical practitioner (cf. this is where we can use this article), and that is why interdisciplinary work is needed.

Conclusion

The 2013-2016 Ebola epidemic captured the attention of the world by storm, and many experts in a diverse range of disciplines sprang into West Africa’s aid. Each of these disciplines valiantly contributed to quelling the outbreak; with medics leading the charge in handling the majority of physical symptoms, while anthropologists liaised with communities, and religious leaders assuming leadership and encouraging cooperation.

Unfortunately, due to the complex lexicon, disciplinary boundaries, and historical paradigms behind these disciplines; their ideas diverge on many seemingly intuitive concepts such as burials and epidemics, and were unable to communicate with one another effectively. An interdisciplinary approach that bridges the wealth of knowledge between each discipline in their interpretation of treatment, healing, and well being, could converge the efforts of each discipline with synergetic effects.

Further disciplines may also be included in the epidemic-quelling efforts, such as mathematical models of disease transmission, governance theories of public healthcare, and psychological perspectives on trauma. While keeping in mind that each of these disciplines have developed their own metrics and criteria for what a good approach is, coherence could be achieved between these knowledge frameworks so long as their differences are consciously reconciled.

The failure to contain the Outbreak was staggering and the consequences were dire. Yet, despite humanity’s millennia long struggle against epidemics, it has let yet another one slip, and bore the consequences.

To combat such catastrophe, the medical field has a well established procedure of isolating patients with any potentially contagious diseases, and thereby preventing the spread of viral illnesses. Yet while this has worked rather well in most of the Global North, it has not necessarily had the same effect in the Global South. Eugenics aside, most disciplines agree all humans are nearly biologically identical, and no amount of variation in immunity could explain the geographic range of large disease outbreaks being confined to the Global South. *quote on disease does not care about wealth* Clearly, Medicine does not represent the full picture in this scenario, and it is worth bringing in some perspectives from the Humanities to explain the discrepancy.

From a Governance point of view, D.R. Congo’s civil war between 1996-2003 stands out as the period around which public expenditure in healthcare has dwindled to the point where it has become a source of government revenue. 40% of medical costs were borne out of families in 2011, and this money is funnelled into government coffers and hands of corrupt officials. Such a setup likely bred skeptical sentiments of the medical system, which, by extension, fuelled distrust between patients and medical workers.

Moreover, since the authorities left a gaping hole in the country’s medical system that remains to be filled, humanitarian donors came to the rescue with NGOs that focuses on short-term deliverable results, leading to a severe duplication of services, and oversupply of nurses for these services since it became one of the very few employment opportunities in the region. The quality of these medical workers varies widely due to the lack of quality control, and infant mortality has risen to 12.87‰. In short, the biomedical healthcare system in D.R. Congo has failed, and could no longer be relied on. Sociologists believe that both dissatisfaction with healthcare outcomes, and preference of doctor-patient relationship drives patients toward traditional healing methods, which explains an estimated 80% of Congolese’s reliance on traditional healers who are often part of the local community and people that they know and trust on a personal level, while approaching biomedicine’s incoming workers with caution.

From a Theological standpoint, like many places around the world, remembrance of the dead is woven into D.R. Congolese beliefs, and the biomedical procedures of isolation prevents the proper procedures to be performed for the dead to proceed into the afterlife, which would undoubtedly antagonise many of the dead's loved ones. A religious justification for such treatment and assurance that the dead with rest in peace would surely go a long ways to dial down the animosity between the parties who share a common objective of doing good for the D.R. Congolese people.

The political response in the region has generally been one of tightening controls, which culminated in the 3 day complete lockdown of the country of Sierra Leone on 17-09-2014. Political authorities has sought to clamp down on the disease by controlling the entire population, and have continued to do so despite it being proven to be not very successful as seen in the reemergence of Ebola in the region shortly after the lockdown claiming to have cleared all cases of the disease, with many reports of the lockdown not being observed, and a medical team was killed by locals in an extreme case.

Political thought in West Africa traces its roots to the age of colonisation, and the political reforms since then has largely followed the footsteps of developments of Political Philosophy in Europe. Authorities here believe that they can derive power and authority from popular mandate, without taking into account the sociological implications of the popular mandate being that the government is trusted by the people and is effective in exerting its power. Moreover, taking from the Realist school of thought, the government seems to have vested its faith in physical force, as images show that government agents in all sorts of uniforms seemed to have been given the role of executing the lockdown, while neglecting public education and all the lessons about establishing trust in Anthropology.

