Issues of Ebola in Africa

For John, BLUF:  Not everywhere has a Public Health approach like that in the US.  Nothing to see here; just move along.

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From Small Wars Journal we have "Ebola and the African Responsibility", by Henri Boré, a retired Colonel of the French Marines, working at the Marine Corps University.

Traditional beliefs remain prevalent within West African rural communities, which represent some 60% of the populations in Sierra Leone, Liberia and Guinea.   Many Christians go to church on Sunday morning and still pay a visit to their family’s witch in the afternoon.   These ancestral beliefs often shape social codes and norms.   Funerals for instance are critical family events.   Rites and procedures stem from a traditional understanding of the universe.   It is paramount for a family to stay with the body of the loved one when he or she passes away.   In the traditional code, parents have to clean the body and bury it to keep the family and the spirit of the dead connected.   Later on, the dead’s spirit will then protect the livings.   Abiding by these rites is critical to maintain harmony between the past, the present and the future through the support of the spirits of the ancestors.   In the context of Ebola, medical procedures such as removing the dead for cremating and keeping the families away from the infected bodies are perceived as evil in many rural areas.   It is seen by villagers as an attempt to destroy the core identity of the family and the social fabric of the community.

Herein lies another of many challenges facing the current fight to stop the deadly propagation of Ebola.   The West African people are a center of gravity of this battle.   However, changing the ancestral culture of some 60% of this population who still abide by traditional beliefs and practices seems mission impossible, at least in the short term.   This is one of the reasons why the epidemic is currently winning the race

I have reversed the order of thse quotes, but the one about culture seemed more important.  I am for respecting other cultures, but I don't think we should necessarily expect "Western World" like outcomes (e.g., US or Western European like Ebola recovery rates and disease spread) from other cultures.  Actions have consequences.

Another thing that struck me was the discussion of corruption, captured here in two paragraphs.  The success of free enterprise, and of individual freedom, depends upon a level playing field.  Corruption tilts that field.  Government with its thumb on the scale also tilts the field.

Sierra Leone, Liberia and Guinea have one thing in common.   Plagued with a large political corruption and economic mismanagement, the three countries had almost no performing public health structure available when the 2014 Ebola epidemic broke out.   Corruption ingrains every layer of the society and the state.   Government bribes, fraudulent business procedures, money laundering, and medical quackery are basic facets of a national culture of corruption.   As seen in other African countries, “the system delights in robbing Peter to pay Paul.   Here, a large number of people pay for services that are not provided, and most of the time, do so under duress.   At the same time, the system allows the minority to enjoy the services they do not pay for.”    In the past 10 years, a considerable amount of money has disappeared in the labyrinth of corruption.  That reality has prevented the states from developing and transforming their medical infrastructure and public health system.   Both were still nonexistent or barely functional in March 2014.

According to the World Bank, Africa loses $148 billion annually because of corruption.   Sierra Leone, Liberia and Guinea are no exception.   Even though ordinary citizens are not the only ones to be blamed for the culture of corruption that plagued their societies, they still participate in disseminating it.   From law enforcement officers taking bribes to custom officers turning a blind eye on smugglers for their own gain, members of local non-governmental organizations (NGOs) receiving cash under the table and government officials embedded in patronage and clientelism, all these ordinary people have fed what has become a national culture of corruption.

There is no doubt that we need to be prepared at home for coping with Ebola, and for quarantining those who might be infected.  We don't know as much as we should about the disease, so more research is needed.  Our preparedness for Ebola has made our Hurraicane Katrina response look like a well oiled machine.

But, we also need to deal with Ebola in Western Africa, lest it be like a large open sewer, spewing diseases which travel throughout our well connected world.  And, there are reasons we have our own customs and why we think those who come to live amongst us should respect those customs.  We have our own ways of dealing with infectious diseases.

Regards  —  Cliff