By Paul Richards, Njala University, Mokonde, Sierra Leone
The unexpected outbreak
of Ebola Virus Disease in Guinea, Liberia and Sierra Leone in 2014–15 constituted
the world’s first epidemic. A more recent outbreak in eastern Democratic
Republic of Congo (North Kivu and Ituri Provinces) in 2018–19 has also begun to
assume epidemic proportions. Medical responses in both countries have been met by
The arguments are
worryingly similar. Ebola, it is asserted, is not real. It is a money-making or
political scam, by unpopular governments or distant international agencies. The
alleged intent is to make money by harvesting blood or body parts, or to reduce
populations for political or religious ends. Ebola is a plot.
This results in
non-reporting of cases and attempts to nurse family members at home, often
using treatments associated with African traditional medicine. Without
biosafety protection for home carers, infection is clustered within specific families
or villages. The resulting situation pits ‘the people’ (family or community
more broadly) against the political and medical authorities (conceived as
remote elites with bad intentions).
Ebola, in other words,
generates a populist politics.
There are many
definitions of political populism, but all share a basic idea of opposition
between ‘the people’ (good, moral) and an ‘elite’ (bad, immoral). Populism mandates
‘the people’ to take action into their own hands, regardless of existing norms
Populism appears to
flourish in market economies in which a majority of small, independent
producers see themselves pitted against distant and manipulative elites. Family farmers directed much of their
populist ire against banks and financiers in a locally influential populist
political movement in the US Mid-West at the end of the 19th
If populism is a
direct challenge to established forms of public authority it also feeds on
suggests that people scoring high on measures of populist affinity are more
likely to believe in unsubstantiated plots and conspiracies, such as the idea
that Ebola is germ warfare gone wrong.
That Ebola should
develop a populist politics is an unexpected finding, since it is confined to
Africa, and Africa has been deemed the continent least affected by populist
political tendencies, perhaps because market forces are relatively
under-developed. This may be beginning
to change. In Sierra Leone, market
integration through better road and rural transportation has been a feature of
the post-civil war economic landscape
A rare exception to
the notion that populism is uncommon in sub-Saharan Africa is the foreign
policy of the late Libyan leader Colonel Gaddafi, who sought to promote
populist uprisings in several West African countries, including Sierra Leone,
based on the philosophy of his Green Book, which advocated for direct political
action based on citizen assemblies. In the 1990s this was a powerful influence
among the youth of the region, alienated both from distant diaspora elites and
from their own tradition-bound rural communities.
Gaddafi’s project motivated
a number of sub-Saharan insurgencies but failed to strike lasting roots. So why does Ebola generate a widespread populist
political response, where the oil money of the Libyan leader could not?
Populism grows through
the strong opposition of community and elite values.
Post-war market integration
in Sierra Leone has generated a wider awareness of differences in wealth and
life chances between political elites and the ordinary people. The civil war drove many people temporarily
out of the countryside and into refugee camps, where they became aware (often
for the first time) of huge differences in life chances between the urban elite
and rural poor.
Some went back to the
villages after the war, but many have continued a betwixt-and-between existence
in large rural towns such as Lumpa and Waterloo, hoping to tap better
educational opportunities for their children living in the shadow of the rich.
It was in these districts that Ebola spread like wildfire, based on a veritable
storm of denial sustained by charismatic religious figures, such as an Imam in
Waterloo who stirred up great excitement by promising a cure for the disease
until he, himself became infected and died.
advise that to counter the growth of populist politics directly by categorising
those who advance this agenda as wrong-headed, deluded or ill-informed only
serves to strengthen populist support. ‘We know better than you’, or ‘trust me,
I am a doctor’ feeds basic suspicions that the truth is being hidden.
The populist prefers
self-reliance. In Sierra Leone, fevers (mostly caused by malaria) respond to
family tender loving care. In Sierra Leone, pepper soup is the great pick-me-up.
Home cooking strengthens the will to live. So, it is the line of first defence
when Ebola strikes – a disease in which the initial symptoms are
response to Ebola (by contrast) sends an ambulance with a siren screaming to
the sick person’s door. The patient is then forcibly removed, with a
moon-suited hygienist spraying great gusts of pungent chlorine on their departing
footsteps. The tearful family follows at a distance, carrying a bowl of food to
offer the patient hope of life, only to be turned away by security guards at the
treatment centre gatehouse.
international media messages that 90 per cent of Ebola victims are doomed to
die, the over-wrought family can only conclude that this is indeed nothing like
a hospital. Rumours of blood and organ
harvesting, and death camps, quickly find a home.
In Sierra Leone rumour
spreads mainly by word of mouth. The other great medium for propagation of
rumour – the internet – has only limited reach in Sierra Leone. According to the
2015 census 87 per cent of Sierra Leoneans over 10 years-old lack internet
access. This figure is even higher in districts where Ebola first emerged and
for people over 40. So, whether Ebola was judged real or not mainly depended on
how people reacted to government warnings conveyed over the radio, versus the
interpretations of friends and neighbours on the street.
What can be done to overcome this populist reaction, now dogging the steps of Ebola response in North Kivu?
Medical treatment has
to change. A large and distant centre devoted to only one disease, which most
people have never before encountered, is a recipe for potential misunderstanding.
Ebola response has to embrace family concerns.
A big step forward in
Sierra Leone was the opening of community care centres (CCCs). Smaller and more quickly built than Ebola
Treatment Centres, these were located in places where cases were on the rise. Their
function was to test the sick, in order to isolate Ebola patients, sometimes by
referral, sometimes within the CCC itself. Families could more easily accompany
patients to a small, local CCC, and visit repeatedly to track progress. Even
home-prepared food could be readily supplied.
A further but equally
important function of the CCC was once a patient was admitted all kinds of sicknesses
were treated, and not just Ebola. Those testing negative for Ebola were treated
free of charge for malaria, typhoid and other complaints. This encouraged rapid
reporting, and thus rapid disruption of infection chains.
The manner in which public
authority was exercised, and by whom, was also important. Increased military involvement was often
counter-productive, since it seemed to confirm rumours about political bias or germ
warfare. Community-based leaders, including traditional chiefs, were more
effective than politicians or technocrats. Ebola is a family disease (it
spreads among those who provide intimate care) and chiefs and elders are
frequently consulted to help deal directly with family matters.
The current problem in
North Kivu is even more perplexing than in Sierra Leone since lack of trust is
compounded by armed conflict; a cease-fire is an agreed urgent need.
But halting armed
conflict will not be enough, by itself, to address the populist challenge
unless Ebola response itself changes. As
in Sierra Leone, it is beginning to be recognised in eastern Congo that a tunnel-visioned
focus on Ebola is a recipe for failure. A better approach is to address other
major local health challenges while simultaneously mobilising communities to play
a more active role in disease control, through (for example) taking responsibility
for case finding and safe burial. This
way, trust emerges from the wider engagement between responders and communities. Unhelpful rumours then have less fertile soil
in which to grow.