What would happen if there were outbreaks of Ebola all over the world within a short period? Would the response be the same as the events from the 2014 West Africa outbreak? Would the view of people, especially from the western world, on this disease with a case fatality rate upwards of 40%, approaching 90% to 100% in some instances, be the same? Would the world stay the same, regarding the preparedness to deal with biomedical threats, response to disease outbreaks, and socio-cultural perspective to disease?
The 2014 Ebola outbreak in the West-African countries, particularly Guinea, Sierra Leone, Liberia, and Nigeria, was a devastating event of unprecedented extent. Thousands of people perished, and the socio-cultural, as well as economic, the landscape of these countries were shaken in ways that are not easily quantifiable. While an Ebola outbreak is a calamity that threatens the health of the world at large, it is a problem that has been thus far confined largely to the West African demographic stretch. This confinement raises several questions concerning the dynamics of such outbreaks, inevitably drawing in socio-cultural issues as well.
What role has the western world played in the improvement of the disease or in perpetuating the pre-existing rhetoric and prejudice against a region that is already grappling with bleak, inadmissible levels of economic misery? What role do the socio-cultural factors inherent in the countries in question play in the outbreak? What are the political and economic changes that follow such a tragedy? How does the social landscape of such countries, in reference to survivors, families of survivors, and the diseased, as well as the general public, become impacted? These are the questions we should consistently be asking ourselves in an effort to construct the public health outcomes of the disaster in the affected countries.
The patient zero in this outbreak is thought to have been a young boy in Guinea, who might have contracted the disease after being bitten by a bat while playing. It is interesting then, that from this case the disease was able to spread to several other countries and kill as many as 11,000 individuals before it was properly contained. One of the major issues that come up in this situation is the question of whether the public health systems in these countries are so flawed that the outbreak was able to extend its reach as far as was recorded. Another question is whether the way nations interact, in terms of movement across the borders, is so flawed that an outbreak like this has the potential of spreading through several countries before being controlled.
Another issue that becomes immediately pertinent is whether the policies and restrictions that are often put in place during such an outbreak can be justified in light of the potential for the spread of the disease and the deleterious effect that this bears on the affected populations, or should it be taken into consideration whether there is an alternative to such policies. One would wonder if the health outcomes that often emanate, and indeed did emanate, from the 2014 outbreak, can be supported by best practice in the spirit of international cooperation in combating such disasters, which after all are the business of everyone and not only the poor West-African countries as is often the case. It is in the backdrop of this question that it is necessary to discuss the social factors and outcomes, policies and implications of them, as well as the cultural factors inherent to the calamitous outcomes of this disease. Public health measures are inextricably linked to these factors; thus, their discussion inevitably invokes a look at the preparedness and efficiency of any measures that are instituted in such attacks.
It would seem that a majority of the social policies that are in place, especially in the western world, are policies that unfairly discriminate against black immigrants in their countries. According to Sturmer et al. (499-513), the socio-cultural representation of the Ebola outbreak as a cultural failure of the people of West Africa is part of an inherent tendency to symbolically isolate the people in a bid to satisfy pre-existing cultural and social prejudices against them. In other words, blaming the outbreak on the practice of eating flying foxes, bats, monkeys, and other wild meat is a way of justifying the cultural unfriendliness towards immigrants.
Sturmer et al., suggest that it is through these pre-existing cultural prejudices that the people in the Western world support policies such as the restrictive policies that are often applied in such circumstance, more than the fear of the spread of the infection itself. The problem is externalized, disowned, and seen more as an African problem or their problem rather than one that concerns all the citizens of the world. It is exactly because of this social-cultural acrimony or disharmony that it becomes difficult to approach the problem with a singular mind. Quarantine, rather than attempts to see how best to solve the problem and limit the infection in a manner that provokes the least disruption to the social set-up, becomes the preferred policy. Ridicule, rather than an attempt to see how any maladaptive cultural and social practices can be adjusted to align them with the least risk of infections, becomes the order of the day.
