“it’s the worst, but I have the opportunity. I’m still alive”

(1)

“it’s the worst, but I have the opportunity. I’m still alive”

An Anthropological Narrative of People who Survived the Ebola Virus Disease and Worked in an Ebola Response Project in Sierra Leone

By Ole-Kristian Hengelbrock, December 2016

University of Groningen

Network on Humanitarian Action Master Thesis

Supervisor: Relinde Reiffers

(2)

1 „Oh friends, not these tones! Instead, let us raise our voices in more pleasing and joyful sounds.”

Ode to Joy (Symphony no. 9)

“Sed omnia praeclara tam difficilia quam rara sunt” (but everything great is just as difficult to realize as it is rare to find)

Spinoza – last sentence of his Ethics

"Two roads diverged in a wood, and I - I took the one less traveled by, and that has made all the difference."

Robert Frosts - The road not taken

(3)

2

5 character amid forces which alienate? How to be and remain African? How to be who Africans are with joy and solidarity and fullness of life? How to survive as human amid economic and political structures which strangle? Ela (1994, p. 21) rephrases anthropological impoverishment with “Anthropology of misfortune”. As mentioned above, it points more to the misfortunate Western anthropology created by omissions, biases, stereotypes and lack of context. The Western world thus is in debt to listen and offer a more profound analysis and understanding of Africa’s various identifies. Ela’s work My Faith as an African shows that there are fruitful native resources which teach us how to read the signs of Africa and what kind of question could be followed. Surely, the conspicuous joie de vivre remains one characteristic, but maybe we learn that “African laughter itself is not only celebration of life, but also a weapon of defense against tears” (Ela, 1988, p. 11).

(7)

6 on the same eye level. Reality shows a clear vertical structure. It is no coincident that the humanitarian regime has been led by Westerners ever since. The nationalities of the students of the Network on Humanitarian Action (NOHA) master program International Humanitarian Action mirror this fact as they are educated to takeover leading positions in the future. They luckily may have never read essays like Et si

L’Afrique refusiat le developpement? (And what if Africa actually rejects development?)

by Axelle Kabou. This is not the point. Rather, that their state of mind may have been subjected to an unintentional indoctrination of Afropessism. Honestly, what are the first associations coming into mind thinking about Africa? Thinking about the color black? Isn’t it as a disadvantage compared to the notion Europe and white? It has nothing to do with racism on the first instance, but perhaps it is necessary to mention that discrimination is defined by those people who are discriminated regarding to the motto who feels it knows it. Therefore, a research about the present demands a historical perspective, especially if it is again a foreign account that defines a situation in Africa.

(8)

(9)

8 is home to terrorist supporters than to acknowledge it also as a self-referencing country.

In general, the struggle for liberation, independence and freedom from colonialism, or as Karl Polanyi (1944) puts it from the Great Transformation that:

 took place in the 19th century,

 concentrated wealth and power within the spheres of the Occident,

 imposed an incremental hierarchical global divide,

 lead to an Western European expansion to a new world order

 reinforced the dynamics of economical and territorial growth which in turn increased the vertical structure,

 signify the political and economic origins of our time

(10)

9 social dislocation through vice, perversion, crime, and starvation. Nature would be reduced to its elements, neighborhoods and landscapes defiled, rovers polluted, military safety jeopardized, the power to produce food and raw materials destroyed” (Polanyi, 1944, p. 42). Karl Marx and Friedrich Engels proclaimed a general inter-linked dependency of nations in 1848. The signum of the age was and seems to be rather an asymmetric dependency based on economic factors. Perhaps it is to mention that the modern self-regulative market system derives from the principle of gain. Unfortunately, the astute observation and warning of Malcom X not to “escape from European colonialism only to become even more enslaved by deceitful, ‘friendly’ US

dollarism” (Mwakikagile 2007, 39) was not taken seriously by the Heads of States

during the African Union Summit in Cairo in 1964. Malcom X shared the fate of Sankara and was assassinated 16 months after his passionate appeal. To submit, the political and economic origins and excesses of our time maintain the distinction between the so-called First, Second and Third World. Hannah Arendt (1970, p. 21) claims “The third world is not a reality, but an ideology.” Thus, it could be changed. Tragically, the conditions of the Third World are reality built and maintained through our ideology over the curse of time, but it is veiled by the positive defined term “developing countries”.

(11)

10 end of the Cold War turned many regions into a descending struggle. The two blocks lost their geostrategic interest on the African continent and dropped their support abruptly in accordance to the sudden fall of the Berlin Wall in 1989. Many countries stayed on the verge of armed conflict as peace is not just the absence war. This relates to economical outbursts on the free market system by association until today. What is happening on the ground can be read between the lines in the recent Land Matrix

Analytical Report II: International Land Deals for Agriculture for instance. It says that

(12)

11 currently ranked described to have a low human development and represent the bottom of the Human Development Index (2014). In memory of Ziegler’s description and regarding the described implications, statements like the following one by Carmie Olowoyo, General Manager of Symbol Base Metals UK, needs to be read as a warning: “Nigeria is the biggest undiscovered opportunity on the continent.” (Nigerian Ministry of Mines and Steel Development, 2016). The claim of Nigerian Minister for Mines and Steel Development Kayode Fayemi “not to repeat the tragic errors of the past” in view of the disastrous environmental damage caused by the oil exploitation (United Nation Environment Program, 2011) sounds like an empty phrase in comparison.

(13)

12 you rescue the whole world’ implying ‘If you lose a single life, you lose the whole world.’ The attack was shameless terrorism and consequences had to follow indeed. The issue here is, why does this incident in which up to 3.000 people were killed changed the face of the world, whereas hundreds of thousands, well millions of people die due preventable diseases like diarrhea each year? Rephrasing it, who divided the age into pre- and post-9/11, whereas our calendars don’t list the millions victims of the protracted conflicts in the Democratic Republic of Congo or Central African Republic? These questions go in line with the tsunami that killed tens of thousands people mainly at the coastlines of India and Sri Lanka in 2004. Honestly, who is aware that the waves continued along the Indian Ocean and reached even coastlines of Kenya and Somalia killing hundreds of people? This neither aims, nor legitimizes any critic on the way how the victims are memorized, but it shows clearly the mental borders of our perceptions. Namely, our biases; how we draw the world with limited narratives. What does it say about the identity of African countries, about the catharsis of their people, when: the world doesn’t account for African victims, state buildings are paid by outsiders (sometimes called development partners), Ghanaians know more about Mahatma Gandhi than Kwame Nkrumah, there is a shortage of food on fertile soil, foreign investors get more from the land than the local people, upright characters are silenced and killed, there is no courage or dare to invent the future, the oppressed believe the worse about themselves and just imitate and desire others, African native accounts are not considered, stereotypes remain…! For those who didn’t understand yet, that is not a question. To name it, the average African state remains then a grand expression of the former slave plantations built on the notion that whole African civilizations, nations and communities do no matter (Anon., 2016, p. 20) and various stereotypes encounter the habitants from the African continent around the globe as we see it today.

