APPROVED: Doug Henry, Major Professor Lisa Henry, Committee Member Katherine Fogelberg, Committee Member Susan Squires, Chair of the Department of

Anthropology David Holdeman, Dean of the College of

Liberal Arts and Social Sciences Victor Prybutok, Dean of the Toulouse

Graduate School

THE PUBLIC HEALTH RESPONSE TO AN EBOLA VIRUS EPIDEMIC: EFFECTS ON AGRICULTURAL

MARKETS AND FARMER LIVELIHOODS IN KOINADUGU, SIERRA LEONE

Molly Beyer

Thesis Prepared for the Degree of

MASTER OF SCIENCE

UNIVERSITY OF NORTH TEXAS

August 2019

Beyer, Molly. The Public Health Response to an Ebola Virus Epidemic: Effects on

Agricultural Markets and Farmer Livelihoods in Koinadugu, Sierra Leone. Master of Science

(Applied Anthropology), August 2019, 87 pp., 6 figures, 1 appendix, references, 120 titles.

During the 2013/16 Ebola virus disease outbreak in West Africa, numerous restrictions

were placed on the movement and public gathering of local people, regardless of if the area

had active Ebola cases or not. Specifically, the district of Koinadugu, Sierra Leone, preemptively

enforced movement regulations before there were any cases within the district. This research

demonstrates that ongoing regulations on movement and public gathering affected the

livelihoods of those involved in agricultural markets in the short-term, while the outbreak was

active, and in the long-term. The forthcoming thesis details the ways in which the Ebola

outbreak international and national response affected locals involved in agricultural value

chains in Koinadugu, Sierra Leone.

ii

Copyright 2019

By

Molly Beyer

iii

ACKNOWLEDGEMENTS

I am overwhelmed while reflecting on all those who have supported me throughout this

process. I would like to thank my chair, Doug Henry, for his guidance. He is responsible for my

introduction to disaster anthropology, cultural and practical knowledge of Sierra Leone, a critical

dialogue about Ebola, and many contacts that I have worked with. This research, getting to Sierra

Leone, and this thesis would never have occurred without his expertise and connections. I would

also like to thank Lisa Henry, Alicia ReCruz, Mariela Nunez-Janes, Adam Dunston, and Andrew

Nelson whose scholarship and mentorship have informed my attempt to practice a decolonized,

critical anthropology. A special thanks to the students and faculty of the Department of

Anthropology at UNT, who have supported me and been my community.

The help of David Mwesigwa and Gabreal Rugalema who tirelessly work at FAO and

helped me acclimate to Salone was instrumental to my success. This work would also not have

been possible without my translator and research assistant, Bernard Kamara. Many thanks are

due to Paul Richards, whose experience with Sierra Leonean agriculture helped to situate and

develop the questions this research sought to inform.

Most importantly, I want to thank the women farmers, the butchers, hunters, and waru

who let me into their lives, gave me their time, and answered countless questions. Without them,

this project would not exist.

Finally, I want to thank my family for their love and patience. Their encouragement to

pursue my dreams, even when they did not make sense to you, is why I am here today. My

mother’s example of standing up to adversity over and over again has surely impacted my ability

to persevere through this process. A de go.

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TABLE OF CONTENTS

Page

ACKNOWLEDGEMENTS ................................................................................................................... iii LIST OF FIGURES .............................................................................................................................. vi ACRONYMS .................................................................................................................................... vii CHAPTER 1. INTRODUCTION ........................................................................................................... 1

1.1 Background ............................................................................................................. 1

1.2 Project ..................................................................................................................... 3

1.3 Selected Client History in Sierra Leone ................................................................... 5

1.4 Research Population ............................................................................................... 8

1.5 Deliverables ........................................................................................................... 10 CHAPTER 2. CONTEXT OF WORK ................................................................................................... 11

2.1 Theory of Methodology ........................................................................................ 11

2.2 History of Ebola ..................................................................................................... 12

