Archives for posts with tag: Disease

In 1995 a major outbreak hit a major urban area for the first time. Kikwit is a large town of several hundred thousand residents in what is now central DRC, and despite two hospitals utilizing somewhat better sanitation practices than those used in 1976, the virus passed quickly from person to person, infecting 315 and killing 254.[1] Although some recent media stories have stated that prior to 2014 Ebola occurred only in remote, rural areas of Central Africa, the Kikwit and previously mentioned Gulu (2000) cases contradict this myth and provide a precedent for how deadly—the deadliest two cases prior to 2014[2]—the disease can become in a dense, infrastructure-poor urban setting when it is not immediately identified (as it luckily was in Johannesburg and now Lagos).

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Kikwit, 2014 (Image Source)

Kikwit is also notable because several researchers have subsequently conducted otherwise scarce social science research into the local responses and explanations for outbreak. The origin stories recorded by de Boeck (2000), and Kibari and Lungazi (1998) describe how the people of Kikwit had a history of resisting ruthless Belgian colonial and later kleptocratic Mobutu sese seko national exploitation and told the story of how the grave of Kungu Pemba (the town’s chief who resisted the colonial state) would curse anyone who tried to sell the soil of Kikwit.[3] Many people in Kikwit believed Ebola was a result of this curse. A competing claim linked the outbreak to an American doctor whom locals believed to have introduced the virus from labs in Europe in revenge for residents accusing him of transforming into a hippo and attacking people.[4] By the time of the 1995 outbreak, the people of Kikwit had a long history of good reasons to distrust the national and international world and to perceive that these external forces were the cause of their suffering. Amplification of the disease in hospitals run by Western doctors did nothing to improve that trust, and, in fact, in the wake of Ebola’s toll, the town did not have a functioning hospital for two years and boycotted a polio vaccination program in large part because of continued mistrust of biomedicine.[5]

These findings from Kikwit add a layer of context to consider regarding the stories we’re currently hearing about tensions between health workers and some communities in West Africa. There may well be similar historical reasons for communities in West Africa to mistrust Westerners who claim to want to help them—after all, colonialism claimed to be “helping” Africans. Prior to Hewlett, WHO Ebola response teams did not consult social scientists with knowledge of the people they were attempting to help, but hopefully, in trying to fight the current outbreak in West Africa, WHO and other health organizations are utilizing Hewlett’s research along with liaisons who are more familiar with the local communities.

Even once this current outbreak is eventually stamped out in West Africa, the state of healthcare in the aftermath of Kikwit’s outbreak demonstrates that WHO’s job won’t be finished, as there will still be work needing to be done in order to repair relations and rebuild trust with local communities. Likewise, as has been the case with past episodes of Ebola, international researchers will likely rush in once the danger has past in order to collect more information on the virology of the outbreak, potentially kindling further mistrust amongst local communities as was found to be the case by Hewlett in post-outbreak Gabon where locals complained of researchers drawing their blood and questioning them without providing explanations and then never returning with the results.[6] A 2009 review of scientific field research on Ebola in Africa found that only 15 out the 34 teams sought individual consent from research subjects, and only three consulted any form of a research ethics committee.[7] Instituting measures to rebuild trust with local communities—including higher ethical standards for post-outbreak researchers—will likely improve local receptions of international response to the next outbreak, hopefully lessening its severity.

The next outbreaks after Kikwit were back-to-back in Gabon, followed by the major Gulu outbreak, and then, in keeping with the trend since 1994, followed every few years since by outbursts in Central Africa with the latest (prior to 2014) occurring in the DRC in 2012.[1] During these outbreaks researchers and witnesses have documented additional noteworthy social reactions to the deadly disease such as how people in Uganda and Congo responded to government bans on traditional handshakes during the outbreaks by instead snapping fingers or bumping elbows.[2] In Uganda business largely ceased during outbreaks because of fears that money might carry the infection, and in Sudan people resisted their loved ones being placed in WHO’s windowless pop-up isolation units because they had no way to communicate and comfort them and were not allowed to see their bodies once they had died, leading to fears that the outbreak was concocted by the international teams in order to harvest villagers’ organs.[3] In societies where belonging to a community is everything and where pain is often treated with the constant comforting presence of a family member or friend, the concept of complete isolation from the community during a disease is utterly terrifying. This finding from Sudan may also help explain peoples’ fear of international health teams in West Africa employing isolation units.

