DOUBT AND DEATH, EBOLA AND ITS NARRATIVES

By Mohamed Gibril Sesay

Last week I came again into contact with Ebola deniers, in Freetown, and in Makeni.
I had gone into this barber’s shop in Freetown, and there was this woman, vehement in her denial that Ebola exists, and deploying ways of speaking and using rules of evidence that reminded me of the best talkers in the junctions of my East-end Freetown, whose arguments win the day.

This lady was saying, ‘hey come let me put you through to my relatives in Kenema, where they say people have the disease, come, this is my relative’s number, hear her say all is lies, I tell you this is all about the money in it. That is why I don’t go hospital now, because I don’t want to be killed to justify some money making by the bigmen, they always manufacture these diseases, In Tejan Kabbah’s time they manufactured Aids, now in Ernest’s time they have manufactured Ebola.’

In Makeni, at a clothing shop, I overheard these other guys denying the existence of the disease, and one was also saying it was all money business. The Freetown lady said she supported the SLPP, and I was quite sure the guy in Makeni supported the APC; two members of the two biggest parties in Sierra Leone, holding identical views on the matter. This is not to say that politics is not aiding misconceptions and blame-fixing in Ebola discussions, only that it goes beyond that, it is much deeper.

We may need to look at the clash of narrative cultures, a clash of rules of evidence, a clash of ways of curing for the sick, of burying the dead, plus some other developments that result in these clashes becoming tragic, increasing rates of transmission, shifting epicenters of the disease.

I believe in the scientific narratives about Ebola, and its rules of evidence. Ebola is real. In humans, the disease is caused by Ebola, a filovirus, of which there are a number of types, including the Tai Forest Virus, the Ebola Virus, the Sudan Virus, the Bundibugyo Virus. It is spread through contact with fluids and tissue of the infected, or things the infected had come into contact with. There is as yet no approved vaccine or cure for the disease. Though there is promising news relating to a number of experimental therapies, these have not yet been approved for preventive or curative use. Whilst between 50 and 90% percent of those who have the virus die, there are survivors. In 1976 in South Sudan, 133 of the 284 persons infected during an outbreak survived; in Yambuku in the Congo that same year, only 38 of the 318 persons infected survive; whilst in the Gulu, Masindi and Mbarara districts of Uganda in 2001, 201 of the 425 persons infected survived. According to official figures on the current outbreak in Sierra Leone, as at July 31, 2014, over 130 persons have survived the disease.

The scientific narrative tells us that the way to stop transmission of the disease is isolation of patients, preventing touching patients, their body fluids, excretions and contaminated utensils and materials; health workers utilizing strict barrier nursing practices; and discouraging or modifying traditional burial rites.

But there are other narratives and practices that clash with this meta-scientific one. These other narratives and practices build up from the ethnomethodologies of the people, their ways of discussing happenings, etiologies, diseases, death, caring, sympathy, ethics, responsibility; and the role of, what in social science-speak, is called the other - the person, who in significant respects, is not like them, and this other could, in various degree of otherness, be the doctor, the nurse, the civil society activist, the government official, the party official, the journalist, the NGO worker.

The way Ebola is explained scientifically lends itself to easy dismissal by persons at community levels using other narrative techniques endemic within local communities. Caring for the sick is a badge of honor in communities, a sign of caring, a marker of one’s identity as an empathic member of a community; being involved in burial rites is also an act of honoring, an indelible part of coming to terms with the death of one’s relative, friend or acquaintance. Explanations about communities refraining from caring for Ebola patients, or burying those who succumb to the disease make perfect sense within rational scientific mentalities. But it could be easily dismissed when pitched against time-honored ways of dealing with illness and death within communities.

What makes scientific narratives easily dismissed also relates to people’s notions about the hospital. People believe the interventions of the hospital on the promise of its healing power. But with the scientific narrative telling us that Ebola has no cure, people would be reluctant to take people to the hospital. It becomes very easy for persons to debunk the scientific narratives and come up with stories that the hospital is a place of death, and health workers become, in the eyes of people, bringers of death. The word is rife that health workers hasten the death of people; that they used to inject them on the upper body, but that now they do it on their toes to hasten death. These types of story catch fire faster than the ones about how the hospital, in isolating the patient, prevents the transmission of the disease to other persons. The isolation unit becomes stigmatized as a place of evil practices; the taking of blood for laboratory analysis becomes, as in the mouth of one lady in Kenema, witchery, a way to increase the stock of blood available to the evil ones of the underworld. Entrepreneurs of the counter-scientific narrative come up with stories after stories, embellishing them with rules of evidence that are credible in our local communities, drawing energy from the social and spiritual discourses of the people.

