EBOLA: THE EFFECTS OF CULTURES IN CONTACT
EXTENDED ESSAY
Introduction
The Ebola outbreak of 2014 to 2016 was the deadliest in history, infecting over 28,000 people and killing over 11,000 across Western Africa. The epidemic caused international support and urgency over the crisis as medical and public health professionals from across westernized countries poured into Liberia, Nigeria, Guinea, Mali, and Sierra Leone in attempt to nip this crisis in the bud. With affected professionals stemming in the United States, global fear grew to new extremes: were people in Western countries ensured safety from this pandemic? As these medical and public health experts consolidated from vastly different communities with different life experiences, belief systems, and ways of life, tension levels grew high.
This essay seeks to analyze how contrasting belief systems between incoming western medical professionals interfered with Liberian culture, belief systems, and social organization during the 2014 Ebola outbreak. Further, how tension between local and foreign communities interfere with the response to outbreaks from occuring in the future. The 2014 Ebola outbreak became an example of how people, no matter their nationality, should respond to large-scale global health crises. This essay raises the question: To what extent did westerners shift belief systems and cause cultural conflict in Liberia during the 2014 Ebola crisis?
This essay also seeks to research how these contrasting belief systems in medical and public health practices influence systemic policy and ethical changes within society to achieve the most effective and efficient response to public health epidemics.
This question is worthy of examination because epidemics and crises are sure to happen in the near future. With a more connected world than ever before, illness has the potential to rapidly infest and infect more people on a bigger scale than ever before. With an increasingly connected world and technological advances exponentially increasing, we, as a society, have the potential to eradicate epidemics faster and more effectively than ever before. With that being said, if contrasting belief systems interfere too much, our potential to most effectively respond to these crises could be diminished.
COLLECTED EVIDENCE
PRE-EBOLA
Brief History of Western Scientific and Medical Practices
Evidence of what westerners now call “science” dates back to over 9,000 years ago—before any form of writing was around. In some of our earliest societies, through agriculture and astronomy, people began to understand connections between what we now realize as scientific disciplines. Perhaps the most notable for the sake of the evolution of science is the beginnings of biology and medicine. In 1628, William Harvey (also known as one of the most seminal scientists of all time), depicted in his book titled “Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus,” translating to “An Anatomical Exercise on the Motion of the Heart and Blood in Living Beings,” and most commonly “De Motu Cordis,” the function of blood circulation. This pivotal moment in scientific discovery paved the way for hundreds of other physicians and scientists to develop a myriad of connections between the functions of circulation and other functions in the body. Once Harvey’s discoveries were published, other scientists began to divert from ancient philosophical and theological explanations.
What differed Harvey from other early 17th century scientists was the way Harvey delved into experimentation—taking account from the physical body and observations he saw. This is what set up the foundation of modern-day allopathic medical practices. The approach Harvey took focused into singular parts of the body and used the body as the sole parameter of how medicine is utilized. While cross connections can be made between various parts of the body, outsider factors are seldom taken into consideration. This greatly differs from other more “traditional” forms of medicine, such as the common practices in Liberia.
Traditional Medicine in Liberia
Indigenous or “traditional” medicine, is defined as the "the sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness," and dates back over 5,000 years to scriptures of ancient Egyptian show herbs used to treat a patient. In Liberia, specifically, traditional medicine is very present. Throughout the country, there is a serious lack of allopathic medical doctors with the World Health Organization stating there are only 0.5 doctors per 1,000 persons. A Popline abstract states that “…traditional healers are used because: 1) they are available, especially in rural areas; 2) they are preferred because they understand the culture of the people and they take time with them; and 3) there is a dearth of physicians available to the general population.” With such a severe lack of medical doctors, the presence of traditional medicine is pushed even further as many people do not have a doctor or other medical access within their community.
While the population of people who believe in traditional medicine weans as more and more evidence in support of western medical practices mounts, we see that this belief system in traditional medicine plays a very prevalent role in the belief systems around both health prevention and health delivery. Because these traditional practices greatly differ from the western allopathic ( ) approach, we see the first key factor for the cultural conflict that arose from the Ebola pandemic.
