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
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."
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
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