‘The human factor’

ITM colloquium, Antwerp, 24 November 2014

Manuel Raab

11 Dec 2014

The following is a report of the first day of a three-day conference on global health and anthropology, held from 24–27 November 2014 in Antwerp. Sponsored by the Institute of Tropical Medicine Antwerp (ITM), Belgium, this conference brought together speakers from a range of academic backgrounds to discuss emerging issues in global health from an interdisciplinary perspective. This report (1) summarizes why the speakers believe that social scientific research and transdisciplinary work is relevant to global health issues, (2) refers to the current Ebola outbreak in West Africa as an example that highlights the usefulness of anthropological fieldwork, and (3) points to some of the problematic issues arising from the integration of anthropologists within epidemiological interventions.

Why do the social sciences matter in global health?

The two speakers for the opening session were Bruno Gryseels, Director, Institute of Tropical Medicine, Belgium, and Koen Peeters, Department of Public Health, Institute of Tropical Medicine, Belgium.

Bruno Gryseels: Global health is a rapidly growing field that takes as its purpose to improve the quality and global accessibility of health care. Nowadays, biomedical technologies, new drugs, and large-scale interventions have penetrated the lives of many people around the globe. While global health has been driven by the need to come up with effective policies and strategies to enhance population health and eradicate infectious diseases, especially in developing countries, its standardized and mostly vertical approaches have neglected the sociocultural factors that are key to achieving long-term changes in global health. The fact that people living in culturally differing contexts take up interventions and new technologies in unplanned ways has been a fairly understudied element in global health.

Koen Peeters: For these reasons, it is clear that global health should not only involve medical experts and policy makers. In order to achieve lasting improvements in the quality and accessibility of public health care services, the social sciences have proven to play an essential role in reaching these goals in an ethical and culturally sensitive way. From this perspective, the creation of a transdisciplinary approach to global health issues is absolutely vital. Experts, researchers, and policy makers from all areas must move beyond the usual stereotypes they have of one another and open up to collaborating across disciplines. By synthesizing qualitative and quantitative research, global health can evolve towards a holistic and innovative field that incorporates the local needs and the expertise of people on the ground. 

Ebola and the anthropologist as ‘social epidemiologist’

The speakers for the Ebola focus session included:

  • Alice Desclaux, Institut de Recherche pour le Développement, France
  • Sylvain Faye, Université Cheikh Anta DIOP de Dakar, Senegal
  • Jean-Jacques Muyembe-Tamfum, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
  • Vinh-Kim Nguyen, Université de Montréal, Canada
  • Melissa Parker, London School of Hygiene and Tropical Medicine, UK

Melissa Parker: The current Ebola outbreak in West Africa has mobilized the global health industry around the world. Humanitarian aid in the form of material goods and medical technologies, as well as health care specialists and military personnel, has been dispatched to Sierra Leone, Liberia, and Guinea. The website http://www.ebola-anthropology.net/ has been created to serve as a tool for anthropologists to be able to provide advice on how to engage with sociopolitical dimensions of the Ebola epidemic. Everyone from the field is invited to contribute to this important project.

Jean-Jacques Muyembe-Tamfum: Ebola is not new to Africa. For example, the Democratic Republic of the Congo (DRC) has thirty years of experience in managing Ebola outbreaks. Even though the magnitude of the current outbreak in West Africa exceeds all past outbreaks, the DRC has accumulated valuable knowledge about the effective treatment of Ebola.

First, the Ebola virus has proven to be an ecological problem. Bats are believed to be the reservoir for the virus, which is then transmitted via animal-to-animal contact; epidemics amongst non-human primates such as apes often precede human infections. For this reason, the close observation and monitoring of the animal world is considered a significant element in recognizing outbreaks in their early stages.

Second, Ebola is a sociocultural issue. Because the virus is transmitted from animals to humans, hunting practices, food preparation, and food ingestion might amplify the virus. Further, local burial rites have contributed to the spread of Ebola. In the DRC, it has proven vital that the authorities develop sensitivity towards these cultural practices in order to avoid mistrust and hostility from local populations, and to enact the necessary measures that will eventually halt the outbreak.

Third, the experience of the DRC has shown that the Ebola virus is also amplified within hospitals. The symptoms of Ebola are very similar to the symptoms of other tropical diseases such as yellow fever, malaria, and Lassa fever. Consequently, Ebola is often not recognized as such, and the necessary hygienic measures are not taken in time.

Sylvain Faye: Because of the current Ebola outbreak in West Africa, various anthropologists have been asked to contribute their expertise to the second point mentioned above, namely the sociocultural aspect of the Ebola epidemic. In Guinea, anthropologists function as mediators between medical staff and the local population. Their experiences show that the outbreak in West Africa has a specific complexity to it.

Transborder migration and population movements, especially in the Guinean forest region, have contributed to the quick spread of the virus, and have made Ebola an international problem. Because of strained tribal relations and mistrust between affected regions and national governments, a coordinated intervention has proven impossible without the necessary understanding of the current political situation. Further, the violence and hostility from local populations against health workers who stand in direct relation to national authorities are a direct consequence of the historically embedded political tensions of the whole region. For these reasons, the anthropologist functions in such settings as a ‘social epidemiologist’ whose tasks are to pacify and humanize medical interventions and behavioral change programs (for example, changing local burial practices) that are meant to slow down the spread of Ebola. 

Vinh-Kim Nguyen: Looking at Ebola as social metaphor, a critical anthropological approach reveals more fundamental issues at stake. For example, the experienced mistrust against health care workers is partly a product of history, a history that repeats itself. Africa has a long history of epidemiological interventions, disease eradication programs, and drug trials with local populations. Consequently, mistrust is only a rational response to the current efforts to stop the Ebola outbreak. Furthermore, the ways in which medical triage and decision-making within a poly-governance structure are being practiced reflect a deep cultural divide. The lives of Western health care workers apparently are valued more, and the sovereignty of local groups is neglected in favor of the global health approach of vertical governance organized from abroad. The anthropological critique of global health goes even further by pointing out that despite the enormous investments made in the past decades to prepare for epidemics like Ebola, global health has systematically failed to create a functioning public health structure precisely because of its own standardizing, vertical approach. 

Alice Desclaux: Besides the failures of global health interventions in the Ebola outbreak, we must not forget the success stories. For example, the management of Ebola in Senegal has proven to be very successful in responding to this epidemic and social crisis.  For this reason, anthropologists should not only focus their research on the pitfalls of global health, but also maintain an open attitude towards learning from successful interventions.

Anthropological reflexivity

Speaker: Patricia Kingori, ETHOX Centre, University of Oxford, UK 

Patricia Kingori: The role of the anthropologist as ‘social epidemiologist’ does not come without costs. Global health’s need for experts in culture and people incorporates the anthropologist in existing hierarchical structures. Here, the expert position of the anthropologist as social scientist is narrowly defined by the demands of medical experts. Even though this transdisciplinary collaboration of the social sciences and the medical sciences is vital to successfully improving the efficiency and quality of global health interventions, such collaboration shapes the future image and academic position of the social sciences. As a consequence, anthropologists produce their own industry and end up researching similar topics in the future. While global health problematizes the culture of the others, it is essential to keep in mind that when intervening in an epidemiological crisis, researchers both bring their own culture of ‘expertism’ with them, and produce it at the same time.

Manuel Raab
Program Group Anthropology of Health, Care and the Body, University of Amsterdam