American anthropologist Barry S. Hewlett, author of the book Ebola: Culture and Politics –The Anthropology of an Emerging Disease has shown that local populations have long been aware of the disease and have their own cultural logic to explain it and social protocols to deal with it.
These include practices of isolation and care that have proved so effective that agencies such as the WHO have incorporated them into their response strategies. In fact, some experts are warning that global efforts to curb the spread of potentially deadly emerging zoonotic diseases (illnesses that jump from wild animals to humans) as well as re-emerging contagious and infectious ailments such as tuberculosis and leprosy in Africa, need a strategy rethink. Public health officials involved in international development are turning a blind eye to ethno-medical models for disease control and prevention that exists in Africa.
If effective intervention is to be achieved, say researchers, then an awareness and understanding of these indigenous strategies can play a practical role in containing and preventing diseases that are presently killing millions on the African continent and have the potential to affect global health.
This negative attitude towards indigenous notions of infectious/contagious diseases stems largely from the assumption that African health beliefs are primarily based on witchcraft, sorcery or black magic. Edward C. Green and other researchers have indeed found this to be true in the realm of mental illness in sub-Saharan Africa (perhaps due to a superficial likeness between spirit possession and symptoms of some mental illnesses) but curiously not so when it comes to infectious diseases.
Western notions of how Africans deal with illness are to blame. Among the culprits have been contemporary anthropologists as well as some of the most famous ethnographers of the early 20th century. These scholars were, consciously or unconsciously, largely ignoring the evidence, which pointed to the fact that infectious diseases were looked upon by sub-Saharan Africa as having naturalistic and not supernatural origins.
Edward Green, an American medical anthropologist at the Johns Hopkins Bloomberg School of Public Health, and author of Indigenous Theories of Contagious Diseases (ITC), sees considerable parallels between indigenous notions in Africa and modern biomedicine.
“Mystical contagion” is a belief that people become ill as a result of contact with or contamination by a substance or essence considered dangerous because it is unclean or impure; and environmental dangers whereby elements in the environment, including the air one breathes, are believed to cause or spread illness.
Such mysterious and exotic explanations as ITC, says Green, are simply indigenous African interpretations of the causes and logically related treatments of infectious and contagious diseases, which are expressed in a distinctly non-Western idiom using cultural metaphors or symbols.
Once these symbols and metaphors are decoded, Green maintains, we then discover that they are addressing the same health promotion and disease prevention issues we find in Western biomedicine.
Pioneering field studies of EVD epidemics by Professor Hewlett and his colleagues at Washington State University were conducted with the first systematic medical anthropological field study of an EVD epidemic in northern Uganda, between August 2000 and January 2001. He then led a team of medical anthropologists into the rainforests of the Republic of Congo during the December 2002-June 2003 EVD outbreak.
These studies illustrate how ordinary Africans perceive epidemic diseases as naturalistic in origin and are linked with notions of contagion and pollution but not the supernatural. Furthermore, they also reveal that these communities had formal or semi-formal “indigenous protocols” for dealing with deadly EVD epidemics, which were independent of Western biomedical influence.
More importantly, they show how international epidemic control teams can apply indigenous knowledge to control and eradication efforts. Take, for example, the EVD outbreak in northern Uganda. At the time it was one of the largest EVD outbreaks on the continent. There were 224 deaths from 425 infected cases, a case fatality rate of 53%.
When EVD first occurred many people treated the symptoms as a regular illness and sought a variety of biomedical cures such as antibiotics and local herbs. However, by early October, a little over a month from the start of the plague, the Acholi community began to realise that this was no ordinary illness.