The Ebola endemic is worsening, and the death tolls in regions of Guinea, Sierra Leone, and Liberia are well over 300. The regions have relatively porous borders, and people are travelling freely between the countries, elevating the risk of viral transmission. More and more people are becoming infected, and the cultural divide between healthcare workers and certain sub-regional communities is becoming strained. As doctors rush and try to quell their patients and inform communities about methods of virus protection, the number of people contracting Ebola continues to grow.
Dr. Robert Garry of Tulane University School of Medicine, is leading a team of relief volunteers, most recently through affected parts of Sierra Leone. Garry has noted that one of the growing problems he and his team face is the divide on infection prevention. While the volunteers are working as quickly as possible to propagate information on viral transmission and how people can protect themselves, the group is sometimes met with resistance from community members who are not as receptive to a few of the teams’ warnings. One such warning is the advisory to be wary of eating what is known as “bushmeat,” the cultural practice of preparing and consuming bats, monkeys and the like, which are often protein-rich and readily available sources of nutrition.
Eating these meats is a practice throughout many communities, and Garry’s team is having a difficult time conveying the message that—among other ideas—people should be cautious of bushmeat, as consuming it may present an elevated risk of transmission of the deadly virus. While not officially confirmed, the Centers for Disease Control and Prevention (CDC) and other health organizations surmise that one possible host of the hemorrhagic fever is the African fruit bat, which often makes its home in central and west-African habitats, close to where communities may use the animal as part of a communal meal.
Volunteers treating the Ebola outbreak are trying to maintain a balance between circulating health care information, and maintaining cultural competence, respecting the divisions between a community or family’s spiritual and religious beliefs. These relationships are becoming more and more strained, as the need to isolate the virus escalates. Volunteers are working with urgency, and a few community and cultural practices are met with concern.
The traditional practice of eating bushmeat is not the only potential hazard that is making this outreach more frustrating. It is not uncommon to have family, tribal or community members participate in the funeral rites of the sick or dying. During an extreme endemic as this recent outbreak, the virus can spread quickly and easily. Ebola transmits primarily through bodily fluids, and when a dying or deceased loved one is washed and prepared for funeral rites, the virus’ circumference of affliction can widen.
Not all religious or spiritual leaders are open to the presence of the volunteer healthcare workers. Spiritual practices and beliefs can vary from region to region, along with its political, economic, and social systems. During some of his visits, Garry notes that leaders do not always agree with him or his team, but offer their own beliefs that perhaps the viral infection is a curse or a spirit of sorts. Walking this line is dangerous, as, it invites the potential for misinterpretation of two very distinct (although not necessarily mutually exclusive) spheres: science and religion.
That is not to say that every community reacts in this manner. Rather, cultural competency is another facet the volunteers are working with, and it begs difficult questions. In many ways, treating the Ebola endemic is a contradictory situation; a cultural divide, a blur, and a cooperation. Treating the outbreak requires that volunteers tread carefully, negotiating and respecting cultural, religious, and spiritual boundaries, a balancing act which is challenging in and of itself.
By Hayden Freed