Africa can innovate unique response to Covid-19

While the coronavirus infection rates in Africa have remained quite low, though climbing steadily, some African governments and their emergency response teams are not complacent or taking chances.

Instead, and quite rightly so, they are busy building scenarios of likely rise of infection rates in the coming days, weeks and months, what the situation would be like in the event that the rates begin to gather momentum and what they would do.

They have followed this with social distancing measures, from night curfews to closure of workspaces to regulation of public transit systems to banning of events that attract crowds. Public health messages about the importance of personal hygiene have also been promoted.

Many global leaders, like the United Nations Secretary General, Antonio Guterres, have also been drawing world attention to the scenario that Africa is a continent destined to a disaster.

The Special Representative of the Secretary General in South Sudan, David Shearer, also chimed in last week, saying that “if corona gets in…tens of thousands could perish,” given the “dire health situation”, the concentration of displaced persons, poverty, political instability and the overall economic challenges facing the country.

Unfortunately, Mr Shearer was not talking hypothetically, as it seems he had known for a while that a staff member of the United Nations had shown symptoms of the virus after returning from Europe on February 28 but the UN did not disclose this information to South Sudan’s Task Force on Covid-19 until April 3, potentially exposing many people to the disease.

This was unsurprising, given the litany of UN’s moments of irresponsibility toward the people for whom they purport to be in the country.

This became the country’s first confirmed case and South Sudanese are now as afraid for their fate as they are outraged about this. But that is a story for another day.

VULNERABILITIES

Indeed, if any of these projections come to pass, the calamity that these scenarios are now predicting will not only be propelled by the poor medical services, the inadequacy of testing facilities, the weakness of diagnostic technologies or the difficulties of doing contact tracing, as has been pointed out. 

It will also be driven by the multitudes of vulnerabilities confronting many Africans, from AIDS to Tuberculosis, heart disease, diabetes and compromised immunity due to malnutrition.

Above all, if this pandemic results in a disaster for Africa, it will also be due to a thinking among emergency program planners that people die of disease alone, forgetting that they die from a combination of disease and the social, cultural, economic and political situations that predicate, enable or emerge from disease.

How people understand disease, seek treatment, what choices they weigh and why they engage in risky behaviour despite knowledge of the danger and how government agencies approach public health response to a crisis can be an obstacle to intervention if they are not carefully weighed.

It is very important to identify the social, economic and political factors underpinning health emergencies, as this understanding can positively shape the course of health interventions.

Experiences from the Ebola epidemic in West Africa (2013-2016) have shown that social and cultural views of disease and illness are often just as important as medical opinions when it comes to individual, family and community health-seeking behaviour.

Furthermore, if it is accepted that the economic, political and cultural realities of a given society combine to influence disease trends, to shape public health interventions, to dictate varying degrees of access to care and to test the country’s capacity to provide equitable medical services, then emergency interventions require a holistic understanding of the local explanation of the nature of pathology and its etiology, the patient’s behaviour and the communal reactions to disease.

But does this also follow with regards to highly infectious, quick-acting and fatal diseases such as the Ebola epidemics or the current coronavirus pandemic, a situation where a community or country is dealing with an unfamiliar disease? 

Anthropological approaches in emergency situations, especially the use of such tools as Rapid Assessment Procedures or Knowledge, Attitude and Practices surveys, have historically been successfully deployed in health crisis intervention, working alongside epidemiologists, clinicians and public health professionals to integrate socio-cultural understandings into emergency response programs.

These methods can highlight conditions that place certain groups at greater risk and local practices that may have stood in the way of emergency interventions due to conflicting worldviews.

DISPARITIES

If the scenarios are a guide, the coronavirus emergency is likely to hit the hardest those people who already suffer acute disparities in wealth, power and social status.

Their understanding of disease, their priorities and potential behaviours might impact response. Among many segments of urban populations in the region, such as the slums of Nairobi, the congested neighbourhoods of Kampala or the displaced persons camps in Juba, physical separation of people is nearly impossible, given that many people in these circumstances continue to try to eke a living in crowded spaces.

As such, this disease needs to be understood from the point of view of families and communities living in these circumstances, as there seems to be a big difference between what the authorities have planned and are implementing and what is happening in peoples’ real lives. After all, public health interventions generally take place along the lines of existing power relationships.

The recent measures to enforce physical separation in East Africa have already heightened levels of mistrust and assumptions and these is likely to damage interactions between response workers and communities being protected. In such situations, the interventions will need to have recognised how behaviours reflect culture and politics.

This applies as much to the culture of the response programme as it does to the culture of local people in crisis.

In sum, just as socio-economic inequities that have always excluded some people from access to quality healthcare are a function of politics, poor governance structures and corruption, so will the coronavirus responses be, only that this time we are dealing with a disease that will not categorise its victims by class or power.

The author is a professor of anthropology at Maxwell School of Citizenship and Public Affairs, Syracuse University.