The Ebola virus infection can no longer be viewed as an African problem. On the contrary, improvement in technology, especially the transportation sector, makes it almost everybody’s interest that outbreaks are not only controlled, but that future outbreaks are averted (Salra et al. 164-177). However, the fear of infection alone, even if justified, does not justify putting in place measures and policies that are isolationist, whose main effect would be the dehumanizing of the people that are at the hotspot of infection and in the middle of untold economic suffering and political frustration. There is always a chance, with traveling, that infections can be carried off to other countries before an outbreak is discovered. Thus, it is necessary that the people affected most are treated as humans first and as potential sources of infection after.
This is not to say that the fears of infection are unfounded, as there have been well-established suspicions that the cultural and social practices of the people that come from these areas are linked to the occurrence of the outbreaks and difficulty in containing them. The overarching message must be that culturally inappropriate stereotyping does little to help the situation and more to disincentivize a people that are already bearing the brunt of systemic failures in economic and political efficiency, and public health unpreparedness.
The Ebola outbreak of 2014, like any other disasters of that magnitude would, caused a declaration of a state of emergency in the countries that were affected. The WHO also characteristically declared a state of emergency in these regions. A declaration like this has many potential benefits. According to Hodge et al. (596), such measures may be necessary as a means of controlling the spread of the disease and installing some order among the masses that is necessary for the public health measures that are instituted to work.
The closing of schools, businesses, and government offices as well as authorization of measures such as screening, are all necessary in this regard. While these changes in the law are necessary, it is also a change that has the potential to be abused. For instance, the president in most such states is given the power to act in a way that makes him infallible in respect to the law. It is this infallibility of the rulers and the capacity to abuse human rights in ways that can be egregious and bordering on blatant disregard even for the laws protecting life, that pose the greatest downside to changes in a law that occur during these crises.
Such was the case in Liberia, where an order was passed to shoot to kill anyone that arrived from Sierra Leone illegally under the cover of darkness (Hodge et al. 596). Moral, as well as political questions, rise from such occurrences and worries of what humanity is prepared to do to protect their fears become pertinent. The question of abuse of human rights, including the right to assemble, freedom to move, and freedom against forced searches, confinement, and all the measures that are often taken by governments during these periods and controversial matters.
These changes inflict a lot of social and economic burdens upon the people. Because people are sick or taking care of their sick family members, their productivity dwindles. Economic growth also stalls or outright falls because of the burden of disease. With a decline in agricultural productivity, the people become in danger of starvation. Further confinement of people and restriction of their freedom of movement makes the situation even more dire, leading to their dependency on aid from the government and Non-governmental organizations, aid which is neither guaranteed nor adequate in most instances (Hodge et al. 596).
Families that have one or more of their members become infected with the disease often suffer a huge toll. Part of the culture of the people of West Africa is that they have to care for their sick loved one. Women especially are the ones often charged with these responsibilities (Nell Gray 1-14). Taking care of other sick members of the family has two grave outcomes. The first is that the rest of the family is not able to be economically productive, diminishing their ability to provide for the family. If the sick family member is also the breadwinner, the problem is compounded. Considering that some of the resources of the family might actually be going into the treatment of the sick one, either through seeking medications for symptomatic relief or through visiting traditional witch doctors, the gravity and devastating effect that this may bear can easily be fathomed.
The second, more devastating consequence of having family members as the primary care providers of their sick relative is the possibility of contracting the infection. Because the disease is spread mainly through contact with the body fluid of the infected person, the care of the patient usually means that the caring person will encounter these fluids and thus it is very likely that they will catch the infection. The result may be deleterious to the family, and the community at large.
It has also been established that families may opt to hide their sick family members as opposed to taking them to hospitals or letting the government have access to them. Part of the reason why this is the practice is that the people fear that they will lose contact with their loved one, or even the ability to bury them in the eventuality that they die. Burying loved ones is a sacred part of the culture of most regions in Africa, so many are not willing to let go of the opportunity to do so, even when they are cognizant of the perilous outcomes that doing so in the case of such a dangerous disease as Ebola might portend. Sierra Leone made it illegal to hide family members, with a two-year prison sentence awaiting those that would be found doing this (BBC). It is not easy to say whether this would be helpful or not.
