The Sunday Mail
Under The Baobab Tree – Sifelani Tsiko
Debate on the Ebola disease is still choked with emotion, controversy and so many unknowns.
Many questions crucial to infection control and prevention remain unanswered.
To many people across the world, it remains difficult to comprehend just how up to 13 042 people got infected and 4 818 died from the Ebola virus.
This was according to the World Health Organisation update of November 2.
What could have contributed to the tragic response to the Ebola virus?
Is it the chaotic response in dealing with the deadly epidemic?
Is the crisis a direct offshoot of failure by the governments of Guinea, Sierra Leone and Liberia to provide adequate health facilities?
Is this a direct effect of the devastating civil war that led to a poor response in this region?
Or is it poor governance, failure of these governments to provide timely and accurate information to the people when Ebola broke out?
Is it rumours and misinformation that compounded the response? Is it an issue of race?
Is it the issue of bioterrorism being used to assault the African race, or is it the World Health Organisation or the international community’s poor response?
There are no easy answers to these and many more questions like them.
The 5th conference of the Infection Control Network Africa in Harare from November 3-7 sparked my curiosity about how poor community involvement and marginalisation of indigenous knowledge systems could have fuelled the spread of the Ebola virus.
African infection control and prevention experts charged that over-reliance on foreign models and approaches without community participation and the utilisation of existing knowledge about the Ebola virus could have led to the tragic response to the epidemic.
This position was grounded in the greater question of how African countries could probably find solutions to their own problems rooted in their own cultural and indigenous knowledge systems rather than merely relying on foreign public health models.
The experts felt strongly that through community involvement, African countries facing the scourge of Ebola could use IKS to communicate a shared problem and to mobilise action, inspire and foster a common approach and agenda firmly rooted on knowledge that existed among affected communities.
With so many unanswered questions, African virologists put foreign and western approaches to dealing with the epidemic under scrutiny.
Professor Shaheen Mehtar of the University of Stellenbosch and ICAN chair told delegates that over-reliance on the input and expertise of outsiders who had little or limited understanding of the situation in Africa contributed to the tragic response to the Ebola virus.
“Africa should have paid more attention on local indigenous knowledge systems and used outside help to enhance the capacity of local community public health approaches,” she said.
“We have a lot of knowledge as Africans but we feel intimidated by outsiders. We don’t use our own indigenous knowledge systems to respond to our problems. We use other people’s policies which do not work well for our own circumstances.
“Outsiders know less about Ebola than ourselves. Our communities know the outbreak cycles of the disease, but their knowledge was completely ignored.”
Prof Sade Ogunsola of the Provost College of Medicine at the University of Lagos said lack of community engagement had been the biggest setback in the fight against the Ebola virus disease.
“It has been a barrier and this has affected the trust and mutual engagement with local communities,” she said. “We have to involve local communities and learn more about the knowledge that they have to effectively respond to the Ebola virus.”
Said Dr Frederick Marais, a researcher at Stellenbosch University: “We must go in an honest and open way, respect local traditions for responding to public health issues in a way that prioritises health safety standards. We need to take communities on board. Affected communities are the repositories of unrecognised knowledge and expertise needed to control the Ebola virus.”
He said there is a disconnect between what is happening on the ground, inside communities, hospitals and the grim holding centres where children, women and men are painfully dying of Ebola and government and international response.
Dr Marais said local knowledge systems embedded in traditions and customs were totally ignored and this created a tense, violent and ineffective response to the Ebola virus.
“The real missing link in the Ebola virus containment efforts to date was due to the lack of early and meaningful engagement of trusted community leaders,” he said. “A deficit mentality perspective still persists among foreign models. You don’t own the problem and the solution. We must work with the communities and avoid disrespecting and invalidating their own local knowledge.”
With the participation of local communities and with strict adherence to safety standards, he said, the Ebola outbreaks could have been quickly throttled.
“The exclusion of local communities and their knowledge systems dehumanises and foments stigma,” Dr Marais said.
“We must go in an honest and open way, respect local traditions for responding to public health issues in a way that prioritises health safety standards.
“We need to take communities on board. Affected communities are the repositories of unrecognised knowledge and expertise needed to control the Ebola virus.”
He said fusing local community ideas and knowledge without compromising health safety standards could have reduced the potential scale of the disaster.
African virologists proposed culturally appropriate strategies to enter and work with communities in addressing the Ebola crisis:
Engagement of local communities in the design and implementation of Ebola response strategies.
Entering communities with cultural humility, respecting community protocol and striving to build respectful partnerships.
Reciprocal learning to build trust and respect without compromising safety. This increases knowledge and dispels myths.
Multi-way communication — developing systems for regular factual and information updates critical.
Sustainability and community empowerment.
“Affected communities know more about Ebola than outsiders. They know the outbreak cycles. Following closely on local knowledge systems, we now know for certain that there is a possibility of another outbreak in 2017,” said Prof Mehtar.
“We need to work closely with local communities and prepare for the likelihood of another Ebola outbreak.”
Africa virologists say helping local people understand how to protect themselves while providing safe patient transport and burial and working with village chiefs and elders to help quell rumours about the origins of disease can help create a robust Ebola response strategy.
It is critical for African governments and international partners to learn from and build on past experiences of local communities when dealing with the Ebola problem.
Greater attention needs to be paid to making Ebola response strategies truly pro-poor because strategies that reinforce the inequities tend to face stiff resistance and outright rejection.
Local community participation should be a key driver for Ebola response strategies.
A World Bank position paper captures this aptly: “The willingness and ability to speak with citizens must be coupled with a willingness and ability to listen to them, incorporate their needs and preferences into the policy process and engage local patterns of influence and trusted sources of information.”
To fend off the Ebola virus, we should aspire to look for African solutions to African problems and examine where we came from in order to better frame our responses to future outbreaks of epidemics.
Like all public health response models, there is no one-size-fits-all solution.
Indigenous knowledge systems may or may not be an effective tool in other places, but debate at the 5th ICAN conference provides clear and useful insights into discussions on Ebola response strategies.
The conference, at least helped to re-direct the thinking of African infection prevention and control experts to promote the desire to live and work within their own context.
A context which takes on board the historical, cultural, economic and political dimensions of local community structures.
The conference, succeeded inasmuch as it sought to remove from the minds of African virologists the induced belief that they ought to reproduce the world as seen by the West.
Ebola response strategies should be in touch with the reality which Africans live day by day and tap on local community capacity, creativity and insight.
They should also be informed by the fact that ordinary people, poor people and powerless people have a right to be heard, to participate in discussing decisions concerning their lives and to have their values and preferences respected.
Any action against this will sow seeds of ill-feelings between people and force Africa to slide into a dark tunnel of conflict.