(14)

13 think that the great wrongs committed during the centuries of slavery and colonialism as well as its continuity in terms of dollarism seem to be rather highlighted passionately whereas the wrongs committed by Africans against Africans seem to be elaborated less openly as the silent but total extinction of albinos in Southern Africa testifies for example (UN News Center, 2016). One should question his/her own responsibility before blaming others - if you point to a person, three fingers point to yourself simultaneously. I cannot uphold a “Black lives matter” banner simply because all lives matter. Nonetheless, there was too less reconciliation and attitude change from the Western world to allow me to be the author of another foreign account. Furthermore, I’m far alienated from any African reality regarding different aspects such as social identity, collective memory, living-environment, socialization, education, symbolic meaning, cultural structure, etc. As I fail to understand the relationship with the invisible, African universe is not fully open to me. The different understandings and perceptions about the past, present as well as future is hardly, if not impossible, to bridge. Truth would be on the edge in my account, while biases and stereotypes may shove it down the abyss. Therefore, it is to ask if the attempt of a naïve middle aged white man to write an anthropological thesis about Sierra Leoneans who survived the Ebola Virus Disease (EVD) and worked in an Ebola response project doesn’t fail in advance. The answer is crucial as the verdict weighs heavily with the future perception of the public (Diop, 2016, p. 42). Certainly, the criticism on who has the right to identify whom is as unavoidable as much as bias transmissions (Boyd, 1985). How to have the courage of facing these unpleasant facts? Perhaps it is expedient to take heart from the words of more dignified characters:

(15)

14

 Wole Soyinka encourages to write by any means:

“Don't take shadows too seriously. Reality is your only safety. Continue to reject

illusion.” (1969, p. 69) “But the ultimate lesson is just sit down and write. That's all.” (1998) “The man dies in all those that keep silent.” (1971, p. 13).

There is still no convincible reasoning that makes me to an appropriate author. Nonetheless, both quotes fuse to a central task of anthropology, namely to account of the 1,000 lives we could have led while ending up to live only one (Geertz, 1973, p. 45). Most lives around the globe fall silent in truth. They neither find importance nor a way into our awareness. Not to re-search and re-call the people of Sierra Leone who survived the EVD and worked against it would withhold their voices, experiences and perceptions of reality. The picture would be drawn without their colors. Not to write this thesis would be a bias itself deductively. Therefore, I feel delighted to have the opportunity to write about their lives. The preface presents itself quite philosophical. Maybe it seems inappropriate to begin an empirical research with such depths, but I believe that depth prevents from the abyss of nothingness. The thesis will remain unfinished work with its submission. We have to imagine Sisyphus, who pushed the stone to the mountain persistently, as a happy man as Rupert Neudeck, founder of Cap Anamur-German Emergency Doctors, describes his humanitarian intrinsic passion.

(16)

15 Abstract

“Here in Sierra Leone we only have the name hero, but it is actually not reflecting on us simply because of the expectation we have of a hero we are not getting that from the members of the public, the government and the international community. I don’t know if the international community is doing something for us, but actually hero is not reflecting on us. But we see ourself as a hero, because we fight and conquer this disease and we contributed greatly to end this epidemic in our country. We did not sit back and wait. We were at the forefront to fight the virus which is a very very positive thing that we did.”, reads a quote by Mustapha who survived the Ebola Virus Disease and worked in an Ebola response project in Sierra Leone. This thesis presents the unique power of people on how they survived the EVD and challenged it afterwards. The unique power refers to the resilient capability of the people of Sierra Leone which is based on an outstanding quality of faith, hope and an acceptance of reality. The thesis reflects the narratives of the local people and links different academic approaches – anthropology, philosophy, psychology, international relations, history – highlighting the inter-disciplinary value for International Humanitarian Action.

(17)

16 List of abbreviations

EVD Ebola Virus Disease

PSEVD People who Survived the Ebola Virus Disease

HDI Human Development Index

IHA International Humanitarian Action

NOHA Network on Humanitarian Action

ETC Ebola Treatment Center

(18)

17

I. Introduction

Sierra Leone President Ernest Bai Koroma has said, as a country, Sierra Leone’s story is no longer about Ebola but one that is ready for business and huge investment opportunities during a business travel to China recently (Independent Observer, 2016 p. 9). He was so inspired by the future that he even forgot to send a condolence message to Cuba regarding the death of Fidel Castro, a head of state who sent hundreds of Cuban doctors to Sierra Leone in order to support Sierra Leone in the fight against the EVD. Does it show naked ingratitude about the past or does it signify confident optimism to step out of the shadow of the biggest Ebola epidemic ever recorded? Either way, Koroma’s statement might have been well calculated as "When you control a man's thinking you do not have to worry about his actions. You do not have to tell him not to stand here or go yonder. He will find his 'proper place' and will stay in it. You do not need to send him to the back door. He will go without being told.” (Woodson, 1990, p. 4). Put a promise into the mind of the people and the state of grief, which is a human necessity, is bridged. It is fair enough and a necessity too, to continue life with another topic than the source of grief. But, if Sierra Leone’s story is no longer about Ebola, isn’t there an untold story then? In fact, thousands of untold stories of people who survived the EVD, millions of untold stories as all people in Sierra Leone were, not infected, but affected. Whoever visits the West African country and sits down with its people realizes that the experiences are still present in the narratives, whereas its presence implying personal memories, implications and consequences becomes blurred in accordance to the lost attention of the media and thus of the international community and humanitarian organizations and thus of the president himself. The experiences may play no importance in the head of the state anymore, the heart of the people talks about it as it is part of one’s life.