Burial rites are one of the ways through which the disease is spread among the African nations. In fact, it is estimated that over 60% of the spread of Ebola in Guinea occurred through burial rites (Manguvo and Mafuvadze 9). Such practices include the washing of the dead before burial, lying over the dead in a bid to get some of the spiritual gifts as may be the case in some African nations, touching the dead over the head, washing hands in a common bowl after touching them, and such other practices. These practices bring the fluids of the dead person into contact with the people, increasing their risk of contracting the deadly disease (Griggs; Tiffany et al.).
Quarantine is also among the issues that adversely affect the family as a setup. Families are unable to meet with their loved ones because of the restrictions that exist. This predictably causes stress among family members. When the affected families have relatives who are sick, and who might end up dying in their absence and even being buried with them being restricted as such, the stress that can be caused, especially considering that closeness among family members as such times is highly valued in these parts of the world, is enormous. Quarantines, when unnecessary, are supposed to be avoided if the families are to be helped to overcome these problems.
In a devastating event like this, it is critical that individuals, families, communities, and the country at large receive psychosocial support to help them cope with the problem. Without this, the effects of the disease may be devastating to the psychological well-being of those that lose their loved ones or experience the trauma of seeing and hearing about other people dying in horrible states.
With the 2014 outbreak, it was shown the rates of mental health issues in the country rose considerably. Unfortunately, Sierra Leone is a country that has only one specialized psychiatric hospital to serve all its population, around 7 million people at the time (Kamara et al. 843). This implies that even in the absence of a devastating event like the Ebola outbreak, the structures of the country’s healthcare were ill-prepared to deal with psychosocial problems adequately. It became necessary, therefore, to have more centers to deal with these problems, as well as more healthcare personnel to help in ameliorating the problem.
The only way to do this would be through the acclimatization of some of the healthcare workers in the country to the provision of these services. The nurses naturally became an attractive target for the inculcation of mental health training. Physicians were also trained, as well as other healthcare personnel. During the period following the outbreak in 2014 and 2015, about a hundred and thirty cases related to the outbreak were seen and treated in the psychiatric hospital in the country (Kamara et al. 843). It is necessary that there are continued efforts to counsel the people who might have suffered, as well as give them education on coping mechanisms to help them overcome the traumatic effect that is associated with the disease.
The most recent data from Sierra Leone indicates that the survivors may still be going through anxiety, depression, and post-traumatic stress disorder after the experiences in the Ebola Treatment Centers and the community after their discharge (Jalloh). One of the issues that made it even more difficult for the survivors to cope was the fact that some of them faced divorce from their spouses upon arriving at home, others lost their jobs due to the stigma and fear associated with having suffered from the deadly disease and fears of contamination which lead to isolation from other members of the society. To combat these myths and misplaced assumptions, it might be necessary to educate the society and remove the ignorance that then precipitates these retrogressive acts against the survivors (NPR; Yadav and Rawal 01-02).
The following chart summarizes the effects of the outbreak:
The Ebola outbreak of 2014 had devastating, deleterious effects on the people in that region. Sierra Leone bore the brunt of the outbreak, with several of its citizens suffering from the disease or its effects, including the death of relatives and friends and the devastating consequences of the control measures that were put in place. There seem to be certain social and cultural practices that hasten the spread of the disease. Practices such as burial rites, hiding the sick, and home caring for the infected predispose the people to higher probabilities of infection. It was clear from the outbreak that the country was not prepared for such an emergency in terms of the lack of a proper healthcare framework and economic instability becoming a stark reality. People suffered not only from the sickness but also from hunger and lack of proper relief preparedness. Those that survived carried with them psychological baggage that also did not have a proper mechanism for treatment in the country. There is continued need to give psychosocial support to the affected people to help them cope.
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