[1] Xavier Pourrut et al., “The natural history of Ebola virus in Africa,” Microbes and Infection, 7(2005), 1005-1014. Online: http://www.sciencedirect.com.ezp-prod1.hul.harvard.edu/science/article/pii/S1286457905001437

[2] WHO, “Ebola virus disease Fact Sheet,” April 2014. Online: http://www.who.int/mediacentre/factsheets/fs103/en/

[3] Barry S. Hewlett and Bonnie L. Hewlett, Ebola, Culture and Politics: The Anthropology of an Emerging Disease, Belmont, CA: Thomson Wadsworth, 2008.

[4] Ibid.

[5] Ibid.

[6] Barry S. Hewlett and Bonnie L. Hewlett, Ebola, Culture and Politics: The Anthropology of an Emerging Disease, Belmont, CA: Thomson Wadsworth, 2008.

[7] Philippe Calain, “Research Ethics and International Epidemic Response: The case of Ebola and Marburg Hemorrhagic Fevers,” Public Health Ethics, 2(2009), 7-29.

[1] WHO, “Ebola virus disease Fact Sheet,” April 2014. Online: http://www.who.int/mediacentre/factsheets/fs103/en/

[2] Barry S. Hewlett and Bonnie L. Hewlett, Ebola, Culture and Politics: The Anthropology of an Emerging Disease, Belmont, CA: Thomson Wadsworth, 2008.

[3] Ibid.

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Although 1976 marked the first discovery of Ebola by international scientists, the virus likely has a much deeper history lurking in Central Africa. By testing stored blood samples of 790 chimps and gorillas from Cameroon, Republic of Congo, and Gabon, scientists determined that primates had acquired Ebola prior to known human outbreaks in the areas where the samples were originally taken.[1] Subsequent blood samples of people living in Central Africa have shown that as much as 32.4% of the population possess Ebola antibodies (igGs), which they likely developed from exposure to fruit contaminated by bat saliva containing inactive strands of the virus.[1B] These findings have led the researchers to conclude that the virus has long circulated in the vast forests of Central Africa, infecting human and nonhuman primates.

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Chimpanzee in tree, Kabale National Park, Uganda (Mark Duerksen, 2011)

Further evidence of a lengthy history of Ebola outbreaks comes from recent calculations based on the mutation rates of Ebola and Marburg viruses (unusually slow for RNA viruses) that show that the two filoviruses diverged from a single common source around 700 to 850 years ago—around the time when larger and more centralized Bantu speaking societies began to emerge in Central Africa.[2] Given this timeframe for Ebola’s emergence, it is highly improbable that isolated human cases of Ebola did not occur at least occasionally for several centuries before 1976. [Of course humans could have contracted other older forms of Filoviruses long before this timeline, and there has been speculation that ancient plagues such the one that struck Athens in 430 BCE were actually caused by Ebola-like filoviruses.[3]]

The reason why international scientists were unaware of the Ebola’s existence prior to 1976 may be in part explained by the research of Barry Hewlett, a medical anthropologist from Washington State University and a member of WHO’s Ebola response teams. Hewlett’s socio-cultural findings suggest that the people of Northern Uganda and Congo have developed effective methods for containing epidemic diseases such as Ebola. When the Acholi people realized that they were dealing with a more serious affliction (gemo instead of yat) during the 2000 Ebola outbreak in Gulu—Northern Uganda’s largest city—they implemented a protocol that prevented an even larger outbreak. This protocol included isolating victims in huts at least 100m from other homes, encouraging everyone to limit their movement, allowing only survivors of the illness (or, if not possible, an elderly person) to treat and bury the victims, and only eating meat freshly butchered from cattle. While the Acholi incorporated modern medicine into their local beliefs and treatments throughout the outbreak, the elders were adamant that the gemo protocol existed before the late nineteenth century arrival of Europeans. Their assertion has yet to be historically verified, but the specificity of the regiment and the degree to which it is enmeshed in the language and religious belief system of Acholi people suggest that they developed the emergency procedures over numerous generations in response to outbreaks of Ebola or other similar diseases.[4] Indigenous medical measures such as the Acholi’s may explain why prior to 1976 Ebola failed to erupt into outbreaks large enough to attract international attention.

