Archives for posts with tag: DRC

As social scientists studied communities affected by the slew of outbreaks that swept through Central Africa in the 1990s and 2000s, virologists began to wonder if the unprecedented number of cases were somehow connected. Initially they developed a theory that a single Ebola outbreak from a single index case was slowly simmering and spreading through Zaire (and then DRC), Gabon, Congo, CAR, Sudan, and Uganda. The reality that the outbreaks included several species of the virus and a multiple suspected index cases connected mostly to the handling of animal carcasses squashed the theory of a single outbreak, but still the question remained, why this sudden and prolonged string of separate and distinct outbreaks?

Scientists next looked for larger environmental patterns that might connect the Central African cases. Most outbreaks of Ebola occur in between the dry and wet seasons, but there has been speculation that broader climatic event might be connected to the sustained spike in cases. The 1976 simultaneous outbreaks of separate species only a few hundred miles from each other also points to an environmental occurrence activating the virus and allowing it to jump from the reservoir to monkeys and humans. Scientists have been studying satellite photographs of the Congo Basin from the past few decades in an attempt to detect any environmental changes that overlap spatially with flare ups of Ebola. These studies have found that especially arid dry seasons disrupt the ecosystem in the jungle, leading animals to move beyond their normal confines in search of food and water, which results in increased human-animal contact.[1] If this is accurate, global warming has serious implications for Ebola outbreaks.

Another study that may lend further support to the environmental activation hypothesis was conducted in 2010 when scientists examined the genomes of living African bats and rodents and found ancient “fragments” of filoviruses in their genomes. Through recent advances in the fascinating subfield of paleovirology the researchers were able to estimate that filoviruses are likely tens of millions of years old based on the genetic remnants of the disease shared by the mammals coupled with the scientists’ knowledge of the mammals’ shared evolutionary trees. If rodents and bats have carried filoviruses for tens of millions of years as they migrated across the world, it’s no surprise that strains of Ebola exist in both Sub-Saharan Africa and the Philippines. The study goes on to suggest that other rodents, marsupials, and bats may carry yet unknown forms of filoviruses in the Americas.[2] The fact that we’ve only seen the virus pass from reservoir to human in Central Africa and the Philippines, lends credence to the idea that it is something particular to the Central African environment (that the Philippines may share) that is “activating” or allowing the virus to jump from the reservoir to larger mammals. Could global warming activate latent filoviruses in other regions of world? [Or, alternatively perhaps other New World strains are similar to the Reston species in that they don’t cause human illness when spread to humans and therefore haven’t been detected yet.]

As promising as the research has been into detecting an environmental link, in focusing on identifying climatic trends connecting the past twenty years of outbreaks, scientists have neglected to consider the often-horrific human history of Central Africa as a potential source of explanation for the string of outbreaks. In the aftermath of the Rwandan civil war and 1994 genocide, the deadliest conflict since World War II unfolded across Central Africa, killing over four million people, displacing many millions more, and dragging in soldiers from throughout the region. The First and Second Congo Wars have not received nearly as much scholarly attention as they require, but books such as Africa’s World War written by Gerard Prunier begin to document the devastating bloodbath that occurred as troops from Rwanda and Uganda marched across lawless Zaire to evict Mobutu from his rotting seat of power in Kinshasa. Two decades later, the conflict continues to this day with fighting between Kagame’s Rwanda and rebel groups such as M23 in eastern DRC. Additionally South Sudan has suffered its own bloody history that persists despite independence from northern Sudan, and the Lord’s Resistance Army has terrorized Northern Uganda/CAR for many years, displacing numerous people.

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Charcoal mural in an IDP camp near Gulu, Uganda (Mark Duerksen, 2009)

The result of the countless armed conflicts in Central Africa has been an upheaval of societies across region, causing an increased likelihood of human exposure to Ebola as starving refugees and soldiers turned to bush meat while they roamed through the Congo’s dense forests, and as they displaced animals by burning and logging forests, which may have put primates in greater contact with both humans and the reservoir. It would be interesting to see what further spatial research tracing the conflict and the virus over the past 20 years might reveal.

Scientists’ omission of the deadliest conflict since WWII from their causal considerations and the dismal results of the ethics review of Ebola research (previous post) suggests a troubling trend where scientists studying Ebola in reality know very little about the region and the people affected by the virus.

[1] Stephen Pincock, “Seeing Ebola from Space,” The Scientist, May 1, 2006. Available online: http://www.the-scientist.com/?articles.view/articleNo/23952/title/Seeing-Ebola-from-space/

[2] Derek J Taylor, et al., “Filoviruses are ancient and integrated into mammalian genomes,” BMC Evolutionary Biology, 10(2010), 1471-2148.

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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.

