Beyond a bio-medical fix – The value of ‘people’s science’

Paul Richards’ 2016 book Ebola: How a People’s Science Helped End an Epidemic provides a powerful reminder of the limits of epidemiology and bio-medical fixes, as well as coercive state measures such as lockdown, in the long-term control, management and elimination of diseases like COVID-19.

Richards shows that, while the Global North and Western bio-medical regime were developing vaccine trails and new nanotechnologies, and even imagining robotic nurses as strategies against the lethal Ebola virus, ordinary people in West Africa were paying careful attention to the actual impacts of the disease on the body.

They quickly came to learn how contagious and deadly the disease was, killing nine out of every 10 people infected, and accordingly adjusted their regimes of behaviour in the area of home care. They changed how they interacted with those who were sick, how they behaved at funerals and how they buried the bodies.

Ultimately, Richards shows how a ‘people’s science’ of behaviour and understanding on the ground mediated through adjustments to local cultural practices and social values emerged to defeat a disease that Western medical science could not overcome.

The role of ordinary people in disease control

The book is a powerful reminder of the importance of the role of ordinary people in social change and disease control. In this context, it is shocking how little attention has been given to the role and insights of the social sciences and humanities in the current COVID-19 crisis globally and in South Africa in particular. For example, all the main scientific advisors to President Cyril Ramaphosa on the current COVID crisis are medical doctors.

In the emerging COVID-19 crisis in South Africa, there is clearly still some way to go before Africans, together with medical scientists and epidemiologists, can co-produce locally appropriate body-based technologies and caring practices, such as those adopted to counter Ebola. This process of learning and sharing has hardly started in South Africa and has still a way to go before an effective people’s science emerges for the management and elimination of the virus.

Meanwhile, the state’s response has failed to produce a number of sought-for behavioural impacts. For example, the evidence suggests that, despite the government’s warnings, social distancing is being widely ignored in the townships, shack areas and rural areas. There is, of course, great difficulty in effectively implementing social distancing in compressed shack areas. However, there are also plenty of suburban-style townships and settlements where people wander around and socialise as if there were no danger.

Some township residents are clearly in a state of denial, claiming this is a white man’s disease from the Global North, despite the fact that there have been a disproportionately high number of deaths among African Americans and other ethnic minorities in the United States. As with the early stages of the Ebola outbreak, there are also theories that mobile evil forces and witchcraft are bringing risk and misfortune.

A one-size-fits-all strategy

Meanwhile, in the absence of a bio-medical fix, the state has resorted to a one-size-fits-all strategy of lockdown which reinforces a national spatial geography of inequality, as poverty and hunger stalk the busy township streets, while middle-class South Africans have taken refuge behind their high walls in the suburbs.

In order to manage this strategy, the state has introduced a massive new welfare programme which aims to plug the poverty gaps. However, this ZAR500 billion (US$27.6 billion) programme fails to promote – and, arguably, even impedes – efforts to align social infrastructures and bodily technologies in the townships to the threat of the disease, activating locally appropriate adaptions and responses that may ultimately produce a people’s science that can temporarily stop, or overcome, the virus.

Top-down, heavy-handed actions by the army and the police in the townships and suburbs against liquor traders, errant street joggers and wayward taxi owners, and charitable drives to distribute food parcels, will have little long-term impact in helping to combat the virus unless civil society is organised to manage the disease locally.

Insights from social anthropology

In initiating a process of appropriate street- and neighbourhood-level responses, the state could rely much more on the insights of social scientists who research, and participate in, the lives of those in high-risk and poor communities. The experience and findings of these experts could inform and help to produce strategies that might bridge the current gap between the present bio-medical imagination of the outbreak and the future possibility of an evidence-based people’s science.

In this field, the state might pay particular attention to the work of social anthropologists, whose in-depth ethnographic research of communities in their historical and cultural contexts reveals aspects of everyday social and cultural life at the local level which might guide life-saving interventions.

The case of the state’s response to how African families are seeking to bury their dead offers a pertinent example of the limitations of official policy and the need for greater inputs from social scientists.

It is now clear from the statistics that COVID-19 is penetrating the rural heartland and homelands of South Africa, as the number of cases in rural communities in the Eastern Cape in particular has risen rapidly. The state has responded by reaffirming its commitment to total lockdown and an absolute restriction on movement among provinces.

In addition, Eastern Cape Minister of Health Sindiswa Gomba has been lambasted for inadequate testing procedures and failing to generate accurate statistics.

Although these are problems, they do not represent the central concern, which is that the majority of poor people, especially those who have arrived in the cities since the introduction of democracy in 1994, continue to be buried at their rural family homes after they die.

There is simply no way the families of these individuals will accept that their loved ones should be put in the ground next to their shacks or in their township yards, or in overcrowded makeshift cemeteries. Dead bodies are transported for burial to be laid to rest with their ancestors at their family homes. There is little the state can do to stop this, hence the provision that people can get permission to cross provincial borders for funerals.

Such permission will often involve taking others along, such as close relatives and friends who can participate in the funeral rites and proceedings. In the COVID-19 context, this may mean 15 or more infected bodies sharing a taxi on a journey to meet several hundred mourners in close proximity at a rural homestead, where beer and food are shared from the same beaker or pot.

Such forms of commune are considered essential for the expression of ‘ubuntu’ and the safe passage of the deceased to a world beyond.

Understanding core issues

In this regard, and from an anthropological perspective, funerals should not be treated as an exception to the regulations but should be considered as a core issue to be addressed by these rules. They are precisely the kind of catalytic event that can push the virus into overdrive in the rural landscape and wipe out entire communities.

Rethinking culturally and socially appropriate funeral procedures and practices is precisely where the new wisdom of people’s science may start to take shape in South Africa. As the deaths mount in the rural areas, and communities internalise and review the evidence of transmission, social practices will be adapted.

This process will take some time. Many will die. However, as is shown by Richards’ fascinating ethnography from Sierra Leone and the history of multiple waves of Ebola infection in West Africa, people’s science can provide solutions – and the South African government should assist the emergence of such responses in order to reduce the death toll.

As part of this process, insights from the West African experience and from South African medical and cultural anthropology could assist the government in working out a range of protocols and strategies to implement preventative measures – and save many lives.

Leslie Bank is professor of social anthropology at Walter Sisulu University and a research director in the Inclusive Economic Development Unit at the Human Sciences Research Council, South Africa. He is the co-author of a new volume on South African migration dynamics entitled Migrant Labour After Apartheid: The inside story (HSRC Press, 2020).