Friday's Khutbah with Mohamed Gibril Sesay | Women, Soutoura, and the Ebola Tragedy

According to UNICEF, women account for 55 to 60 percent of the deceased in the current epidemic in Liberia, Guinea and Sierra Leone. “Women constitute a large section of the health workers and are on the frontlines of this crisis,” Sia Nyama Koroma, first lady of Sierra Leone, told  Washington Post in a telephone interview this week. Understanding the role gender plays in an Ebola epidemic is crucial, health experts said.

Here Sierra Leonean commentator and presidential adviser Mohamed Gibril Sesay looks deeper at why women are most affected in the Ebola outbreak in Sierra Leone

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Funerals are commentaries, not only on the lives of the dead but also on the values of the living. And also upholding these values could, as we are witnessing during this Ebola outbreak, bring further tragedy; whilst at the same time not upholding them also brings anguish, and feelings of not having fulfilled one’s duties.

May be, you read Antigone, that play by Sophocles about the woman who was struck by tragedy for refusing to follow the diktat of the state not to bury her brother. She damned the state and its distant logic and buried her brother. The same is happening in many communities in Sierra Leone; people damn the state and its medical agents.

But I will come to this later to discuss a concept, a value, known variously as "soutra," or "soutoura," and how this plays out in practices relating to Ebola, and how our people’s adherence to this cardinal virtue in dealing with the sick, the dying and dead is deepening the tragedy.

But my mention of Antigone above draws my attention to the gendered nature of the Ebola outbreak, and how its toll, in terms of morbidity, mortality, widowhood etc are heavier on women, all because of the confluence of a number of factors.

Women are our nation’s primary caregiver, at homes, and at hospitals. Also, because they are so involved in so many chores and cares, they tend to refuse hospitalization more than men. They would say to themselves ‘who will take care the kids? who will take care of the home?. So they also tend to refuse the confinements and separation from their homes and families that hospitalization entails. So they go to "pepper doctors and nurses" more than men; and they tend to seek community based therapies that do not require hospitalization, including relying on traditional/spiritual remedies more than men do.

A deeper look at the statistics reveals this gendered tragedy of Ebola. And also the fact that it hit a particular socio-economic and religious strata of society more than any other.

But let me come to the virtue of soutoura, which from its Islamic roots means to respect, to cover the shame of, and has now been appropriated in our communities. to mean almost the same, and in situations of disease and death, it means to cover the shame of the sick, the shame of the dead. In the Qur’an, in Suratul Maida, a corpse, the naked corpse is called a shame, and it behoves a brother to cover that shame, to bury it.

Amongst Muslims, washing the corpse is a religious obligation, and it is also an obligation not to expose the nakedness of the corpse to strangers. I have seen, where, in a lot of cases, before a death is announced, it is expected that the corpse should first be ‘soutora –ed’; cleaned if there are any vomiting or other fluids. That is a virtue, an obligation. And that is not something you leave to strangers.

Weaning people off this habit and obligation is not just a function of them knowing that Ebola corpses are infectious to others. People have heard this, but the pull of these ingrained obligations trump the scientific truth of the Ebola messages.

And also the fact that, though for Christians, the management of corpses could be left to strangers, like for example, corpses being in specialized hands at funeral homes, getting suits, coffin and other practices; for many people, especially Muslims, and the overwhelming majority of people in rural and urban areas, funerals are not as ‘externalized.’ So. Expertise in burials for many is usually a low skilled activity, something more people at the local community could do, or are involved in, from washing the corpse, to putting it in the grave, to toting the bier back to the mosque etc.

Or take the idea of caring for the sick, of Soutora-ing them. Ebola is what could be referred to as a disease that ‘disgraces’ the sick: the vomiting, the diarrhea, the patient’s inability to take care of themselves. How many of our people would want to leave the cleaning up of their sisters, mothers, fathers in the hands of others? How many would ‘externalize’ the covering of the shame of their kith and kin? Communities do not easily forgive a family that allows the ‘disgrace’ of the kith and kin to be seen by others.

People may know that it may be Ebola, but is knowing enough to push people to abandon soutoura-ing? And especially so when Ebola, as has been pointed over and over has symptoms, in its early stages that are like so many other diseases in the country? The other diseases that ‘disgrace’ the sick, like cholera and diarrhea.

