Paul Richards writes “Ebola is a disease of social intimacy” (Richards 1). Ebola is transferred through bodily fluids, and therefore is often transferred to those caring for the sick or washing the bodies of the dead. There is no cure for Ebola, simply palliative care. Although there have been several recorded outbreaks of Ebola, the 2013 outbreak in Upper West Africa quickly turned into an epidemic. With inadequate domestic health systems, Doctors without Borders, among other NGOs, were the main actors on the ground (Arreguín-Toft and Mingst 420).
The efforts of such aid agencies can be understood through the constructivist lens. A book published in 2017 notes that constructivists would focus on “how we think we know what world health means, and how that meaning came to be established” (Arreguín-Toft and Mingst 424). This means that all foreign aid efforts and healthcare infrastructure must be evaluated in terms of their cultural and historical contexts. As mentioned previously, Ebola is a very intimate disease. There are many social practices deeply engrained in local cultures that contributed to the spread of the disease. For example, ritual burials where the bodies are washed before they are buried is a very dangerous practice during an Ebola epidemic. Due to the spiritual and social implications of a traditional burial, however, many Africans continued to wash and bury bodies in the traditional way. Western aid workers, however, drew problematic assumptions based on this fact. Many assumed that Africans were “stubborn” in their “unsafe” traditions and unwilling to listen to the recommendations of aid workers (Richards 48). This apparently problematic assumption does not recognize that from a social and spiritual perspective, an “epidemiologically safe” burial is deemed spiritually unsafe by the local population (Richards 52). The issue is the social disconnect between the Western aid workers and the African locals, who are acting on their ingrained social practices. This idea exemplifies the fact that cultural ‘norms’ and ideas drive the behavior of a country’s citizens.
Despite providing medical resources, the aid workers were primarily responsible for “changing the ideas” of the people in Western Africa (Richards 28). This, in itself, exemplifies the “constructivist” viewpoint. Western aid workers acted in ways that reflected their individualistic, direct, and informal upbringings. They struggled to understand the communal, traditional, and spiritual characteristics of African culture. This led the aid workers to act in a way that did not include locals in the Ebola eradication efforts.
In a 2014 post, Susan Shepler describes the popular coverage of the Ebola crisis, “People on radio call in shows have asked: Why can’t they understand what needs to be done? Why they need to submit themselves and their loved ones to quarantine? (Shepler)” This type of coverage highlights the “ignorance” of African citizens. This is not “ignorance,” however, and can be explained by several cultural factors. The most important factor that highlights the ‘constructivist’ viewpoint is that African citizens have a “mistrust for the state” (Shepler). Because of this “mistrust,” many ignore public health warnings from the state. This “mistrust of the state” that Shepler mentions is something that is deeply woven into the actions and decisions made by many African people. This exemplifies the ‘constructivist’ viewpoint in that politics and decisions of people are shaped by “non-material” elements.
The “constructivist” viewpoint can also be explained by the differences in the “norms” between the home countries of the aid workers and Western Africa. In developed countries, it is common to have a surplus of household supplies including trash bags, rubber gloves, and rain jackets. In developing countries, however, these items are not common. In 2014, as the international push to stop Ebola began, The World Health Organization developed their agenda to fight Ebola based on what they call ‘the messaging approach’ (Richards 124). The “messages” spread by the World Health Organization included how Ebola is spread, how to safely care for someone who supposedly has Ebola, and how to create protective clothing from “common” household items. The World Health Organization, however, did not acknowledge the impracticalities of these messages. Resources such as raincoats, trash bags, and gloves are difficult, if not impossible, to find locally in Western Africa. The differences in resource constraints, and the “norms” in each society influenced how The World Health Organization initially responded to the Ebola crisis and how locals reacted to the messaging.
As a final point, it is important to recognize that while the Western response of aid workers to the Ebola epidemic can be explained by the “constructivist” point of view, the situation entirely violates the ‘liberalist’ view. From a liberal perspective, the efforts to end the Ebola epidemic should have been a group, “holistic” approach. It is clear that this is not what occurred. The efforts to end Ebola were more divisive than communal.