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Situational Analysis of the Emergence and Spread of Ebola
in Sierra Leone
Sylvester Amara Lamin
1
&Consoler Teboh
1
#Springer International Publishing 2016
Abstract
Purpose This study explores the effects of traditional
and cultural practices on the spread of Ebola.
Problem statement Ebola was first identified in Sudan
and Zaire in 1976. Since then, there have been sporadic
episodes, but the recent outbreak in West Africa, offi-
cially declared on March 22, 2014, has been the worst
ever. In the three countries most affected (Guinea,
Liberia, and Sierra Leone), Sierra Leone has recorded
the most cases. In February 2015, the British
Broadcasting Corporation reported that nearly 9729 peo-
ple died from the Ebola virus disease in six countries;
Guinea, Liberia, Sierra Leone, Nigeria, the USA, and
Mali, with more than 23,943 cases identified. Little
has been done to examine the role of traditional and
cultural practices in the spread of Ebola in these
regions.
Method This research uses the case study approach of a small
group of community leaders in Sierra Leone and secondary
data to arrive at thematic inferences.
Conclusion The study proposes that traditional and cultural
methods of caring for loved ones infected by Ebola enhance
the spread of the virus.
Implications The study recommends that changing these
practices will significantly reduce the spread of future Ebola
outbreaks.
Keywords Ebola virus disease .Traditional practices .
Cultural practices .Socioeconomic factors .Human behavior
in the social environment .Bush meat processing and
consumption
The 2014 Ebola outbreak in West Africa gained American
media attention when after Thomas Duncan traveled to the
USA from Liberia. He was admitted to Texas Presbyterian
Hospital and, eventually, died of the deadly Ebola virus.
Shortly afterwards, two of the nurses who cared for him be-
came infected but survived. It became obvious that something
needed to be done, and quickly, to contain the virus. Prior to
2014, there had been very little media coverage of earlier
Ebola outbreaks, including the 1976 episode in Sudan and
Zaire (now known as the Democratic Republic of Congo).
The first outbreak of Ebola, known as BEbola-Sudan,^in-
fected nearly 300 people. The second episode, code-named
BEbola-Zaire,^emerged in the village of Yambuku, Zaire.
The death rate of Ebola-Zaire was very high and thus, drew
the attention of international agencies such as the U.S. Centers
for Disease Control and Prevention (CDC) and other groups
from South Africa, France, and Belgium. With previous se-
vere outbreaks in 1989 (Virginia, USA), 1994 (Cote d’Ivoire,
West Africa), and 1997 (Uganda), researchers from multiple
countries were determined to identify the reservoirs of the
virus, but to no avail (Jones 2011; Quammen 2014). After
further research, however, the World Health Organization
(WHO) in the 1990s confirmed that BEbola is introduced into
the human population through close contact with blood, se-
cretions, organs or other bodily fluids of infected animals^
(IRIN 2015, p. 1). Although strides have been made to iden-
tify and localize the particular host, or hosts, there has been no
confirmed identification. Thus, there is currently no vaccine
for the virus.
*Sylvester Amara Lamin
salamin@stcloudstate.edu
1
Department of Social Work, School of Health and Human Services,
St. Cloud State University, 230 Stewart Hall, 720 4th Avenue South,
St. Cloud, MN 56301, USA
Glob Soc Welf
DOI 10.1007/s40609-016-0049-1
The symptoms of Ebola include fever (greater than 101.5
degrees Fahrenheit), severe headache, muscle pain, weak-
ness, diarrhea, vomiting, abdominal (stomach) pain, and un-
explained hemorrhaging (bleeding or bruising) (CDC 2014).
Generally, the symptoms may appear anywhere from 2 to 21
days after exposure to the virus. Worthy of note is that there is
no cause for concern if an individual is asymptomatic after
the 21-day incubation period. Although the death rate of peo-
ple infected by the disease is between 50 and 90 % (Jones
2011, p. 1), some patients do recover with early intervention
(CDC 2014).
The main hindrances associated with combating this
ferocious virus are many. First, Bit strikes rare, it pro-
gresses quickly through the course of infection^
(Quammen 2014, p. 71). Second, Ebola outbreaks se-
verely affect health workers (Alexander et al. 2014).
For instance, the first outbreak in Kikwit killed 20 doc-
tors (Quammen 2014). Third, curbing its spread is fur-
ther complicated by traditional and cultural practices
found within affected societies. BCaring for the patients,
or preparing the deceased for burial^(Alexander et al.
