Old Habits Die Hard

Publié: 24 mars 2015 15:24 CET

By Elhadj As Sy, Secretary General for the International Federation of Red Cross and Red Crescent Societies (IFRC)

Tensions between public health and human cultural and social practices are nothing new. Think about boys exchanging blood to seal their friendships as “blood brothers”; people riding cycles or skiing without helmets; a lack of basic hygiene like regular hand washing; rites of passage like circumcision where the same razor was used over and over; unprotected and unsafe sexual behaviours; and even practices like spitting which used to be far more widespread across the globe, until it was found that it could transmit tuberculosis. So governments and global health experts are no strangers to having to find ways to discourage or even ban some cultural practices in the name of public health.

Today, in West Africa we are at a similar juncture with Ebola and the long practiced burial customs that are so meaningful to people in bidding farewell to their departed loved ones but which have played such a major role in this latest outbreak, enabling this terrible disease to spread so effectively. The number of new Ebola cases in the region may now appear to be levelling-off, with vaccine trials on frontline health workers now underway, but this is far from over. Until we address the root cause of how the disease was able to spread, the risk of resurgence will remain high.

Dubbed as “super-spreader events”, funerals have had a disproportionate impact on the early transmission of Ebola, primarily because of the customary practice of mourners making physical contact with their deceased, when the body is most contagious. While there are now more beds, medical personnel and protective equipment available to help to isolate patients and identify those they have come into contact with, the single most important and practical step in driving the number of new cases down has been the changes in burial practices.

The latest research suggests that even if transmission in the community or in hospitals could be eliminated through better isolation practices, the virus would continue to spread, with each Ebola case causing up to 1.5 new infections. However, if transmission through burial practices were eliminated, then the secondary infection rate would drop to less than one person per Ebola case, and so begin to peter out.

Bringing about such change has been no small feat. Following the initial response to the outbreak many communities were left scared and suspicious. But by working not just with the community, but from within it through our vast network of tens of thousands of local volunteers, the Red Cross Societies in Guinea, Liberia, and Sierra Leone, supported by the International Federation of Red Cross and Red Crescent Societies (IFRC), have transformed what was previously known as “dead body management” into the practice of safe and dignified burial.

By engaging and working with community and religious leaders, families and individuals, we have helped to find alternative ways for mourners to pay their respects. Sometimes this can be as simple as allowing family members to sprinkle water over the body, instead of touching and bathing it, or by placing written scripture verse on the deceased before the body bag is closed. Such adaptations not only help to maintain dignity and meet the heartfelt needs of the family, but also go a long way in building trust in the community.

So far this has proved very successful in bringing about positive changes to practices. Since the beginning of the outbreak the IFRC has helped to carry out more than 8,000 safe and dignified burials, in addition to its other work in clinical case management, contact tracing and social mobilization and information campaigns. But when this crisis is over and all the hospital tents are packed up and the foreign medical staff head home, how do we support communities to recover and help people to move from safe and dignified burials to safe and dignified lives? How do we prevent this kind of devastating outbreak from happening again?

Strengthening health systems is one solution, as many commentators have observed and pretty much everyone agrees. But frankly, given that almost all African states still have failed to meet their 2001 Abuja Declaration commitments on increasing their investment in health, we did not need Ebola to teach us this lesson. Health system strengthening alone will not prevent future outbreaks on this scale. For this we need sustained change at the grass roots.

When Ebola came to Guinea, Liberia and Sierra Leone, it found us there: 25,000 Red Cross volunteers from three National Societies, backed up by the IFRC and partner National Societies. In the process we have lost three of our own to the virus and endured countless physical attacks by scared locals, but when Ebola eventually leaves the region – and I hope this will be soon – Red Cross and Red Crescent volunteers and staff will remain behind and will continue to support their people and communities.

Ultimately you cannot force cultural change on people and you cannot make it happen overnight. It takes time and engagement. Like tuberculosis, the battle against Ebola is as much against a social disease as an infectious one; not just because it especially preys upon the poor and vulnerable, but also because its spread is rooted in societal customs and practices.

In the absence of an accessible treatment or vaccine, engaging with people about their most sacred and deeply held beliefs about the dead will help us to keep others alive in safety and dignity, and to confine these Ebola epidemics to the history books.

Elhadj As Sy is Secretary General of the Geneva-based International Federation of Red Cross and Red Crescent Societies (IFRC), the world’s largest humanitarian organization.