Political System in Liberia
A large factor that influences one’s beliefs is the political system that they live under. Liberia utilizes a similar hierarchical and political system as we see in America; presidents elected by democracy who rule as the head of state and head of government. Up until 2005, Liberia’s elections were dominated by the settler oligarchy, or by two dictators, Samuel Doe and Charles Taylor. These two dictators ruled as Liberia’s Presidents from the early 1980s until 2003 respectively, putting Liberia under strict military control. From Samuel Doe’s military coup in 1980, to the rise of Charles Taylor after Samuel Doe’s execution in 1990, the state of Liberian politics was certainly unstable. International parties declared that
In 2005, Liberia finally reaped the freedom and liberty it has sought previously. However, the consequences were abundant. Because of the almost constant civil war that plagued Liberia, not only did Liberia fall to be one of the world’s poorest countries, but the already poor medical infrastructure in Liberia fell to new depths. Almost every healthcare facility was destroyed and the country only had 51 doctors and 5,000 health workers to serve Liberia’s population of 3.8 million. These situation of medical infrastructure plays a multifaceted impact. To start,
BEGINNING STAGES OF EBOLA
Rapid Spread
Ebola is one of the most lethal and dangerous viruses in the world. The Center for Disease Control (CDC) classifies Ebola as “ a rare and deadly disease most commonly affecting people and nonhuman primates (monkeys, gorillas, and chimpanzees). It is caused by an infection with a group of viruses within the genus Ebolavirus.” Originally discovered in 1976 in the Democratic Republic of the Congo, Ebola has since been very present in West Africa. It’s most likely source is that of animals, specifically bats, and is spread from animal to human through direct contact with bodily fluids. In fact it’s bats that are suspected to be responsible for the case that catalyzed the eruption of the 2014 Ebola outbreak. Throughout December of 2013, in a village in Guinea called Meliandou, two year old Emile Ouamouno was most likely playing in a hollowed tree where Ebola-infected bats were found when he began to feel ill. Unfortunately, Emile passed away. And while the village of Meliandou is home to around just 50 villagers, the spread of the disease began to run rampant. We will see how the rapid and uncontrolled expansion of the virus contributed to the influx of western medical professionals coming into West Africa and thus the tension that ensued.
Ebola first made its way to Liberia in March of 2014, three months after the first case arose in Guinea. Unbeknownst to healthcare providers in Liberia at the time, a few remote cases of Ebola would soon turn into one of the biggest global health crises they would ever see. Liberia, as it was at the time, was already unstable from the political impacts both the militant and violent rule Charles Taylor and Samuel Coe had on the infrastructure of the country. Additionally, because Liberia is one of the poorest countries in the world and at the time of the first cases only had a few doctors per 100,000 individuals, with the World Health Organization stating that “the meagre workforce has now been further diminished by the unprecedented number of healthcare workers infected during the outbreaks,” and the country simple didn’t have the medical workforce to secure the damage of the outbreak. With also so few doctors and nurses, the infections in these professionals hit even harder. Hospitals and clinics were commonly where the disease hit hardest—with a lack of essential protocol equipment and higher possibility for transfer of bodily fluids—and by the end of the year, almost half of the 700 affected health care workers had died.
This put Liberia at a very vulnerable state; with weaning options, outside help and resources would be necessary in order to achieve any form of maintaining the situation. This, also, put Liberia at a heightened state to be exposed to, and conform to foreign health policies, unfamiliar belief systems, and unfamiliar medical practices. This outbreak, we now know, is unlike many other outbreaks we have seen. The rapid spread of Ebola is responsible for the foundation that resulted in the belief system and political shifts.
Initial Liberian Response
The first primary step taken by Liberian government, when word of the outbreak really began to run rampant, was to employ several of the IMS (Incident Management System), including elements such as a National Coordinator for response. Many precautionary steps were taken—these included looking at and attempting to attack from all of the different factors of the outbreak (ranging from the psychological aspects, medical aspects, social mobilization, laboratory and research, and many more factors).
However, while this simple, more bare-bones approach to responding to a crisis had worked in the past in Liberia with smaller scale outbreaks, there were many areas this response lacked. For example, the national coordinator in charge of response was not solely focuses on Ebola; in fact, they were in charge of all public health related issues, including malaria, immunization, tuberculosis, and other viruses that were and still remain very prevalent in Liberia. So, when crucial decisions needed to be made, the Ministry of Health and Social Welfare (MOHSW) was spread incredibly thin. Additionally, the operations of the MOHSW were severely lacking. In their meetings, with attendance reaching over fifty persons at times, MOHSW found it incredibly challenging to get tangible impacts complete. And outside the meeting times, communication was very weak among members.
