John Rainford: Adapting to cultural norms before treating deadly diseases

Vignette on cultural adaptation and being sensitive to local traditions in the current Ebola crisis:

Consistent with protocols, the WHO experts had been dressing in their protective gear prior to arriving at the village. It covered their faces, their hands, which immediately raised suspicions. The equipment was white, culturally associated with the supernatural, which further raised concerns.

Exposure to victims was known to be the primary way in which the disease spread and so guidance was issued not to touch the dead and to bury them immediately. This flew in the face of local traditions whereby the dead were surrounded by loved ones until their souls passed into the next world.

Isolation hospitals had been established and – following best practice — the sick were whisked away from their families into the facilities. Of course, few ever came back. Villagers never saw their loved ones again and suspected the foreigners were to blame.

So the GOARN team adapted — they had little choice. With no real treatment beyond supportive care, the key intervention would be behavioural change. The experts could have all the qualifications in the world, but if their advice was ignored, more people would die.

Teams began suiting up in their protective equipment only after arriving at the villages and learned local greetings to help rebuild trust. They worked with religious leaders to modify burial customs to minimize the threat of infection. They lowered barriers surrounding the isolation hospitals so family members could see those inside a send a simple, but essential message: “we have not abandoned you”.

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