2014, p. 4), makes human-to-human transmission a ma-
jor source of infection. Fourth, challenges such as the
lack of running water and electricity, and people’s diets
(insects, monkeys, and rats), which are all suspected
carriers of the disease,^(Hoffman 2007,p.2)havealso
been determined to hinder the fight against Ebola.
Social services workers and healthcare providers, es-
pecially those working with recent immigrants and those
whose families still live in Ebola-prone areas, know
only the simplest fundamentals about identification and
treatment of the disease. On the bright side, the com-
plexities of fighting the disease may be many, but they
are fixable. Eradicating the disease must therefore in-
clude creating an awareness of the components of harm-
ful traditional and cultural practices that spread the virus
amongpeoplelivingininfestedregions.Tothisend,
this study not only explores how traditional and cultural
practices contribute to the high incidences of the spread
of Ebola but it also looks at how such harmful practices
can be reduced. As espoused by the social work profes-
sion, studying the person within his or her environment
is an important prelude to a biopsychosocial understand-
ing of the disease. Thus, in spite of the large geograph-
ical expanse of the regions recently hit by Ebola, there
are traditional and cultural correlational trends among
these peoples that are yet unknown to expatriate person-
nel that may help unravel the otherwise unscientific ex-
planation of its transmission. If this is done, we con-
tend, Ebola can and should be contained.
According to Ojua et al. (2013), cultural practices that are
very important to people affect their health considerably. Each
society, or community, has its ways of operating that go a long
way toward influencing the peopleor community, has its way,
and behaviors in the management of diseases and health-
related problems. Schein (1985) defined culture as follows:
…a pattern of basic assumptions, invented, discoursed
or developed by a given group as it learns to cope with
its problems of external adaptation and internal integra-
tion that has worked well enough to be considered valid
and therefore, to be taught to new members as the cor-
rect way to perceive, think, and feel in relation to those
problems. (p. 9)
Culture involves key behavioral patterns that are intergen-
erational to a particular group (Lum 2007). Culture determines
what is acceptable or unacceptable, important or unimportant,
right or wrong, and workable or unworkable. It encompasses
all learned and shared, explicit or tacit assumptions, beliefs,
knowledge, norms, and values, as well as attitudes, behavior,
dress, and language (Lum 2007). Noteworthy is the fact that
some of these behavior patterns are still relevant to people,
some are no more relevant, while some are outright dangerous
andneedtobeeradicated.
Literature Review
Bush or Game Meat
The consumption of bush meat (game) is very common in
nearly every country of the world. In the USA, Klein (2014)
states that game meat is hunted from non-domesticated, free-
ranging, and farm-raised animals and birds for personal con-
sumption, or reared, slaughtered, and commercially sold for
food. Klein also asserts that in Africa and other parts of the
developing world, the term Bbush meat^is used and has
been Bassociated with the great apes and monkeys; it also
includes hippopotami, water buffalo, elephants, giraffe, ze-
bra, wild hoofstock, caracals, jackets, reptiles, birds and
rodents^(p. 4). In this research, however, the term Bbush
meat^refers to meat that comes from a variety of wild
animals (bats, monkeys, rats, grass cutters, antelopes), cap-
tured, processed smoked, dried, or salted and considered a
treat by some, a main food source for others (CDC 2014).
Generally, Ebola is not spread by food. Nevertheless, in
Africa, human infections have been associated with tradi-
tional and cultural practices, hunting, butchering, and pro-
cessing of meat from infected animals (Corum 2014).
Additionally, the consumption of bush meat, or the touching
dead animals like chimps, gorillas, and monkeys, has also
been associated with the spread of Ebola (CDC 2014;
Hoffman 2007;Jones2011).
Unlike in the USA where four federal agencies enforce
laws designed to protect humans and animals Bthrough their
Glob Soc Welf
respective regulatory authorities^(Klein 2014, p. 2), most
regions of the world, particularly in Africa, do not have such
regulatory bodies. In addition, the USA ratified the
Convention on International Trade in Endangered Species
of Wild Fauna and Flora (CITES) in 1974, and the federal
government enforces laws pertinent to this ratification.