Healthcare spending often rests on the fact that the society in question considers healthcare a public good paid for by public funds and before that, its access a fundamental human right that none can be denied to. Since the initial ebola outbreak in then-Zaire, its healthcare spending as a percentage of its GDP has fallen from it’s peak of 6.2% in 1985 to a low of 1.7% in 2000. This reflects the opportunity cost decisions that the country has taken, to prioritise other items, and to consider the asymmetric returns of healthcare to be lower that that of economic development.

From a theological perspective, African beliefs consider ailments the result of the spirits of one person working against another’s, and in addition to cures that take the form of powders, chanting, roots, avoidance of certain foods and/or people; the herbalist who prescribes the cure also provides a spiritual explanation to why the illness has befallen the ill. This knowledge is considered sacred, hence herbalists are considered proxies of the deity, and entrusted to safeguard the community from threats.

In traditional African religions, performing the correct rituals such as cleaning the corpse of the deceased and extracting the foetus from a pregnant deceased women is essential; as this is a huge part in ensuring the well being and safe passage of a loved one, and for them to join their ancestors in the afterlife to protect the living in many traditional African religions. Yet perhaps more importantly to the survivors, such failures could lead to haunts and troubles .

Meanwhile, the electrolyte and isolation treatments offered often could not reconcile with the traditional spiritual wisdom that represents the teachings of their gods, and therefore is received as a secondary form of care. This explains why many West Africans would first visit herbalists, and only consult doctors in biomedicine when the herbalist methods fail, while also refusing to disclose any previous visits to herbalists due to perceived incompatibility.

When medical care fails, and the patient dies from Ebola, biomedical procedures that were employed prevented loved ones and the community to send the deceased off in their burial rituals, which endangers the deceased’s path to the afterlife, and perhaps more importantly, challenges their well being amidst fears that sprits are going to haunt their loved ones. This renders the biomedical procedures unacceptable and offensive to the communities impacted by the epidemic.

From a theological perspective, African beliefs consider ailments the result of the spirits of one person working against another’s, and in addition to cures that take the form of powders, chanting, roots, avoidance of certain foods and/or people; the herbalist who prescribes the cure also provides a spiritual explanation to why the illness has befallen the ill. This knowledge is considered sacred, hence herbalists are considered proxies of the deity, and entrusted to safeguard the community from threats.

Burial rituals are performed with great respect in traditional African religions. Great pains are often undertaken to ensure the body is taken care of, with procedures that range from the basic corpse cleaning, to complex surgeries that removes a deceased foetus from its dead mother. This ensures safe passage to the afterlife for those who passed on, and subsequently join their ancestors to protect the living. Yet perhaps more importantly to the survivors, such failures could lead to troubles and pose dangers for close ones, which explains why these rituals are not only revered, but also feared by the community, and their insistence for these rituals being undertaken properly.

However, biomedical workers are often lack understanding in the teachings of these religions, and are thus ill equipped to handle such scenarios. In Guinea, this has led to an incident where the burial procedures have been brought to a standstill amidst disagreements between a Kissi family and the medical team on how the corpse should be handled, and the body begins to rot while the dispute carries on.

Due to the distinct paradigms of burial in biomedicine and theology, especially when biomedicine was largely developed in what is now the global west, continents away from West Africa, the meaning of a burial in an epidemic entails very different activities. In biomedicine strongholds such as Western Europe, it is widely understood that contact with the infected, dead or alive, could spread the disease, and thus theological rituals are often treated as a second priority to isolation of the body, as it is assumed that the body has been infected.

By contrast, the teachings of West African theology dictates it to be a window to gaining insights to ailments. While they are not prescribed in scriptures, they are nevertheless full religions that Per many West African religious beliefs, burials are an opportunity to inquire about the cause of one’s death, and for the deceased to pass onto the afterlife to join their ancestors, with the cost of failure being the dead’s spirits lingering in the living realm to taunt loved ones. Thus, theological procedures to physically contact the deceased’s body and perform necessary treatments, ranging from cleansing to surgical removal of foetuses, are strictly adhered to during burial. According to local religion, the physical contact interrogates the body and helps uncover any unnatural causes to the death, while the correct rituals would turn the deceased into an ancestor that overlooks and protects the family.

Since the concept of burial entails very different meanings in biomedicine and West African theology, disagreements over how burials should be performed has arisen during the ebola outbreak. In Guinea, this has led to an incident where the burial procedures have been brought to a standstill amidst disagreements between a Kissi family and the medical team on how the corpse should be handled, and the body begins to rot while the dispute carries on.

hapless

Meanwhile, the electrolyte and isolation treatments offered often could not reconcile with the traditional spiritual wisdom that represents the teachings of their gods, and therefore is received as a secondary form of care. This explains why many West Africans would first visit herbalists, and only consult doctors in biomedicine when the herbalist methods fail, while also refusing to disclose any previous visits to herbalists due to perceived incompatibility.

