Although medical anthropology has existed for a number of decades, it has gained momentum within the recent past. As a discipline, medical anthropology seeks to explain human health from a panoramic ranging from human ecology, cultural to medical and subsequently exploring how interplays between culture and modern day medicine influence the overall societal health (Singer, 97).Different people across the world are subjected to dissimilar cultural environments that influence their thinking and consequently their perceptions pertaining to diseases and illnesses. Traditional medicine has equally been shaped by inherent cultural beliefs and practices that have been passed from one generation to the other. Cultural beliefs and traditional medicine influence the contemporary Western medicine and healthcare models in different manners. Realistically, there are various cultural beliefs and traditional medicines that reinforce Western medicine. Even so, traditional medicine may equally gainsay or conflict with Western medicine and to some extent, rendering Western medical interventions fruitless. The 21st century has been hit by devastating plagues or epidemics that have challenged the present-day medical technologies. Ebola and SARS standout as the most severe epidemics that have hit the 21st century world; the epidemics have been exacerbated by the fact that they are comparatively highly infectious. Seemingly, traditional medicine and beliefs have had a hand in exacerbating the severity of the epidemics. This implies that to passably arrest or contain these infections; there should be a thorough research of people’s cultures and equally incorporating some of the cultural practices and beliefs in care. Compellingly, some of the modern-day medical interventions in fighting Ebola and SARS touch on various cultural aspects of the society such as burying of dead and imposition of quarantines. This phenomenon has hampered the fight against the two diseases and to a large extent; this situation may be blamed to a lack of link between traditional medicines, beliefs and western medicine (Singer, 103).
As depicted by various studies that have been conducted on different world populations and geographies, it is apparent that interplays between western medicine and traditional medicine are very important through epidemics. Precisely, the studies provide vivid descriptions of the emergence of the 21st century plagues, their epidemiology, and interventions and how cultural aspects have influenced the management of the epidemics. In one of the case studies by Hewlett during EHF outbreaks in Central Africa, he asserts that people usually held strong beliefs and perceptions with regard to their cultures and the biomedical models used by nurses were considered as a violation of the cultural norms. The locals shied away from the nurses, and their houses were burnt (Hewlett, 2005:293). When the nurses arrived to assist in containing the disease, people had already been accustomed to traditional medicine and beliefs as the only therapies for the disease. Citizens in ROC described the illness from a supernatural perspective and classified it as ‘ekono’. HEF was initially considered as a natural illness. However, after several deaths occurred, people started to view the disease as sorcery (ekundu). Similarly, after this approach failed to heal the disease in ROC, it was later classified as ‘opepe’ or a disease caused by dirty contact. Consequently, local medicine men began to isolate people who had the disease and restrict physical contacts. Coupled with other political and financial challenges in the country such as lack of equipment and protective tools, the problem became even more severe. Most countries within central Africa subjected to harsh treatment by their French colonial masters-something that inculcated mistrust among Africans in this region. Therefore, locals within ROC were objected to any Western intervention and viewed it as another form of exploitation of colonization (Garrett, 67). Despite the nurses’ knowledge of the cultural barriers that existed, they chose to remain silent to the international bodies since they would have been considered primitive. Similar scenarios occurred in Congo and Gabon during the 2002 outbreak of EHF (Hewlett, 2005:294).
During the initial stages of the disease, people sought attention from medicine men and other traditional medical specialists. Modern day biomedical models were blatantly condemned by the locals, and a ritual-based point of view was highly regarded in healing the disease. However, with futile attempts by traditionalist to cure the disease, biomedical models began to gain momentum. Despite the cultural stigma that faced the nurses in ROC, an eventual solution to the epidemic was attained when nurses and medical practitioners saw the need to negotiate the cultural models with the international community and equally negotiate biomedical models with the local people (Hewlett, 2003: 1243). The ROC EHF cases study underscores the need to strike a balance between biomedical models and cultural models in containing epidemics such as EHF. The study unearths the importance of understanding cultural models and subsequently identifying the effects of various cultural practices on the provision of care. As such, nurses should identify strengths within cultural models and capitalize upon them in amplifying the effectiveness of the biomedical models. The case study that was primarily based in ROC strides towards combating the spread of EHF began to be realized when the biomedical models and the cultural models started reading from the same script. Isolation of infected individuals is one of the clinically recommended interventional approaches and as soon as traditional medicine began isolating the sick ones and prohibiting body physical contact. This was a major boost to the biomedical models and was a typical exemplar of situations whereby cultural models and biomedical models have worked collaboratively. As much as traditional medicine in the eventuality came to the assistance of the biomedical models, in the initial stages traditional medicine had hugely compromised the efforts by nurses to contain the disease. In ROC, the high mortality rates associated with Ebola may be attributed or blamed on the traditional medicine. Likewise, the nurses also carry blame in the sense that they failed to negotiate between biomedical models and cultural models during the early stages of the epidemic. In modern day medicine cultural competence as a concept has gained a lot of momentum with nurses having the obligation to understand the unique cultural characteristics of the patients and how these cultural aspects can be fine-tuned to supplement or compliment the biomedical models(Hewlett, 2005: 296).
