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From the Front Lines: Kissing the Banana Trunk

Posted By Prucia Buscell, Thursday, October 16, 2014
In parts of Sierra Leone and much of West Africa, people have traditionally kept the bodies of loved ones in their homes for several days after death as mourners wash, caress, dress them and pray over them. Because the corpses of Ebola victims are highly contagious, the tradition has been a key vector in spread of the disease. Burial teams from the Red Cross and other organizations have been attacked trying to interfere with care of the dead. Some families have even hidden corpses to make sure proper rituals can be performed.

In a Psychology Today post, Steven Hayes, PhD, Foundation Professor of Clinical Psychology at the University of Nevada, writes that behavioral science is as important as medical science in discovering alternative rituals that honor both culture and safety.

Four years ago Beate Ebert, a German psychologist and others formed Commit and Act, a nonprofit in Sierra Leone devoted to bringing psychotherapy to people traumatized by a decade of civil war and violence. Hannah Bockarie, a social worker fluent in Krio, the local language, led workshops, evaluated through a partnering agreement with the University of Glasgow, to train indigenous counselors and health care workers. When Ebola hit, the organization was in a unique position to help. Hayes explains that Commit and Act, already known in the community, was able to educate people about Ebola and the practices needed to halt its spread. Bockarie also led local groups through therapeutic sessions that helped them come up with alternative burial customs that honored their values while allowing health care workers to safely dispose of bodies.

"A beautiful example one group came up with was substituting the corpse with a banana trunk," Hayes writes. "The body of the infected and now diseased person is burned. Relatives keep a banana trunk at home, and perform all the customary rituals on it, including kissing the banana trunk before burial. In the end the banana trunk is buried."

Hayes says he is awed and inspired by "a pathway forward" that could not have come from the outside, and that could not have been produced by military intervention nor dictated by foreign aid workers.

He explains that the evolutionary biologist David Sloan Wilson's Evolution Institute combined with Commit and Act to use Acceptance and Commitment Therapy (ACT) along with principles from the late economist Elinor Olstrom, who won a Nobel Prize in 2009 for works showing the skill of indigenous people in protecting common resources.

People who face a problem are the best poised to find ways to solve it. That's a key insight of Adaptive Positive Deviance. After the disclosure of the Ebola infection of a second nurse who worked at the Dallas hospital where a man died of the disease, health officials have aimed to promote caution without feeding panic. The second nurse flew on a commercial airline before she had symptoms and the CDC has asked all 132 passengers on her flight to self-monitor and call a CDC hotline. Some politicians propose a ban on travel to the U.S. from Western African countries. In Texas, a community college announced it was rejecting students from any country with confirmed cases of Ebola.

Officials don't know exactly how the two Texas nurses were infected, though multiple news reports have suggested infection control protocols in place at the hospital were insufficient for Ebola. National Nurses United, a nurses' union, said nurses at the hospital complained of confusion, frequently changing policies and protocols, inadequate protection from contamination and spotty training. Indeed the CDC has now recommended extra levels of protection for healthcare workers caring for Ebola patients, as well as detailed guidelines for the potentially hazardous process of removing contaminated protective gear. CDC Director Dr. Thomas R. Frieden has said the most important protection is for a site manager to oversee workers as they put on each piece of personal protective gear, and as they remove and properly dispose of each one. One hopes front line workers will be engaged in finding the best ways to adhere to new protocols.

When Plexus Institute led a multi-year initiative to stop MRSA infections, the protocols in use at the time differed from what is being recommended now for Ebola. But MRSA infection rates dropped dramatically when front line healthcare workers collaborated to developed methods that would achieve the most consistent adherence to the known protocols. The late Jasper Palmer, a patient transport worker at Einstein Medical Center in Philadelphia, devised a way to remove protective gear safely while also reducing the volume of contaminated trash. It became known as The Palmer Method. Watch here.

Tags:  buscell  complexity matters  culture  healthcare  MRSA 

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