“Invisible Enemy”: Translating Ebola Prevention and Control Measures in Sierra Leone
Sylvanus N. Spencer (U Sierra Leone)
|Publication||SPP Working Paper No. 13|
|Publisher||DFG Priority Programme (SPP 1448): "Adaptation and Creativity in Africa"|
In December 2013, Ebola appeared for the first time in West Africa, in the Republic of Guinea, and in May 2014, it crossed the border to Sierra Leone. This paper seeks to examine why time-tested scientific measures of contagious disease prevention and control recommended by international health experts and promoted alongside various Sierra Leonean actors have been slow in yielding the desired results and led to unintended outcomes with very tragic consequences. Sylvanus N. Spencer (U Sierra Leone) suggests that a broader notion of translation is necessary to understand the chains of Ebola translation in Sierra Leone.
The Ebola virus disease (EVD) was first discovered in 1976 in the Democratic Republic of the Congo. It was in December 2013 that it first appeared in West Africa in the forested region of south-eastern Republic of Guinea. In May 2014, it crossed the border into the Kissi Teng Chiefdom of Kailahun District in the eastern region of neighboring Sierra Leone. This region was to become one of the epicenters of the disease. From there it spiraled into other parts of the country. Using the concepts of travelling models and translation (Behrends, Park and Rottenburg 2013), this paper seeks to examine why time-tested scientific measures of contagious disease prevention and control recommended by international health experts and promoted alongside various Sierra Leonean actors (including health practitioners, politicians and media practitioners) have been slow in yielding the desired results and instead have in many cases led to unintended outcomes with very tragic consequences. The prescribed biomedical Ebola prevention and control measures primarily seek to break the chain of transmission of the virus by, among other things, discouraging contact with mainly dead or living victims of the disease and their body fluids, undertaking contact tracing and quarantining victims or suspected victims, providing symptomatic or supportive treatment and safely disposing the corpses of those infected.
In this paper I suggest that a broader notion of translation is necessary to understand the chains of Ebola translation in Sierra Leone. The notion of translation cannot be reduced to the linguistic translation of biomedical measures into local idioms to counter people’s denial of Ebola and the misinformation about its origin (see also Chandler et al. 2014; Abramowitz et al. 2015). While this translation work is without doubt important, it is better understood as a vernacularization, as Sally Engle Merry points out (Merry 2006, 44), which constitutes only one form of translation. In my analysis of the dramatic spread of Ebola in Sierra Leone I suggest to use translation as an analytic which following Paul Richards and others emphasizes that social and material factors are “important to understand the epidemic and [the] ways in which it might be stopped, but these factors have so far been little analyzed” (Richards et al. 2014, 1). The process of translation described in this article shows that these social factors are far more heterogeneous than the conventional representation in popular discourse, which narrowly focus on traditional beliefs. Instead, I argue that a full understanding of the Ebola epidemic has to capture the heterogeneity of social factors and the multiplicity of actors inserting agency in the translation of Ebola intervention measures. For some Ebola was a result of witchcraft, claiming that its pathogenesis is of a spiritual and not a physical origin. For others it was another ploy by mischievous politicians to attract donor funds and to reduce the population of the south-eastern part of the country which is the stronghold of the main opposition Sierra Leone Peoples Party thereby reducing opposition votes in the much anticipated 2017 General Elections. This conspiracy theory gained credence from the fact that a National Population Census which often informs the drawing up of constituency electoral boundaries was to take place in the latter part of 2014.
Again, others claimed that Ebola was a ploy by Western conservationists who wanted to discourage local inhabitants from depleting the dwindling stock of wild life in the nearby Gola Forest and therefore came up with the story that fruit bats and monkeys which are eaten by some inhabitants of the forested region are known carriers of the Ebola virus. The presenter of a popular local radio program called Monologue, argued that the main reason for the initial spate of denials was that the community members in the epicenter of the disease initially learnt about its spread into Sierra Leone from politicians who are generally discredited as deceitful. The lack of confidence in the credibility of the messengers, he maintained, led to denials, misinformation and conspiracy theories. However, even when players other than politicians came on the scene with the same message, denials continued. It was mainly the sheer number of deaths, including deaths of health workers, like the country’s only virologist, coupled with massive awareness raising campaigns that the level of denials was reduced. As people gradually accept that Ebola is real and deadly, the drive to get them to know and practise the scientifically approved Ebola prevention and control measures gained momentum. There was also the task of providing the required medical treatment for those infected with the virus in order to save their lives and prevent them from infecting others. For this, the health delivery system of Sierra Leone and the other Ebola affected countries proved to be grossly inadequate even in terms of basic amenities (Park and Umlauf 2014). Although Sierra Leone made some strides in health and medical research during the colonial period, the post-independence period gradually witnessed a decline in even basic bio-medical research which often promises results that could be utilized as effective tool in the prevention and control of diseases threatening public health and socio-economic viability (Gbakima 2000).
Sylvanus N. Spencer (U Sierra Leone), from the Fourah Bay College, Department of History and African Studies at the University of Sierra Leone, is a cooperation partner of the SPP 1448 sub-project “Translating Global Health Technologies: Standardisation and Organisational Learning in Health Care Provision in Uganda and Rwanda”.