To prevent Ebola, some recommended a combination of raw onions and coffee consumed for three consecutive days. Others suggested that mixtures including herbs, tree bark, condensed milk, Nescafe, hot chocolate, and sugar were effective for prevention and treatment of the virus. Folk remedies, herbalists, and traditional healers known as guérisseurs are common within West African cultures and used throughout the Ebola epidemic.
Neima Candy is the Ebola coordinator at the Liberian National Red Cross. She says that in rural areas of Liberia, traditional healers are influential and respected members of the community. “People have more trust in traditional healers, especially with Ebola. They are more trusted by community members because these are people that live within the community. They have known and been interacting with them for ages and they believe in them.”
In contrast, there can be a distrust of outside influence; this was reflected in the initial disbelief about Ebola, explains Candy. “At the beginning, when Ebola was raging, they didn’t believe whatever messages were being conveyed to them about Ebola. The mode of transmission, where it came from—there was a belief that people from the healthcare facility were educated by the whites and brainwashed. They believed healthcare workers were telling them lies, saying the white man has influenced them. They believed the traditional healers were not influenced by the Western world and prefered to go to them. They didn’t believe what people from the health care facility were telling them.”
A history of colonialism, government corruption, and oppression has contributed to distrust of outside influence. Paul Richards, an anthropologist who has worked in Sierra Leone for 40 years, contextualized community dynamics, telling National Geographic, “You have to take into account a history in which local people have learned to distrust the government.” He adds, “It’s a situation not unlike that in Ferguson, Missouri, where a legacy of slavery, exploitation, disregard, and abuse leads people to think their own solutions are better than those from the outside.”
Sometimes viewed as a conspiracy or a way to profit, this distrust has been reflected in the perception of Ebola and reaction towards healthcare workers. The reliance on traditional healers complicated Ebola treatment and eradication efforts. In Sierra Leone, a patient was forcibly removed from a treatment center by her family because they believed a traditional healer could provide better care; the patient died while being transported to another hospital. Traditional healers have also succumbed to the disease and, consequently, been linked to transmitting it in the process.
There have been attempts to dispel beliefs about traditional healers and folk remedies. The government in Sierra Leone issued a fact sheet to refute rumors including a belief that alcohol consumption could prevent Ebola and that it could be cured by a mixture of ginger, honey, garlic, onion and vinegar. More creatively, a radio drama developed by BBC Media Action, Mr. Plan-Plan and the Pepo-oh, has aired in countries impacted by Ebola. In one of the episodes, a person exhibiting symptoms of Ebola seeks treatment from his friend Bai, a traditional healer. Even though Bai is a traditional healer, he refuses to treat his friend. Bai explains that “country medicine” cannot be used for Ebola and recommends that his friend call an Ebola hotline.
In March of this year, Jean Marie Dangou, head of the World Health Organisation in Guinea, said the “Stop Ebola” campaign was unsuccessful because “communication was top down and the way we delivered the messages was wrong.” He said communication needed to be modified for different cultures and not reliant entirely on modern technology.
Rather than solely being dismissed, traditional healers may play a role in effectively communicating information about Ebola and other epidemics, particularly in regions where oral tradition is a deeply ingrained aspect of culture and in regions with inadequate radio broadcast signals or access to television.
Candy says traditional healers have been part of the Red Cross efforts to disseminate Ebola information in Liberia but they do not exclusively focus on them. Instead, she emphasized the need to be inclusive of women’s groups, youth, and all the respected and influential leaders within the community. All of these stakeholders are trained in the scientific aspects and implications of Ebola, symptom detection, the importance of early treatment, and also how to adhere to the infection prevention and control measures within the household to prevent transmission of the virus.
“We found it to be very successful,” Candy tells me. She adds, “One of the lessons we learned is that it is necessary to get the all the leaders and stakeholders within the community involved in whatever you are about to implement, from the planning stage up to the evaluation stage. It helped us a lot.”
In 2003, a polio vaccine initiative was met with resistance and led to a boycott in Nigeria, highlighting the cultural, religious, political, and historical aspects of epidemics--something to consider with the positive preliminary results for an Ebola vaccine recently published in the Lancet.