By October of 2014, over 200 healthcare workers had been affected with Ebola, and with half of them dying from the virus, it became immediately clear that outside organizations and professionals must aid in the disaster. Naturally, many of these organizations are western-centric. Perhaps the most prevalent kickstart to the emigration of workers into Liberia was the UN Mission for Ebola Emergency Response (UNMEER). As stated by the WHO, “The first-ever UN emergency health mission, the UN Mission for Ebola Emergency Response (UNMEER) has been set up to address the unprecedented EVD epidemic. The strategic priorities of the Mission are be to stop the spread of the disease, treat infected patients, ensure essential services, preserve stability, and prevent the spread of EVD to countries currently unaffected by EVD.”
Suffice to say, the initial Liberian response had great room to optimize. And because of the gaps and deficiencies within their initial plan, the impact westerners could make on the system were only amplified. Liberia was in an extremely vulnerable state. Therefore, they were very open to not just feedback, to potential changes to the state of their policy and ways of thinking when it came to epidemics.
Epistemological Conflicts with Traditional Medicine
The Ebola pandemic came at a heighted time of transnational medicine. As stated in ethnography Medicine, Mobility, and Power in Global Africa, “…the increased diversity in religion, traditional, and biomedical healing practices, syncretistic forms of healing and treatment emerge and are further modified and reconfigured in “African” healing processes.” As the Ebola outbreak grew more and more out of hand, it was clear critical action was necessary. Thus came foreign medical aids. From the arrival of the very first westerners, it was stated that “some patients were grateful; others resisted [the new western] treatment.” Frustration grew, and even though it became very difficult to practice allopathic medicine, ““It was really frustrating at times,” Dr. D’Cruz said. “I didn’t miss the CT [computed tomography] scanner or lab tests so much, but not being able to listen to a heart or lungs was really difficult to get used to,” traditional medicine started to come up time and time again for debate.
In more rural regions of the country, western healthcare providers didn’t know what to expect when it came to non-allopathic medical practices. In previous studies, it was estimated that 80% of the population used “African Traditional Herbal Medicine.” But many westerner
s rejected the idea of working with traditional herbal medical practices. In previous trials, scientists performed extensive clinical trials to test for the effectiveness of traditional medicine. But there, conflict began to start. Immediately, it was debated if traditional medicine could be tested with western scientific practices, as science went against the belief systems of African traditional medicine users and the meaning behind the healing process in general. Additionally, distrust began to form between traditional medicine users and the western healthcare workers as the people who used traditional medicine believed that scientists in charge of the trials were swaying the results with a mindset that traditional medicine wasn’t legitimate to start.
Because of the forming tension, local Liberians whose belief system is in traditional medicine went into what is known as “preservation stance,” a “[view that] indigenous medical knowledge must be protected and preserved.” In an essence, indigenous medical knowledge was at stake—attacked of sorts. And this plays a large role in the shifting of belief systems of Liberians. Now exists a divide not only between westerners who believe in allopathic medical practices, but within Liberians: one side who now believe even stronger in their traditional medical practices and one side who see the impacts of allopathic medical techniques and now “side” with western medicine. This digs deeper from just opinion; these belief systems represent a part of one’s identity and culture. With these trials and westerners dismissing the traditional practices, we see one of the critical ways belief systems shifted. And with these growing tensions, we begin to see one of the influences westerners had on the policy within Liberia.
American Health Prevention Policy Influence on Liberia
America, as a country, was one of the most involved western countries when it came to aid and support during the Ebola crisis. In March of 2015, in the midst of the rapid influx of infected persons across West Africa, America, with the aid of the Centers for Disease Control (CDC) and Association of State and Territorial Health Officials (ASTHO) put in place an edited response and mobilization model to effectively treat the Ebola outbreaks if crises occurred in the future. This plan of action, more specifically, is an extensive ten-step plan that covered every step to take in the future of any major epidemic outbreak.
The first and second step of the program involves communication, one of the vital factors that caused such a huge influx of infected people across West Africa; without communication, surrounding areas were unable to properly implement disease prevention techniques. The third and fourth step deal with education and preparation; determining which factors are most likely to contribute to the spreading of disease in communities and educating communities where knowledge about whatever disease at hand and understanding of proper protocol is the poorest. The fifth surrounds collaboration, primarily with Community and Faith Based Organizations (CFBOs), typically the organizations that have the most influence, support, and power in rural villages and communities. The sixth and seventh steps depict proper operational strategies and methods to spread the message of the outbreak and protocols across a community in a more prevalent way. Step eight and nine deal with the more physical analysis of the outbreak in the community; stepping back a foot to see which strategies and working and which are not. The final step surrounds maintaining and further establishing strong relationships with CBFOs to not lose touch with the organizations and build stronger approaches in health outreach and prevention.
