10. Ebola, Genies, and how we think about Disease

I was asked to write an article about Ebola for the SABAAR, which is a quarterly publication for the Senegal Peace Corps community. I wrote it with a lot of help from my friend Rin, who is going to grad school for disease ecology and epidemiology, her knowledge was extremely helpful. However, it ended up getting edited down quite a bit— losing, in my opinion some of the most interesting bits— before being published. So I am going to put it here, edited mildly to be more fitting for this blog.

(Sorry but I have no relevant pictures to go with this post.)

Ebola, Genies, and how we think about Disease.

When a bat is found living in the village where I reside, it is killed. This is not the case everywhere—many villages value bats for their mosquito eating—but where I live kids and adults alike will explain that bats are bad animals, or even that they bring evil. Are these people aware that the deadly Ebola virus is carried and can by transmitted by bats? Do they know that bats are, in fact, probably the reservoir species of this awful disease virus?

The answer seems to be no. They do not understand that the bat transmits or carries any disease in specific, or how precisely this happens. However, people do understood, or at least believe, that bats bring ill health and misfortune—but this not scientific understanding. [1] Rather, the cultural intuition that impels people to want to kill bats seems to be rooted in more traditional logic. This does not mean, however that the knowledge is without an empirical basis. Perhaps, over many years in Senegal/West Africa people may have noticed an increase in disease prevalence when/if they were in close contact with bats. So the cultural stigma against bats might have emerged as a social defense against their potential negative impacts on human health.

 In many cases the cultural stigma assumes a robust, spiritual form. Almost any Senegalese person can tell you about Jinaaji din’s, or genies, which are spiritual entities that bring misfortune. They are often associated with, or believed to inhabit/ take the form of certain animals. Belief in genies of various forms permeates much of society. Bats are only one example of a creature possessed with some sort of negative, evil spirit. There are many such animals in Senegal—although the list varies from region to region and even village to village—such as snakes, rats, owls hyenas, lizards, and sometimes even chameleons, frogs, and dogs.  In some Mandé languages (Like Jaxanké, which I speak), the word for Owl and (evil) sorcerer, kikiyongo, is the same.

It is not hard to understand how a negative stigma could be attached to rats, bats, snakes or hyenas; they can be directly associated with some kind of pestilence or bodily harm. However with animals such as owls and dogs, it is harder to understand how/why a cultural stigma might have emerged. Perhaps by examining the religious and cultural systems at play, we can shed some light on the origin of these stigmas.

Theodicy is the “answer to the question of why God permits evil.”[2] It is a question that has afflicted theologians since the advent of monotheism. A polytheistic system, of which many existed in Africa prior to the spread of Christianity and Islam, generally has an array of gods that help to explain the world, and shore up the unstable edges of human understanding. Such a system can circumvent the potentially contradictory question of theodicy by endowing deities with the same flaws and jealousies that plague humanity. No god is strictly good or evil and although some may be more inclined towards one or the other, their actions are less predictable, in a word; more human. Thus, bad things could happen to good people, and evil or misfortune in the world could be explained by having failed to please certain gods while angering others, or simply by the unpredictable, human nature of the gods.

Monotheism, on the other hand, generally leaves less of an ideological cushion to explain evil, because God (not the gods) is unconditionally transcendental. This of course, leads one to the basic question of theodicy; If God is indeed omnipresent, omnipotent, and omniscient, then how can you explain something like Ebola, the death of an infant child, or a failed harvest happening even to someone who prays every day and lives in strict accordance with what his/her faith entails? In communities with little to no understanding of science, something has to be able to fill in the void, and explain the presence of something so horrible as Ebola. Is it not possible to believe that genies; erratic, little understood, devious spirits, fill this void and vindicate God for allowing evil to exist? I believe that this may explain, at least partially, the presence of genies in Senegalese culture. They do not conform, and slyly defy the will of god. Obviously, there still seems to be a theological contradiction, but this seems to work for people here!

Either way, whether or not God exists, and whether or not evil exists, Ebola does exist, and with the most recent outbreak in Guinea, it has been the subject of extensive attention in the media, and sent ripples of fear throughout West Africa.

To understand the worldwide fascination with Ebola, we need to go back about one hundred and fifty years to a guy named John Snow. This is not a Game of Thrones reference.  John Snow lived in London working as a doctor and anesthesiologist in the mid 1800s.  At the time he was most famous for successfully putting people under for surgeries, something that until the time was understudied and underutilized.  Pulling teeth and removing limbs was far more painful before Snow came around. We’ve all probably benefited indirectly from this scientific advancement, wisdom teeth or appendix removal perhaps? 

But Snow was busy with much more than just helping people pass out, semi drunk on ether vapor. He used his incredible attention to detail and scientific experimentation to stop a cholera outbreak sweeping though London in 1854 that killed over 600 people.  Not only did he halt the spread of cholera by removing the water pump that served as a reservoir for the disease, he also discovered that cholera was transmitted through contaminated water - all before the germ theory was developed. Most people blamed the evilness of disease on God or the devil’s will or something called ‘miasma,’ or ‘bad air.’  Snow boiled his water until the day he died, knowing that contaminated water caused many diseases including cholera, while politicians and scientists continued to discount and disregard his theories on waterborne illness, calling his theories ‘depressing.’[3] The public couldn’t handle the gruesome fact that fecal-oral contamination was the cause.  No one wants to consume someone else's waste, even accidentally.