(19)

18 apocalypse? In fact, the thesis confronts with the question what do we know about Sierra Leone - Isn’t it the poor and abused country within the ocean of corrugated - iron huts with its traumatized child soldiers, begging amputees, and dyslexic unemployed? And then Ebola, a lethal virus without remedy, the disclosure of medical incapacity, a shadow which spreads from East to West Africa, feared by the whole world. A lethal virus hits a fragile state-structure. Hesiod would not have been able to imagine a more devastating chaos. This might be one picture of Sierra Leone mainly painted by the headlines of the media. But as mentioned above, there is another narrative of the people. This thesis asks precisely how people who were infected managed to survive the EVD, and moreover, were able to step forward to work in an Ebola response projects afterwards? It is a local narrative that is unknown in the Western world as much as in the official reports of the international community. Therefore, the voices analyzed in this thesis are a main contribution to the individual and collective memory.

(20)

19

II. No proof, but exploration

(21)

(22)

21

2.1 The intuitive empiricism

According to Thea Bauriedel’s (1998) book Relationship Analysis, intuitive empiricism describes the connection of objective data and subjective meaning. It concludes that something which is collected needs also been felt. This maxim aims to understand the collected data in its most profound meaning following Jon Kabat-Zinn’s quote: "When experience is viewed in a certain way, it presents nothing but doorways into the soul" (Rutledge and Walker, 2012). Emotional participation and involvement in the living condition, an "entanglement" (Ader, 2004, p. 323), is therefore prerequisite for a researcher. It stems from the old Latin saying Sie comes esse lupis uis, uoce sibi

simileris (Who wants to be with the wolves, has to howl with them). The Franciscan

(23)

22

2.2 The principles of qualitative research

The main goal of qualitative research is the discovery and development of subject-related theories, which are based on empirical surveys. Whereas qualitative research methods have been underestimated historically, they are highly valued today. As early as the end of the eighties, Siegfried Lamnek (1988, p. 120) stressed that qualitative research is more than merely a preliminary stage of quantitative research. He refers to the original direct reference to the empirical reality and bases his argument on the

Grounded Theory of Barney Glaser and Anselm Strauss (1967, p. 23) stating that

(24)

23 qualitative research process and differentiated 13 pillars of qualitative thinking among others specificy on individual cases, openness, method control, Holism and Historicity. The pillars serve as a prerequisite enabling the researcher to create a situation which is as close as possible to the original situation (everyday life) as well as allowing the researcher to process and express relatively free. Instead of random sampling, quantitative variables or statistical analyses, the research approach of this thesis goes with a small sized research-group in order to achieve a detailed and focused insight in the individual-subjective perspective. This opens a profound insight in unknown perspectives and dimensions of human life.

(25)

24 2.2.1 Participative observation

(26)

25 2.2.2 The narrative interview

According to Fritz Schuetze (1977, p. 52) the narrative interview can be described as an open form of speech which is most closely connected to the interviewee’s actuality. Interviewees are seen as event-bearers who experience a chain of events that is characterized by stressors, condensations of highlights or temporal incidences (Glinka, 1998). The narrative about such chains reflects the subjective view of the person. Therefore, each narrative interview contains an "autobiographical note" (Voelzke, 2005, p. 13) and should be interpreted by the principle of charity meaning to consider the statement in its strongest possible interpretation (Baillargeon, 2007, p. 78). The narrative method is regarded as highly valuable in qualitative research, but is widely underrated and misjudged to an easing disturbance of the progressive goal-oriented institutional code of conducts of various working field (Schlutz 1984, p. 95). The time-effort factor might be the crucial argument explaining its little application. Schuetze (1977, p. 54) complements the narrative interview with the consecutive interview. This supports the expression of people who may not be used to talk freely and openly in front of an unknown person. Intercultural and -personal sensitivity is the dominator in this regard. The consecutive interview is a set of openly formulated questions in order to achieve the greatest possible openness combined with the required structure (Kammann, 2001, p. 82). Open questions mean renunciation of predetermined categories within the formulation of questions (Müller-Kohlenberg, 1996, p. 52).

(27)

26

2.3 Research phase

The field study took place in Sierra Leone and was divided into two phases. While the first phase experienced the direct context of the Ebola epidemic from June 2014 to May 2015, the second phase was conducted from mid-October to mid-December 2016. It is to mention that the first phase was not planned and remained quite non-purposeful in view of the fact that the research idea wasn’t outlined at that point of time. Nevertheless, private diary entries are highly valuable as they witness the life of the people who survived the EVD and worked in an Ebola response project. Some meet the basic requests of participative observation and can thus be considered. This phase was based on a first hand involvement in the context as well as on personal impressions through profound dialogues with a good amount of people. The second research phase was mapped-out in advance and included the purposeful conduct of narrative interviews and group discussions. It is supported by extensive reflection. The combination of an unintentional and intentional field study recalls the concept of "exploration" (Merkens, 2007, p. 31) allowing authentic and unrestricted encounters.

To submit, the field study doesn’t examine existing hypotheses, but offers a theoretical model that explains past and the present happenings. The methodical approach of triangulation supported the reduction of hierarchical divides between the researcher and the respective group of people. This is crucial as the expression of personal experiences has to be understood as an exposure of one’s inner life and thus demands a good basis of trust. Hence, a close but professional attitude formed the relationship that prevented contra-productive research behavior according to Bader, Elster and Ludewig (2006) such as rigid definition of terms, unilateral plan and goal elaboration and one-sided problem orientation.

(28)

(29)

28

2.4 Preparation and analysis of research data

The data were retrieved from external as well as internal indications according to the hermeneutic cycle of Wilhelm Dilthey (Gadamer 1990; 1993) and transcribed, read and interpreted subsequently. A total of 14 participative observations were identified in the diary accounts. Whereas 4 of the entries have been written down during the observed situation, 10 were documented in the aftermath. Furthermore, 16 narrative interviews as well as 3 group discussions were transcribed. While Creole was the main language in 11 interviews, 5 interviews were conducted in English. A translator was needed in four cases in order to confirm the correct understanding. The translation from Creole to English was attempted to be literally as much as possible, but content summarizes occurred partially. All interviews are available on original record, only one group discussions were not recorded through technical problems. The sample of participants of the narrative interviews was people who survived the EVD and worked in an Ebola Response project afterwards. No age restriction was given, but attention was paid to include a various range of age. All people were above the age of 18 years. The sample aimed furthermore for a balanced gender proportion. In the 16 narrative interviews, seven were female and 9 male participants.