Although the three countries affected by the 2014 Ebola out-
break were signatories to CITES, enforcing the regulations
was bedeviled by the lack of resources, corruption, and, to
some extent strong affiliations to traditional and cultural prac-
tices. Thus, although the consumption of bush meat Bmay
pose a public health risk because the health of these animals
is unknown and many species may harbor diseases that could
infect people^(Klein 2014, p. 4), people remain steadfast to
their traditional and cultural ways of doing things.
Additionally, Phillip (2014) noted bush meat is not only the
food of their ancestors but also an important source of pro-
tein. Given the forgone, it is difficult for locals to comply
with CITES regulations.
Inadequate Health Sector
In addition to bush meat-related problems, Jones (2011)ob-
served that all of the countries in Africa with an Ebola out-
break lack the necessary infrastructure to curb the disease.
This is especially so when the magnitude of the outbreak is
high. Most of the few hospitals or health centers in these
regions rarely have the personnel or the equipment to handle
basic healthcare needs. Rogers (2014) asserts that hospitals
lacked not only medications and equipment to fight the virus,
but also poor sanitary conditions, lack of basic personnel pro-
tective equipment in the 2014 Sierra Leone outbreak.
According to Corum (2014), Bhospitals and clinics are the best
places to recognize Ebola. However, unprepared hospitals can
concentrate or amplify an outbreak^(p. 1). Another point to
note is that of the poor road infrastructure. There is little or no
road infrastructure to transport infected or suspected cases of
Ebola to the hospitals or health centers. During the rainy sea-
son, many roads become impassable with potholes and mud,
making it impossible to travel.
Fearmongering and Distrust
Corum (2014) posits that Ebola thrives on fear and distrust.
Many people in communities experiencing Ebola outbreaks
are reluctant to seek help for fear of being infected at hospitals
and treatment centers. In a country like Sierra Leone, many
people saw Ebola management and treatment centers, or large
holding facilities, as death traps. They refused to seek treat-
ment when they experienced early symptoms of the disease
(Sack et al. 2014) and instead resorted to archaic methods of
cure. Fearmongering and distrust made the isolation of
suspected cases through contact tracing, which was used
greatly during the 1976 outbreak in Yambuku, Zaire (Corum
2014), cumbersome and fruitless. Each time that contact trac-
ing was introduced, expatriate authorities in Sierra Leone met
with resistance when interviewing families because people
thought they would be taken to these n to these Zaire (eatly
during the 1976 outbreak in Yambuku,d to make tracking of
the disease nearly impossible, while its spread increased
among the local population.
Cultural Beliefs
People’s cultural belief patterns include a totality of socially
transmitted behavior, patterns, arts, beliefs, institutions, and all
other products of human work and thoughts (Koppelman
2014). However, culture is learned and shared within social
groups and is transmitted by non-genetic means.
According to WHO (1997),
Special attention must be given to the actual perception
of the outbreak by the community. In particular, specific
cultural elements and local beliefs must be taken into
account to ensure proper messages, confidence, and
close cooperation of the community. (p. 6)
Even with the 1997 WHO declaration, many social scien-
tists are aware of the role of people’s behaviors toward disease
outbreaks. This notwithstanding, literature is lacking regard-
ing the role of cultural practices in the spread of Ebola. In
nearly all of the countries experiencing an Ebola outbreak,
communities believe that Bsome sort of vampirism or evil
spirit^causes the outbreak (Quammen 2014, p. 41). Among
the Acholi in Uganda, the Ebola outbreak was attributed to Ba
form of malign spirit called gemo^(Quammen 2014). For
them, the Ebola outbreak was not their first gemo as they
had Bsuffered epidemics of measles and smallpox^(p. 42).
As with Uganda, people in many other regions of Africa still
attribute calamities to angry gods. In Sierra Leone, many de-
nied that Ebola was real and blamed witchcraft as the cause of
mass deaths. (Nielsen et al. 2015). In such cases, the people
call upon griots, or charlatans, to cleanse infected persons of
their diseases. In doing so, the griots and charlatans not only
infect themselves but many other people as well. In some of
the instances in Uganda, the traditional healers are pregnant
women, and in their bid to perform these healing rites, they
endanger themselves and their unborn babies (Hewlett and
Amola 2003).
Mistrust Owing to Weak Response
In many cases, locals tend not to believe information about the
Ebola outbreaks. Therefore, they do not take into
Glob Soc Welf
consideration the necessary precautionary, preventative steps
that are suggested in many areas of Sierra Leone. For example
in Freetown, workers at an Ebola treatment center noted
pockets of resistance Bthey do not take into consideration the
necessary precautionary, preventative steps that are sugg
(Farge and Fofana 2015, p. 1). According to Penfold (2015),
Sierra Leoneans, like most people around the world, found it
difficult to onse before the surgere the in manpara, 18).
