A dramatic shift in cultural models took place and the people began to classify the EVD outbreak as an epidemic illness. The indigenous protocol for its prevention and control was kick-started and quite different from the treatment and control of other illnesses.
This particular protocol included the identification of homes of EVD victims. EVD patients were also isolated and kept a distance of at least 100 metres from the home of others and with visitors strictly forbidden. Strict limitations were placed on people’s movements, they were dissuaded from venturing to other’s houses and villages, and had dietary and sexual restrictions put on them to control the deadly disease. Furthermore, the Acholi recognised that mothers to be and young children were particularly vulnerable.
Somewhat less formalised than the Acholi model, during the 2003 outbreak of EVD in the Mbomo and Kelle sub-districts of the Republic of Congo, near the border with Gabon, 129 people died out of a total 143 cases – a 90% fatality rate.
As in the Acholi model, the Congolese indigenous communities also emphasised the identification and isolation of infected and affected households as well as the need for special attention towards keeping children safe from infection and the use of culture in communicating the message of EVD prevention.
The various ethnic groups in DRCongo affected by the EVD outbreak were also able to distinguish the natural from the supernatural. When Hewlett and his wife Bonnie, also a medical anthropologist, arrived in the affected area of Mbomo, most of the Congolese there indicated that EVD was an epidemic illness, which they called opepe ekono, and not sorcery. Locals told Hewlett’s team that they knew epidemic illnesses were transmitted by contact with infected individuals.
During such epidemics, national and international healthcare workers worry that traditional funeral and burial practices such as washing and dressing the dead body and love touches contributed to the spread of the outbreak. However, African communities such as the Acholi had no qualms about modifying their funeral and burial customs. Hewlett reported: “Even the burying of victims at the airfield, while a bit dramatic for some, was consistent with burying epidemic victims outside or at the edge of the village.”
Many aid agencies are still unaware that traditional cultural practices across Africa offer what Western medics would consider to be effective means of disease control and prevention.
“Western medical science has long dismissed African indigenous medical theories as superstitious gibberish, unworthy of consideration,” says Green.
Health care workers need to be aware that such cultural models exist, says Hewlett. He believes that once these positive aspects are identified, epidemic control teams can build upon them and implement health education messages. It’s a simple idea, yet there is potentially much to be gained.
But by the beginning of August, not only had Nigeria’s largest airline, Arik Air as well as Asky Air, cancelled flights from Liberia and Sierra Leone (after a passenger from Liberia collapsed at Lagos airport, later dying in hospital from Ebola), but CÔte d’Ivoire had blocked the return of 400 Ivorians who wanted to return from Liberia to escape the epidemic. Nigeria has put all its entry points on red alert.
Dr Sheik Umar Khan of Sierra Leone, and prominent Liberian doctor Samuel Brisbane both lost their battle against the virus they contracted.
Dozens of local health workers and two American medics in Liberia have also died, including a US missionary, highlighting the dangers faced by those trying to halt the disease’s spread in West Africa.
When New African asked Dr Julius Lutwama of Uganda’s Virus Research Institute whether or not untested and unlicensed Ebola drugs like TKM-Ebola should be used in this outbreak, he said: “My conviction is that, if I am on my death bed and there is something that might alleviate my quick death in a condition where nothing conventional is approved, I would go for what is available.”