Not only that, since these other diseases have been here for long, including such other symptoms as headache, muscle pains etcetera, people think they know how to treat them; in every society, knowledge as to how to treat its common diseases is widespread, if even a fraction of all the headaches and fevers in the country are taken everyday to the hospital, hospitals would get hundreds of thousands of visitors every day. That is a fact of life, just as if every little palaver are taken to the police everyday, they too would be overwhelmed by hundreds of thousands of cases everyday.

But no society works like that, and Ebola fools people, in its early symptoms, to believe that it is like the other known ailments that daily afflict us. So many people fail to report until it is late; even as I was informed some medical professionals. Ebola denial is not only about denying the disease in its entirety, it is also about denying that these early symptoms showing in this or that person, or me, could be Ebola. You could believe that there is Ebola, but fail to attribute its early symptoms to it, until it gets worse, and in the process others could have been infected. Ebola denial comes in various guises. That is why, as somebody advised, Ebola victims and their families are not stupid, or intent on deliberately spreading the disease. Too many things are at play, and empathic approaches are required.

But back again to our observation that Ebola is also gendered tragedy, and the role notions of soutoura play in this.. Women soutoura their husbands, they soutoura their sisters, they soutoura their daughters; men are few in this business of soutoura-ing the bodies of the sick and the recently dead. And because more women are involved, these deaths are more a tragedy for women than men.

There is this story of one of the first cases in Kailahun involving a sowei or digba. She died of the virus, but tradition demands that other soweis honour the corpse, and those other soweis were infected. It is important to also the role soweis play in traditional therapeutics, how they are first responders to many an ailment. Now another tragedy is commencing in Moyamba, of a head sowei who died and many of the soweis in the district attending the funeral to do the rites, and how they are now feared to have contracted the disease and are being monitored. People know about the disease, but the behaviourial changes required by this knowledge involves jettisoning of many of ways in which so many values are operationalized in the daily lives of people.

The country’s previous engagements with Lassa fever also put our health professionals on a higher confidence level of dealing with Ebola.

Dr. Khan was a Lassa Fever Specialist, the country has the best Lassa fever facility in the sub-region, there were other specialists working on these matters in the country, but the outbreak overwhelmed that confidence. The experts advised against declaring an emergency when the outbreak began, the WHO advised against it, the other experts advised against it, guiding their turf against the encroachment of the non-medical agents of the state. They thought it was a simple matter of patients diagnosed, brought to hospital, laying still on their bed, or on ambulance and listening to instructions as given. The outbreak was underestimated, the country’s clinical preparation over-estimated.

Late June/early July I attended a meeting on Ebola; it was tense, there were arguments for a beyond-the-Ministry-of-Health approach, but the Ministry of Health, and the experts therein were still assertive that their measures were the right one; the disease would be stemmed. The Ministry of Health team won the day. Were the experts therein acting on bad faith? No. But frustration was also setting in because in their overtly scientific exclusivity, they could not fathom the behavior of the people. Ordinary people were being blamed, their habits of caring and management of cadavers stigmatized as indices of ignorance, illiteracy, and indiscipline.

There is this school of thought, in the social sciences, that tell us about the governance of human bodies, and how the ascent of certain professions and institutions, in our case the medical profession and the clinic ensure that bodies are regulated, disciplined, cured, administrated, confined. In Africa, and in our case Sierra Leone, this ascent of the medical profession and its ways of instructing our bodies is far from what it is in the West, particularly in relation to a disease like Ebola that disgraces bodies, that shames corpses. The instructions given by the medicos are heard loud and clear; but because the instructions are also oppositional to the values of soutoura, and other related practices, there are great difficulties in obeying them.

But as things are, adjustments have to be made. Practices and discourses that empathize with long held values, but that also do not compromise the integrity of better clinical exercises must be devised. And these approaches must have champions at the community level who know about soutoura and other values, persons who are recognized as legitimate cultural interlocutors and translators, and who are also aware of, and believe in the ‘scientific facts’ about Ebola.

These persons could include imams, priests, chiefs, community bras, but especially women, women, women, women, and women; they are bearing the brunt of this outbreak, and they have got better socialization into, and more practice for the empathic approaches that are now needed to tackle the outbreak.

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