Ebola Illness Narratives

Ebola Illness Narratives

Background

Ebola is known as one of the deadly viral diseases which occurred mostly on the African continent. It affects mostly people and non-animal primates such as monkeys, gorillas, and chimpanzees (CDC, 2021). Ebola was first discovered in 1976. It was believed that the Ebola disease was an animal-borne disease whereby, the bats or the non-human primates were most likely to be the source (CDC, 2021). Other animals like the apes, monkeys, duikers, and the humans were infected by the Ebola virus through the other infected animals which were carrying the disease (CDC, 2021). There are various signs and symptoms which tends to appear when a person is been infected by Ebola disease. The symptoms tend to appear 2 to 21 days after the person has been in close contact. Some of the signs and symptoms are fever, aches, and pains such as headache, weakness, sore throat, loss of appetite etc (CDC, 2021).

In 2014-2016, the Ebola outbreak in Western Africa started in a rural setting of Southern Guinea, and within weeks, it spread towards the urban areas as well as across the boarders and latter on within months the Ebola outbreak became a global epidemic (CDC, 2021). The Ebola virus was most likely to spread to people via direct contact with blood, body fluids, and tissues of animals (CDC, 2021). The health care workers tend to be at higher risk of getting infected from the Ebola virus, as they might not take proper measure when been in close contact with patient while treating them (WHO, 2011). The children, pregnant women, and elder people tend to be more affected by the Ebola viral disease. Almost 3600 children lost both parents, they started becoming wage earners, and most of the children were stunted (Elston et al., 2016). The pregnant women who suffered from acute Ebola and recovered, they still had chances of carrying the virus in the breastmilk, pregnancy related fluids or tissues which may further be a risk to be transmitted to the baby (WHO, 2011). The older people who suffered from Ebola virus tend to live shorter and had higher risk of mortality rate (Zhang et al., 2015).

There were also different types of factors which contributed towards the Ebola Viral Disease. Firstly, one of the biotic factors which contributed towards the Ebola disease were, through ingestion of the fruit that was been contaminated by the infected fruit bat’s saliva or feces, here is whereby, the bats might lead to infect other species such as duiker, non-human primates or even humans (Alexander et al., 2015). Additionally, also close contact with blood, secretions, organs, and other bodily fluids of the infected animals may spread the disease (WHO, 2011). One of the abiotic factors which contributed to the Ebola outbreak was climate change, whereby, the Ebola outbreak tends to occur more during the dry season, that is because the hydrological changes may tend to influence the forest fruit production (Alexander et al., 2015). For instance, during the dry season the production of fruits tends to be more whereby there are more chances for the infected bats to spread the disease by leaving their saliva or feces on the fruit (Alexander et al., 2015). It was also found out that Ebola Virus survive more in dry areas (CDC, 2021). Looking at the cultural factors which contribute toward Ebola outbreak, the religion practices such as Burial practices was one of them as it involved washing and touching of the deceased individual, which may lead to huge spread of the disease, moreover, funerals were known as one of the features which led to transmission of the Ebola disease (Alexander et al., 2015).

Local perspective

The medical system in Western Africa during the Ebola Outbreak tends to be poor, whereby, some of the health system functions which were known to be essential were not functioning properly, there were inadequate number of qualified health workers (Kieny et al., 2014). Moreover, the health infrastructure, logistics, health information, surveillance, governance, and drug supply in Western Africa was weak (Kieny et al., 2014). For instance, in areas such as Sierra Leone, Guinea, and Liberia were not prepared for the Ebola outbreak, whereby, their health systems were underfunded, under resourced as well as overburdened (Elston et al., 2016). When the outbreak spread towards the urban areas, there were not enough treatment beds, there were inadequate supplies of medicines whereby, the patients who were symptomatic of Ebola virus were turned away (Elston et al., 2016). For instance, due to the poor medical system, some patients used traditional medicines and herbal remedies. Moreover, large number of cases went without care, whereby, there was an increase in the population health needs which were not met (Elston et al., 2016).