Villagers also distrusted foreign medical practitioners and sci-
entists. Many locals were not convinced of the real motives of
researchers. Such mistrust in the case of Ebola can be
calamitous.
Kobie (2015) states that there are many misunderstandings
and misconceptions between the government and the popula-
tion with respond to Ebola. An example is the mistrust that
exists between the Ministry of Health and the local popula-
tion. According to Kobie (2015), the issue of mistrust comes
from the fact that for decades, people have suffered from chol-
era, diarrhea, dysentery, and malaria fever, but the government
has not seemed to care. People thusquestion why the Ministry
of Health suddenly cares for them when it came to the Ebola
outbreak. Thus, it is commonplace to hear questions like,
Bwhat is the Ministry of Health up to this time?^or Bwhere
were them when cholera killed many poor people?^
Quarantining
Quarantining is a proper way of containing Ebola. It is the
restriction of healthy individuals presumed exposed to the
disease during period of communicability (Kris Ehresmann
2014, personal communication). Once a case is identified,
families that are already poor find it hard to observe the quar-
antine and still put food on the table. Community members
find it difficult to get able-bodied men to help on the farms
since they see any form of gathering to be a great risk for
catching the disease. Even during Ebola-free periods, many
African countries suffer from unusually severe problems of
food scarcity (Lamin 2007); when Ebola strikes, people are
predisposed to more scarcity of food.
In all cases, families are quarantined for 21 days with hard-
ly enough food for the entire family. Among the Acholi in
Uganda, their 2000 quarantining involved Bays with hardly
enough food for the entire family. Among the Acholi in
Uganda, their 2000 quarantining ind still put food on the table.
Command suspending the ordinary burial practicesi
(Quammen 2014, p. 42). According to the U.S. Centers for
Disease Control and Prevention (2014), human remains
should be cremated or buried promptly in a hermetically
sealed casket. As plausible as CDCd still put fos were, most
of the people whose loved ones died from Ebola maintained
their traditional and cultural methods of parting with the dead,
such as washing the corpse, and thereby failed to observe
necessary precautions.
Traditional Healers
In most African regions, local people cut off from townships
or urban areas usually resort to traditional healers for all their
medical needs. The reliance on traditional healers to cure the
Ebola virus disease was therefore not new. Quammen (2014)
wrote Ba family disbelieved the Ebola diagnosis and preferred
relying on a traditional healer^(p. 43) when there was an
outbreak of Ebola in Mboma village, Republic of Congo, in
1979. In Gulu, Northern Uganda, locals sought traditional
healers known as witchdoctors when the outbreak occurred
(Hewlett and Amola 2003). Since the outbreak of Ebola in
Africa, the WHO and other international and national health
workers continue to face many challenges because of the way
traditional healers have handled Ebola outbreaks (Hewlett and
Amola 2003). In Gulu, it was believed that a certain traditional
healer infected many people with her bodily fluid before her
death. Batty (2014) also submitted that, with the 2014 out-
break of Ebola in Sierra Leone, some villagers contacted tra-
ditional healers instead of medical personnel and ended up not
surviving the disease. In other parts of Sierra Leone, the Ebola
virus quickly spread because a certain female traditional heal-
er who was active in treating Ebola patients passed away and
in the course of preparing her corpse for burial, several people
were infected.
Ebola in Sierra Leone
This study highlights the reality of the Ebola outbreak in the
African sub-region through the examination of one of the
countries hardest hit by the Ebola outbreak in 2014. Sierra
Leone is a small country on the west coast of Africa. The
country covers an area of about 72,000 km
2
(28,000 mile
2
).
Sierra Leone is bordered on the north and northeast by the
Republic of Guinea, on the east and southeast by the
Republic of Liberia, and by the Atlantic Ocean to the west
and southwest (Lamin 2007). Along the coast, B. Along the
coast BThe Atlantic Ocean extends approximately 340 kilo-
meters (211 miles)^(Statistics Sierra Leone 2014, p. 1). Sierra
Leone has 14 districts. Freetown, the capital city is located in
the Western Urban District. The country gained independence
from the British on April 27, 1961. It Bis endowed with sub-
stantial mineral wealth, ample cultivable agricultural land, and
rich fisheries^(World Bank 1993, p. 7). However, many peo-
ple remain poor with little or no access to basic health care,
living in congested areas and in unhygienic slums.