2.3 Anthropology of Ebola .......................................................................................... 13

2.4 Anthropology and High Mortality Epidemics ....................................................... 20

2.5 Fear, the Media, Securitization, and a State of Exception.................................... 21

2.5.1 “Bushmeat” in the News ........................................................................... 22

2.5.2 Impacts on International Travel ................................................................ 24

2.5.3 A Breakdown of the Logic of Control of Movement ................................. 25

2.6 Anthropology of Development ............................................................................. 29

2.7 Disaster Anthropology .......................................................................................... 31

2.8 The Anthropology of Humanitarian Intervention ................................................. 33

2.9 Traditional Ecological/Local Knowledge, Resilience, and Value Chains ............... 34

2.10 Definitions of Concepts: Value Chains and “Resilience” ...................................... 36 CHAPTER 3. METHODS .................................................................................................................. 40

3.1 Evaluation ............................................................................................................. 40

3.2 Study Site .............................................................................................................. 41

v

3.3 Preliminary Investigation ...................................................................................... 42

3.4 Data Collection Methods ...................................................................................... 43

3.5 Data Analysis ......................................................................................................... 45

3.6 Limitations............................................................................................................. 45 CHAPTER 4. RESULTS ..................................................................................................................... 48

4.1 The Koinadugu Women’s Vegetable Farmers Cooperative .................................. 48

4.2 EVD Quarantines and Restrictions on Movement in Koinadugu and Beyond ...... 49

4.3 The Impact of Ebola on Vegetable Farming .......................................................... 53

4.3.1 Collective Funds ........................................................................................ 53

4.3.2 Farming Inputs and Loans ......................................................................... 54

4.3.3 The Difficulty of Farming Under Restriction: Lack of Labor and Access to Farms ......................................................................................................... 56

4.3.4 Getting Product to Market ........................................................................ 57

4.3.5 School Fees and Unwanted Teenage Pregnancy ...................................... 61

4.4 Adaptive Strategies by KWVC ............................................................................... 62

4.5 The Impact of Ebola on Beef Value Chains: Markets, Transport of Cows, and Butchers ................................................................................................................ 63

4.6 Adaptive Cooperation in the Cattle Market ......................................................... 65

4.7 “Bushbeef” ............................................................................................................ 66 CHAPTER 5. DISCUSSION ............................................................................................................... 68

5.1 Economic Livelihoods and Adaptive Strategies .................................................... 68

5.2 Access to Institutional Spaces ............................................................................... 70

5.3 Cultural Mediators vs Capacity Builders: What Is the Role of Applied Anthropologists? ................................................................................................... 73

CHAPTER 6. PERSONAL REFLECTION ............................................................................................ 77 REFERENCES .................................................................................................................................. 79

vi

LIST OF FIGURES

Page

Figure 1: Agricultural Value Chain Resilience (Vroegindewey and Hodbod 2018) ....................... 37

Figure 2: Map of Study Site, Districts ............................................................................................ 42

Figure 3: Quarantined Home (BBC 2015) ..................................................................................... 49

Figure 4: The Frequency of New Cases in Sierra Leone during the Ebola Outbreak from March 25, 2014 to April 13, 2016 (CDC: 2014 Ebola Outbreak in West Africa Epidemic Curves | 2014-2016 Outbreak West Africa) ......................................................................................................... 51

Figure 5: Loading of Driver’s Union Truck..................................................................................... 58

Figure 6: Cattle Market in Gbindi .................................................................................................. 64

vii

ACRONYMS

AAA American Anthropological Association

ABC Agricultural business centre

ACDI/VOCA Agricultural Cooperative Development International / Volunteers in Overseas Cooperative Assistance

