Essay: Ebola viewed through the Sociological Imagination

This essay will present the works of various research articles on the Ebola virus, focusing on the traditional, geographical and political circumstances that contribute to the prevalence of the virus in the researched areas, as well as influence the way locals perceive the virus. After the various views have been presented, a conclusion based on the information shall be drawn.
Ebola is the current epidemic raging through Sub-Saharan Africa, and has been occurring intermittently since 1976. The Viral Haemorrhagic Fever (VHF) is characterised by nonspecific symptoms early in the disease and often causes internal and external haemorrhaging as the disease progresses. In recent years, cases of Ebola outbreaks have increased and are gaining attention from international health organisations such as WHO. One of the worst cases in Ugandan history occurred during 2000-2001 and was recorded by Hewlett and Amola, who conducted a study in the affected area after the outbreak. Despite the research being conducted in such a short period of time, the information obtained is nonetheless relevant and important.
‘Cultural’ or ‘explanatory’ models refer to an individual’s or culture’s explanations and predictions regarding a particular illness (Hewlett and Amola, 2003). According to the research article by Hewlett and Amola, local residents of the affected area, Gulu, have three explanatory models to describe the reason behind the Ebola epidemic. The first two were spiritual or supernatural while the third was biomedical. This indicates that the locals were able to integrate various definitions and apply it to their responses and behaviour toward the outbreak, without thinking of them as contradictory or conflicting. For example, some locals believed that the epidemic (which they call gemo) was brought by a malignant spirit. Despite believing this, they still resorted to purchasing biomedical cures for the illness.
The Gulu District is located in Northern Uganda and has a population characterised by a majority of one ethnic group, the Acholi. The Acholi’s cultural explanatory models for the Ebola epidemic are as follows:
The first explanatory model speaks of the Jok, spirits or gods that are generally benevolent but turn malignant when disrespected. According to the Acholi, the Ebola epidemic occurred because of a lack of respect and unity among community and family members. This resulted in family and community heads turning to traditional healers (who were believed to have Jok of their own) for help, who recommended that they remove poisons called yat around the household and sacrifice livestock so that the deaths would stop. However, the deaths did not.
The second indigenous explanatory model is the illness epidemic model (known as two gemo by locals) that justifies the cause of the epidemic as a bad spirit called a gemo that moves like the wind, infecting and killing many in a short period of time. The locals had various rules that govern the way the community should behave during periods of gemo. These measures were found to lower the risk of contracting the illness.
The biomedical model came after these two, and was effectively campaigned by the government to increase public awareness and decrease risk of further infection. The only drawback was that the awareness campaigns were established so late, and by then locals had already gone through the first two explanatory models and many had fallen ill due to risky traditional practices.
Various traditional and cultural practices were found to contribute to infection and contraction of the disease. For example, funeral practices that required the female to wash the body and prepare it for the funeral ceremony as well as the ‘love touch’ where families touched the body one last time may have contributed to the high case count in the early months before the biomedical model was established by the government. This also explained why the majority of infected patients were female (63%). Another risky traditional practice was the sucking out of poisons orally by traditional healers. Although this practice has mostly been phased out due to many traditional healers contracting, spreading and dying from HIV/AIDS in the past, some traditional healers still practice it in Northern Uganda. One such healer was ‘healing’ the ill in the district of Gulu and picked up the Ebola virus from one of her patients, subsequently spreading it to several others before returning to her hometown and spreading it to more people there before death. Such traditional practices need to be stopped entirely since it endangers not only the indigenous healer but also all that he/she comes into contact with.
This incident, however, led to various misunderstandings. The Ugandan government decided to ban all traditional practices under the mistaken belief that all traditional practices are detrimental to health and counteract efforts to decrease disease contraction. This is not true. As mentioned previously, traditional measures put in place to counteract gemo or epidemics were found to lower the risks of infection. For example, one of the rules states that the ill patient should be quarantined from the healthy and only cared for by someone who had fallen ill and recovered or someone who had cared for many ill without succumbing themselves (in other words, someone who is immune to the disease). This ensures that the disease does not spread to the healthy. Another measure insists that pregnant women and children should not be exposed to the ill, thus ensuring that the vulnerable with weak immune systems are shielded from the disease. Also, marking the houses and villages where the epidemic has struck alerts visitors to the hazards of entering, thus reducing the number of accidental contractions and preventing it from being spread to other families or areas by passing visitors.
Brown and Kelly also took a similar approach, although they did not physically enter the affected areas. Instead they gathered information on the three VHFs (Ebola, Lassa and Marburg) from various sources then interpreted it, adding another not often researched concept to their interpretation: how interactions with animals contribute to the epidemic.
