Roads, funerals, and the risk of Ebola in West Africa

Note: this is a guest post from D.S. Battistoli.  We were chatting about the Ebola vaccine in the DRC, and he sent me an email that was so interesting that I asked to reproduce parts of it here.  D.S. is an international development specialist who has worked around West Africa and the Caribbean.  He managed field operations for a healthcare NGO in Liberia starting in November 2014, just before the outbreak there peaked.

After the West African Ebola outbreak started, there was the infamous rediscovery of Knobloch et al 1982, which found Ebola antibodies in the blood of 6% of assayed Liberians less than a decade after the virus was first identified in Zaïre.  This indicates is that in late twentieth-century Liberia, Ebola was both present and less likely to spread uncontrollably than it was at the same time in the Congo.  Conversely, by 2014 Liberia was a place seemingly more convenable to uncontrollable person-to-person spread than the DRC.

The rub lies in what changed in the interim. There are a number of factors at play, including the growth of the natural resource extraction industry, which increased rates of human-animal contact; marginally improved transportation networks between urban and rural areas; and of course the civil war, which gutted the healthcare and other governance systems and reduced trust in what remained. Shifts in funerary practices may also play an important role. I believe that many pre-colonial funerary practices once “priced in” the risk of mortality arising from contact with the corpses of people who died from hemorrhagic fevers and other deadly communicable diseases, and helped survivors minimize the risk of transmission.

As a point of comparison, let’s take the funerary practices of Surinamese Maroons, an Afro-American people living in that part of the Amazon rainforest spread over the Guiana Shield. They still have a number of ritual praxes which their ancestors brought over from West and Central Africa in the eighteenth century, including funereal praxes of corpse-washing, corpse-divination, and delayed interment. Over the last century, even as changes to core Maroon funerary practice have been only fairly minor, certain praxes that are barely even classifiable as funereal have changed in a way that would increase societal risk if they were in an Ebola-endemic area. For example:

  • Prior to the 1960s, before transport and communication revolutions made it so that related people would be expected to travel halfway across the country to make it in time for a person’s funeral, attendance at funerals was lower, and fewer attendees then travelled great distances to get “home”.
  • At the same time, it became more normal to transport corpses across-country to be buried, whereas earlier, there were clear distance horizons beyond which only hair and nail samples would be moved.
  • The set of “dangerous deaths”, types of decease requiring immediate burial, without transport to a cemetery, and almost without ceremony, decreased to near nothingness, as economic development made it possible to accord almost everyone full funeral honors.
  • Norms preventing gravediggers and corpse-washers from cohabitating and otherwise socializing with other villagers during funerals also fell by the wayside; before this, non-gravediggers were forbidden from cohabiting, socializing, or even sharing food with gravediggers and corpse-washers until after the “second funeral”, which was usually several weeks after the interment of any adults.
  • More than a few adult deaths in a short period of time would cause the total abandonment of the village where the deaths took place; it would often be months or years before a “broken” village’s diaspora would rejoin permanent settlements (this was prior to the 1880s, at which point new norms of the amount of property by households made such relocation increasingly uneconomical).
  • And starting in the 1990s, thanks to advances in Western medicine, it became far more common to transport the critically ill from one place to another to seek treatment.

During my eighteen months in Liberia, I wasn’t able to fully establish beyond any doubt that local rural populations had similar perifunerary practice adaptations that would have increased their risk, but there were strong indications that such was the case, including the fact that Ebola transmission rates were lowest in the counties with the lowest HDI (an exception to this correlation was Bong County, where the way of life was transformed by intensive mining operations). Thus traditional funereal praxes weren’t in and of themselves as dangerous as mixtures of tradition and modernity that often left people between two stools when it came to protection from this disease.

Admittedly, social praxes vary from one people to the next, and even from one village to the next, and Surinamese Maroon funereal and funeral-adjacent praxes are not direct total-system transplants, but rather amalgamations of praxes sourced from all over West and Central Africa.  However, it remains important to understand that the fact that nothing like Ebola ever, in 400 years, entered the historical record as a disease of which Arabs or Europeans were aware. All this combines to suggest that in the past, “traditional” African funerals included infection-risk-management procedures whose efficacy was greater than contemporary medical professionals assume.