Archives for posts with tag: Uganda

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.

This Nairobi matutu mapping project is one of the coolest things I’ve seen in a while. The idea is to create a map of the informal bus (known as matutus) routes in Nairobi in the aesthetic style of subway maps. Having something like this would have been extremely helping for navigating the bus systems in Kampala and Kigali. I’m the kind of person who rarely takes the bus around Boston because it’s too much of an effort to figure out the dozens of routes and the times that change depending on day of the week and time of day, so you can imagine how much fun I thought it was getting to class in Kigali or making it across town for a meeting in Kampala via bus (they’re more like oversize vans in Uganda and Rwanda) routes only found out about through word of mouth (or pointing when you don’t know the language). Of course those conversations to figure how in the world to choose which of the numerous matatus zooming by to hop into were an interesting opportunity to strike up a conversation and learn a little more about the city’s geography. And, once I knew the routes to use (distinguishing between the names of the destinations that the conductors would yell out took the most time), it felt like I had tapped into an esoteric transportation network not otherwise accessible through any kind of material map. But if I end up in Nairobi anytime soon, I know I’ll be thanking my lucky stars for this map. I’d be curious to know what Nairobians think about the project–a positive development for making the city more welcoming to new arrivals, visitors, and tourists? A lose of privileged knowledge that empowered and distinguished [poor] Nairobians from outsiders? I’d also be interested to read the history of how these routes have been slowly negotiated over the years without the oversight of government regulation. However anyone who thinks this private transportation network is an example of the efficiency of the private sector to provide what are elsewhere public services has not relied on hot, dusty, cramped, and dangerous matatus to get anywhere. But this takes nothing away from the ingenuity and creativity of the developers of these informal routes. One of the members of the team working on the project is a Cambridge, MA based company called Groupshot whose goal is to create, research, and develop “technology-driven projects that interface with and support existing local systems.” This matatu project seems like a great way to do just that. One thing to watch going forward is how current this mapping project is able to stay with the bus routes in Nairobi (how well and how long the project is maintained…) as one of the benefits of an informal, decentralized bus system like this is that it can change rapidly to adjust to new developments and flows of people in the city without having to wait for bureaucratic approvals or the redrawing of countless bus transit maps throughout the city as Boston would have to if a route was altered even the slightest. A cell phone crowd sourcing effort of the likes that the project website talks about for the future may be a solution to this upkeep problem, and something that city governments in the western world might want to pay attention to in order to keep their transportation networks agile and adaptable as changes in cities accelerate with the massive growth they’re undergoing around the globe.

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Thinking about the people of Nairobi tonight. And hoping there is no violent backlash on the Somali community there. Here’s a Time article (a year old but still relevant) on the war against Islamic terrorism in East Africa. It does a good job summing up the situation, including the US’s behind the scenes involvement, and gives a detailed account of the investigations after the 2010 Kampala World Cup bombings. And here is the New York Time’s aggregator page on Al-Shabab and a firsthand account of today’s tragic attack.