In Western African areas like Sierra, Leone, and Liberia, the Clinicians doctors, and nurses used to treat the patients who were symptomatic to the Ebola Virus, but it was found out that, they were at the most risk of getting infected by the Ebola Virus, and therefore they left their work and refused to work because of the getting infected by the Ebola disease, whereby by this led to closure of hospitals (Elston et al., 2016). The health care workers (clinicians, doctors, and nurses) were at the most risk of getting infected because they worked in close contact of the patients when treating them without following proper control measures (WHO, 2011). Due to all these health care constraints, in the patients who were suspected from Ebola virus where been taken care at home by the family members. The family members were being addressed on how to take care of the patients such as by washing hands frequently, isolating the patient separately from other people, not touching the patient as well as the items which have been in contact with the patient and assigning one single care giver (Schmidt et al., 2020).

Some of the examples of local causation of Ebola Outbreak in Western Africa were through the bat’s exposure, and cultural practices. Looking at the bat’s exposure, it is whereby other animals ingest the fruit that was been contaminated by a bat infected from Ebola Virus disease (Alexander et al., 2015). Moving towards the cultural practices, in some areas of Western Africa such as Guinea, it was found that cultural practices such as burial practices were linked to Ebola disease, that is because such practices involve touching and washing of the person who has Ebola disease. Therefore, such cultural practices were known to be the causation of Ebola disease(Alexander et al., 2015). For instance, it was also found out that being in close contact of infected person or animal’s blood, organs, secretions etc. without taking proper control measures may also pose high risk for an individual to get Ebola (WHO, 2011).

The local treatment towards the Ebola Outbreak were, that the patients were been offered with supportive care, whereby, the patients were provided with fluids and body salts either orally or through infusion into their vein (CDC, 2021). Additionally, to improve the survival of the patients, patients were given medicines to treat particular symptoms such as headache, muscle pain, fewer, upper abdominal pain or burning sensation (Zhang et al., 2015). According to CDC there were two treatments by the U.S. Food and Drug Administration which helped in treating the Ebola virus. The First one was first one was a combination of three monoclonal antibodies, and the other one was a single monoclonal antibody (CDC, 2021). These two treatments were known to be effective because they both had monoclonal antibodies, whereby, monoclonal antibodies tend to act as natural antibodies which stop germs like viruses from replicating after infecting a person (CDC, 2021).

Narrative/Interpretive Perspective

The first narrative is about Preston Gorman, a male aged 38 at the time of the narration. Gorman was born and brought up in Cedar Hill, Texas, in an evangelical family (Bernstein, 2019). He trained as a paramedic and firefighter before returning to school to study and become a physician assistant. Gorman quit his job when there was an Ebola outbreak in West Africa and volunteered with the Boston non-profit Partners in Health Organization to help Ebola victims in Sierra Leone, Maforki, where he contracted the disease, just after 16 days (Bernstein, 2019). This narrative is told from the journalist's view of the statement recorded from Gorman after opening up about the condition and how he suffered trauma due to PTSD for an extended period leading to a loss of family, the girlfriend he was to marry, and friends.

This type of illness narrative is a chaos story told from a sufferer's narrative perspective (Singer et al., 2020). The rationale behind the chaos story is that although Gorman recovered from the illness of Ebola and went back home to Texas, he still discusses how PTSD contributed to his state of uncertainty, hopelessness, and confusion in his life, which he has started to rebuild (Singer et al., 2020). Gorman had the calling to help out and even quit his job to volunteer in an outbreak pandemic that was so dangerous. However, he contracted the disease, and his health deteriorated fast. At first, he recounts how he was left alone despite being sick to care for himself, such as getting out of the ambulance and barely walking to the treatment center while in Sierra Leone. His isolation and deteriorating health made him so hopeless, and he even tried to stop treatment. He was later airlifted to one of the most advanced facilities in the US NIH, with a team of dedicated physicians to help him recover. Despite almost giving up and being forced to be sedated, he recovered and was released to go home in the company of his mother. However, his condition of depression before the volunteer and illness experience also accompanied by the trauma he had gone through made him ill with PTSD, which led to him cutting off his family, friends, and even the girlfriend he was to marry. Although he is getting better, a lot of intervention has been implemented to help him. There are some characters introduced in the narrative, especially the mother and family that tried to be there for him, the team of doctors who rejoiced in his recovery as he was at the point of dying, and the organization in Sierra Leone that Gorman claims it did not have so much impact in helping him recover as they downplayed the impact fo the trauma he went through. Therefore, the central idea is how he suffered the Ebola disease, an account of how his condition deteriorated, and how the trauma he went through continues to haunt him as he tries to recover. In the narrative, there no usage of metaphors because of a vivid description of Gorman’s suffering and situation of despair.

