Embedded Files
conceptions of the etiology, symptoms, and treatment of disease [28–31]. Therefore, witchcraft, sorcery, and traditional medicine still prevail in remote regions of Africa [28]. For this reason, traditional healers, who are agents of supernaturalism, are considered reliable sources for understanding misfortunes, affliction, and painful diseases. The Guéckédou and Kissidougou Prefectures in the forest region of Guinea are large landscapes where people embrace various healing traditions. In their villages, there is no clear distinction between scientific medicine and traditional medicine (ethnomedicine), so they are compatible with everyday life [32]. For instance, in Guinea, when a patient dies, the body is rendered to the community, and the bereaved family performs the Kissi mortuary rites [32], a practice wherein ethnomedicine and biomedicine coexist. In the postcolonial period, the growth of international networks and technologies has Journal of Health and Social Sciences 2020; 5,1:073-090 The Italian Journal for Interdisciplinary Health and Social Development 78 increased Africans’ mobility and changed their understanding regarding their sense of belonging [33]. With this change, the culture of funerary rituals has altered. First, African international migration has risen [34]. Thanks to the telephone and the Internet, the connection between expatriates and those at home is strong, and more people are simply buried in the city to which they have immigrated [34]. Additionally, with the advent of new technologies, refrigerated transport of a corpse can reverse migration: Those who have migrated from rural to urban areas can be transported back to their natal homes for commemoration ceremonies and burials [19]. Second, fear of death has become far less common. In the past, children were not allowed see corpses, but now they can—and burials that were once conducted at night can now take place in the daytime [34]. Third, after mortuaries were gradually adopted, people began to delay burials for weeks or even months [34]. During the delay, people gathered resources, communicated with distant parties, and organized grand burial affairs for the dead [34]. However, the majority of people in Guinea and Sierra Leone are Muslims, and they have a fundamental Islamic duty to bury the deceased as soon as possible [34]. Furthermore, most households struggle with high mortuary fees, so they avoid delaying burials [34]. Risk factor for touching the dead body: Link between funerary rituals and Ebola outbreaks In addition to the retrospective studies conducted by the WHO and Guinean health officials who were searching for the origin of the 2014–2016 Ebola epidemic, other studies were conducted to determine whether traditional funeral practices posed a substantial risk for Ebola transmission [20, 35]. When traditional healers die, Africans show respect for these prominent individuals during their funerals. It is common for people to lie over a dead healer, hoping that the spiritual gifts from the deceased will transfer to them [36, 37]. The first Ebola index case in Sierra Leone was a young woman from the Kenema District who had crossed the border during the Ebola outbreak to meet a well-known, widely respected traditional healer in Guinea [20]. She was predictably infected with Ebola by the healer who died. To honor the healer’s memory, hundreds of mourners from every corner of town participated in the traditional funeral and burial ceremony [20]. The consequence of attending this one funeral was devastating; local health authorities conducted quick investigations and reported that participation in the funeral was linked to more than 365 deaths from Ebola [20]. Later, the Sierra Leone Ministry of Health and Sanitation and the Centers for Disease Control and Prevention (CDC) conducted a retrospective analysis of laboratory-confirmed Ebola cases that occurred from July 11 to October 31, 2014 in Moyamba District, Sierra Leone, to investigate the cause of a sharp increase in cases in September 2014 [35]. Attending a village chief or village elder’s funeral is as common as attending one for a traditional healer in West Africa. Through community engagement, active surveillance, and close follow-up of contacts, investigators learned that among 108 individuals with confirmed Ebola, 28 had attended the three-day funeral (September 5–7, 2014) of a prominent pharmacist in Moyamba who had treated an Ebola patient from a neighboring village [35]. Among them, 21 (75%) had touched the corpse, 16 (57%) had had direct contact with the pharmacist when he was alive, and eight (29%) died [35]. All eight of the dead were men because in Sierra Leone, family members and friends who are the same sex as the dead are responsible for preparing, washing, and clothing the body for a traditional funeral, so they have direct, prolonged contact with corpses [35, 38]. The risk for Ebola transmission at funerals is substantial because the viral load is often highest during the later stages of the disease and at death [39]. Funerals invariably attract family, friends, and colleagues from different areas, and attendance is important to demonstrate respect for the deceased [35]. Mourners from other locations or travelers who become Journal of Health and Social Sciences 2020; 5,1:073-090 The Italian Journal for Interdisciplinary Health and
Report abuse