When medical care fails, and the patient dies from Ebola, biomedical procedures that were employed prevented loved ones and the community to send the deceased off in their burial rituals, which endangers the deceased’s path to the afterlife, and perhaps more importantly, challenges their well being amidst fears that sprits are going to haunt their loved ones. This renders the biomedical procedures unacceptable and offensive to the communities impacted by the epidemic.�Due to the distinct paradigms of burial in biomedicine and theology, especially when biomedicine was largely developed in the global west, continents away from West Africa, a burial entails very distinct meanings in the disciplines. Biomedicine embraces and legally institutionalises quarantines in burials to limit contagious diseases from spreading.

Contrastingly, African theological teachings preaches religious insights into ailments. Many West African religions consider burials an opportunity to inquire the cause of one’s death, the occasion for the deceased to reach the afterlife, and join their ancestors; whereas ill-performed rituals would lead trap the spirits in the living realm and taunt loved ones, correct rituals makes the deceased an ancestor who overlooks and protects the family. Thus, theological procedures on handling the deceased’s body are strictly adhered to. Bodies are cleansed and foetuses are removed from the body to uphold natural cycles and ensure the wellbeing of all.

Since the meaning of burials diverges between biomedicine and West African theology, disagreements over how burials should be performed have arisen during the outbreak. In Guinea, a burial was brought to standstill amidst disagreements between a Kissi family and the medical team on how the corpse should be handled. The body rotted as the dispute carries on, which risked further infections upon leakage.

Meanwhile, another team in Guinea substituted an old repatriation ritual for the foetus’ removal, and successfully buried the pregnant body to everyone’s satisfaction. This underpins the importance of theology in complementing biomedicine and anthropology to understand, manage, and quell epidemics like ebola in West Africa.

Understanding the 2013-2016 Ebola epidemic

The 2013-2016 Ebola epidemic captured the attention of the world by storm, and many experts in a diverse range of disciplines sprang into West Africa’s aid. Each of these disciplines valiantly contributed to quelling the outbreak; with medics leading the charge in handling the majority of physical symptoms, while anthropologists liaised with communities, and religious leaders assuming leadership and encouraging cooperation.

Unfortunately, due to the complex lexicon, disciplinary boundaries, and historical paradigms behind these disciplines; their ideas diverge on many seemingly intuitive concepts such as burials and epidemics, and were unable to communicate with one another effectively. An interdisciplinary approach that bridges the wealth of knowledge between each discipline in their interpretation of treatment, healing, and well being, could converge the efforts of each discipline with synergetic effects.

Further disciplines may also be included in the epidemic-quelling efforts, such as mathematical models of disease transmission, governance theories of public healthcare, and psychological perspectives on trauma. While keeping in mind that each of these disciplines have developed their own metrics and criteria for what a good approach is, coherence could be achieved between these knowledge frameworks so long as their differences are consciously reconciled.

Due to the distinct paradigms of burial in biomedicine and theology, especially when biomedicine was largely developed in the global west, continents away from West Africa, a burial entails very distinct meanings in the disciplines. Biomedicine embraces and legally institutionalises quarantines in burials to limit contagious diseases from spreading. Contrastingly, African theological teachings preach religious inquires into pathology. Many West African religions consider burials an opportunity to inquire the cause of one’s death, the occasion for the deceased to reach the afterlife, and join their ancestors; whereas ill-performed rituals would lead trap the spirits in the living realm and taunt loved ones, correct rituals makes the deceased an ancestor who overlooks and protects the family. Thus, theological procedures on handling the deceased’s body are strictly adhered to. Bodies are cleansed and foetuses are removed from the body to uphold natural cycles and ensure the wellbeing of all. Disagreements over how burials should be performed have arisen during the outbreak, due to diverging understandings of burials in Biomedicine and Theology. In Guinea, a burial was brought to a standstill amidst disagreements between a Kissi family and the medical team on how the corpse should be handled. The body rotted as the dispute carries on, which risked further infections upon leakage. Meanwhile, another team in Guinea substituted an old repatriation ritual for the foetus’ removal, and successfully buried the pregnant body to everyone’s satisfaction. This underpins the importance of theology in complementing biomedicine and anthropology to understand, manage, and quell epidemics like ebola in West Africa.

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Medics' repeated warnings that the disease was seriously contagious, whilst intending to promote protective behaviours, bore the opposite effect. Leading to mistrust, fear and mass hysteria within the local community. In Liberia, this was linked to the development of clandestine family rituals and burials that avoided such socially ostracising medical approaches. Western medicine, often imposed by neoliberal policies, has throughout history delegitimised African social relations and unfairly branded them as superstitious. Consequently, there were numerous cases in which western medical experts were viewed as being the ones propagating the disease.