What I've learned about Ebola - Part 1

          When trying to understand the complexity of the spread of Ebola in Sierra Leone, it is a grave mistake to downplay the importance of cultural and social behavior. The tragic reality of Ebola was that it targeted the very fabric of social and cultural life in Sierra Leone. The mechanisms that communities would normally use to confront hardship and death, such as visiting the house of mourning families or just spending time with friends on a daily basis, were now a threat to one's life. Ebola spreads by direct physical contact with the bodily fluids of a symptomatic infected person. So, any behavior that involves touching an infected person, such as shaking hands, a mother caring for her sick child, or an extended family washing a loved ones dead body, carries high risk of death. In a society where every one relies on each other, people were forced to fend for themselves.

            In the beginning of the outbreak, a myriad rumors swirled around the country, both denying Ebola's existence, and questioning its origins. Sometimes rumors took on a political form – some said the ruling APC government wanted to suppress the SLPP party supporters who formed a majority in Kailahun District, where the disease began. Concurrently, the disease was attributed to deeply held beliefs of witchcraft. These beliefs were a barrier to the behavioral changes that needed to occur to combat the disease. The changes that needed to be put in place to fight Ebola were numerous, and directly conflicted with deeply held cultural practices. As every parent, teacher, and international development worker knows, behavior change is hard, but in this situation, with so many lives at risk, the stakes couldn’t have been higher. Even though there were numerous cultural, social and political barriers to widespread acceptance of Ebola's threat, gradually, communities like Bauya began to take up the fight.

            In Kongbora Chiefdom, where Bauya is located, community leaders organized a task force to restrict the movement of people in and out of the Chiefdom. No one was allowed to sleep in Bauya. If you left the community, you weren't allowed back, punishable by a 500,000 Leone fine. Select people were chosen to monitor the checkpoints to ensure that there was no movement in or out. Due to the hard work of many community leaders, Bauya and all of Kongbora Chiefdom did not have a single case of Ebola, even as every bordering Chiefdom had registered cases.

            My friend Joseph recounted a story to me of a time during the height of the Ebola epidemic when fear was at its highest. Joseph was invited to give eulogy at the local church for a person who had not died from Ebola. While reading from the bible, word got out that two of the attendees of the funeral had just come from another funeral in Moyamba. When people began to find out where they had come from, everyone quickly evacuated the church. Apparently, before church started, the men had touched the same bible Joseph was reading from. After the crowd dispersed, he was left with the sinking uncertainty that he may have now contracted Ebola. At home, with a heavy heart, he shared the news with his wife.  With each passing day, he marked his calendar, quietly waiting for the end of the 21-day incubation period. Every day he awoke with the belief that the disease could take hold. Could the itch in the back of his throat be the beginning of a cough? Was the pain in his stomach just from the food he ate the day before or could it be something more? On the 21^st day with no symptoms, he could finally breathe a sigh of relief. It was a blessing during a time when many families weren't so fortunate.

            This story was a grave reminder to me that while, on the surface, so many aspects of my visit back to Bauya were familiar, everything was not the same. Imagine being afraid for your life and the social structures that would normally comfort you have all been dismantled. Imagine being afraid to go to a funeral of a friend because their death could have been from Ebola. Imagine not being able to hug your friend's mother because she could also have Ebola. Imagine living every day with that uncertainty. Another close friend confided in me that Ebola was worse than the civil war because at least then you could go with your family and hide in the bush. With Ebola, there was nowhere to hide.

            For me, Ebola was a dire lesson in the importance of cross-cultural understanding and the value of human connection. When I returned home from America after being evacuated I was hit by a wave of ignorance. I could not watch the news. Headlines of death and disease whipped up a frenzy of fear that implied Ebola might be coming to America. The message seemed to be, “let's just quarantine West Africa to protect the lives that matter in America”. While some news outlets eventually told stories of the human impact of Ebola, most stories I encountered at first spoke in terms of numbers and vague details of some faraway land. Having spent a year developing professional and personal relationships in Sierra Leone, for me, those statistics were not just numbers. Each number on the death tally could have been a friend, colleague, or student of mine. My intention is not to blame anyone for their ignorance; three short years ago I had to look for Sierra Leone on Google Maps. Instead, I want to propose an antidote to ignorance – compassion.

            The impediments to true cross-cultural understanding take on many forms – racism, fear, class divides, language barriers, unchecked nationalism – but each of these challenges can be overcome with a person-to-person conversation. The more connections we have with people who appear different on the surface, the more we will realize that, when we dig a little deeper, those differences vanish. Walls, whether physical barriers that divide countries, or walls of ignorance that divide cultures, are not the answer to the threats we face. To overcome the global challenges of the 21^st century we need a greater understanding of the qualities that unite us. We need to recognize that what we have in common with our neighbors greatly exceeds what divides us. I'm not claiming that this process is easy, or that it will happen without effort. This is not the path of least resistance. It involves uncomfortable silences and misunderstandings, fumbled handshakes, and mistranslations. Ebola will not be the last crisis that shines light on the critical importance of cross-cultural understanding. Therefore, let us as a global society learn from our missteps in our response to the Ebola crisis. Compassion starts at the individual level. Begin the process by starting one conversation with someone different than you.