(30)

29 other experts. This step helped to correlate findings with the probable truth, but the main achievement of this retrospective approach is a person-independent interpretation (Ader, 2004, p. 324). This signifies the third reading cycle which generated the formulation of a theoretical model in accordance with the ambiguity tolerance, meaning to leave the outcome open as illustrated below:

The results are based on the elaborated categories and were shared to the participating people as far as possible through personal feedback and distribution of the master thesis in digital form.

Reading cycle 1 Reading cycle 2 Reading cycle 3 Formulation of

theory model Formulation of _hypothesis

Preparing, reading and coding of documents Reading with created category system Intersubjective review Low Degree of Specification High Collection of data from the field

Most natural settings

(31)

30 III. Theoretical Framework

The perspective of a person is subjective. This implies that individuals have their own way how to interpret a situation as well as how to maintain or change it. A society is thus enriched by an uncounted amount of individual theory formulations. While the real meaning of the notion theory is not determined exactly, the Greek theo (God) and

horao (see) induce an absolutistic claim of truth whereas theu (stage) and horao (see)

(32)

31

3.1 The theory of the Lebenswelt

The theory of the living-world stems from two traditions, namely the hermeneutic-pragmatic and the phenomenological tradition. The first describes the pre-existing and therefore pre-interpreted, but still influence- and changeable reality. Wilhelm Dilthey (n.d., cited in Thiersch, 2010, p. 182) states that a reconstruction of the interpretation processes produce a “higher understanding” of reality. The phenomenological tradition reconstructs the daily life of a person according to cultural arrangements. It needs to be understood in a dialectical and reflexive manner. A reconstruction of the daily life is an opportunity to see a person influenced by specific conditions which can be modified in turn (Thiersch 2010, p. 183). Moreover, the theory of the living-world is enriched by a critical understanding, namely to be aware of pseudo-concreteness in the light of truth and deception (Kosik, 1967, p, 9). The method of social diagnostic, which requests biographical and ethnographic approaches, plays a crucial part in the reconstruction of the living-world. It opens a multiplicity of perspectives towards the different dimensions of the environment and a person. The different dimensions such as health, education, economy, housing, employment, personal development, society, social contacts, family relations, etc. determine the living-world. Whereas the interaction of the person with the environment works in some cases, it bears the risk of failure. This is easily misjudged as individual incapability. In fact, challenges, problems and conflicts need to be understood in a dialogical person-environment manner. If the root causes of the failure cannot be identified within the interaction process, a person is in danger to drop out of the system. This leads Hege (1974, p. 10) to criticize a society according to its exclusion of people as it reveals the deficits of participation. He manifests that every person has the right of emancipation (Hege, 1974, p. 12). Rather than a rigid diagnose, social diagnostic is a successive process with a holistic view as it focus on the ongoing reconstruction of the person-environment interaction and thus of the living-world.

(33)

(34)

33

3.2 Anthropology in International Humanitarian Action

(35)

34 3.2.1 The professionalism of International Humanitarian Action

Originally, the humanitarian mandate seeks to relief suffering. The principles were manifested by the International Committee of the Red Cross, the oldest humanitarian organization established after the Battle of Soferino in 1870. Henry Dunant and his followers based humanitarian work on the principles of neutrality, impartiality, and independence. Their official manifestation and application broke new land despite their “history of centuries” (Smillie et al., 1993). The maxim is to help people unconditionally. In the aftermath of World War II, humanitarian work was interpreted as a conduct of charity and defined by the good will the people. The pure humanitarian act enjoyed more importance than the practical outcome in the so–called era of

romance. The rising inability to relief human suffering had fatal consequences. A more

critical perspective sounded the bell for a paradigm change. The step into the so-called

era of doubt developed the charitable approach into a profession. Initiatives like the

(36)

35 3.2.2 The emerge of the discipline anthropology

Anthropology underwent a similar development to an academic discipline. The etymology refers to the Greek term anthrōpos meaning man. The original point of interest lays on the plurality of man and indicates the study of humans, cultures and societies all over the world. Unlike other disciplines that also studies humans such as psychology or biology, anthropology is less interested in what is going on within the mind of individuals or what is common for all humans. Instead, it focuses on what happens between people in groups as well as what differs or is common between groups (Persson-Fischier, 2016). Its description as the “the natural history of society” (Harris 2000, p. 159) or as the “comparative study of cultural and social life” (Eriksen, 2010, p. 198) gives an idea about its long evolution that arose from two original motivations, namely the interest in comparison of people over space as well as the interest in long term human processes or humans as viewed through time (Harris, 2000, p. 8). Its questions are raised since antiquity. Some historians applied an anthropological approach already in the classical age and were pioneers in the methodical use of reading past and contemporary accounts, interviewing witnesses and locals, or taking observational notes themselves. To name are Herodotus, the so-called “pater historiae” (Hartog ,1988, p. 379), who described the life of the multi-cultural troops during the Greco-Persian Wars, or Tacitus who provided insights about the unknown Celtic and Germanic people. James Redfield (1985, p. 97) attributes Herodotus even as the “Father of Anthropology” as his accounts attest a scientific intent about culture by researching about:

 diaitia, material artefacts such as houses and consumables,

 ethea, the manners and customs; and

 nomoi, the authoritative norms and laws.

