Listening to Dr. Tai-Ho Chen recall his time spent in Africa, working for the CDC with Ebola, I was wondering what was actually done to be culturally-sensitive in a place where medicine is predominantly governed by spiritual healers and "witch doctors." Surely enough, I found a CDC article on "Improving Burial Practices and Cemetery Management During an Ebola virus Disease Epidemic- Sierra Leone, 2014."
The article documents the work of the CDC in being receptive to cultural practices whilst striving to mitigate ebola transmission in a very delicate part of life- death.
Ebola is mainly transmitted by physical contact with an infected person or their bodily fluids. Transmission is especially dangerous in the later stages of illness and death, and this is an issue in Western Africa, as cultural policies dictate touching and washing of the deceased- a prime route for ebola transmission.
The CDC assessed burial practices, cemetery management and adherence to recommended practices by directly observing burial ceremonies to assess the risk of transmission and to come up with a comprehensive burial plan which a) mitigated the risk of transmission whilst b) was receptive to the social and spiritual needs of the community.
The primary assessment showed that burials often took place in mass unmarked graves, and that community burials were more widely accepted, as this allowed the community more involvement and offered more transparency.
Namely with the help of the UK government, a burial team command centre was established in the west of the country (near the most densely-populated areas) to coordinate safe burials.
The preliminary assessment carried out by the CDC found that deaths were not always reported, testing for Ebola wasn't always carried out (even when recommended), decontamination of homes where ebola was present was not always carried out properly, and not all bodies were collected by burial teams, with multiple instances of bodies being hauled off in the back of trucks in unidentified burial bags to be placed in unmarked graves recorded, as well as examples of undignified burials whereby proper religious practices were not followed or families not allowed to observe the ceremonies.
It is easy to see how civilians were discouraged from reporting deaths, due to ebola or not, for fear of undignified burial ceremonies, and this was a crucial catalyst in the outbreak, as it encouraged further transmission of ebola.
From this case study, lessons must be learned about social and cultural sensitivity, as cause and effect analysis shows that a disregard for said practices will only make people turn to dealing with burials themselves; exacerbating an already deadly situation.)
Photos: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6401a6.htm
1- A burial team preparing to collect another dead body for transport in the back of a truck
2- Unmarked graves in an ebola burial section of a cemetery
3- Dead bodies, personal protective equipment and medical waste buried together
-Jack Whitehead
The article documents the work of the CDC in being receptive to cultural practices whilst striving to mitigate ebola transmission in a very delicate part of life- death.
Ebola is mainly transmitted by physical contact with an infected person or their bodily fluids. Transmission is especially dangerous in the later stages of illness and death, and this is an issue in Western Africa, as cultural policies dictate touching and washing of the deceased- a prime route for ebola transmission.
The CDC assessed burial practices, cemetery management and adherence to recommended practices by directly observing burial ceremonies to assess the risk of transmission and to come up with a comprehensive burial plan which a) mitigated the risk of transmission whilst b) was receptive to the social and spiritual needs of the community.
The primary assessment showed that burials often took place in mass unmarked graves, and that community burials were more widely accepted, as this allowed the community more involvement and offered more transparency.
Namely with the help of the UK government, a burial team command centre was established in the west of the country (near the most densely-populated areas) to coordinate safe burials.
The preliminary assessment carried out by the CDC found that deaths were not always reported, testing for Ebola wasn't always carried out (even when recommended), decontamination of homes where ebola was present was not always carried out properly, and not all bodies were collected by burial teams, with multiple instances of bodies being hauled off in the back of trucks in unidentified burial bags to be placed in unmarked graves recorded, as well as examples of undignified burials whereby proper religious practices were not followed or families not allowed to observe the ceremonies.
It is easy to see how civilians were discouraged from reporting deaths, due to ebola or not, for fear of undignified burial ceremonies, and this was a crucial catalyst in the outbreak, as it encouraged further transmission of ebola.
From this case study, lessons must be learned about social and cultural sensitivity, as cause and effect analysis shows that a disregard for said practices will only make people turn to dealing with burials themselves; exacerbating an already deadly situation.)
Photos: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6401a6.htm
1- A burial team preparing to collect another dead body for transport in the back of a truck
2- Unmarked graves in an ebola burial section of a cemetery
3- Dead bodies, personal protective equipment and medical waste buried together
-Jack Whitehead
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