These policies and procedures established now serve as some of the most highly-regarded policies in the world, but they influenced the state of Liberian belief systems and the methods used to continue treating the outbreaks. In the case of the wide scale burst of infected persons with Ebola in Liberia, the MOHSW was searching for any outside help to aid in the catastrophe about to ensure. This is a prime example in positive shifts in Liberian belief systems. Through policy, the two contrasting belief systems melded—with utilization of local religious and otherwise-impactful local community centers and medical treatment approaches rooted in western healthcare— into a successful plan for effecting rapid treatment in the future. Because policy plays a large role in the fundamental morals and beliefs of many people within a nation, we can assume that these policy changes had withstanding impacts on belief systems within Liberia post-Ebola. And, while the collaboration may be a positive one, one of the results from this policy is that Liberians have more eurocentric belief systems.
Further Cultural Discourse
As stated in the Journal of Global Health, “Ebola has been exoticized, associated with “traditional” practices, local customs, and cultural “beliefs” and insinuated to be the result of African ignorance and backwardness. Indeed, reified culture is reconfigured into a “risk-factor.” Overall, it’s evident that with Ebola came an immense case of “othering.” As depicted in anthropology, othering, or the human tendency to think that they, and only them, are under the proper way to think; that other groups outside the subject’s culture, race, nationality, ethnicity, etc are inherently incorrect, stems from the Post Colonial theory. Post Colonial Theory is “a literary theory or critical approach that deals with literature produced in countries that were once, or are now, colonies of other countries…The theory is based around concepts of otherness and resistance.” It is important to look at Post-Colonial theory in this context because of the extensive othering that occured over the duration of the pandemic. Ebola is a prime example to use when discussing this theory because of the stark differences between the euro-centric healthcare providers and the local Liberians. While Postcolonialism comes from Europeans
Western medical professions were not an isolated group; western countries and citizens not partaking in the international aid played a large role in cultural discourse. It’s stated that much of western hysteria surrounding the virus didn’t come from its emergence; it came from its emergence from Africa. This plays a crucial role. First of all, by viewing the virus as removed, westerners often felt that because of “African beliefs,” the outbreak was not being properly treated and thus could travel to the West and put westerners in harm. Specifically, this othering of Africans and Liberians could also be rooted in racism. More specifically, in the portrayal of Liberia and Africa by the western media throughout the duration of the Ebola crisis, Africa was further made the other. We see example of this othering in media such as the now-revealed hoax that stated “Black man on the run with Ebola in English city.” “African culture is seen as an obstacle to overcome when implementing outbreak control. Locals are presumed to subscribe to alternative disease models rooted in “traditional healing,” believe in sorcery or the supernatural as the cause of the disease, or generally hold “misconceptions” about its etiology.”
It is essential to consider the effects that the media had on the belief systems of Liberians during the Ebola crisis. Media isn’t cement; it is made to travel and be dispersed. This media demands us to consider the attack is was viewed as by Liberians; the use of frequent “othering” rhetoric was likely another root of both defensiveness and persuasion by local Liberians. They were in the international spotlight, and they were constantly being told that their “ways” were wrong. This is clearly a root of shifted belief systems—the pressure to conform led to more support for western medicine and to detract from current methods. Therefore, more Liberians “believed” in allopathic medical practices post-Ebola not solely because they came to that conclusion on their own, that those practices are more effective, but it was what western medical professions within Liberia, and the surrounding global community conveyed was the only right way. Now, this is also a cause for the shift in policy towards a more western standard.
Beyond Direct Medical Practices: Religion and Tradition
Another large source of cultural discourse came not from the direct medical treatment, but from what followed treatment. A large part of cultural discourse came from the mourning process—an experience all too familiar for so many people within Ebola affected areas. The mourning process is held near and dear to many West Africans; a cultural ritual that has been held for thousands of years, mourning implements various factors of one’s religion, their ways of living, and the significance the deceased held in their community (whether that be as a mother, a worker, a child, a leader, etc). However, many obstacles arose during the Ebola crisis that interfered with thousands of years of deeply important tradition. To start, it’s crucial to remember how Ebola is spread: through bodily fluids. Now, this doesn’t end when one dies; a person’s blood, saliva, and other bodily fluids remain infected with the Ebola virus. Now, this gets particularly tricky when an Ebola-infected pregnant mother dies. From a National Geographic ethnographic report, we know that “In their traditional Kissi, [a traditional Liberian] culture, a woman buried with her fetus disturbs the world’s natural cycles—beginnings and endings among humans, animals, and plants.” This is important because to remove the fetus, many bodily fluids would be released, and thus infect potentially many more people, only to perpetuate the outbreak. However, “the villagers would not relent…Even if the surgery was as dangerous as the outsiders suggested, the villagers worried that the results of disrupted natural cycles could be worse.” Now, the visiting medical professionals a) didn’t understand this practice and b) were not tolerant. Their goal was to end the pandemic; these mourning practices were clearly dangerous. So, they had one answer. The rituals had to end. They called upon the World Health Organization to bring in professionals from many different fields to aid their attempts to end mourning practices.