But what does this have to do with Ebola?  Well, John Snow is often referred to as the father of epidemiology.  Epidemiology is the science of studying disease causes, effects, and prevention methods in populations, and avoiding epidemics.

Back in John Snow’s day, epidemics of deadly and terrifying diseases were the norm.  Think bubonic plague, tuberculosis, small pox and cholera.  But thanks to him and many other brilliant scientists, the scientific world began studying disease in a more accurate and informed way, resulting in the cessation of more and more epidemics.  We became masters of diseases that once mastered us.  By the early 1970s we had nearly eradicated deadly bacteria and viruses like small pox and polio, successfully eradicated malaria in the United States, and discovered a treatment for tuberculosis, all diseases that once spread uncontrollably and killed many people before their time. 

We became confident in our ability to win the battle with disease once and for all, or even perhaps, that we already had.

Fast forward to 1976, to a jungle in Zaire, Africa.  Someone eats an infected, undercooked bat.  Or gets too cozy in a guano filled cave.  We’re not exactly sure how the first epidemic began.  But when it did, it hit hard and fast.  Ebola spread through Zaire and Sudan, with an 88% fatality rate of those infected, killing over 300 people in horror movie-like conditions.[4] Ebola is a hemorrhagic fever, meaning blood pours from every opening in an infected person’s body.  It's scary.  And what scared us the most was that we had just defeated the diseases. Where did this one come from?  At the same time, HIV was emerging and beginning to come under the scrutiny of epidemiologists and scientists.  So we hadn’t won the battle of deadly disease control, or even of understanding.  Ebola came out of nowhere and it was incredibly deadly.  It opened up the possibility for more deadly and uncontrollable diseases, and our fascination and fear of Ebola commenced.

Since 1976, and including the recent outbreak in nearby Guinea and Liberia, which killed a total of 142 people, about 1,800 people have been infected with Ebola, with 1,300 infections resulting in death.  There are many different strains, and there is no cure and no vaccine.  The prevention involves thoroughly cooking meat, and avoiding contact with the blood and fluids of infected individuals. 

Meanwhile, over two million children under 5 years old die every year from water borne diseases resulting in diarrhea, including cholera.  These deaths are 100% preventable and treatable through proper sanitation and rehydration of sick people, but diarrhea is a more, well, private matter.  It is also not nearly as publicly horrific or inexplicable, which leads to a lack of interest in the media and scientific world.  And unlike Ebola, the spread of these diseases is complicated, and not as simple as avoiding bat meat and contaminated fluids.  The prevention of diarrheal diseases can be complicated, and relate to structural and cultural issues, like lack of clean running water and toilets or lack of hand washing and proper nutrition.  But that doesn’t mean these diseases should be ignored.  We don’t have to make the same mistakes as John Snow’s peers, who ignored the evidence pointing to the cause and prevention of a deadly disease simply because it made them uncomfortable.

Ebola is a horrible, terrifying disease that deserves our attention.  But I challenge you to get past the media hype and innate human instinct that incites our fear of that which is loud and deadly, and shift our focus to the silent and deadly.  Our risk assessment is not always as good as we think it is, especially when someone else is telling us what to worry about.  The children in my village (and me, for that matter) are far more likely to suffer from a silent diarrheal disease or malaria than an uncommon hemorrhagic fever like Ebola.  And, unlike Ebola, I/you/we can do something about diarrhea and malaria in children, and it will make a difference. 

If you don’t believe me, consider this; neither the World Health Organization, nor Doctors Without Borders, nor any major health organization ever recommended to Senegal to close its border with Guinea. This is because the disease’s mode of transmission is so specific that the threat of transmission over any distance is negligible. Senegal closed the border anyway (to great inconvenience: no more avocados), but this was just to cover it’s ass, and give the appearance that it has some control and authority over the situation, just like why your boss imposes arbitrary rules.

So I don’t mean to dismiss Ebola as ‘all hype.’ I just believe that mainstream media has a tendency to focus on tragedy with a disturbing selectivity. This, of course, is not controversial; it’s just difficult to keep in mind.

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[1] In fact, even the scientific community is still coming to understand the full capacity of bats as vectors of infectious diseases. It is currently estimated that in addition to Ebola, bats are hosts and probable reservoir species for approximately 60 other ‘Zoonotic diseases,’ that is, “A disease that can be transmitted between species from animals other than humans to humans.” These diseases include Rabies, a number of viruses

 related to SARS, Nipah fever, Hendra fever, Histoplasmosis, Marburg hemorrhagic fever (known as the cousin to ebola), coronaviruses and Lyssaviruses.

See http://www.cdc.gov/features/bats/

[2] Plantinga, Alvin (1974). God, Freedom, and Evil, William B. Eerdmans Publishing Company, p. 10.

[3] The Ghost Map: The Story of London's Most Terrifying Epidemic -- and How it Changed Science, Cities, and the Modern World by Steven Johnson (2007)

[4] The Coming Plague: Newly Emerging Diseases in a World Out of Balance by Laurie Garrett (1995)