Culture: Cultural Rituals and Ebola

Ebola has been on my mind since the mid-1990s.  I actually transcribed the original screenplay of “Outbreak,” written by Laurence Dworet, MD, when I had my medical transcription service in Santa Barbara, CA, where he still resides. If you have not watched it, check it out.  Life imitating art?

I want to consider the cultural issues at both ends of the spectrum of Ebola.  As we have learned, Ebola originated in animals infected with the virus. The meat from these animals is called “bush meat.”  The writer states, “To many Africans, however, bush meat — the cooked, dried or smoked remains of a host of wild animals, from rats and bats to monkeys — is not only the food of their forefathers, it is life-sustaining protein where nutrition is scarce.”  It is readily available in the markets and street corners. 

The risk to the hunters of bush meat include “bites, scratches or contact with feces of bats, infected primates or other sick animals might transmit the disease.”  This exposure to and exchange of bodily fluids is how the disease is transmitted. Unfortunately,this cultural phenomenon appears to be the bridge from animals to humans.  It only takes a single transmission of the virus to infect a human and start the human-to-human contagious cycle.

“Life is not easy here in the village,” Guinean Sâa Fela Léno told the Guardian. Authorities and aid groups “want to ban our traditions that we have observed for generations. Animal husbandry is not widespread here because bush meat is easily available. Banning bush meat means a new way of life, which is unrealistic.”

Let’s fast forward to the other end of the Ebola spectrum; death.  As we have learned, the Ebola virus is at its most contagious state at the time of death.  The effects of the disease cause diarrhea, vomiting, open wounds, bleeding from the skin and all orifices, causing the virus to flow freely outside of the body. 

Individuals treating family members at home, especially in the early weeks of this outbreak, had no idea they were exposing themselves to this deadly virus during the process of the most sacred cultural ritual following the death of an Islamic patient, which requires thoroughly washing of the body prior to burial, ensuring the deceased is “pure” and able to ascend to Paradise.  Mr Sperry reports that many of the victims of Ebola in the three hot-spot nations (Sierra Leone, Guinea and Liberia) are Muslim.  It is thought that these burial rituals, known as Ghusl, are “a key reason why health officials can’t contain the spread of the deadly disease in West Africa.” 

In those areas where they understand the risk and wish to follow the health workers recommendations, there simply are not enough trained individuals and vehicles to handle the volume, causing these bodies to sit for many hours, exposing everything and everyone around them. Sadly, even after the body is placed in double plastic bags, along with all their belongings, and removed from the premises, the area where they were laying has now been infected. This situation has occurred both in homes as well as hospitals.

One writer closes her article with the following, "“Officials there have created “dead body management” teams, often staffed by paid members of the community, to bury the dead, and the system seems to be improving overall. But, said Red Cross team leader Daniel James: “There are still many other communities who do not believe Ebola is real, and who continue with the local custom of preparing bodies for burial themselves.””

Question: Given all the training and communication efforts to follow the necessary precautions to prevent exposure and contamination of this deadly virus, how can healthcare officials and community members protect the living and still respect the cultural practices of its members?

References:
Ohlheiser, Abby, WashingtonPost.com, “People are struggling to bury the Ebola dead. Here’s why.” 7 Aug 14

Phillip, Abby, WashingtonPost.com, “Why West Africans keep hunting and eating bush meat despite Ebola concerns,” 5 Aug 14

Sperry, Paul, International Business Times, “Islamic burial rituals blamed for spread of Ebola,” 16 Oct 14