There are two stages of transmission: primary and secondary. ‘Primary transmission’ is the spread of zoonotic disease due to human-animal exchanges. For instance in their research in the Democratic Republic of Congo the locals hunt bats that migrate to the nearby forest every spring. Two of the three species of bats are carriers of Ebola and one of these bats was purchased by a man who ingested it and contracted the virus, subsequently passing it on to his young daughter and others.
Another example that can be used is from a research article by B.S. Hewlett, Epelboin, B.L.Hewlett and Formenty titled Medical anthropology and Ebola in Congo: Cultural models and humanistic care. This article focused on the areas worst affected by outbreaks of the Ebola virus on the border between Congo and Gabon in 2003. The fatality rate for the overall outbreak was 90% with 129 deaths out of 143 cases. These outbreaks are believed to have originated from the ingestion of gorilla meat. Allegedly, a band of forest hunters came across the carcass of a dead gorilla while out hunting, and perhaps thinking themselves fortunate to have found so much meat, took the carcass back to the village where it was eaten by many, resulting in the transmission of the disease from the gorilla to the humans. This situation could have been prevented if the people of these border villages had a better standard of living and were food secure. They would not have seen the need to hunt for daily sustenance in the forest and ingest wild and questionably ‘safe’ meat. In other words, unequal division of resources can be considered as a contributing factor. This can be viewed globally as well. Epidemics tend to occur more frequently and viciously in the ‘third world’ countries of Africa that truly struggle financially. The ‘first world’ countries that receive the best resources and are the most developed both economically and politically are seemingly not as affected by it. Better resources mean better and more effective healthcare systems as well as more efficient public awareness campaigns on illness and disease, which greatly reduces the chances of numerous deaths in such regions explaining why epidemics are so uncommon in ‘first world’ nations. The inverse can explain the situation in the less developed countries that, due to a lack of adequate resources and literacy rates have poorly developed healthcare systems and are not well equipped to deal with crisis situations such as epidemics.
Another article titled Investigating the zoonotic origin of the West African Ebola epidemic also speaks of primates and bats as carriers of the Ebola virus, and the opportunistic hunting of these bats and bush meat by locals.
‘Secondary transmission’ refers to human to human infection and contraction of the virus. For example, as mentioned earlier from the article by Brown and Kelly, the father who had eaten the bat meat sold to him by forest hunters passed the Ebola virus on to his young daughter through his body fluids, and after the young girl had passed on, an old lady who was involved in the preparation of the body for the funeral fell ill and died. The old lady was the first recorded Ebola death, but the trail could be traced to the secondary transmission between the girl and old lady to the primary transmission between the father and the bat that carried the virus’indicating that both primary and secondary transmission work together to play a key role in the epidemic of zoonotic diseases.
Another key aspect of Brown’s and Kelly’s article is their focus on the concept of ‘hotspots’. ‘Hotspots’ are places defined by excess and lack, the absence of resources and the abundance of pathogens (Brown and Kelly, 2014). Hotspots integrate all the required circumstances for epidemics to flourish. By comparing and contrasting hotspot areas to other areas one can deduce precisely why hotspots are the worst affected and what measures should be taken to prevent it happening again or at least occurring again as severely. It also helps us understand the social determinants that result in such areas being more prone to epidemics.
Economic, political and traditional circumstances influence an area in various ways, including its susceptibility to disease. Poor economies result in citizens living a low standard of living without access to many resources such as healthcare facilities, thus increasing the rate of infection. Political circumstances such as colonialism, terror, war and conflict also affect disease management and prevalence. For example, looking at the case of the old lady, young girl and her father again, we observe that colonial occupation in the past has played a role in the settlement patterns of Congo. After independence villages in more disadvantaged areas were rebuilt near roads and other transport routes for better access to public services. However, residents still remained attached to their original villages within the forest areas and visited them often, especially for hunting purposes. One such forest village became home to bats during the spring season and were hunted for meat and sold, then subsequently eaten by the father. This was the index transmission event that spread the virus, causing the outbreak.
The social circumstances of an area also determine the way Ebola and other diseases are perceived in that area. Traditional and cultural beliefs contribute greatly to the way in which the layman interprets illness and disease: many adopt the angle of traditional medicine and believe that the cause of the illness and deaths is due to some spiritual or supernatural cause. However, public awareness programmes can help educate the public on the biomedical model. This has been the general shift in perception of the Ebola virus from the 1990’s to the present. In this way, people have started to integrate all their explanatory models and it has been noted that individuals in the Ebola hotspots often use several models simultaneously to explain the epidemic.