Ebola is spreading like wildfire in the Democratic Public of the Congo where many people are refusing to get vaccinated against the disease out of fear and superstition.
In some cases, even the sick are turning away treatment.
Many people in the Congo believe that Ebola is the result of a curse or sorcery and insist that prayer, not medicine, should be used to treat the illness.
In response, the African Centers for Disease Control and Prevention has dispatched anthropologists alongside public health responders in a desperate attempt to contain the crisis in the face of deep superstitions.
There have been 28 confirmed cases of Ebola in the Democratic Republic of the Congo. Health workers are trying to control the outbreak, but superstitions stop many from getting treated
Ebola has emerged in the city of Mbandaka and surrounding rural areas, where 28 cases of the deadly disease have been confirmed and more than another 20 are suspected.
The World Health Organization is scrambling to distribute more than 15,000 doses of the vaccination against the disease that killed 28,216 people in West Africa between 2014 and 2015.
Ebola can spread through contact with the blood or bodily fluids of an infected person.
The vaccine gives people immunity to the virus – which can cause severe bleeding and organ failure – but it it can take up to 10 days to take effect, making it crucial that people get their shots expeditiously.
But distrust of Western medicine runs deep in Congolese culture.
‘As you can imagine, there’s a long history of outsiders manipulating and taking advantage of local people, so there’s generally some mistrust in terms of colonial history,’ says Dr Barry Hewlett of Washington State University in Vancouver.
Though this wariness is not necessarily specific to medicine itself, Dr Hewlett, who studies the anthropology of infectious diseases and was the first such scholar to be involved in an Ebola outbreak response, says ‘any international health worker should assume that most people are not going to trust the service they’re providing.’
The outbreak may well have begun with people in the DRC eating ‘bush meat,’ wild game that is one of the nation’s primary sources of protein
The Democratic Republic of the Congo (DRC) has a long history of colonization and mistreatment by Westerners.
Combined with the sudden periodic descent of health workers amid periods of sickness, the people of the DRC have gotten a strange and negative impression of responders.
‘Outsiders come in in a short period of time, doing these vaccination programs,’ such as those for meningitis, or measles, ‘and some people die and [the Congolese people] don’t understand,’ says Dr Hewlett.
Many locals, he says, think that health clinics are just facilities where organs are harvested from unsuspecting locals and sent to Europe for transplants.
He notes, too, that the people there have ‘their own indigenous “vaccination” system,’ wherein they ‘use razor blades to insert “medications” to prevent attacks from others.’
The early stages of a disease outbreak are seen as just that – ‘attacks’ by spirits or witches.
We always tend to see the local people as problems to overcome, and don’t see them as having own indigenous systems that could be used to help control an outbreak
Dr Barry Hewlett, Washington State University epidemic anthropologist
Dr Hewlett says that our view of the concept of ‘witchcraft’ in the Congo has to be tempered.
‘Witchcraft is often linked to promoting community and the origin of the outbreak has to do with someone who didn’t share,’ he explains.
These beliefs are ‘contributing to problems with control efforts in part, but the truth is that these particular beliefs contribute to sharing in the community because people who don’t share are potential targets for attacks by witches,’ he adds.
Currently, many people in the DRC believe that Ebola started in Bikoro, where a victim was cursed for eating stolen meat or the meat of a wild animal.
The rumor may not actually be that far off from the real source of the outbreak.
Because tsetse flies in the region spread disease from cattle to humans, people in the DRC cannot keep livestock. Instead, their primary source of protein is wild game.
Often, early cases of diseases like Ebola ‘are associated with people who are farmers or hunter-gatherers going out and hunting, coming across a dead [infected] animal and think, “boy, that’s pretty nice,” cut it up, boil and eat it,’ says Dr Hewlett.
So when ‘people who are relatively health, middle-aged adults die quickly, a common explanation is witchcraft or sorcery’ as vengeance for the misdeed of eating stolen meat, Dr Hewlett says.
This is the first outbreak since the development of the Ebola vaccine, but many in the DRC fear vaccines due in part to historical confusion amid past health crises
‘If you believe it’s a curse, then why do you need treatment?’ he asks. Instead, locals believe that they need prayer, and simultaneously see the arrival of health workers as a suspicious imposition.
‘But as deaths continue, they stop believing that and shift their own indigenous beliefs closer to their own sense of an epidemic…as something that comes with the wind and attacks many at the same time.’
He argues that the local cultural distinction between epidemics and witchcraft needs to be taken into account and leveraged by Ebola responders.
‘We always tend to see the local people as problems to overcome, and don’t see them as having own indigenous systems that could be used to help control an outbreak,’ Dr Hewlett says.
‘We need to speak the local language and put it into local cultural context and develop trust by doing a relatively few things to show respect for where they are coming from, then we can do this vaccination program.’
The latest outbreak is the first test of the new Ebola vaccine.
Its existence will hopefully help to contain the outbreak more quickly, but it also adds a layer of complexity to the interactions between health workers and locals.
Getting vaccinated is ‘a behavioral think we are asking people to do so we need to present it appropriately,’ he says.
‘So much of outbreak control is behavioral and social, so we need behavioral and social scientists in there to work with the biomedical folks because local communities have to be behind [the response] and understand it on their own terms if control efforts are going to be effective.’