When disease strikes in the developing world, like the current Ebola outbreak in Guinea, doctors, nurses and epidemiologists from international organizations fly in to help.
So do anthropologists.
Understanding local customs — and fears — can go a long way in getting communities to cooperate with international health care workers, says Barry Hewlett, a medical anthropologist at Washington State University.
Otherwise, medical efforts can prove fruitless, says Hewlett, who was invited to join the World Health Organization Ebola team during a 2000 outbreak in Uganda. There are anthropologists on the current Doctors Without Borders team in Guinea as well.
Before the World Health Organization and Doctors Without Borders started bringing in anthropologists, medical staff often had a difficult time convincing families to bring their sick loved ones to clinics and isolation wards. In Uganda, Hewlett remembers, people were afraid of the international health care workers.
“The local people thought that the Europeans in control of the isolation units were in a body parts business,” he says. “Their loved ones would go into the isolation units, and they would never see them come out.”
Because of the high mortality rate, virtually every Ebola victim died. To prevent further spread of the disease, medical workers “would zip [the bodies] up in a body bag.”
And health care workers would not always notify relatives of a death because of the need to dispose of the body quickly, Hewlett wrote in a report on his experiences in Uganda.
“The anger and bad feelings about not being informed were directed toward health care workers in the isolation unit,” he noted. “This fear could have been averted by allowing family members to see the body in the bag and allowing family members to escort the body to the burial ground.”
In addition, he says, the large tarps surrounding isolation units were removed so family members could see and talk with a sick relative. And medical team members were encouraged to attend funeral services as a sign of respect.
Today, efforts to contain such outbreaks must be “culturally sensitive and appropriate,” he says. “Otherwise people are running away from actual care that is intended to help them.”
One key mission for anthropologists is to help doctors understand how a local population perceives disease.
Yoset, a spiritual healer near Arua, Uganda, works with the Centers for Disease Control and Prevention to detect the plague in his village.
In sub-Saharan Africa, he found, when death comes quickly, the locals blame sorcery. So they may not necessarily believe that there’s a disease that can be transmitted via contact with bodily fluids, as is the case with Ebola.
In Uganda, as the death rate rose during the 2000 Ebola epidemic, the local communities came to see Ebola as a type of gemo — or bad spirit — that kills people for not honoring the gods.
So while they did not believe that a virus was the villain, says Hewlett, they did hew to traditional beliefs that if you stand too close to a person with gemo, it’s easy for the spirit to catch you.
And that’s helpful information for doctors whose goal is isolating patients to contain an Ebola outbreak.