BSL Biosafety level

CDC Centers for Disease Control

DERC District ebola response center

ECU Ebola care unit

ETC Ebola treatment center

EVD Ebola virus disease

EWS Early warning system

FAO Food and Agriculture Organization of the United Nations

FBO Farmer based organization

HIV/AIDS Human immunodeficiency virus/acquired immunodeficiency syndrome

IHR International health regulations

IMF International Monetary Fund

IRB Institutional Review Board

KWVC Koinadugu Women’s Vegetable Cooperative

MAFFS Government of Sierra Leone via the Ministry of Agriculture

MSF Médecins Sans Frontières

NERC National Ebola Response Center

NGO Nongovernment organization

P4P Purchase for Progress

RAP Rapid assessment procedures

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SAP Structural adjustment policy

SCP Smallholder Commercialization Programme

SNAP Sustainable nutrition and agriculture promotion

UNICEF United Nations International Children’s Emergency Fund

UNMEER United Nations Mission for Ebola Emergency Response

USD United States dollar

WFP World Food Programme

WHO World Health Organization

1

CHAPTER 1

INTRODUCTION

1.1 Background

From December 2013 to June 2016 there was an outbreak of the hemorrhagic ebola virus

disease (EVD) in Guinea, Liberia, and Sierra Leone, in which there were 28,646 reported cases

and 11,323 reported deaths. Sierra Leone was the hardest hit country with over 14,000 diagnosed

cases and almost 4,000 deaths. This epidemic peaked in mid 2014 and ended in 2016, but social

impacts were felt long after the “end of the epidemic,” a day public health officials consider

twenty-one days of negative testing from the last contact of someone who had the virus. Social

impacts were in the form of increased morbidities from neglected diseases not related to Ebola,

education system closures, rises in unemployment from commercial closures, and slowed

agricultural production (“Socioeconomic Effects of Ebola in Africa” 2015). Long-term and

secondary health impacts, such as the impact of losing many caretakers and nurses to the disease

in a country with few healthcare providers, the negligence of malarial control during the

epidemic, the mental health of EVD survivors, and the previously unknown potential for latent

EVD cases to be transmitted via sexual or conjunctival fluids were studied.

While the immediate and tangible health impacts of EVD have been well documented,

more comprehensive study of the social impact of the epidemic has been less fully realized. The

2013/16 outbreak was a seminal event in the history of international health responses to

epidemics, given the sheer number of responders involved. There has been limited discussion

about how local and international responses and, more specifically, epidemiological quarantines,

impacted local communities. With respect to the public health and medical response, much of

2

the media attention focused on retaliations by West African locals against responders, with an

apparent lack of discussion of the impacts of quarantines, curfews, and limitations on physical

movement on the everyday lives of locals. There is a lack of conversation surrounding the impacts

of quarantines and public health controls on trade and agricultural markets, on social life, on

livehlihoods and business operations, or on the movement of families and kin networks. This

thesis will explore the impacts of epidemiologically motivated quarantines and restrictions on

movement on agricultural value-chains in one district, Koinadugu, in Sierra Leone.

According to a 2014 report by David Mwesigwa, Head of Programme Implementation at

Food and Agriculture Organization of the United Nations (FAO), and who I reported to for this

project, in Sierra Leone about 46% of farmers perceived the EVD epidemic to have considerably

disrupted their farming activities, including land preparation, planting, weeding, harvesting, and

marketing. In September 2014, over 60% of respondents expected a reduction in production

levels in Sierra Leone (Mwesigwa and Sheriff 2014). Market disruptions due to movement

restriction, high transportation costs, roadblocks and check points, the fear of travel, and the

closure of markets affected the state of agricultural production during the outbreak. In interviews

with Mwesigwa (2015), women farmers indicated that they feared traveling to deliver their

agricultural product to market due to risk of getting infected with the disease and that this led to

significant reported losses of perishable commodities, which ultimately led to unemployment.

