Mistakes in fighting Ebola repeated all over again, says pioneer
‘Médecins Sans Frontières is repeating the same mistakes from earlier Ebola outbreaks’. Prof. Barry Hewlett, the first anthropologist ever to be invited by the World Health Organization in fighting Ebola, has given an interview to the Belgian MO* Magazine.
In 2000 Barry Hewlett joined a mission to fight Ebola in Uganda. On this and other outbreaks, he wrote Ebola, Culture and Politics: The Anthropology of an Emerging Disease, a compulsory reading for medical anthropologists. In an interview with the Belgian MO* Magazine, Hewlett contends that medical teams are repeating the same mistakes all over again. With the death toll passing 700, this is the deadliest Ebola outbreak up to now.
How long have you been working as an anthropologist in combating Ebola in Africa?
Barry Hewlett: I worked with several other tropical diseases—schisto, oncho, Guinea worm- before working on Ebola. In 1997 I started the Ebola research. I was the first medical anthropologist invited to participate in an Ebola outbreak in Uganda in 2000. I worked on another in the Republic of Congo in 2003.
You were the first one to be contacted by the WHO?
Barry Hewlett: The full story of this is in our book. Basically, I wanted to get involved in Ebola outbreaks because I was tired of the way African people were being represented in the media. I contacted folks at CDC and WHO and asked them the name of the anthropologist working with them. They said they did not have a medical anthropologist. One of the physicians I talked with at CDC (Ed. the American Centers for Disease Control and Prevention) was someone I worked with on a schisto project in Cameroon. He talked with people at the WHO (World Health Organization) and they invited me. Not at the early stages, but once they were having problems when the number of cases started to go up rather than down.
Today people are still reluctant to be treated. Health workers and hospitals have even been attacked. Why is this the case?
Barry Hewlett: Outbreaks generate fear. Many people are dying every day, and people have to trust the information provided. Isolation units and health workers working with Ebola often look like they’re from outer space. In Uganda, local people thought the international team working in the isolation units was in a body parts business, very similar to the story in Guinea as to why local people attacked MSF-teams. So there’s a lack of trust in international teams, conflicting information, the lack of a cure; and all this contributes to problems.
Which major errors have been made, in your view, in fighting Ebola-outbreaks in Africa?
Barry Hewlett: Firstly the lack of culturally sensitive and appropriate control effort. There’s also a lack of incorporating local people’s knowledge into control efforts. If you take a look at my book, the problems described in all the previous outbreaks are taking place again. I am surprised that MSF-team members are not familiar with previous experiences, but I think they hire new people all the time.
Nothing has improved since your first mission? The WHO now has a whole section on anthropology in their toolkit “Communication for behavioral Impact”, in dealing with outbreaks.
Barry Hewlett: This is excellent, but for some reason or another it has not made an impact on infrastructure. The WHO now sends out a medical anthropologist in the early stages of an outbreak. One of the problems with medical anthropology is that no infrastructure exists to get them involved in outbreaks. When outbreaks occur the WHO calls CDC, MSF (Médecins sans Frontières, Ed. “Doctors without Borders”) and other organizations. All these medical agencies help with the outbreak, but none of them have permanent medical anthropologists with background in outbreaks.
MSF has sent out anthropologists this time. Maria Cristina Manca just got back from Gueckedou in Guinea and Jesse Verschuere is taking over.
Barry Hewlett: I know MSF sent out people. They’ve asked me to go to Liberia, but I am a Congo Basin specialist, do not know folks well, so I suggested other anthropologists that work in the region. I talked with MSF years ago. They said they would hire full time anthropologists for outbreaks, but as far as I know, this is not the case. Again I heard in news reports that international teams will send more people to help control the outbreak. How many do you think will be medical anthropologists? Probably none. Still most of the issues are cultural and behavioral.
During an outbreak of Marburg in Angola, mentioned in the WHO-toolkit, the family could not bury the deceased or even attend the funerals. Is this one of the biggest challenges today in West Africa?
Barry Hewlett: Read my book! People have indigenous systems that realize that it’s ok to alter burial practices during deadly outbreaks. But it is true that during any deadly outbreak, like smallpox and Spanish flu in the US, respectful burial practices are important.
The Angolan case revealed other challenges such as the little ownership of population in the disease control management.
Barry Hewlett: I see this as major issue. Local people need to be involved and take control of their own circumstances. This is as major a problem as with the current move to quarantine villages in West Africa.
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