[1] E. M. Leroy et al., “A Serological Survey of Ebola Virus Infection in Central African Nonhuman Primates,” Journal of Infectious Diseases, 190(2004), 1895-1899. Online: http://www.ncbi.nlm.nih.gov/pubmed/15529251

[1B] Dieudonne Nkoghe et al, “Risk Factors for Zaire ebolavirus—Specific IgG in Rural Gabonese Popultions,” The Journal of Infectious Diseases 204(2011), S768-S775.

[2] A. S. Carroll et. al., “Molecular Evolution of Viruses of the Family Filoviridae Based on 97 Whole-Genome Sequences,” Journal of Virology, 87(2013), 2608-2616. Online: http://www.ncbi.nlm.nih.gov/pubmed/23255795

[3] Constance Holden, “Ebola: An Ancient history of a “new” disease?” Science 272(1996), 5268. Online: http://search.proquest.com.ezp-prod1.hul.harvard.edu/docview/213553956/79244C745EFA4C4DPQ/2?accountid=11311

[4] Barry S. Hewlett and Bonnie L. Hewlett, Ebola, Culture and Politics: The Anthropology of an Emerging Disease, Belmont, CA: Thomson Wadsworth, 2008.

This post is the second part in a short series I’m writing on the history of Ebola. For immediate information about how to help prevent the further spread of Ebola and keep yourself safe please consult and share the Ebola Facts website.

While there are numerous virology and pathology articles trying to pin down the scientific facts of the elusive Ebola virus, social scientists do not seem to have thoroughly studied the dreaded virus…and it’s not hard to imagine why historians and anthropologists would shy away from field research on a disease like Ebola.

I haven’t researched Ebola in the field, and when reading this historical summary please note that I am not a doctor, nor am I a historian of science, so please consult the sources cited for more thorough information. That being said, as compellingly argued in a recent Journal of African History article on the social history and biology of HIV/AIDS in Africa, scientific understanding and treatment is often enhanced by a greater awareness of the social and cultural contexts in which diseases have developed and spread. These kind of historical insights are why I hope I’m able to offer something by giving an account of Ebola from an African history perspective without having an advanced background in biology.

However a quick synopsis of Ebola’s basic biology is of course necessary. Ebola virus disease (EVB) or Ebola hemorrhagic fever (EHF) is an RNA virus that is part of the Filoviridae Family of diseases of which there are three members—Marburg Virus, Cueva Virus, and, our concern, Ebola Virus. Within its branch of the Filoviridae tree, Ebola comes in five species: Zaire ebolavirus (EBOV, discovered in1976), Sudan ebolavirus (SUDV, 1976), Tai Forest ebolavirus (TAFV, 1994), Reston ebolavirus (RESTV, 1989), and Bundibugyo ebolavirus (BDBV, 2007). Amongst these five strains, Zaire, Sudan, and Bundibugyo are responsible for the deadly outbreaks in Africa, while Reston has never caused human illness or death despite several people testing positive for it (they remain asymptomatic), and there has been only one human known case of Tai and the victim fully recovered within six weeks.[1]

Ebola is a public health nightmare because it can be contracted easily and is almost always fatal. Ebola is introduced into human populations from contact with the highly contagious blood or body fluids of infected animals such as monkeys or bats, and then spreads through human-to-human transmission. There is also some inconclusive evidence that the virus can spread through airborne nasal and throat secretions.[2] The signs and symptoms of Ebola have been well publicized, and they include the sudden onset of fever, sore throat, extreme weakness, headache, and muscle pain within 2 to 21 days of infection. Additional symptoms soon appear that make transmission more likely, including vomiting, diarrhea, rashes, both internal (gastrointestinal) and external (gums, nose) bleeding.[3] There is no known treatment for Ebola (although vaccines are in the works), and once the onset of symptoms occur, victims usually die within 5 days with Zaire ebolavirus’s fatality rate nearing 90% and Sudan’s being slightly less between 53% and 66%.[4]