World Food Programme (WFP) and FAO co-authored a special report about crop and food

security in January 2015, noting that due to the EVD outbreak and a general decline in economic

activity, household wages were severely affected, and the number of food insecure individuals

went up. As such, FAO and WFP called for flexibility and care in the type and scale of interventions

3

in food assistance, given the loss of livelihoods and market uncertainty (“FAO/WFP Crop and Food

Security Assessment — Liberia, Sierra Leone, and Guinea” 2015). According to Juliet Bedford, the

lead anthropologist for the UN Mission for Ebola Emergency Response (UNMEER), understanding

how Ebola and its regulation by international and national actors were affecting areas where

trade and small market agriculture was essential to local livelihoods was unknown as of early

2015 (Bedford, personal communication).

There remain theoretical and practical questions of how international humanitarian,

multilateral organizations, and national governments should approach a response to public

health emergencies; Specifically, to what degree do epidemiologically motivated quarantines

imposed by international actors impact other aspects of life beyond the epidemiological control

of the disease? Epidemiological regulations during the recent EVD outbreak, at times, consisted

of no public gatherings, closure of many lumas (periodic markets), restriction of movement on

all major roads, and curfews. In an intensely social and cooperative society such as Sierra Leone,

this research demonstrates that these regulations affected agricultural markets in the short-term

during EVD and had long-term ramifications on food security and livelihoods. The forthcoming

thesis attempts to detail the ways in which the EVD international and national response affected

the livelihoods of locals involved in agricultural value chains.

1.2 Project

The purpose of this research is to understand the impact of EVD epidemiological

regulations by local, governmental, and international actors on agricultural supply chains in

villages across Koinadugu, a district in the northeast of Sierra Leone, with a particular focus on

Kabala. This area of the country was sometimes referred to as the “bread basket” of Sierra Leone

4

due to its favorable climate and soil for growing vegetables, which are important as a commodity

for trade, and thus livelihoods. The Koinadugu district did not have many Ebola cases, making this

study insightful into the ways in which international crises response can affect communities. This

work addresses challenges to agricultural livelihoods as a result of a market disruption due to

Ebola within the framework of international multilateral and humanitarian aid agencies

relationship to these problems. I explore how the knowledge of these local agricultural

community experiences can inspire a different type of response in future public health

emergencies by aid agencies. A secondary question of this research is to understand how these

rural, subsistence, and small-scale farming communities in Sierra Leone responded to a complex

emergency through cooperative strategies.

Particularly, this research highlights the situation of women vegetable producers during

“Ebola-time,” as it was commonly referred to by Sierra Leoneans, as well as narratives about the

impact of regulations on butchers, waru (cattle traders), bushmeat hunters, and anyone

associated with the agricultural supply chain in Koinadugu. Additionally, I provide a vignette on

the situation of a particular government initiative (Agricultural Business Centres) as an

organizational tool for agricultural producers and detail how these centers were or were not able

to play a role in insuring community or individual food security throughout the EVD epidemic.

Ultimately, my research assessed the state of agriculture in Koinadugu during the 2013/16 EVD

outbreak, serving as a narrative of what happened to and within agricultural supply-chain actors

during the epidemic.

This research was done, in part, for the purpose of recommendations to targeted United

Nations Food and Agriculture Organization Sierra Leone (UN FAO SL) programs, in order to aid in

5

moving towards long-term food security and stabilizing small-scale, cooperative agricultural

markets in Koinadugu and, more broadly, Sierra Leone. I hope this narrative will give insight, both

theoretically and practically, to approaches used by international public health workers,

governments, NGOs, and multilateral responders during complex emergencies, especially

epidemics, and protracted crises in the future.

1.3 Selected Client History in Sierra Leone

The client for this applied research was the Food and Agriculture Organization of the

United Nations (FAO), a large multilateral strategic organization whose main goal is to achieve

food security worldwide (“About FAO | Food and Agriculture Organization of the United Nations”

n.d.). FAO developed a new strategic framework in 2013 that all country agendas and operations

are developed and carried out under. This framework includes goals to work to: 1) help eliminate

hunger, food insecurity, and malnutrition, 2) make agriculture, forestry, and fisheries more

productive and sustainable, 3) reduce rural poverty, 4) enable inclusive and efficient agricultural

food systems, and 5) increase the resilience of livelihoods from disasters (FAO 2013). This project

primarily addressed increasing the resilience of livelihoods from disasters, or Objective 5, due to

this thesis centering on the Ebola epidemic and its ensuing regulations. However, aspects of this

research fed into understanding food (in)security more broadly.