Sierra Leone’s civil war had a devastating effect on the
country. Even before the civil war, “the influx of nearly
Glob Soc Welf
200,000 Liberian refugees (equivalent to five percent of
Sierra Leone’s population) and Sierra Leone’sparticipation
in the West African states peacekeeping initiative exerted
significant pressure on government finances”(World Bank
1993, p. 2). This influx seriously affected the countryn the
country. Even before the civil war, ng in congested a The
Ebola outbreak took the same route as the refugees of the
1991 Liberian civil war had taken into Sierra Leone (Batty
2014), spreading across porous borders where many people
regularly crossed into and out of Sierra Leone in search of
markets for their products. With such an unregulated border,
the deadly virus was able to smolder undetected across un-
suspecting communities (Stylianou 2014).
One area hardest hit during the Sierra Leone Civil War was
the health sector. BIn 1997, there were fifty-nine hospitals
owned and controlled by various agencies: the Ministry of
Health, missions, mining companies, and private individuals”
(Lamin 2007, p. 128). Interestingly, most of the infrastructure,
including healthcare facilities burned down by rebels during
the war, still needed rebuilding. Also after the civil war, many
trained health personnel who fled the country never returned
to work. Although the country has seemingly returned to nor-
malcy today, the 2014 Ebola outbreak was met with excessive
corruption by government officials and an ineffective
healthcare infrastructure unable to contain the massive impact
of an almost continental crisis (Rogers 2014). On the other
hand, pervasive corruption caused the general populace to
develop a lack of trust when dealing with hospitals or other
healthcare personnel. The local population now feels that the
healthcare sector is cost prohibitive, and although the
Government of Sierra Leone introduced Free Health Care
Initiatives in 2010, Bare personnel. The local population now
feels that the (Wilkinson and Leach 2014, p. 7). Wilkinson and
Leach (2014) assert that a compounding problem is the lack of
commitment by emergency health responders even after the
establishment of hotlines. At times, it takes days before assis-
tance gets to people in dire need of medical attention.
Officials of the National Ebola Response Center (NERC),
created by President Ernest Koroma to coordinate and robust-
ly combat the spread of Ebola, grossly misappropriated funds
donated to fight the disease. A report on the audit of the man-
agement of Ebola funds found that Bfficials of the National
Ebola Response Center (NERC), created For instance, pay-
ments which exceeded Le 14 billion [$2.5 million] were made
from the Emergency Health Response and Miscellaneous
Accounts without any supporting documents to substantiate
the utilization of such fundsy (Audit Services Sierra Leone
2015,p.4).
On the whole, health facilities have deteriorated consider-
ably with severe Bconsequences on the people, especially
women and children”(Lamin 2007, p. 128). In Sierra
Leone, some of the affected areas lacked basic personal pro-
tective equipment and disinfectants including chlorine,
bleach, and soap essential for simple hygiene such as
handwashing. A report by Statistic Sierra Leone (SSL) states
that before the Ebola outbreak, BForty-eight percent of house-
holds had no water, soap, or other cleaning agente (p. 18)
available for handwashing. Thus, inadequate resources were
compounded by corruption (Wilkinson and Leach 2014). The
pervasive and endemic corruption also led to the lack of trust
by people to seek services in government-owned and operated
health facilities. Another factor of concern at the start of the
outbreak was that many districts lacked items like chlorine
sprayers, body bags, shovels, earth movers, or vehicles to
effectively combat the spread of the virus and get the situation
under control.
The International Monetary Fund (IMF) and the
Wor l d Bank’s introduction of the Structural Adjustment
Programmes (SAPs) in the country during the J.S.
Momoh government in 1989 designed to ensure debt
repayment and economic restructuring, created severe
consequences for the people. Since then, government
expenditures on the health sector have been seriously
affected (Jones 2011;Lamin2007;Wilkinson and
Leach 2014). Ferme (2014) asserts that “since the early
1980s, public hospitals in Sierra Leone have been so ill-
equipped that wound dressings, drugs, antiseptics, cath-
eters, and even stitching materials for surgeries”(para
4) are borne by patients and/or family members been so
ill-equipped that Ministry of Health is the main provider
of medical care to sick and poor people, but cutbacks
by the government have led to the reliance on interna-
tional non-governmental agencies for basic health mate-
rials, including health personnel. It is also important to
note that in many cases, Bovernmental agencies for ba-
sic health materials, including health personnel. It is
also important to not (Wilkinson and Leach 2014,p.