In regions that have experienced EHF pandemics, a close link has been established between community perceptions about the disease and the appropriate medical and therapeutic treatments that are applicable to help combat the spread of the illness. In most cases, the questions of how the affected community refers to the illness, explaining the causes, the preferred treatment modes and methodologies available to the community play a key role in determining how well the illness is combated. Hewlett & Amola (2003: 1244) explain that the EHF outbreak in Uganda was majorly controlled by aligning the proposed guidelines by the WHO and the Ugandan authorities to the perceptions of the affected community in this case the Acholi. The community having been taken through a gradual but quick awareness program about the disease, its epidemiology, etiology and pathophysiology was able to provide the much need support that the care providers needed to be able to effect their measures of treatment, prevention and health promotion. The cooperation between the care providers and the local community has been widely acclaimed as having been a key concept of the effective prevention and control programs. The case in Uganda was unique from the previous cases of EHF that had been witnessed. In DRC and Gabon for instance, the outbreak was widespread cutting across many ethnic groups. The Ugandan case was only limited to a single ethnic region, the Acholi. Most of the medical personnel and decision-makers mainly comprised of the local Acholi community (Hewlett & Amola, 2003: 1245).
Hickson et al. (2004: 358) argue that the stigmatization of the groups that are at high risk of infection of such epidemics as SARS could probably help the course of prevention and eventual eradication. The rate at which such illnesses spread cannot be taken rightly and the lack of research studies and recommendations that offer practical solutions such epidemics makes the situation worse. The 2003, SARS epidemic in the USA offers a realistic view of the need for combined approaches in the treatment and prevention from further spread. With a total of 418 cases reported and 74 having been confirmed as probable SARS infections, the population was at fear of the spread with the scientific response having no immediate solutions to the epidemic. In fact, Hickson et al. (2004: 359) note that available the scientific data on the disease changed dramatically at hourly rates. The at-risk communities were stigmatized, and there was a general sense of fear and discrimination against them. Public health official had to devise strategic outreach programs that would help mitigate the fear, stigmatization and discrimination towards these groups. This was necessitated by the need to develop a platform that would provide the at-risk communities and other communities with a chance to act as active participants in the prevention exercise. Communication strategies such as the use of mainstream media and internet to sensitize the population on the risks of the disease, observable common symptoms and the reporting strategies were taken with high regard. This indirect and direct community involvement immediately relieved the burden on the healthcare providers so that they would focus on the more pressing issue of handling the population that was at higher risk and those who had reported infections or probable infections.
The effectiveness with which the EHF was handled in Uganda has its basis with the early manifestations of the illness and the community’s response to the same. Initially, the illness had been labeled as a normal bacterial or viral infection with much of the population seeking biomedical treatment. As Hewlett & Amola (2003: 1243) notes, tetracycline or chloroquine were primarily used as the biomedical interventions to cure the illness. The increasing prevalence of the illness and the increasing mortality rates associated with the disease signaled a change in tact for the community as the medical providers also realized the need for a more pragmatic approach. While the community resulted to spiritual intervention, the authorities and care providers opted for a sensitization program through all forms of media. The Acholi community being largely an agropastoral community and with an intact social organization consulted their gods, the jok. As the use of traditional healing also proved futile, the community labeled the illness a gemo or epidemic and among the solutions was quarantine for the affected as this was associated with a curse. This coincided with the biomedical interventions which called for the quarantine for the infected persons (Hewlett & Amola, 2003: 1245).
While spirituality and cultural beliefs played a key role in the prevention and mitigating of the illness in the Acholi community of Uganda, the USA SAR epidemic prevention was primarily facilitated by the community outreach programs through the SAR Outreach Community which could be an equivalent of the closely knitted Acholi social organization that was based on their spiritual commonality in reference to the to the joks (gods). Seemingly, the Ugandan community intervention was based on traditional beliefs that luckily enough augured well with the biomedical interventions. Both techniques had an objective to curb the spread of the illness. The biomedical quarantine technique focused on minimizing the contact-spread of the disease, while the traditional intervention was based on the belief that the illness was a spiritual curse in which the infected person would spread the curse if they came in contact with other persons.