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Bats on an island in Lake Kivu (Mark Duerksen 2014)

One of the greatest mysteries surrounding Ebola has been identifying the “reservoir”—the animal that asymptomatically carries the virus between outbreaks, allowing it to go silent for years at a time. Scientists have come to consider fruit bats as the most likely reservoir candidates after capturing and testing thousands of African animals, and after numerous attempts to infect various animals and plants, which confirmed fruit bats could contract and carry the virus.[5] However most human cases are thought to be the result of exposure (hunting, eating) to infected nonhuman primates and duikers (small deer) that have acquired the virus from bats.[6]

[1] WHO, “Ebola virus disease Fact Sheet,” April 2014. Online: http://www.who.int/mediacentre/factsheets/fs103/en/

[2] C. J. Peters and J. W. LeDue, “An Introduction to Ebola: The Virus and the Disease,” The Journal of Infectious Diseases, 179 (1999), ix-xvi. Online: http://jid.oxfordjournals.org/content/179/Supplement_1/ix.full.pdf

[3] WHO, “Ebola virus disease Fact Sheet,” April 2014. Online: http://www.who.int/mediacentre/factsheets/fs103/en/

[4] A. S. Carroll et al., “Molecular Evolution of Viruses of the Family Filoviridae Based on 97 Whole-Genome Sequences,” Journal of Virology, 87(2013), 2608-2616. Online: http://www.ncbi.nlm.nih.gov/pubmed/23255795

[5] Ibid; and Xavier Pourrut et al., “The natural history of Ebola virus in Africa,” Microbes and Infection, 7(2005), 1005-1014. Online:

[6] A. S. Carroll et al., “Molecular Evolution of Viruses of the Family Filoviridae Based on 97 Whole-Genome Sequences,” Journal of Virology, 87(2013), 2608-2616. Online: http://www.ncbi.nlm.nih.gov/pubmed/23255795

For immediate information on how to help prevent the further spread of Ebola and how keep yourself safe, please consult and share the Ebola Facts website.

The terrible news that a man—who we now know was an American citizen on his way home to Minnesotadied from Ebola upon arriving in Lagos from Liberia jolted me when I read about it a couple of days ago. Ebola—the disease my older sister used to give me nightmares about after she read The Hot Zone—seemed oceans away when I was researching in Lagos several weeks ago, where car crashes, malaria, and Boko Haram seemed like much more immediate fears.

But now, in a matter of hours, via one single horribly unlucky man on one ill-fated flight, the disease has arrived in Nigeria’s megacity—a city where as many as 20 million or more people live without a reliable source of power, without a well functioning sanitation system, and without much infrastructure whatsoever (a topic I am currently writing another post on). The people of Liberia, Sierra Leone, and Guinea along with the health workers bravely working to treat those affected have already suffered horribly from West Africa’s first outbreak of the Zaire strain of Ebola—an outbreak that has killed at least 1,500 people since early 2014—and it is terrifying to think of the virus traveling to a major international city like Lagos where the toll could be even more horrific and from where it could more easily spread beyond West Africa (over seven million passengers traveled through Murtala Muhammed International Airport in 2011 alone).

With fear for my friends in Nigeria in mind, I decided to research more about the deadly disease, and have been writing a summary of the virus’s history because the wikipedia entry didn’t provide much information and because the double mystery surrounding Ebola and Central Africa—still imagined by many in Heart of Darkness terms—is in part why many people find the disease so terrifying. Over the next few days I’ll upload a series of posts on the history of Ebola, so check back or follow Arcade Africa for notifications of those posts.

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Murtala Muhammed International Airport (Mark Duerksen 2014)