I’m reproducing an email that I sent to a friend about Ebola, largely in response to an article from the New York Times about local responses to doctors and growing mistrust of medical interventions. Confusion around the Ebola outbreak is not new, but there are some big questions that few people are asking and they certainly are not getting answered. I’d like to address a few glaring problems presented in the article, which suggest that Africans are somehow anti-modern because they are seeking alternatives to allopathic medicine. I’d like to also raise some important points about areas where greater information and clarity are needed.
The response by villagers in Sierra Leone, Liberia, and Guinea is not anti-modern as much as the doctors appear to provide little in remedies that work and as the conduit for returning the dead they are associated with death, not life. Families see their loved ones sent off to hospital alive and returned dead. This isn’t a case of rejecting modernity, this is seeing the connections between life and death through this movement to and out of medical care as the process that brings death. What gets called “traditional” medicine or witchcraft by some is a valiant effort to find living practices that can bring relief. Allopathic medicine is confounding and obtuse for many who see its blood draws, stool/tissue samples, and regimented approach as a dangerous thing. Pills, injections, and hospitals are objects that appear dead or sterile – they lack the living quality that many expect to experience in seeking medical care. Pills are strange objects with mysterious properties that are manufactured in places far and away – hidden, secret, and controlled. Plurality of care is something many people seek to bring comfort, to ground the suffering in something that appears less foreign.
The movement of infected persons within and outside of the infected area has also arisen as a point of concern as the international community increasingly frets that the virus might spread beyond the immediate zone of infection. International travel certainly exacerbates the issue and increases the chances of infection as people get on airplanes and land in new destinations – unknowingly transporting pathogens through the air and exposing fellow passengers to disease. Movement is the problem here, but not in the way we think. While we focus on international travel as the danger, we’re forgetting the travel between village and medical center. Isolation has typically been the best method approach, but it is contrary to what is understood as a standard of care in allopathic medicine. People must be brought to hospital to receive care, in the process shedding the virus as they go – this is actually a strange thing to consider. The return of the dead body with all its fluids and tissues continues this process. Isolation wards function on the premise that those in isolation can still receive treatment, that cure is still within the realm of possibility. Isolating the sick in their homes may present a more pragmatic approach, but with such a widespread epidemic there is inadequate staffing to do this work. And the return of bodies to their loved ones is a key piece of our highly ritualized and symbolic relationship with the dead.
The larger questions that aren’t getting asked relate to how Ebola found its way to this part of the African continent and why it hasn’t been observed before. According to the Centers for Disease Control in Atlanta, prior to 2014 there have been no outbreaks of Ebola in this part of Africa. With the one exception of a Taï-type Ebola virus sub-strain that was contracted by a scientist who did a dissection of a chimpanzee in the Ivory Coast, there have been no human to human cases of transmission before this year. The absence of Ebola during the preceding decades of war and conflict in the region seem peculiar. Diseases tend to be opportunists and arise during times of social upheaval. Did it go undocumented, mediated at the household and community level in the absence of international intervention? Or it is truly something new in this region. If it is new, how did it get there? If fruit bats have been the reservoir, why now? During the war people must have consumed fruit bats to survive. The problem is no one is asking these questions, at least not the media outlets. Nor is the CDC or WHO, the only perspectives coming out on the outbreak further reify notions of African ignorance and lack of understanding. I would argue they know all too well.