The second narrative is about a medical doctor Kent Brantly, a male aged 33 years. Kent is an American from Texas and married to Amber, and together they have children (Fox, 2014). In this interview, Kent narrates alongside his wife the ordeal of his Ebola disease in Liberia (Fox, 2014). The type of the illness narrative is restitution (Singer et al., 2020). This is because Kent became sick and was admitted to the hospital and was near the point of death. At the time of his illnesses, the wife and children had traveled back to Texas while he became admitted and later transferred to a hospital in the U.S. Kent received medication and treatment helped him. Throughout the narration, Kent mentions that though he feared he would stop breathing and die based on the interventions and treatment, he remained hopeful because of the support he received from the family and physicians. Therefore, this narrative is told from the perspective of hope and a person that was very sick and getting better despite facing death and uncertainty of the Ebola outbreak. The linear story starts with Kent's serious illness condition and ends with him being healthy, although he indicates he is still recovering his strength (Singer et al., 2020). In the narrative, the main characters introduced include the physicians who helped him. For instance, the nurse who was the primary caregiver is introduced, and the two interact in a way that shows the desperate situation of the doctor is about to die because of the breathing difficulties. Therefore the nurse is introduced at the point Kent almost gave up and the beginning of restitution. The wife is also introduced as a person who witnessed the suffering perspective of Kent and how the family had to cope with the situation. The narrative has no metaphors used because it is an emotional delivery of the sufferer’s experience, hope in God and love of the family.

The two narratives have similarities in that both patients volunteered to work in West Africa during the Ebola Outbreak. They also come from the same region in Texas and are American citizens. However, the two worked in different countries and had different experiences. While Gorman worked in Sierra Leone and had additional mental problems of depression history and PTSD, Kent had none of the diseases except the time of Ebola. Fort Kent was in Liberia and received the ZMapp drug, which was not approved for human trial as an experiment. Gorman did not receive the drug despite enrolling for it because he was in the control group. From a medical anthropology point of view, their experience highlights various perspectives of illness narratives from the victims and how they experienced the condition negatively. While Kent did not break down and had hope because of the family support, Gorman cut off his family friends and girlfriend after recovery and returned to Texas, where his family was awaiting him to celebrate him. Knowing these experiences helps to see how the condition affects people differently and the impact of culture on the patient outcomes in dealing with illnesses such as Ebola.

Critical Medical (Health) Anthropology Perspective

Understanding a disease requires one to understand also the disparities and inequalities in the physical and social environments that contribute to the better management of a health condition or enhance its spread and difficulty in containment. In the critical medical/health anthropology perspective (CMA), the model entails that both the political ecology and political economy contribute to the social determinants of health and inequalities that exists among communities (Singer et al., 2020). Therefore, issues such as cultural differences, poverty, government regulations, capitalism and how goods and services are distributed in the society, the environment and the biocultural factors all contribute towards understanding the diseases in the society through a holistic perspective (Singer et al., 2020). At an individual level, some of the social inequalities contributing to the disease development may include level of education, income levels, and cultural values among others (Singer et al., 2020).