(37)

(38)

37 judgement officially on the banal fact that slavery was not permitted by positive law. However, his objection to the then common dehumanizing attitude on slavery suggests a more profound reason. Perhaps it is the growing recognition of human diversity. It is to highlight that the slave abolition process was supported by anthropological research interest in commonalities and uniqueness. Unfortunately, this development didn’t end slavery immediately as Olaudah Equiano autobiography An

Interesting Narrative from 1789 accounts. Until today, it neither prevents human

trafficking and slavery, gives back lost identification, protects from crimes against humanity, ensures application of universal human rights, nor does it grant all human beings a life in dignity. This knowledge but inability to change remembers about the moral paradox of Thomas Jefferson, the man who found it self-evident that all men are created equal but who also bought and sold people as slaves. Marc DuBois (2016), former executive director of Médecins sans Frontières UK, formulates therein the pertinent questions: What will proves our Jeffersonian blemish? What is our humanitarian age about? What will leave people in hundred years shaking their heads, shocked and outraged about our deep moral and logical flaws? DuBois (2016) suggests: The Jeffersonian problem implies that we may have to live another hundreds years of tomorrows to recognize the atrocities of today. While there may be people who support a stronger anthropological movement promoting humanity, the discipline wilted to “a tiny university subject” (Eriksen, 2004, p. 1) in comparison to the historical and ongoing atrocities that neglect any sense of ethical value and produce moral nihilism. As a result, individuals may be at risk to exist in a state of anomie, a condition in which society provides just little moral guidance to individuals (Wilson 1963, p. 352). The incipit of Albert Camus’s (1942) novel The Stranger describes apathy as a possible consequence: "Aujourd’hui, maman est morte. Ou peut-être hier, je ne sais pas" ("Today mother died. Or maybe yesterday, I don't know"). Fyodor Dostoyevsky’s novel

The Brothers Karamazov reads apathy and detachment in similar lines. It states that

(39)

38 events all around the world. Consequently, Wilberforce’s peremptory request “not to look away” formulates the imperative of today’s anthropology. Put it differently, anthropology contributes to the enduring discussion about what it means to be human. Hence, the motivation for research can only be evaluated with reference to its sense of responsibility towards the enrichment of humanity. This argument is supported by Donald Brown’s (1991, p. 70) book Human Universals that issues not only a duty to exaggerate the differences, but also to stress on the commonalities that hold humanity together. Some may see therein an irreconcilable dichotomy between universality versus relativism thinking. However, anthropology strikes a balance as “it tries to grasp its object through its most diverse manifestations” (Levi-Strauss, 1983, p. 49).

(40)

39

 social cultural anthropology; studying human societies, cultures and their development,

 biological anthropology; studying human biological, physiological characteristics and their evolution,

 linguistic anthropology; studying the language of a particular group of people and the role of language in human society, as well as

 archeologic anthropology; studying the past and present material objects in order to learn about human cultures (Oxford, 2016).

This interdisciplinary four-field approach achieves a more holistic analysis of humans (Bradd 1999, 4). Holism describes the interrelation of different parts and implies the need to understand them as a whole. In other words, an understanding of various individual parts will be insufficient without an understanding of the whole. It is the conceptual departure point of anthropology encompassing three dimensions: The social dimension refers to the ways how humans act in relation to another, the material dimension refers to how humans organize their physical environment and the symbolic dimension refers to how both the social codes and the material world get infused with meaning (Persson-Fischier, 2015,p. 4). The dimensions are interrelated and affect each other. This involves a dynamic of dependency. If one dimension changes, something changes also in the other dimensions.

Graphic 3: The Interrelation of the Social, Material and Symbolic Dimesnsion, in (Persson-Fischier, 2015, p. 4)

Social Material

(41)

(42)

41 3.2.3 Anthropology in International Humanitarian Action

No doubt, an immediate reaction as described in the aforementioned metaphor of the drowning child is more than honorable, but the beneficiaries of IHA rely on more appropriate as well as professional assistance. This quality can only be achieved through a proactive approach. The key term is preparation. Preparation involves valuable input in advance concerning attitude, knowledge, skills, material, strategy, contacts, administration or supply chains that is developed to the best possible standard. The achieved standard defines the professionalism of IHA and requests its professionals to meet the expertise. Humanitarian workers have to assess what people around the globe need in different emergency settings. The assessment determines the project proposals. Hence, it is essential for an effective relief of suffering. In other words, anthropological produced knowledge helps to conduct a convenient preparation and thus response to a disaster. The importance of a contextualized understanding of local populations and their individual, cultural and regional needs is already acknowledged (Zwi et al., 2002). Consequently, humanitarian workers are on duty to understand how people perceive life itself and an interruption of the usual living-world through the emergency context. A disaster is a set of family embrace (Smith, 1999). It affects all of human life. Furthermore, people tend to resort to belief systems like religion, fate, randomness or witchcraft, if an incident goes beyond ones rational scope (Tambiah, 1990). Both phenomenons request an anthropological perspective. Ulrika Persson-Fischier (2015, p. 2) sees in the question if anthropology researches either in humanitarianism or of humanitarianism not a distinction, but a mutual enhancement. The in perspective has its focus on the humanitarian beneficiaries, whereas the of perspectice focus the humanitarian worker. Both ways are absolute relevant. Together they forge the holistic field of anthropology in IHA.

(43)

(44)

43

3.3 The concept of Disaster

Definitions about disasters are given frequently. While the lack of consensus causes concern in the eyes of some authors (Quarantelli, 1985; 1995), others see the continuing discourse as a sign of vitality as it prompts an exploration of past and emerging dimensions of disaster. The latter consider definitional discussion as more important than definitional consensus. Noticeable, the widening of the definitional sphere is only valuable, if it can be operationalized through appropriate intellectual and methodological procedures to advance systematic research (Rocha, 1995, p. 5). Especially anthropologists open up new questions, broaden the focus and foment the debate. In effect, inhibiting issues of disaster research may be clarified, new perspectives be developed, further problem areas be identified, and new potentials be explored. For example, a major contribution of anthropology poses the reconsideration of disaster less as a result of geophysical extremes, but as a function of ongoing social orders, human-environment relations and historical structural processes (Oliver-Smith, 1999, p. 19). The definition scope stems from the widely ranging phenomena of disaster. Ludwig Wittgenstein (1973, p. 32) suggests terming categories or concepts with an extensive thematic array “family resemblances” as they implicate “a complicated network of similarities, overlapping and criss-crossing: sometimes overall similarities, sometimes similarities of detail”. Other examples are the concepts of art or democracy. He uses a metaphor of spinning a thread in which fibers continue to overlap on a frequent basis. Noticeable, boundaries can still be drawn between the fibers, but differences are not necessary to make the concept useable, expect for a special purpose (Wittgenstein, 1973, p. 33). Specific purposes create the variety of the definition. Disaster definition is thus an identification of family resemblances. A disaster profile with a purpose to encompass specifically the events of the Ebola outbreak in West Africa 2014 can be outlined consequently.