8) is made. In many rural areas of the country and parts
of capital city Freetown, lack of passable roads greatly
affects access to healthcare, making it extremely diffi-
cult for patients to get to government healthcare centers.
Family members transport patients in hammocks, wheel-
barrows, and, in some cases, on their backs. With the
lack of proper building codes and poor road network in
Freetown, many people living houses built on hills and
in the mountain tops find it extremely difficult to move
patients to health centers.
Method
This is a qualitative study to explore reasons behind the con-
tinued spread of the Ebola virus disease in spite of millions of
dollars having being spent to get the situation under control.
This research used a case study approach that included
interviewing a small group of community leaders in Sierra
Glob Soc Welf
Leone and using secondary data: books, journal articles and
agency documentations (CDC, WHO), and media and
Internet sources as well as direct observation of participants
to arrive at thematic inferences (Berg and Lune 2012;Yin
1989,2009). “Case studies can provide a kind of deep under-
standing of phenomenon, events, people, or organizations
(Berg and Lune 2012, p. 328). A purposive sampling method
(Patton 2008) was used to select the group of community
leaders for the study. Informants were identified and selected
in the cities of Bo and Kenema. The group consisted of 20
community leaders who were considered key informants
(Hardcastle et al. 2011; Netting et al. 2012). Two social work
graduate students from Njala University and the primary in-
vestigator contacted the participants in person and via tele-
phone for in-depth interviews (Padgett 2002). The researchers
used open-ended questions to allow participants to expand on
the topic. Participants were asked open-ended questions to
allow them to expand on the topic. The researchers ensured
that all participants consented to the study. All interviews were
conducted in English. The resulting sample totaled 20 partic-
ipants, 18 men and 2 women. All the participants had com-
pleted secondary school education and nearly half of them had
post-secondary qualifications.
Findings
Key themes that emerged from the data analysis were those of
traditional and cultural practices, the consumption of bush
meat, distrust of the government, stigmatization, and corrupt
practices by health workers and government officials. The
themes are reported below.
Traditional and Cultural Practices
Participants explained that it was very difficult for people to
abandon their traditional and cultural practices. In spite of the
risks of exposure to bodily fluids of the deceased, community
members, loved ones, parents, and relatives were determined
to perform the traditional and religious burial rites, since many
believed that anything other than the norm would condemn
the soul of the deceased to wander around instead of going to
its final resting place.
We will need to pray on our people for them to get the
mercy of God, for all they have done on earth and thereby
enter the kingdom of God. (Community leader, Dodo Section,
Bo).
Another community leader in Kenema explained,
The government tells us to observe safe burial practices
but this is very hard to do. Can you despise or shun your
mothere kingdom of God. (Community leader, Dodo
Section, Bo) the deceased to wander around instead of
going to its final resting place.tervieng psychological
distress.
A community leader in Kenema explained that every death
is treated as an Ebola case, and people find it difficult to
comprehend this. The leader stated,
The use of an epitaph, the burial of a family member is
common in the country but as a community, a main
concern is burial of the dead in unmarked graves. This
means the bereaved will never have the opportunity to
visit the gravesides of their relatives. Indeed, burial
should be dignified, in spite of the situation.
Bush Meat
Nearly all of the community leaders interviewed believed that
the consumption of bush meat was not at all harmful nor could
it cause an individual to get the Ebola virus disease. They also
strongly believed that the practice would be very difficult to
break.
There is no way that animals like monkeys or squirrels
are risky to eat. People have been eating these animals
even before our forefathers were born. The bush meat
saved many families during the rebel war, and they nev-
er got infected with any disease. Why only now?
(Elderly Community leader in Kenema)
A young community leader explained that the rearing of
livestock had dwindled considerablyover the years, especially
after the end of the civil war. During the rebel war, Byoung
community leader explained that the rearing of livestock had
dwindled considerably over the (Community leader,
Manjama, Bo). He further explained that many people
resorted to, or maintained, the consumption of bush meat as
it is cheaper, affordable, and very tasty.