In this particular case, the outbreak of Ebola in West Africa depicts the nature of the social inequalities and health disparities in contrast to other countries. The condition which was mainly spread through bats that spread to both non-primate animals and human beings in West Africa (Alexander et al., 2015). Despite many people outside the US being diagnosed with the disease because of the human interactions and immigrations, the disease most affected the west African countries which had the majority of the cases while most of the foreign countries especially in developed regions contracted the diseases but was able to manage it in a way that reduced the spread and longevity compared to west Africa (Alexander et al., 2015). The differences in how the cases were managed and the accessibility of healthcare show the health disparities not only between the rural and urban centres in West Africa but also between African and European countries and the United States. There are three main factors that contributed the social inequalities and health disparities from a political/economic perspective of the CMA which include poverty, lack of sufficient health facilities and resources, and lack of cultural competence and educational awareness.

Firstly, Poverty is a main issue in most of the African countries (Singer et al., 2020). During the Ebola outbreak, most of the people in West Africa were living in poverty (Alexander et al., 2015). Those affected especially in the rural areas could not afford to access to good healthcare and tried use local approaches towards treatment of the disease. As a result of poverty, most people in areas where there was congestion were also exposed to a higher risk of contracting the disease compared to people who were wealth and could afford better healthcare access including to private hospitals and outside the country (Elston et al., 2016). From a country perspective, most African countries did not have the sufficient funds or resources in dealing with the conditions which led to straining most of its resources compared to most of the developed countries such as the US (Elston et al., 2016). In this case, the poverty issue contributed significantly to the high number of cases and mortality in crowded places and in West Africa especially compared to developed places and the wealthy in the society as part of the health disparities.

Secondly, the West African governments did not have sufficient health resources and facilities, or the scientific resources to combat the disease (Elston et al., 2016). This majorly reflects on the political ecology and economy differences between countries in developed and underdeveloped regions. In this case, most West African countries mostly concentrated on providing few treatment health facilities and had few specialized physicians working in urban centres (Alexander et al., 2015). Most of the experienced health professionals try finding work in foreign countries where the returns for their services are higher compared to the home countries (Alexander et al., 2015). Therefore during the outbreak, most of the hospitals in the urban centres became congested and many people were turned away and left to die which prevented access to healthcare. Besides, the hospitals in rural areas were few and this contributed to limited access to healthcare. Some of the foreign nationals especially those volunteering as care givers and physicians during the Ebola outbreak had to be flown back to their respective countries to receive specialized medications leading to improvement of their health although some succumbed to the Ebola disease (Alexander et al., 2015). Most of the research institutions that were able to come up with the ZMapp drug were from the United states which shows the disparities in the investments in the health infrastructures and capacity of the people in containing such an outbreak or finding a vaccine (Alexander et al., 2015). These disparities contributed significantly to the spread of the disease mostly in West African and high mortality rates compared to other regions despite the help from volunteers across the world.

Lastly, from an environmental perspective, the lack of cultural competence and educational awareness contributed to the health disparities during the Ebola outbreak that mostly affected the West African countries. The environment consists of both the physical and cultural and especially how human interactions within these environments contribute to the aetiology of the disease (Singer et al., 2020). In the case of Ebola, one of the significant cultural factors contributing to the spread of the disease was the ritual of burying the dead (Alexander et al., 2015). Considering Ebola was being transmitted through close contact and touch of body fluids with an infected person, the washing and dressing of the dead without proper protective gears especially of the dead person was infected led to a massive spread of the disease (Alexander et al., 2015). This shows how such a culture contributed to the health disparities compared to areas where such culture was not followed (Singer et al., 2020). This shows the lack of awareness programs to the public not only on educating the public on how the disease is spread but also the need for self-prevention. Lack of education also contributed to the way humans interacted with the ecology and natural environments leading to the spread of the disease from bats or the foods collected such as fruits that had the infection from bats as a result of either faeces or eating part of the fruits and infecting it (Alexander et al., 2015). If the educational awareness about the ecological and social/cultural environments were determined through the biocultural lens, then it could have helped many of the west Africans to take preventive measures from contracting the disease.

References

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