Suggested Readings

The Cultural Anthropology Editors’ Forum: Hot Spot, “Ebola in Perspective,” is a compelling collection of short pieces by anthropologists and artists presenting locally informed insights written at the height of the Ebola epidemic in 2014. We highlight a few here that are instructive to understanding population reticence.

In her contribution, Mariane Ferme discusses the countless obstacles to obtaining medical care experienced by populations living in rural Sierra Leone. Arduous journeys to far away clinics on barely passable roads, costly payment for treatments, supplies, and food, even if services rendered are free, bureaucratic, and confusing spaces that require an advocate to be present to ensure attention is paid to the patient, generally end in inconclusive interactions given reduced capacities and limited access to advanced medical technologies. The avoidance of formalized medical institutions, or what is perceived as inaction of people in remote villages, she describes is driven by a belief in fatalism that must be understood as a calculated decision about the costs and benefits of expensive care based on the experience of people living on the margins of subsistence. Local traditional healers are physically more accessible, attentive to patients, and more affordable, thus remaining the first line of care.

Paul Richards and Alfred Mokuwa provide insights on the perceived problematic funeral practices, focusing on the heavily affected Mende Villages in Sierra Leone. They link funeral rites to familial and marriage ties, explaining that when a woman marries outside her village, her body may be returned home to be buried if her marriage was incomplete. A survey of three Kpa-Mende villages revealed that more than 80% of all the marriages to female partners from another village are incomplete, suggesting that many mourners and corpses may move between villages for burial. Yet, as Richards, Mokuwa, and others argue, funerary rites practices were adjusted for security reasons during the civil war, or because someone died far from home, with “place-holder” gestures performed or rituals skipped altogether. You can listen to an interview with the authors here. Paul Richards offers greater details in his book, “Ebola: How a People’s Science Helped End an Epidemic.”

Jackie Sayegh, Theresa Ammann, and Anita Shroven examine the state of the State in Liberia and Guinea, respectively. Jackie Sayegh describes the public in Liberia as watching democracy from the sidelines, “spectators rather than players in a game that should be inclusive.” She asserts that most Liberians are deeply distrustful of the government, with the Ebola crisis a fiction created to receive donor aid to be distributed among the governmental elite. Theresa Ammann further indicates how government efforts fueled fear, civil unrest, and noncompliance in Liberia, specifically their call for a state of emergency; the dumping of bodies into community wetlands rising concerns about water contamination; the shooting of a sixteen-year-old; the closing of a newspaper over allegations of false information spread about a government change; and, uncertainty about how, if, and to whom ZMapp (treatment) has been distributed. Anita Shroven argues that government members in Guinea so rarely leave administrative centers that they are viewed as distrustful “foreign elements” leading to government health workers being denied access to villages and attacks on health clinics.

The Ebola Response Anthropology Platform, developed during the 2014-2016 West Africa epidemic, aimed to build locally appropriate and socially informed outbreak responses by providing clear and practical advice from social scientists that engaged with crucial socio-cultural and political dimensions of the outbreak. The site offers policy briefings rooted in both historical and rapidly changing contemporary contexts of affected communities, with a focus on identifying cases, caring for the sick, managing the dead, preparedness, and communication and engagement.

Among others, James Fairchild offers an account of the character of resistance in Guinea, which he argues is rooted in a much deeper political and economic experience. First, he argues that resistance should not be inferred from non-compliance. He links resistance to Ebola containment efforts as attributable to (a) the social distance between the institutions of epidemic response and the communities affected; (b) the politicization of health delivery where political parties are read as ethnically aligned; and, (c) the social effects of the extreme inequality where outsiders’ wealth is built on the labor, resources, and woes of Africa’s poor.

Fairchild’s argument aligns with Juliet Bedford, who perceives resistance as a form of empowerment in the face of unacceptable or provocative interventions initiated by the national and international response. They both argue that epidemic containment responses need to be delinked from national politics and grievances and re-orient their relationship with the community by embedding efforts into trusted health delivery systems and engaging with community structures.

Finally, Paul Farmer offers a touching personal account of his experiences as a medical doctor, anthropologist, and global health practitioner in “Fevers, Feuds, and Diamonds.” He attests through historical accounts, anecdotes, and personal stories, to the impact of legacies of structural violence; centuries of exploitation and injustice under formal colonial rule, and now global politics driven by neoliberalism collectively resulting in chronic health failures. He describes the inability of governments to respond when the crisis began and the devastating effect of the Ebola epidemic on what little healthcare was available. His accounts of the ordeals of Ibrahim and Yabom reveal how people have lost hope in the State. The inability to trust officials during times of uncertainty pushes people towards groups, practices, and spaces they understand and take comfort in. Dr. Farmer talks about “irrigating the clinical desert” in an interview with Harvard Medical School. 

For a perspective on the global response to the Ebola epidemic, what the global health governance structures are and why it failed to prevent and stop the epidemic, we suggest this free course, Lessons from Ebola: Preventing the Next Pandemic, offered by the Harvard Medical School and the Harvard T.H. Chan School of Public Health.