CAN YOU HEAR ME NOW? Trust, Culture, and the Ebola Crisis

Abstract

This thesis seeks to examine the conflicts that arose between cultural values and medical interventions in the 2013-2015 Ebola epidemic in West Africa. The research questions include: 1. What were the main sources of social and cultural conflict during this outbreak? 2. What made these conflicts so significant? 3. How might cultural factors shape trust, and how might trust in turn shape intervention efficacy? 4. What are the ethical concerns and considerations in balancing cultural and health rights? 5. What implications might these answers hold for future epidemics in the developing world? I expected to find that a lack of consideration and respect for traditions and other cultural values would have led to a distrust of external agents seeking to impose medical interventions, and that this distrust would limit compliance with response efforts. Ethically, I believe that it is important to consider cultural and traditional values strongly in developing interventions for a specific context, particularly when a power imbalance exists for economic and historical reasons. However, cultural rights should not necessarily outweigh the public right to health and well-being. To examine these questions, I engaged with academic sources, with responders’ testimony, and with news articles. In order to gain a deeper understanding of the impact on trust and other sociopolitical factors upon intervention success, I performed regression analysis using data from the Afrobarometer survey of Liberia’s regions in 2012 and data from the Liberian Ministry of Health Ebola Situation Reports. My analysis of the qualitative and quantitative research suggests that respect of culture and tradition are vital to building trust, trust is important in inspiring cooperation, and cooperation is essential for effective healthcare interventions. Not only is this respect of culture important morally as a normative protection of individual rights to autonomy, but it is also important practically to avoid case-hiding and other cooperative challenges. In future epidemics, international response efforts and healthcare workers on the ground should take special care to work with the afflicted communities and to incorporate their input and beliefs in order to design mutually beneficial and ultimately effective healthcare interventions.