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The Ebola virus epidemic in West Africa has had a large effect on the culture of most of the West African countries. In most instances, the effect is a rather negative one as it has disrupted many Africans’ traditional norms and practices. For instance, many West African communities rely on traditional healers and witch doctors, who use herbal remedies, massage, chant and witchcraft to cure just about any ailment.[1][2] Therefore, it is difficult for West Africans to adapt to foreign medical practices. Specifically, West African resistance to Western medicine is prominent in the region, which calls for severe distrust of Western and modern medical personnel and practices.(see Ebola conspiracies below.)[3]
Similarly, some African cultures have a traditional solidarity of standing by the sick, which is contrary to the safe care of an Ebola patient.[1][2] This tradition is known as "standing by the ill" in order to show one's respect and honor to the patient. According to the Wesley Medical Center, these sorts of traditional norms can be dangerous to those not infected with the virus as it increases their chances of coming in contact with their family member's bodily fluids.[2] In Liberia, Ebola has wiped out entire families, leaving perhaps one survivor to recount stories of how they simply could not be hands off while their loved ones were sick in bed, because of their culture of touch, hold, hug and kiss.[4]
Some communities traditionally use folklore and mythical literature, which is often passed on verbally from one generation to the next to explain the interrelationships of all things that exist. However the folklore and songs are not only of traditional or ancient historical origins, but are often about current events that have affected the community. Additionally, folklore and music will often take opposing sides of any story. Thus early in the Ebola epidemic, the song "White Ebola" was released by a diaspora based group and centers on the general distrust of "outsiders" who may be intentionally infecting people.[5][6]
This initial misinformation increased the general distrust in foreigners, and the idea that Ebola was not in Africa before their arrival led to attacks on many health workers, as well as blockages of aid convoys blocked from checking remote areas. A burial team, which was sent in to collect the bodies of suspected Ebola victims from West Point in Liberia, was blocked by several hundred residents chanting: "No Ebola in West Point." Health ministries and workers started an aggressive Ebola information campaign on all media formats to properly inform the residents and allow aid workers safe access to the high risk areas.[7][8] In Guinea, riots broke out after medics disinfected a market in Nzerekore. Locals rumored that the medics were actually spreading the disease. In nearby Womey, 8 people distributing information about Ebola were killed by the villagers.[9]
The Ebola epidemic of 2014 has forced West Africans to face numerous difficulties on a daily basis regarding their traditional norms and practices. In essence, their traditions have been severely disrupted due to the Ebola virus. For instance, West Africans have had the tendency to remain close to their sick family members to nurse them during illness for centuries. Unfortunately for West African communities, many have been encouraged to keep their distance from their infected family members as potential contact could be fatal. In addition, it is part of their culture to touch the deceased at funerals and for the sister of the deceased's father to bathe, clean, and dress the corpse in a favorite outfit. When there is not an aunt to perform this task, a female elder in their community is then held responsible. Not only is it customary to wash and touch the deceased, but also to kiss those that have passed.[citation needed]
Specifically, funerals are considered to be major cultural events for families and friends to gather around to celebrate the deceased. The funeral performances, which involve wailing and dancing, is done out of care and respect for the dead. Funerals in West Africa often last for several days, depending on the status of the person who died. In other words, the more important the person who died was while they were alive, the longer the mourning will last. More importantly, there is a common bowl used for ritual hand washing towards the end of the ceremony, including a final kiss or touch on the face, which is to be bestowed on the dead. This is commonly referred to as a "love touch." The Wesley Medical Center has confirmed that prohibiting West African families from performing such rites is a disgrace as it insults the deceased, putting the remaining family in danger. Specifically, it is believed that the dead person's spirit, also known as "tibo," will cause harm and bring illness to the family as a result of an improper burial.[2]