Today I wrote a response paper summarizing and comparing this article by Filip De Boeck and this powerpoint presentation by Vanessa Watson. I’m not satisfied with what I wrote so I’m going to attempt to hash out my ideas a little better here. So the Watson presentation is intended for her architecture students at the University of Cape Town and in it she runs through the big African planned “future cities” or what she calls “fantasy cities,” showing glamorous designs of them, and then on the next slide shows the “reality” of the actual slums that make up most of the area of these cities. I haven’t been in her actual lecture, but her criticisms seem to be, 1. these cities create islands of wealth that don’t help most of the city’s poor, and 2. the designs of these cities are transplanted from the West via Asia and are not fitted for the realities of African cities. Both points seem fair and accurate, but then the De Boeck piece seeks out the voices of Kinshasa’s urban farmers who are surprisingly attracted to the skyscraper-centric plans, saying “Yes, we’ll be the victims, but still it will be beautiful.” The dream of these new cities can also be alluring and captivating even to the urban poor who will not have access to them…the thought of one day being part of an international megacity frequented by the world’s who’s who evokes pride in one’s hometown and offers hopes that that wealth may find its way throughout the city. These are the similar sentiments to what Wole Soyinka expressed when he said Eko Atlantic is “[r]ising like Aphrodite from the foam of the Atlantic.” Many African urban dwellers desire symbols of beauty and pride to rise from the centers of their cities—buildings that are “so beautiful that it makes one dream.” In this light of these local reactions, current plans for shiny business districts of African cities might rather be looked at as monuments to the potential of the surrounding city, not as unsustainable parasites of corporations. Yet Watson is absolutely right that many of the “monuments” that are being sold by international corporations and architectural firms to African politicians are problematic in that they segregate cities often more than their colonial predecessors did:  De Boeck describes how Belgian colonial planners divided Kinshasa between the white island of wealth—La Ville—and the surrounding ocean of poverty—the black townships—with railroads and army barracks. Now the new wave of planned cities are gated island or 40 km away from the old city, taking the colonialist exclusionary model even further than before. Yet they’re still beautiful and desirable to the urban poor….their allure stimulates dreams for the future….and dreams are what keep everyone going. And also if you were an African doctor or lawyer or business person who might be tempted to leave for opportunities elsewhere where it is safer and stabler to have a family and raise kids (the brain drain), wouldn’t you be more likely to consider staying if you could have a home in Eko Atlantic or Cité du Fleuve? The ways in which the urban poor of Kinshasa have navigated and adapted to their infrastructurally scant neighborhoods (as described by Koolhaas and De Boeck) and the construction of Eko Atlantic and Cité du Fleuve can both be seen as different manifestations of the very human drive to create order and predictability in life. For me this is where the state comes in–as both a creator and moderator of human impetus for stability and security. Here again, the mayor of Lagos, Fashola, seems to be doing a better job at this than his counterparts in much of Africa, including in Kinshasa. Fashola has attracted investment in the glamorous dream of Eko Atlantic but he has also raised tax revenue by not just promising but delivering services, including housing and bus lanes to improve traffic. And the success of Fashola’s incrementalist approach of improving services and infrastructure for neglected, “informal” communities suggests that De Boeck’s prescriptions for slow and achievable planning goals for Kinshasa’s slums are dead on. When rapid changes come to poor neighborhoods, they’re more likely to be uprooted and turned inside out after years of self-organization than to be improved. But the political will has to be there, and the planners, lawyers, business people, and doctors have to be (live) there too….and in subtle but significant ways they will appropriate and alter this “imported” architecture as their own.

Kigali:  “Fantasy and Reality”

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Highlights from McKinsey report on “How to Make a City Great”:

-by 2030 60% of the world (5 billion people) will live in cities.

-While cities are world’s economic engines, they also account for the most resource consumption and greenhouse gas emissions.

-The report focuses on what successful leaders do to make their cities great. Cites 3 things:  smart growth (that balances the economy, social conditions, and the environment), doing more with less, and winning support for change by delivering results swiftly.

-Smart growth:  simpler tax codes, focus on clustering industrial sectors in city, invest heavily in infrastructure, train English speakers, constantly set short term achievable goals, adopt regional perspective and collaborate within that region, make planning inclusive (bottom up), build high-density areas (smaller more compact infrastructure), regulate construction projects to build “green” projects, provide opportunities and infrastructure for the marginal residents of the city.

-More with less:  embrace technology, rigorously monitor expenses.

-Win support for change:  be accountable, provide citizens information, build a high-performance team, invest in education, create culture of accountability.

Not surprisingly, there was little ground breaking information in the report. What did strike me was actually how balanced and, in my view, spot on much of the report was (although it was corporately vague and general also). I guess I was hoping it would be actually prescriptive rather than just descriptive couched in prescriptive language. I was looking for it to layout steps and priorities at each stage of development rather than a laundry list of everything cities should be doing (even when doing more with less it’s impossible to do everything). I have an image in my head of representatives from a global corporation equipped with the McKinsey report on Africa sitting down at a meeting with the governor of an African city who has a copy of this city report in his briefcase, and each side being miffed at McKinsey:  the governor annoyed of the portrayal of Africa as a fruit ripe for the picking, where resources can be extracted and consumerism sold, and the corporation disappointed that the governor is demanding infrastructure investment and environmental pledges in exchange for business licenses and trading rights. I guess that’s the nature of soliciting information from a consulting firm.

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Image source (Kinshasa skyline)