Furthermore, community leaders explained that communal
eating was common, and there was no way for people to eat
alone and not to share with other people, especially those who
were in need or sick, Ebola notwithstanding. Burthermore,
community leaders explained that communal eating was com
One female community leader explained that caring for the
sick was the responsibility of family members and abandoning
a sick relative would bring a curse to the individual. She also
said that although the government had admonished people
from handshakes and other pleasantries, many people found
it very difficult to do so. This so-called no-touch policy is very
difficult for people to abide with as it shows that you are
snobbish, and people see it as foreign (Female community
leader, Bo No. 2).
Glob Soc Welf
Distrust of the Government
Most community leaders claimed that the government was
very negligent at the start of the Ebola outbreak in the country.
They lamented about the inaction of the government and the
delay in closing the borders with Liberia and Guinea, espe-
cially as it took months before the first case was confirmed in
Sierra Leone. Bost community leaders claimed that the gov-
ernment was very negligent at the start of the Ebola outbreak
in the (Community leader, Blama).
Another community leader said, although the government
wanted people to report symptoms of Ebola to health centers,
people were not convinced that the centers were well
equipped.
As soon as you go there (health center) with even a
slight fever or malaria the health officials will keep
you at the holding center and subsequently move to
quarantine your family. (Community leader, Sewa
Road Area Bo)
Besides the closure of the borders, many community
leaders explained that the hospitals lacked the requisite equip-
ment and emergency prepared staff for the disease itself. One
female member lamented that Bfemale member lamented
thatorders, many community leaders explained that the hospi-
tals lacked the requisite equipment and emergency prepared
staff for the disease itself. r fa
Stigmatization
Some community leaders expressed concern that certain
Ebola patients who are now free of the disease after successful
treatment at the holding centers were stigmatized by commu-
nity members, and it was another difficulty that they had to
deal with. Honestly, stigmatization of people now Ebola free
is a big problem. Bome community leaders expressed concern
that certain Ebola patients who are now free of the disease
after successful tre (Community leader, Hangha Road,
Kenema).
The community leaders believedthat more education about
the disease was needed since there were misplaced fears and
panic among people. Many people who recovered from the
disease continue to experience stigmatization and rejection in
the community. In some cases, neighbors stigmatized individ-
uals from quarantined houses, especially if a family member
was taken to an isolation center.
Corruption
Many of the participants explained that the Ministry of Health
officials and the National Ebola Response Center were not
very sincere about fighting the disease.
Really, philanthropists and many companies have been
very generous to dig deep in their coffers and donate to
the government but the money did not get tothe families
that are quarantined. (A community leader in Kenema)
He further explained that the government publicized the 3-
day lockdown only for them to give families a cake of laundry
soap for handwashing and no other form of assistance such as
food, since many breadwinners need to buy food on a daily
basis.
Another community expressed concern over the lack of
transparency and the state of emergency imposed by the gov-
ernment. BAnother community expressed concern over the
lack of transparency and the state of emergency imposed by
the government. ent but the money did not get to tnds. The
government will simply arrest you under the state of emergen-
cy laws.s (Community leader, Bo)
Discussions
The study’s findings concerning (1) the hunting, pro-
cessing and consumption of bush meat, (2) distrust be-
tween the government and the people, (3) stigmatization
of survivors of Ebola, and (4) corruption can be said to
be deeply rooted in the traditional and cultural practices
of Sierra Leoneans. Since humans are creatures of habit,
people form strong habits when they repeatedly do
things. At some point, they find it difficult to determine
if some of those practices have become harmful or dan-
gerous. Clinging to traditional and cultural practices,
especially harmful ones, thus needs further examination.
Culture is a ple, (3) of responses discovered, developed,
or invented during the groupouploped, or invented dur-
ing the groupvivors of Ebola, and (4) corruits members,
and between them and their environment^(Lum 2007).
These responses are considered the correct way to per-
ceive, feel, think, and act and are passed on to new
members through immersion and teaching (Lum 2007).
Given the forgone, changing aspects of strongly rooted
traditional and cultural practices among people tends to be
an uphill task. Difficult as this may seem, in order to ensure
the suspension or eradication of the disease, we suggest that,
through cultural desensitization, people become emotionally
insensitive or even callous to specific cultural practices that
would otherwise evoke fear, anxiety, or guilt if they did not
perform the Bold fashion^way (Koppelman 2014).