This created another layer of cultural conflict. The ultimatum of the two different groups—non-Kissi, often western and the Kissi—was starkly different. One one side, we see the importance of these rituals to the identity of the Kissi people. These rituals were not arbitrary acts but acts of deep personal significance. Not only did the mourning process have spiritual significance, but the Kissi people believed that not properly following the rituals would result in geological disturbance with severe natural disasters and poor harvest seasons. On the other side, we see great intolerance from non-Kissi people.. Many western medical professionals sought aid from any other professional they could find to re-morph the belief systems of the Kissi people. As we’ve seen throughout the Ebola pandemic, the influence of westerners is significant. As the World Health Organization brought in “experts”, anthropologist, religious leaders, and scientists into Liberia, the Kissi people were almost forced to shift their belief in their mourning rituals.
This shows only one case study. Countless other communities across Liberia with contrasting religious beliefs from westerners were similarly compelled to shift their beliefs to a more western-centric and western-approved belief system. Is a form of raids, outsiders came into villages (often touting “Ebola People communities”) to push and force their own beliefs until the local people are too tired to keep fighting. This is, in one form, ethnogenicide: “the intent to destroy an ethnic, national, racial or religious group.” While outside people are not physically removing or killing people of these communities, the practices and beliefs they hold deep to their identity is destroyed.
POST-EBOLA
Conclusion
After examination of the Ebola pandemic in Liberia, it is clear that throughout the Ebola pandemic, westerners were at the root of cultural conflict and shifted belief systems. However, the factors that led to these changes are multifaceted. The Ebola pandemic certainly wasn’t Liberia’s first outbreak. But because of the rapid spread of Ebola in Liberia, the lack of preparation caused international hysteria that led to the influx of foreign western cultures coming to Liberia. With a highly inflated number of outsiders from western countries within Liberia for a single goal and for a very short period of time, a prime case of societies and cultures in contact arose.
It seems that the primary factors of western medical practices affected Liberia two-fold; on one hand, western allopathic medicine proved to often be the quickest and more effective treatment method, and new policy standards put in place these standards. In fact, belief systems in Liberia began to sway after seeing the effectiveness of allopathic medicine for patients with Ebola from more traditional practices to more allopathic practices. However, while benefits came from the influence of western medical professionals, many repercussions remained present. With the “othering” of Liberians during the crisis from western media and lack of education from the western healthcare professionals, very little attention was paid to the belief systems and cultural normalities during the crisis and cultural conflict grew to new extremes. From the medical treatment itself to how Liberians were treated post-treatment and in communities with affected persons, we saw how postcolonialism This caused rifts to form and, often, disdain for scientific medicine and westerners as a whole by Liberians whose customs and cultures were at times completely ignored and often forced to change.
This essay utilized both ethnographic works that utilized participant observation and other tactics to gain inside information from Liberians whose voices were often ignored, and global journals and other works that show different layers to the factors and situations that caused cultural conflict and changes in belief systems over the entire duration of the crisis.
This essay concludes that the factors of western media, ignorance and distrust around Liberian customs, and othering of Liberians forced many Liberian belief systems to shift towards a eurocentric and allopathic health practices. Of course, with the help of western forces, stronger political practices were put in place and many lives were saved from outside medical help. Nonetheless, research shows that the cultural conflict caused by many westerners . For if the workforce of western professionals hadn’t entered Liberia, it is obvious that belief systems wouldn’t be as allopathic.
It’s critical to look at what impacts helpers and professionals have on a community post-situation. Because of the arise of cultural conflict and forced beliefs system changes, many Liberians feel distrust towards westerners. This is imperative to understand. As a singular, global society, our purpose is to help each other; in this case, to eradicate diseases as effectively and quickly as possible. How can this be accomplished if conflicts persist?