It is easy to dismiss these stories as hogwash when one utilizes the scientific meta narrative framework, but they have greater hold on the people. It is so in Guinea; it is so in Liberia; it is so in Sierra Leone. In all these countries, the disease is spreading, despite the authorities’ heavy reliance on scientific narratives and rhetorical strategies, and on statist and clinical interventions with disdainful dismissals and wishing away of communal discourses. The statist and scientific approaches so far hardly utilize empathic understandings of communal discourses in order to counter them.

But most times, the finer subtleties of the statist and scientific narrative create gaps or misunderstandings that feed the counter narrative. For instance, take the narrative that Ebola has no cure, but that some people survive anyway. I know the explanations for this, and I believe these explanations: that the immune system of the survivor might be stronger, that perhaps certain mutations in somebody’s genome might be constraining viral virility, that perhaps early detection and cocktails of treatment for the other manifestations of the disease reduce viral loads and get persons free from Ebola. But these explanations do not fit well into modes of plausibility within our people’s ethnomethodologies; and so, masters of the counter narratives, etiologies and other discourses could easily counter them.

Ours are societies that have to contend with multiple ways of understanding and explaining happenings - multiple mentalities and narrative traditions, sometimes oppositional, sometimes contrapuntal, palimpsestic, with varying degrees of internalization or plausibility.

At the start of the outbreak in the country, there were people who thought that it was wholly spiritual, in the indigenous African way. So they gathered articles for damnation, and brought them to the center of town as a way of dealing with the virus. I have heard people argue that men and women of God could cure the disease by laying their hands on victims. The narratives are sometimes deployed complimentarily, and other times in opposition, or with one taking the air of being superior to the other, particularly where one narrative or practice may not be bringing the desired effect. We have seen, well before the outbreak, of people removing their relatives from hospital because they believe the illness is not a ‘hospital sick.’ It may be spiritual or native; so off to a church or a traditional healer or spiritualist. I have seen relatives die from this when their sons and daughters remove them from hospital for native treatment.

Of course, this is no blanket blaming of native African Medicine with its deep roots in homeopathy as opposed to Western Medical tradition mainly based on allopathy. Much violence has already been done unto homeopathic practices by the exclusivist claims to healing by the dominant allopathic medical establishment. But that should not dissuade us from the need to interrogate many of these native and spiritual etiologies, their discourses about witches, sin and underworld, and their claims of abilities to cure nearly all diseases, including aids and Ebola.

Belief in these traditional etiologies and claims does not only grab those who did not go to school, it also, to varying degrees, afflicts some of the most educated. The only difference, however, would be that the types of diseases that the educated say are not hospital illnesses might not be as many as those of their less educated compatriots. The propensity to come up with counter scientific narratives is strong; the country is very vulnerable to it, to declarations that a disease is ‘native’ or spiritual, that it is caused by witches or the underworld, or by some krifi, jinna or ngafay, or sin as defined by the ascendant preachers. There is even a story of a lab technician during this current Ebola outbreak who on suspicion of being infected, sought healing from a man of God. We have heard calls for religious interventions; that the disease is beyond human understanding.

And there are people that feed on the gaps between these multiple narratives to come up practices that increase the spread of the disease. They utilize the climate of deniability, or the fear of the workers in mask to set up ‘pepper clinics.’ These persons may be druggist in corner streets, nurses and the like, who set up shop based on deep traditions of pepper doctoring in the country, and so expose themselves and more people to the virus. The masters of pepper doctoring may be trying to be relevant, to be champions of cure in moments of doubt and death. They are trusted because they are there, in the neighborhood, they are not ‘others’ and they are not becoming ‘the other’ by wearing the protective masks that many a community now interpret as symbols of death, rather than means of protection.

The pressure on people to succumb to the communal narrative is strong, very strong. I heard stories of people, even those who live within the same communities, been stigmatized as being bribed to pass on the scientific narratives of Ebola’s existence, and many have been intimidated into silence. The charge of bribery becomes plausible when posited by the masters of the communal counter narrative. They have seen persons squander monies for sensitization before, they have heard stories of persons even now misappropriating money for Ebola sensitization, so it is easy to blanket sensitization efforts as attempts at making money, of people selling their souls on the alter of lies about the existence of Ebola.