(45)

(46)

(47)

46 capabilities. The result is a set of overwhelming events in all that are called disaster. Since humans only have perfect imperfections, meaning vulnerability or adaptive inabilities, the risk of disasters is omnipresent. The principle of causality asserts that “if the first object had not been, the second never had existed” (Hume, 1748, p. 76). It bases vulnerability of people to the core of the concept of disaster. In fact, the patterns of vulnerability will condition the behavior of individuals, groups and organizations throughout the period of a disaster far more profoundly than will the destructive physical force. The same patterns may equally sow the seeds of future disasters in the long run. This implies that the life history of a disaster begins prior to its appearance (Oliver-Smith, 1999, p. 29). That calls attention to the causal associations between cultural systems and the appearance of disasters. These can be examined by the so-called Bradford-Hill criteria, a guideline established by Austin Bradford Hill upon Hume’s’ tradition. It subjects a putative causation to various criteria that distinguish causal and non-causal associations and account evidence either pro or contra a causal relationship. Bradford (1965, p. 295) describes up to nine criteria. For sure, none of the nine criteria ensures indisputable evidence or signifies a sine qua

non, but an enlightened causal thinking may reveal the social causation of a disaster.

(48)

47 Graphic 5: The social causation of a disaster.

(49)

48 social and environmental events, their sociocultural construction as well as their implications for the overall sociocultural adaption and evolution of societies (Bates and Pelanda, 1994, p. 147). Thus, the conceptualization of the web of relations needs to be modified:

Graphic 6: The web of relation that links environment, society, culture, politic and economy.

(50)

49 Sahel zone which causes a recurrent risk of famine, for the populations of the lands below the Sahel which face increasing desertification partially causing factors of wars as seen in Darfur for instance, or for the farmers of Sierra Leone who experience an extension of the raining season causing a delay in the sowing and in turn in the harvesting process challenging food security. The climate changes may cause mass movement of people impacting not only those who stay in the region or leave before the appearance of a disaster. The impact will also upon the countries to which they flee concludes Tim Marshall (2016, p. 281) in his book Prisoners of Geography. Marshall looks even further ahead sizing disastrous conflicts about water resources, for example in the Middle East with an emphasize on the Murat River that normally rises in Turkey before feeding the Euphrates that serves as a lifeline for Syria and Iraq.

(51)

50 Kleinmann and Kleinmann, 1997; Crew, 1998; Gourevitch, 1998; Henry, 2000; 2002; 2005; Platt, 2000). To submit, anthropology is indispensable towards disaster preparedness and prevention and thus for IHA. Taking Kent’s (1987) Anatomy of

Disaster Relief into account, more research is still needed especially concerning the

(52)

51

3.4 The notion of people who survived the Ebola Virus Disease

This thesis bases its understanding of humankind on a holistic concept. All people are born with bio-psycho-social needs and hold them throughout life. Those are the essence of human life and signify the core of its definition. The satisfaction or fulfillment of these needs is an inherent right of all people caused by their nature, regardless of status, nationality, condition, performance or limitation. This reflects the right of emancipation mentioned in 3.1 The theory of the Lebenswelt. “All men are created equal” is a common sense. It doesn’t state an equality of all people. Instead, it declares that each individual bears an own personality and that the value of all personalities is equal. It is an "anthropological decision" (Siegenthaler n.d. cited in Dörner, 2002, p. 69) as the imperative of anthropology towards humanity mentioned in 3.2.2 The emerge of the discipline anthropology explains. The common characteristics of all people are the general evidence of this principle (Dörner, 2002, pp. 69-70).

(53)

(54)

53

IV. Context Analysis

“The crisis consists precisely in the fact that the old is dying and the new cannot be born; in this interregnum a great variety of morbid symptoms appear.”

Antonio Gramsci, Selections from the Prison Notebooks, 1934

4.1 The new old context of Sierra Leone

(55)

54 further causes of the conflict which are also found in the original accounts of the Sierra Leone Truth and Reconciliation Commission (2004). It is to mention that the causes of the complex disaster lay not rigid within the omissions of state functionality. Various authors elaborate on further causes like the involvement of external actors (Richards, 2005; Gberie, 2005; Wai, 2016) or the failures of peacekeeping actors (Reno, 2001) for instance. The research attention draws also on the question of sustainable peace in such an environment (Turay, 2001; Bell, 2005; 2006; Shaw, 2005) and the impacts of the conflict (Hoffmann, 2004; Shaw, 2007) with an emphasize on women and children (Turshen, 2007; Denov and Maclure 2009; Macauley, 2012).

Concerns about the contemporary situation are reasonable taking these causal factors into account. While the stakeholders of international peacebuilding and democratic transformation celebrate the two elections following the conflict with a peaceful change of governance in 2007 as exemplary regarding Boutros Boutros-Ghali’s (1992)

Agenda for Peace, no significant change to the socio-economic conditions or

(56)

(57)

(58)

57

4.2 Sierra Leone – a made ground for the Ebola epidemic

The consequences of the civil war cannot be counted in numbers, but the country represented an “anatomy of state collapse” (Musah and Fayemi, 2000, p. 81) by the end of the conflict in 2002. Around over 2 million people were reported to be displaced - with 500,000 refugees in other countries, approximately 215,000 women were reported to have been subjected to sexual violence – with a high degree of unreported cases, more than 72,000 ex-combatants were reported needed to be reintegrated – with unaddressed psychosocial wounds, over 300 towns and villages were reported to be destroyed– with summed up to 340,000 households, and a total of 80% of the social services were reported to be vanished (Baker and May, 2004, p. 36). The collapse can be further illustrated by the judiciary situation with only 15 presiding magistrates for 4.5 million people (Zack-Wiliams 2016, 32) or by the security institutions which suffered the loss of 900 police officers (Kamara 2010). The country was in need of support and reliable commitment in order to build up new structures. Fatally, „The continent, too, is marked by influences directed from inside and outside, often under cover of economic aid, but actually in the perspective of an interest that has nothing really humanitarian about it but its label.” (John Paul II, 1980, p. 4). The development of the medical situation reads a tragedy that leads to the Ebola epidemic.