Resistance to Western medicine is considered to be a significant barrier to battling the Ebola virus.[3] The Wesley Medical Center claims that the interference with West African burial rituals caused by Western medical practices has prohibited them from properly honoring their loved ones. They believe that this may have been a reason for heightened distrust in medical professionals, and that the mistrust enhances each time family members of infected persons are prohibited from participating in the funeral or seeing the dead body in person.[2] Due to the mistrust, Ebola-stricken communities in Liberia reportedly hid family members with Ebola from health care providers and held secret burials.[10] In Sierra Leone, health workers made more progress because health measures were implemented according to WHO guidance, which advises health workers to heed the traditions of the threatened communities when attending to the dead. Therefore, funerals were held in agreement with the wishes of the families, but also gave health workers an opportunity to disinfect the bodies.[10] In many of the Ebola infected areas in Africa, Western medicine is also believed either to be ineffective or to be the actual origin of the virus. In other words, there is a belief among the African community that Western doctors are intentionally killing their patients with their treatments. A conspiracy theory also says that the medical professionals are planning to harvest the organs of those dying from Ebola.[3]
Resistance to Western medicine exists also because of the look of the hazmat suits, which are worn by healthcare workers to protect themselves from becoming infected with the Ebola virus. The protective equipment is said to frighten many West Africans and also believed to be hostile and intimidating to the West African families.[2][3] Lastly, the interference in the family's care for the patient diminishes the honor of the patient as well as hindering the family's duty to provide comfort and care.[2] Regardless of the existing resistance towards Western medicine, handling the bodies of the deceased poses a high risk of contagion as Ebola is contracted through physical contact with an infected person's bodily fluids. This is mainly because preparation for burial includes touching, washing, and kissing as is mentioned above. Those that are preparing for the funeral can become easily infected as they can easily become exposed to the infected person's blood, vomit, diarrhea, and other bodily fluids as these are the main symptoms of the virus.[3]
Apart from the fact that traditional West African healers have been using ritual and herbal remedies for many centuries, the West African people also trust these treatments and find the costs more affordable. Traditional procedures include the following: magic, biomedical methods, fasting, dieting, herbal therapies, bathing, massage, as well as surgery. Surgical procedures often involve cutting a patient's skin with unsterilized knives. Sometimes, traditional healers apply blood to the skin to rid them of their sickness.[2] Despite the severe distrust of Africans in modern medicine, the Ebola virus has been said to spread rampantly across West Africa due to a shortage of healthcare workers and limited medical resources and facilities. The unsanitary conditions in the overall West African region have also made it easier for Ebola to spread.[3]
Alakey Osei, a student and bank-teller from Freetown, Sierra Leone, described the Sierra Leonean capital as a ghost-town, as a result of the increasing death toll in the West African region caused by the Ebola epidemic. Osei states that "everyone is scared to be out of their houses. No one is going to church or mosque, no one is going to work, the kids are not going to school, [and] people are not even going to the market place". The fact that the city of Freetown has been completely abandoned is foreign to the student, because the nation is and has always been heavily reliant on physical contact and very close interaction. Osei has indicated that following the no touching rule that the medical personnel have been promoting is extremely difficult for her. Osei continues by saying that she does not even know how her people are surviving.[citation needed]
In her interview, Osei provides some insight about her childhood. She moved to US in 2008, when she was thirteen years old. She experienced extensive bullying for her obliviousness to American culture and simply for being the "uncivilized" African. For example, others had asked her if she was getting accustomed to wearing shoes since people do not wear shoes in Africa. She was also called names, such as monkey and pre-historic. As a result of this cruelty, she began to believe that American culture was very cold. She also noticed that Americans were "protective of their property", space, and time. She concluded that American society is "extremely individualistic". This truly made her miss living in Africa, "... where every woman is your mother and every man is your father, ... where you are never alone, because everyone is family and family is all around you".[citation needed]
As of October 2014, the Ebola virus had not reached her home-town back in Sierra Leone; however, she said that her family still living in the country claimed that Freetown did not "feel like the same place" anymore. Her aunt had told her that people were not sharing food anymore nor spending time at each other's houses as they used to because of the fear of becoming infected. Osei finds it heart-breaking that people in Sierra Leone have turned to isolation as a way to stay Ebola-free. Osei now says that "Freetown has become Fear-town", and that "Ebola has turned us into prisoners in our own country".[11]
The Ebola virus, for which the primary host is suspected to be fruit bats, has been linked to bushmeat, which is commonly consumed in areas of West Africa that use it as a protein source. Although primates and other species may be intermediates, evidence suggests people primarily get the virus from bats. Hunters usually shoot, net, scavenge or catapult their prey, and butcher the bats without gloves, getting bites or scratches and coming in contact with their blood.[12][13]
