Some cultural guidelines in the fight against Ebola
The fight against Ebola in West Africa cannot be won with medical knowledge alone. This virus affects Africans whose thinking and activities are strongly determined by local cultures and customs. These traditions have developed over hundreds of years. They may at times appear strange in the eyes of Europeans, but they are the collective wisdom of the different ethnic groups and determine their daily activities. These traditions, which developed over a long period of time, play an important role in the fight against Ebola.

Which are the cultural traditions regarding health matters?
Despite some regional variations, one can find many cultural traditions, related to sickness and death, which are common to all ethnic groups in sub-Saharan Africa. They involve the understanding of the cause of sickness, care of the sick and funeral rites. Whereas Europeans are often helpless in the presence of death, Africans understand death as part of life. They have developed very complex rituals to cope with this reality, which is challenging them regularly. The Kenyan sociologist Ali Mazrui, therefore, once said that Africa is the continent of abundant life and of speedy death.

1. Understanding of the cause of sickness.
When people show signs of serious illness, the first reaction of relatives is to ask themselves who might be responsible for this misfortune. This does not exclude the fact that they will also seek treatment at a dispensary or hospital later on. But hospitals are often a long distance away. Their immediate question is: Who sent the virus and why am I infected? In their thinking, not a virus or mosquito have caused the sickness, but an evil power, a sorcerer or an enemy have caused it by using mysterious powers including poison. Especially the occasional use of poison is a reality. This is why family members will consult a traditional healer or even a witchdoctor, in order to neutralize the evil influence and turn it against the attacker. This is done at the same time as seeking medical care and taking part in Christian or Muslim healing rites. There is no contradiction between the two in their eyes and it is an essential condition for the successful medical treatment of the patient. People will search for help from whatever source. This means, that even if Ebola is clearly diagnosed by a doctor, the matter is not finished: Relatives of the sick person will continue to look for traditional help. Besides applying the necessary medical measures, health workers should, therefore, be aware of the traditional understanding of sickness.
What does this involve? When a serious sickness occurs, the relatives of the sick person will try to find out why the person has been attacked and by whom. This process can seriously delay the decision by the family to take the person for hospital treatment. Consequently, patients often arrive in a health centre in a serious condition, resulting in high mortality rates. This means that modern hospitals often have a bad reputation with patients used to using traditional medicines. This, in turn, reinforces the reluctance to seek modern treatment. This vicious circle can be deadly.

2. I am, because we are.
In a somehow simplified way one can say that Descartes’s dictum “cogito, ergo sum” (I am, because I think) is characteristic for the European mind, whereas African thinking and doing is based on: “I am, because we are”. In other words, solidarity and the social dimension of togetherness are vital in Africa. People who do not relate to others are not considered as normal. Often they are suspected as being witches and wizards. Especially when a person falls ill, his or her friends and relatives feel obliged to show their concern by visiting the sick person. This relationship of the family or the neighbourhood to the sick person makes prevention by isolation or any form of quarantine, as required in the case of Ebola, very problematic. The traditional vision of a healthy life in most African cultures does not see good health as a purely biological issue. Good relationships are what gives a person or a family strength, and protects them in times of difficulty. Good relationships are what gives a person or a family strength and protects them during times of difficulty. The experience of a patient that he or she is loved and cared for by the community, is an important asset in the healing process. The same can be said of patients who draw strength from their belief in a higher being, because they understand that they are not alone. Ways must be found to reconcile the medical need for isolation with the human need for togetherness.
Health professionals in Africa ought to be aware that they are not treating a disease, but a person! This person is not an isolated person, but part of an extended family and of a social network. The treatment should, therefore, not only concentrate on the patient, but should include, to some extent, also his or her family.

3. African Hospitals
In most African Hospitals, there are small buildings nearby to allow family members to stay near the patients and to prepare food for them, because food is often not provided by the hospital. One never leaves a sick person alone. This is a great help in the healing process. It is, therefore, very problematic to isolate Ebola patients, because it deprives them of the essential emotional and moral support, on which they depend. This alone may kill the patient. If a patient dies in these circumstances, there is a grave risk that their immediate family will be accused of having abandoned the sick person. This again can disturb the harmony and lead to conflicts and divisions in the extended family.

4. Can cultures change?
We need to explore possibilities how the medical and the cultural requirements can coexist. The purpose of cultural traditions, generally speaking, is to protect and enhance the life of the individual and to strengthen harmony and peace in the community. These traditions are, however, not static. They have changed over the centuries and have been adapted. Aids, for example, has changed some sexual practices. If some traditions endanger life, they, therefore, need to be modified. People will normally accept these changes once they have understood the reason for the change. Hence the importance of community workers and church personnel, who possess the authority and confidence of the people. They are in a better position than politicians to explain these issues to the community.

5. Funerals
Traditional societies are very anxious not to put in danger peace and harmony in their communities. One way to strengthen the harmony in their community is by visiting the sick, and even more by attending funerals. People will travel long distances and spend a lot of time and money for this purpose. If one does not attend the funeral of a relative or neighbour, he or she might be suspected of being responsible for the death. This fear alone is a strong motivation for attending funerals. The huge number of funerals in Ebola stricken countries is, therefore, in danger of paralyzing the social structure of these countries, simply because many people don’t turn up for work.
Funeral customs are probably the most elaborate and respected traditions in Africa. Once a person is dead, women wash the body and remain with the body, often touching it right up to the moment of burial. Respecting funeral customs is the condition of having a happy life in the village of the ancestors. It is also a guarantee that the dead person will not return to claim his due by interfering in an inopportune way in the life of the living on earth. It is also believed that disrespect of funeral custom may provoke the anger of the ancestors. Dying a good death is, therefore, a central preoccupation in most African societies.

6. Conclusion
It is evident that many traditional practices related to the Ebola pandemic are conflicting with medical practices. The often strong resistance to preventive measures, isolation or quarantine cannot be explained solely by lack of information or education. Even if many people in the affected areas may not be able to read or write, they do not lack wisdom and they are not ignorant about the dangers of life. They have often experienced that life is precarious and not to be taken for granted. They know about the importance of solidarity in their community where one can only survive as an accepted and honored member of the community. Any isolation kills! The medical measures in the treatment of Ebola are, of course, of vital importance. Without them there can be no progress. But these measures need to supplemented by the deep wisdom of the African community. It seems that we are only begin to understand the complexity of how to cope with Ebola, or to say it in a proverb from Sierra Leone: “We are only seeing the ears of the hippo”!
Health workers, community leaders and religious leaders of all denominations, Christians, Moslems and traditional believers need to work closely together in order to cope with the demands of the Ebola pandemic.
Fritz Stenger, M.Afr.