The Sierra Leone Ministry of Health (2006, p. 7) issued a vision ten years ago: “By the Year 2015, the Ministry of Health and Sanitation shall have in place adequate, well-managed, efficient and motivated human resources for health and social welfare capable of providing equitable access and distribution of services leading to a healthy and productive Sierra Leone”. Despite the claim, the government spent only 7.8 percent of its total expenditures on the health sector (Zack-Williams 2012, p. 155) and provided only three physicians per 100,000 people according to the Human

Development Report in 2009. The consequences were demonstrated for instance by

Amnesty International which warned of a childbirth crises for women and proclaimed a “human rights emergency” in 2009 (Smith, 2009) as well as by UNFPA’s documentary A

(59)

58 pregnant women have to face in medical facilities. President Ernest Bai Koroma implemented a free health care programme for children under five years and pregnant women complemented by a the Women’s Initiative for Safer Health in response to the public outcry about the highest infant and maternal mortality rates of the world. Nevertheless, the voices remained unheard in the end. Reports state that 70-80 per cent of the essential facilities needed were not ready up to two weeks before the start of the initiatives. On example, the Koidu Government Hospital, referral hospital for an entire district, were described neither to have a X-Ray, drug store, nor reliable electricity supply, but required service fees, insufficient professional medical staff, inadequate beds without mattresses and only one ambulance instead (Massaquoi, p. 2010). Further reports like Horner (2010) testify financial and logistical obstacles preventing an effective implementation of Koroma’s laudable but insufficient initiative. Retrospectively, both the vision and the initiative have to be judged as complete fallacies according to the ongoing devastating medical situation. In fact, it kills people as patients remain untreated. With the accomplishment of the Ministry of Health vision in 2015, Sierra Leone is ranked 181th out of 188 countries in the latest HDI (2015) with a health profile as follows:

Sierra Leone - HDI Health indicators

Life expectancy at birth 50.9

Adult mortality rate, female (per 1,000 people) 423 Adult mortality rate, male (per 1,000 people) 444 Deaths due to malaria (per 100,000 people) 108.7 Deaths due to tuberculosis (per 100,000 people) 143 HIV prevalence, adult (% ages 15-49), total 1.6 Infant mortality rate (per 1,000 live births) 107.2 Infants lacking immunization, DTP (% of one-year-olds) 2 Infants lacking immunization, measles (% of one-year-olds) 17

Public health expenditure (% of GDP) 11.8

(60)

59 Depending on the viewer, some may read the figures progressively regarding the fact that Sierra Leone isn’t ranked last at least like in 1990. In fact, the figures show stagnation and a recurrent cycle of omission as the country’s health profile lays below the average for countries in the low human development group and below the average in Sub-Saharan Africa with the highest children under five and maternity mortality rate. Sierra Leone is further said to have the lowest life expectancy for both genders (50.8 years for women and 49.3 years for men) despite the fact that dramatic gains have been made globally. This comes with an average growth of five years in 2000-2015 while the largest global growth of 9.4 years was made on the African continent. Senegal (66.7 years) and Ghana (62.4) are the only West African countries found among the top 20 African countries. This brands West Africa, Sierra Leone in particular, to stand – literally standstill - for the major inequalities that persist within and among countries according to the newest World Health Organization (2016b) report. The statement that “The world has made great strides in reducing the needless suffering and premature deaths that arise from preventable and treatable diseases” (WHO 2016a) by the WHO Director General, Dr. Margaret Chan, is thus void in the Sierra Leone context.

Retrospectively, the mentioned developments indicate omissions and failures that produced the right amount of vulnerability within Sierra Leone’s health system designating the country as a possible ground for an epidemic like the Ebola outbreak in 2014. At its official end in November 2015, 3.590 lives were lost in Sierra Leone to an epidemic that was also a social epidemic as it devastated families and communities across the country and disrupted every aspect of life (WHO, 2016c). The root causes and contributing factors are complex as the wide literature shows. Whereas the official explanation by the WHO (2015b) about the index case is less challenged, the question how the Ebola calamity could reach such excesses is highly disputed. Chernoh Alpha Bah, a Sierra Leonean journalist, is one who contradicts the WHO narrative. His book

The Ebola Outbreak in West Africa is written in passionate but thoughtful lines. The

(61)

(62)

(63)

(64)

63 both to say ‘we’ll get it under control’.” (The Guardian, 2015). It took further three month before the crisis was admitted as a PHEIC as mentioned above. The why is disputed controversially. Whereas the WHO refers to legal conditions and specific conditions which have to be met, other perspectives see the delay motivated by political calculation and placation to avoid economic consequences for instance. For sure, implications of the working structure at country level and in the regional headquarters need to be taken into account. The WHO is organized in a three step structure with Dr. Chan at the top informed by the regional offices which receive specific reports by the country representatives. Interestingly, Africa’s ministries of health fund not only partly the African regional office; moreover, the ministers elect its director. The question of external interferences has to be addressed in such a depending constellation. Peter Piot, one of the discovers of the Ebola virus in 1976 and head of the London School of Hygiene and Tropical Medicine suggests: “What should be WHO’s strongest regional office because of the enormity of the health challenges is actually the weakest technically, and full of political appointees” (The Guardian, 2014). A rhetorical question, what is the outcome if a minister of health who doesn’t have expertise in the specific field of medicine and health meets an incompetent regional office at the frontline of a creeping virus? The outcome is the in 2003 jointly established but dormant early-warning system, so-called Integrated Disease Surveillance and Response, adumbrates the answer. From there, we are Condemned to

Repeat as Fiona Terry (2002, p. 13) describes The Paradox of Humanitarian Action: “The causes of most crises are political; some consequences may be humanitarian. But

labeling them “complex emergencies” and “humanitarian crises” disconnects the consequences from the causes and permits the international response to be assigned – and confined – to the humanitarian domain.”