Given the ramifications of the spread of Ebola through
traditional and cultural practices, it is imperative to involve
and engage community leaders to educate and sensitize local
people to the importance of suspending traditional and cultural
practices, at least during outbreaks like the 2014 Ebola
epidemic. Communities can resume their normal cultural
Glob Soc Welf
and traditional practices once the outbreak is over. This is
particularly crucial since most participants explained that
family members found it difficult to abandon the corpses of
loved ones. Jones (2011) asserted that in some cases, “African
cultureisseenasanobstacletoovercomewhenimplementing
outbreak control”(p. 3).
Findings also indicated that community members
were skeptical about discontinuing the consumption of
bush meat, as it was indeed a major source of protein
for them. In Sierra Leone, hunting of animals in the
forests and on conservation grounds is common. In ad-
dition, with few veterinarians or public health workers
to do phytosanitary inspections, monitoring of bush
meat sales and consumptions is even more problematic.
Additionally, the sale of dried bush meat and cooked
bush meat in local restaurants along major highways is
common. In some cases, phytosanitary workers are
bribed to certify meats in the markets that may not meet
health standards (Lamin 2007). Thus far, efforts to dis-
courage people from eating bush meat have not been
effective. With very limited sources of sustenance, many
families, including those who have been affected by
Ebola, find it hard to refrain from traditional and cul-
tural practices without adequate foreign aid to continue
them to try something other than what they know and
have consumed all their lives. Funding to reintroduce
animal husbandry in these regions may be a good place
to begin to supplant the consumption of bush meat.
Many Ebola survivors discharged from treatment cen-
ters experienced intense stigmatization, making their sit-
uation precarious as they dealt with post-traumatic stress
disorder from having the disease and depression after
losing loved ones. In some cases, survivors are forced
to begin life afresh as their clothes and other useful
belongings were burned or abandoned by their loved
ones.
Conclusion
The study found that human-to-human transmission of the
Ebola virus was associated with traditional and cultural prac-
tices such as the washing and kissing of corpses. People em-
braced these practices in spite of the potential risks. Besides
traditional and cultural practices, other sociological and envi-
ronmental factors amplified the spread ofthe disease. In Sierra
Leone, a country still grappling with the throes of a brutal civil
war that has had debilitating effects on the infrastructure, the
ability to handle the Ebola virus was limited or non-existent in
many areas. The population explosion particularly in the city
of Freetown was a major factor. Housing and other social
services was poor and many of the city’s inhabitants lived in
slums, making them more prone not only to Ebola but to
water-borne diseases as well. Poverty and squalor were con-
tributing factors, coupled with the high incidences of corrupt
government officials who continued to embezzle public mon-
ey and international aid. Indeed, the study brought to light the
reliance on international aid by the government for provisions
of basic health equipment, healthcare workers, food, and care
for orphans.
Implications
The role of traditional and cultural practices in the spread of
Ebola is still under study. Thus, this study has only scratched
the surface of the issues related to the severity of the spread of
Ebola. While calling for continuous research in this area, we
recommend that changing these practices will significantly
reduce and help contain the spread of future Ebola outbreaks.
The cultural practices of people affect not only their health but
also all their affairs including health and disease (Ojua et al.
2013).
Another important area that needs immediate attention is
that of stigmatization. Hewlett and Amola (2003) found that
Many survivors experienced intense stigmatization.
Some were not allowed to return home, many had all
their good clothes burned, and some were abandoned by
their spouses. Their children were told not to touch
them, and wives were told to go back to their home
villages. Such discrimination also extended to family
and village members. For instance, community mem-
bers from one of the first rural villages affected were
regularly turned away at the marketplace and watering
hole. One man eventually committed suicide, in part,
because he had lost his wife to Ebola but also, reported-
ly, because of the stress of rejection, harassment, and
discrimination in public because of his association with
Ebola. (p. 1246)
It is evident that while the fight against the spread of Ebola
remains challenging, healthcare workers (doctors and nurses)
need to team up with social workers and community leaders to
find out what works, what injures, and what needs to be aban-
doned. Bringing new methods and imposing them on locals
only breeds suspicion and limits efforts toward curbing the
virus. A holistic approach, more than any single model (med-
ical, social, or psychological, and community involvement),
may not work well in a standalone manner. Given these mul-
tiple layers of challenges, continuous and collective scientific
as well as sociocultural research is required if future Ebola
outbreaks are to be contained, managed, and stopped. Every
society has values, norms, beliefs, attitudes, folkways, behav-
ior, styles, and traditions within it that mold individuals and
even the groups to which they belong.
Glob Soc Welf
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