In 2014, the suspected index case for the Ebola outbreak in West Africa is a two-year-old child in Guéckédou in south-eastern Guinea, who was the child of a family that hunted two species of fruit bat,[13] Hypsignathus monstrosus and Epomops franqueti.[14] Some researchers suggested the case was caused by zoonotic transmission through the child playing with an insectivorous bat from a colony of Angolan free-tailed bats near the village.[15][16]
Despite health organisations warning about risks of bushmeat, surveys pre-dating the 2014 outbreak indicate that people who eat bushmeat are usually unaware of the risks and view it as healthy food. Because of bushmeat's role as a protein source in Western Africa, it is traditionally associated with good nutrition, and efforts to outlaw the sale and consumption of bushmeat have been impossible to enforce and have met with suspicion from rural communities.[17] The UN Food and Agriculture Organization estimates that between 30 and 80 percent of protein intake in rural households in Central Africa comes from wild meat.[18]
One major Nigerian newspaper published a report about the widespread view that eating dog meat was a healthy alternative to bush meat.[19] Dog meat was implicated in a June 2015 Liberian outbreak of Ebola, where three villagers who had tested positive for the disease had shared a meal of dog meat.[20]
There are a number of Ebola-themed jokes circulating in West Africa to spread awareness.[79]
In July 2014, the Liberian Football Association made an announcement that all soccer related activities would be put on hold "indefinitely to protect players and fans."[80] In September 2014, in a joint venture between FIFA and WHO, the Antoinette Tubman Stadium was converted into an Ebola treatment center.[81]
The 2015 African Cup of Nations (AFCON) was temporarily put on hold when the original hosts, Morocco, asked the Confederation of African Football (CAF) to postpone the final games till 2016, due to the Ebola outbreak.[82] CAF eventually moved the finals to Equatorial Guinea, which eliminated Morocco from the game as hosts, and brought Equatorial Guinea in, even though they had been eliminated prior.[83]
However the qualifiers for 2015 AFCON have been influenced by many countries' fear of Ebola, with many refusing to enter or allow entry of teams from affected countries. In July 2014, Seychelles refused entry to the Sierra Leone team. CAF ruled that Seychelles forfeited the game, giving Sierra Leone an automatic pass to the next stage. Lesotho refused to send the Under-20 team to Nigeria. CAF again ruled that Lesotho forfeited the game, sending Nigeria through to the finals.[84]
In August 2014, CAF also decided to forbid any official games in Guinea, Liberia and Sierra Leone. For Liberia, who had already been eliminated, this was not of concern.[84] Sierra Leone managed to move some home games to the visiting team's home; both home and away games against DR Congo were played in Lubumbashi,[85] and both games against Cameroon were played in Yaounde.[86] Guinea managed to get their home games moved to Casablanca, Morocco.[87]
Even after calls to have the 2015 AFCON postponed, the Equatorial Guinea government and CAF organisers have downplayed these concerns, and insisted that they would have ample measures in place, including: [citation needed]
On 7 August 2014, a social media hoax message was doing the rounds in Nigeria. It urged readers to "bath with hot water and salt before daybreak" and to drink as much of it as possible. On 8 August, the person who started the joke message to see how many of their friends would fall for it, identified it as such and posted an apology.[89][90] The hoax message quickly went viral when "several gullible, unsophisticated opinion leaders" repeated the hoax message.[89] Within days many were hospitalized due to excessive salt intake, with 2 deaths in Jos, Plateau,[91] 2 deaths in Makurdi, Benue[92] and at least 3 deaths in Bauchi.[93]
It is ironic that these deaths all happened in states that had no known EVD infected people. In fact only Lagos State and Rivers State had any infected. Furthermore, the unconfirmed death toll of the hoax cure is as many as the EVD death toll for Nigeria, with 8 deaths each.[94][95]
In two separate incidents in October, flights have been delayed from disembarking because of an Ebola joke. On 8 October 2014, US Airways flight 845 from Philadelphia to Punta Cana, Dominican Republic was held up for two hours on the tarmac when an American passenger sneezed, then announced "I have Ebola. You're all screwed," during the flight. After landing, he was escorted off the plane by four emergency personnel wearing blue hazmat suits, and detained until medical tests cleared him.[96] On 30 October 2014, during the Aer Lingus flight EI 433, from Milan, Italy to Dublin, Ireland a passenger wrote "'Attenzione Ebola'" ("Attention Ebola") on a coffee lid before handing it to his daughter. The container and lid were discreetly disposed of, however a flight attendant noticed, and alerted the captain. The passenger was arrested, and later pleaded guilty to "engaging in threatening, abusive or insulting behavior on an airplane contrary to the Air Navigation and Transport Act", and was fined 2500 euros.[97][98]
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