(65)

64 diseases expert at the University of Minnesota, claim “If we fault WHO for the early dropping of the ball, the whole world has dropped the ball in some sense," (AP, 2014) is reasonable. I myself kept the eyes wide shut until it was too late. To be fair, the WHO is an easy target and their good work may suffer underestimation, disregard and even sarcasm, but it’s also “the only agency with the authority to lead a global response to health crises by diverting financial, human and logistical resources to epidemic response” (Buchanan, 2015) and thus on duty not only to allow but to address critical questions. The critical self-reflection seems half-hearted and the two points about experience and other organizations signify reasons, but bring no results. An impetus: To admit one is not the only at fault indicates more guilt than excuse. Moreover, the world saw clearly which consequences a fearful attitude might have relating to the shocking pictures of Somalia in 1991 towards the hesitative response of the international community in Rwanda in 1994. And lastly, the maxim nobody is to blame because everybody is to blame contradicts to all UN maxims such as to prosecute those with the greatest responsibility of atrocities at the International Criminal Court; and if nobody his mirror, the world remains condemned to repeat as Terry describes. If the WHO continuous to celebrate its achievements but silence its failures, the self-portrait that was framed in 1948 pledging the attainment by all peoples of the highest possible level of health shines in ignorant, arrogant and self-righteous colors reflecting unreliability. Time will prove if the WHO’s (2016c) statement on end of Ebola in Sierra Leone, “to work with the Government of Sierra Leone and partners to build a more resilient health system that can prevent, detect and respond to future outbreaks and to revive and strengthen essential health services across the country”, will succeed or remain another unfulfilled vision or initiative. For today, a patient in a Sierra Leone hospital who looks to the framed portrait may fall back in laughter echoing through the wards. For those who didn’t pay attention to the

Preface, this is neither the conspicuous joie de vivre, lack of knowledge or resignation,

(66)

65

V. Findings

(67)

66

5.1 „If not by God, I wouldn’t have strength… God make me live.”

In a place that shows “Only suffer” (Osman) and makes a person “so feared seeing colleagues dieing on the bed or even on the floors” (Hassan), most interviewee participants mentioned trust in God and “the divined powers of God” (Yusif) as the major factor on surviving the EVD. The divined powers of God are described in a reality in which “no treatment was given to me, but only first aid. Even if you vomit or stool they just say ‘patient patient’. I had the opportunity to go to a treatment center, so I say that is the divine powers of God that make me defeat the virus.” (Yusif).

(68)

(69)

68

5.2 “The main thing that make me to survive was a promise”

Faith and hope cannot be seen separately within the Sierra Leone context. The combination of the expectant and proactive approaches mean that an opportunity will occur if one keeps it up. In practice it needs “trust in God and working hard.” (Mustapha). “the strong believe in my heart, even though I feel the shock, I had the strong believe to make it up.” (Abdul) despite devastating brutal facts, “There are so many homes that were suffering. So many widows, vulnerable, lonely husbands, some lost all people, caregivers” (Hassan), indicates an outstanding sense of hope.

(70)

69

5.3 “l will consider myself at one of them”

Next to faith that promises hope, acceptance of reality is another major contributing factor for survival. This comes with an attitude which puts distressful facts to the back of one’s mind, but focus more on productive solution-orientated facts and adaptive capabilities.

While acceptance of reality involves facing brutal facts in the first instance: “So before we move on to the treatment center I asked the doctor, out of ten people infected with Ebola, how many will survive? She told me maybe three to four or something like that. I said by the grace of God l will consider myself at one of them. So I stood up from the bench and went into the ambulance.” (Osman), adaptive capability comes with a drawback of negative feelings: “I forgot about everything that stress me.”(Bockarie). These points seem to be contradicting, but also reasonable: “So they admit us in PTS. We stay there one month and ten days in PTS. I just lay down at one place. I think to the situation but not so bad. This reduced headache.” (Kadiatu). Another participant describes it as follows. “Of course I was in the treatment center and my thoughts were I am dying because prominent people were dying too… we were just 2 in number who survived. All others died. Ok?... I was getting hope when I was in stage 1 seeing me not dying like all the other colleagues. So I see God will make it possible for me to save and I only think to this overcoming the situation I am in now.” (Kallon). Naming it, “Once there is life there is hope.” (Beatrice).

(71)

70 right time. No visitor will not come here. When you survive you will see her. This is just the place to survive. So do not stress about that.’ In the end he died. I survive. There are people that cannot just adapt to situations.” (Bockarie). Noticeable, people go back to religious practice if they understood the full degree of reality: “The thing that makes me to cope with the happenings in there, it is prayer… We should not be so worried about the world because everything is temporary. Have this one strongness in you and you can overcome the happenings.” (Beatrice). From there, realistic opportunities start open: “One morning I wake and say I need to arrange my body. I saw around and saw one woman and man go around. Exercise. Walk so and so. Me myself I was not able to climb a step. Unable. I was paralyzed, but I say I can do it little by little. I hear a boy saying to me you need for drink the medicine, and eat small. You go well. I try to go and arrange my body. The moment I lay down I see the lady next to me was death. It was then when I decide I need to grap. Her lips was filled. I have fear to die or chance to go. Then they came to give medicine, I was unable to drink it, but I focus only on this. But they bring me softdrink for the sour taste. I took one tablet and put it down. So the one lady died. Another lady who came died. Blood came out of her nose. People died next to me, I was afraid, but I only focus to take the medicine. There mouth were not locked… So I say myself if I drink and eat I go up, I go well and come out.” (Algari).

(72)

(73)

72

5.4 “The people who died didn’t get this motivation”

The mentioned mind produced and followed a specific aim, namely to survive the Ebola disease for being an example and a role model against the odds, for the shake of lost people or to inspire and motivate other people.

Some people say Ebola catch me, I don’t make it up again. They felt ashamed. I say to myself I want survive so anyone will see me. So I didn’t give up. I make it up. That gave me the hope, to get up. I encouraged again not to get under the sick. I wanted to make it up. Others gave up, they were not able, because of the provoking and the shame: ‘They get Ebola, they get Ebola. Don’t touch them.’ So they died. But those who said to themselves: ‘I will survive’, they survived. I made it up to make the other people ashamed. To see me again. This was my motivation. The people who died didn’t get this motivation. (Kadiatu)

“So I was laying down at my bed in Connought hospital wondering how it happened. I just lost a key man in my life and the life of my family. Maybe this the reason why I’m here. Maybe I have to be the new key person. So doctors came in and took my blood for a test. After three days back my results came back, I was positive of Ebola. I put into prayer and asked the Almighty God to take control over the situation, I need to survive... So I stood up from the bench and went into the ambulance.” (Hassan)

“it’s the worst, but I have the opportunity. I’m still alive”

“it’s the worst, but I have the opportunity. I’m still alive”

Table of Contents