Ebola and the deadly love kiss in the age of globalization

All cultures have traditions that mark important occasions in life, promote unity and transmit values to new generations. These traditions may be based on such factors as age, gender, stage in life, social status, or may arise out of disasters (natural or man-made). Many traditions promote intra and inter generational harmony; others undermine the health and dignity of individuals, usually females. Some of the most harmful traditions have persisted because the community has lacked adequate access to education, to information, and to other services.

Time and again, we are reminded how some traditional practices become deadly, particularly under conditions of emergent diseases. For example, there are rural communities in Africa that still practice the old custom of wife inheritance. The practice varies in form, but basically, if a husband dies, the widow is inherited by a brother or a close male relative of the deceased. The widow has no choice in the matter except to choose among available potential inheritors. Apart from the horrific injustice inherent in this practice, wife inheritance proved to be a disaster in the HIV/AIDS pandemic. Likewise, socially unsanctioned behaviors like prostitution, infidelity, rape, sodomy, etc. are equally dangerous in the context of the HIV/AIDS pandemic.

The Ebola epidemic, currently ravaging West Africa (Guinea, Sierra Leon, Liberia, Nigeria and Senegal) has come face to face with policies, poverty and traditions. Ebola is a virus that causes hemorrhagic fever. Its origin is not known for sure, but is thought to be an animal virus transmitted to humans via contact with wild animal meat or other body fluids. Unproven speculations are also rampant that it is a laboratory bug manufactured in the United States. With proper awareness and protection, human infection can be minimized. In the event of an Ebola epidemic, proper medical care and quarantine, the disease can burn itself out within a relatively short time as was the case in Uganda and other countries.

The ongoing West Africa epidemic seems to defy all efforts. It has now raged on for seven months with no signs of abating. As of September 26^th, Ebola had killed 2,917 people while leaving 6,263 others infected. Why so? The answer is a combination of factors. With the exception of Nigeria, the affected countries including Liberia and Sierra Leone are both recovering from decades of war and are poor with inadequate healthcare facilities. Poverty and low literacy levels lead to lack of knowledge of diseases in general and Ebola in particular.

Under these conditions, many patients end up staying home to be cared for by relatives. Then, when they die, relatives are traditionally required to wash, dress, kiss and quickly bury them without protection in the absence of refrigeration. In the process, they unknowingly become infected with the virus released by the dying person in body fluids including blood, saliva, vomit, sweat and diarrhea. Some people also suspect that men who are lucky enough to survive Ebola continue to pass on the virus in their semen for up to seven weeks after recovery. Since women are generally the primary caregivers, they tend to be the most vulnerable to Ebola infection.

The Ebola virus infection is difficult to diagnose, particularly in the absence of the necessary tools and personnel. The initial symptoms are similar to other diseases like malaria. By the time a person goes to the clinic or hospital, he/she is already infectious. Without proper protection, family members and medical personnel who are unaware that the sick person is Ebola positive can easily become infected.

Another factor that makes it hard to combat Ebola is ignorance which breeds superstition and wild rumors. Consequently, some people attribute the cause of the disease to curses, evil eyes, supernatural punishment etc. Medical staff appearing in protective gear and using liquid spays to disinfect protective gear and dead bodies are often suspected or mistaken for causing and spreading the disease. Even worse, some people think that the disease and the need to quarantine Ebola patients to limit its spread is a hoax. In Liberia, angry citizens stormed an Ebola Center and bare handedly retrieved their sick relatives, thus helping spread the infection.

The need to bury the dead in plastic bags without relatives and friends seeing the body also fuels the rumor that foreigners come to kill people for body parts. Moreover, the knowledge of the history of some unconscionable researches carried out by some American, German and Japanese scientists helped worsen the suspicion. This time, the Viral Hemorrhagic Fever Virus consortium laboratory at Kenema Government Hospital, Sierra Leone, was attacked. The conspiracy theorists and spin doctors whipped up emotions by dubbing this a bioweapon research laboratory, thus generating enormous fear with tragic consequences. In a remote village in Guinea angry residents killed 7 health workers and wounded many others on the mistaken notion that they were coming to spread the disease. To allay the fear of irate citizens, the Sierra Leonean government was forced to close down the Kenema Research Laboratory.

While it may be justifiable for uninformed citizens to be suspicious of any Ebola experimentation, they should not accept the allegation of evil intent willy-nilly. To quash the rumor mills, the research consortium must be truthful and transparent; the spin doctors must also desist from spewing irresponsible rumors for the sake of notoriety. Without such restraint, lives will be lost needlessly.

Even if the current epidemic is controlled, the virus can still hide in reservoirs. Animals get infected without getting sick and die from the virus. Humans become infected when they unwittingly handle body fluids of such animals. Animals suspected of being Ebola reservoirs include primates, bats, bush antelope and even pigs.

Apparently the world has not learned its lesson from other disease epidemics including immunodeficiency syndrome (AIDS) caused by HIV, severe acute respiratory syndrome (SARS) caused by N1H1 swine flu virus and the recent bird flu caused by H5N1 flu virus. World reaction to the Ebola virus outbreak was initially anemic. Wealthy nations, notably the United States, did not respond robustly until the virus became a global threat months after its start.

During the struggle for independence, African leaders like Nyerere, Obote, Kenyatta, Kaunda, Nkrumah etc., made it their goal to fight against ignorance, poverty and diseases. While fifty years or so ago, the responsibility belonged to each country, in the era of globalization, fighting disease epidemics must be a global effort. This also means that disease epidemics cannot simply be fought from a narrow view of health. They can only be successfully controlled by addressing all the social, economic, political, medical and cultural conditions that promote the emergence and spread of diseases. In this regard, the timely intervention of organizations like Doctors Without Borders, The Bill and Melinda Gates Foundation and others, and the belated but robust response of wealthy countries like the United States are highly appreciated. They point to the possibility that with a united international effort, the Ebola epidemic can be controlled.

Future responses must be pre-emptive, swift and decisive. Information about research must be made understandable and accessible. Cultural practices such as wife inheritance or love touch/kiss during funeral rites must be modified or abandoned completely in the event of disease epidemic. Otherwise, a small local epidemic becomes a pandemic and a love kiss becomes a kiss of death.