This manufacturing of otherness, this charge of sell out, is part of the strategies of the communal narrators to delegitimize the message and messengers of the competing scientific narrative. Other times, the other is not manufactured in the wake of the disease, he or she or it is already there, in the form of the other political party, the person from the other region, or from another continent, so it is easy to affix blame to them on the basis of this. Conspiracy theories thrive. Thus the charge that the government, led by the other party, wanted to lower population figures in their opponent’s stronghold, or that they are not serious about the fight against the disease because it is in a region they does not support them. And of course, I have also heard the counter-argument, that the other party is deliberately spreading denial about the virus.

The arguments go back and forth, sometimes amongst members of the same party, or the same government, or the same ministry - deployment of uppity infantilism, wanting to do policy by social media, ‘megalomania-ing’ on narratives of death; popularity by the fictions of Facebook likes; flaunting before audiences privileges of access with thirty-two-teeth glee. And about the fighting for turf amongst officials at central government levels, and also at local government levels; the lack of tact in the use of words in referring to the Ebola situations and its victims, perhaps well intentioned but inappropriate for public officials in these times of great stress, and how these unwise utterances easily feed into evidence machines that could only manufacture blame-points for government as a whole.

A narrative, in its battle for supremacy with counter narratives, may often tell us that lack of success, or effectiveness of those who subscribe to it may due to lack of strict adherence to its prescriptions. For instance, health workers who fell victim to the virus might have been a little less rigorous with regards to their protective clothing; fatigue from too much work might have caused this; or perhaps insufficient training in handling this disease; or such other explanations plausible according to the narrative’s rules of evidence. In other narratives, the reason for the failure of the intervention may be given as ‘oh he has little faith,’ or he did not perform the ceremonies as he should. Or it could be some mix up of procedures. We had this way of saying it where I grew up, the Kossoh Town, Crojimmy, Fourah Bay Communities of Eastend Freetown, ‘e drink the wan for rub, en rub di wan for drink.’ This refers to the controversial Muslim version of unguents or spiritual water called the Manassi, one has problems when one drinks the one you should bathe with or bathe the one you should you drink.’ This is used to refer to all sorts of mix-up; a jocular way of referring to the possibility of a mix up of procedures that got somebody into an agonizing situation.

Freetown’s speech acts are full of the jocular to refer to tragic or serious situations; the city’s speech acts in relation to the rebel war are replete with such jocosities. And even during this current Ebola outbreak, one hears so many jokes about it. Something that has led many to call Freetown’s people heartless, as lacking empathy, as the city of the other, the distant people hosting a distant central government. Like city like government. This is a narrative about government that comes up again and again, irrespective of which party controls it, making it easy to spread storylines about governments having lackadaisical approach to emerging national emergencies: like the 1991 war, like the 1997 Johnny Paul coup, like the current Ebola outbreak.

A city that flips stories from the sublime to the jocular is one that is tolerant to all sorts of narratives. All narratives provide fodder for its flipping: from the pastor’s homily to the governor’s edict, from the madman’s rants to the dying man grunts. The woman I encountered denying the existence of Ebola did it with great candor, flipping between the serene and the jocular. And therein lies the difficulties of any attempt by the scientific narrative or the state narrative to trump it. The latitude of flipping for the scientific or state narrative, on such a serious issue as Ebola is far limited. Narrative moves by the deniers’ are defter, with more latitude, and easily deployed unto the Freetown audience that has great tolerance for jokes about even the most serious of issues.

This is a reality we must contend with; a people’s perception is a reality to be contended with, and a great way to deal with it is by going to the grounding of the counter narratives, to see how narrative resources and rhetorical strategies could be utilized, to look for points of convergence and building on these to cast our scientific narratives in plausible forms, in ways that turn the tide of skepticism and denial that surrounds this Ebola virus like a protective clothing against the shafts of our better efforts.

That is why we may need to give our messages about Ebola with vibes of hope, that people are quarantined not because they are terminal cases, but because it increases their chances of survival; give hope, let survivors be primary communicators, identify masters of organic speech-acts within communities and get them unto the fight, let people who are like the bulk of the people be the ones to get to the bulk of the people. At the community level, limit the use of the visages and voices of CSOs, NGOs and other faces of otherness in communications about Ebola. Deploy peer-to-peer communication methodologies; get the peers to identify the salient points of denials, and develop the counter-arguments using the same rhetorical strategies that heighten plausibility amongst ordinary people. That is the crux of it: heightening plausibility of the information amongst the people; for the information is out there, that there is Ebola, but because so many do not believe in its veracity, they cannot take on the burden of behavioral change that a belief prescribes. The State of Emergency is a good step, it places much needed external constraints on behavior, but without those internal constraints imposed by belief in the scientific truths about Ebola, the fight will be much more tasking. The battle against Ebola is as much a battle of narratives as it is about statist controls and clinical techniques.