Hewlett et al. (2005) in their article “Medical anthropology and Ebola in Congo: cultural models and humanistic care” provide a detailed account of the events that took place in the border between Congo and Gabon during the very first instances of the occurrence of Ebola. The authors assert that the spread of the illness and the association of the illness with witchcraft and sorcery made it difficult to control even as the infected population continued to mingle from within the community. The social-economic situation of the regions affected could be described as poor and remote and thus community education and awareness programs to work hand-in-hand with the traditional interventions were minimal. This led to accelerated spread of the illness and those who were suspected as the cause of the deaths through sorcery fell victim to merciless deaths. These perceptions of sorcery and the lack of acceptance by the locals for biomedical interventions to work collaboratively worsened the situation. Poor education standards in these remote areas had a fair blame for the ignorance of the populations to the adoption of biomedical techniques. However, the persistence of the illness and the increasing number of deaths led to a change in perceptions from the community with the local leaders playing a key role in bringing in a wholly new perception that the sorcery does not cause deaths vastly without reason or cause as it was happening. This led to the recognition of the epidemic as an illness away from previous perceptions of sorcery. It is this collaboration with the local elders that enabled the medical personnel to restriction and prevention further spread of the illness through in late stages (Hewlett et al., 2005: 232).
The culture and political intrigues of a society tend to have a significant impact on the emergence and spread of epidemics such as SARS and Ebola. Hickson et al. (2004: 360) explains that the SARS infection in the USA was more widespread within the Asian-American communities which have historically remained the minority population and whose political representation and economic situation remains far from the standards in other parts of the USA. To show that correlation between politics, culture and spread of epidemics, Hewlett & Hewlett (2007: 12) describes Gabon as one of the wealthiest nations in Africa owing to their possession of oil reserves. Surprisingly, the regions of Gabon hardly hit by the Ebola epidemic are the poorest regions of the country and the literacy levels are literacy low. The Mekouka gold camp which was artificially created by the government through an agreement with the French government to allow the disposal of nuclear waste lies within this area and has been reckoned as the origin of Ebola due to the uncontrolled nuclear waste disposal. McMichael (2005: 495) also dwells on the issue of the economic disparities of the southern China, a region that was hardly hit by the SARS epidemic in 2002-2003. The region has historically remained poor and remote with education levels still demanding. On the other hand, its close association or perceived support for Hong Kong was a major political reason for its sidelining from national development projects which explains why the region had lagged behind in terms of education and development. Public awareness and education programs did not initially achieve much due to the low education standards and the stereotyping of the region as undeveloped and thus requiring less focus since the returns of investment from such a region would be low anyway.
In an article by Samuel Aranda in the New York Times on the 2014 spread of Ebola in West Africa and other parts of the world, the author in his chronological account of development of the Ebola epidemic infers to culture as a catalyst in the spread of the disease. Although cultural prejudice f Western medical interventions are seemingly diluted in 2014, there still remain cultural aspects that have catalyzed the spread of the deadly virus. According to statistics provided by the World Health Organization, African traditional burial rites account to up to 20% of Ebola infections. Before the disease was declared a global epidemic and subsequently burial standards and protocols developed by the WHO, contact with infected persons during burial rites increased the prevalence of the disease. As can be seen from this account, Ebola once again caught the international bodies unaware with the past mistakes being replicated in the 2014 Ebola outbreak. Among aspects that are relatable to earlier Ebola transmissions in Africa include; lack of favorable political climate and conflicts between traditional medicine and Western medicine. According to this article that was recently published in the New York Times, it is apparent that the current declining statistics can be associated with increased cultural awareness and joined efforts of biomedical and cultural models (Aranda, par 6).
Conclusion
As demystified in the above case studies on countries with histories of Ebola and SARS, traditional medicine and subsequently cultural models impact on modern-day Western medicine in different ways. There are cultural beliefs and hence practices that render the services of nurses futile. As seen, the spread of Ebola and SARS was speeded up by cultural models that condemned or prejudiced Western interventions to the epidemics .However, it cannot be ruled out that all cultural models are risky when it comes to controlling of epidemics such as Ebola and SARS. For instance, once traditional medicine men started to view Ebola as ‘opepe’ or ‘gemo’ they embarked on isolation. This step provided invaluable insights about the spread of the disease to the biomedical staffs that were already operating in the region and significantly shaped a better clinical understanding of the disease. Similarly, isolation was pretty in line with modern clinical practice and as such boosted the efforts of the biomedical models. Overall, it is the role of modern medicine to understand the interplays between cultural models and the biomedical models and ensure that the two models work effectively. This is through capitalizing upon the strengths of traditional medicine and subsequently fine-tuning the weaknesses of traditional medicine to work in the aid of biomedical models (Singer, 73).
Works cited
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