Within Sierra Leone, about half a million of the six million people living in the country

were subsistence farmers and were being encouraged to “farm for business” via programs by the

Sierra Leonean government and FAO. Program initiatives carried out by governmental agencies

were being funded by international donors, including FAO’s Smallholder Commercialization

Programme (SCP). Significantly, prior to the Ebola epidemic, an Agricultural Business Centre (ABC)

6

Programme was initiated by the Government of Sierra Leone via the Ministry of Agriculture

(MAFFS) in a program called the Smallholder Commercialization Programme (SCP). The program

intended to help small-scale commercial agricultural farmers transition towards a cooperative

small-scale commercial operation by establishing 193 “Agricultural Business Centres” (ABCs).

ABCs were physical structures across Sierra Leone’s 149 chiefdoms that contain a rice processing

machine, a generator, and other farm or educational equipment. These centres were designed

to be managed and owned by existing community Farmer Based Organizations (FBOs) that had

been organizationally formed in the years prior to the initiative with the help of FAO. In

Koinadugu, there were ten ABCs in six chiefdoms. The Koinadugu Women’s Vegetable Farmers’

Cooperative were considered a collective of FBOs that had access to the ABCs.

The ABCs were intended to act as a supply point for farming inputs, such as fertilizer,

pesticides, seeds, and tools, with technical support from MAFFS and funding from FAO and other

multilateral and aid agencies (Mokuwa and Richards 2014). MAFFS and FAO have provided

monitoring and functional support, for example in maintaining equipment, but ABCs were

encouraged to work to be independent and procure their own inputs and maintain their assets.

The intent of MAFFS and FAO with the ABCs was for the farming community to be autonomous

in their market activities, with little support beyond inputs for farming and operations. FAO saw

the ABCs as a way to functionally realize this goal of autonomy. Mokuwa and Richards (2014: 22)

report that FBOs do not see the ABCs as being owned by the government or any outside agency,

but rather open, cooperative governance existed within them.

Members of the community in which the ABC was located can become members of their

respective centre, and in doing so often became signatories to the bank for loans and assumed

7

cooperative responsibilities. These groups often pooled their agricultural products in order to

sign larger distribution contracts and secure clients who needed larger supplies of crops. Each

ABC was run by different local agricultural associations, such as FBOs or other groups, and

membership was not prescripted by any outside entity. The group I primarily worked with,

Koinadugu Women’s Vegetable Farmers Cooperative (KWVC), was a stand-alone entity separate

of the ABCs; however, many of KWVC’s twenty-five member groups utilized the ABCs, especially

in smaller communities, and were often “members” of both the KWVC and an ABC. One

difference between KWVC and ABCs was that ABCs executive boards were largely men (Mokuwa

and Richards 2014), while KWVC’s leadership was exclusively women. The only male members in

KWVC were the secretaries of each cooperative group, as male literacy is higher in the region.

Esther Mokuwa and Paul Richards (2014) evaluated the ABCs for FAO in an attempt to

answer how the business centres in more “urban” areas were operating differently compared to

those located in outlying villages, and how they varied in their effectiveness. Mokuwa and

Richards concluded by asking further questions about whether a monopolization of the ABCs by

rural elites existed, what Richard calls elite capture. Outlying villages often did not know about

ABCs or reported that the ABC was too far away from them, suggesting a rural disparity or elite

capture. Additionally, ABC villages were “larger, older, and better provided with basic facilities,

such as roads, water supply, and health facilities, than outlying settlements” (Mokuwa and

Richards 2014: 20).

While research by Mokuwa and Richards was not intended to have any interaction with

the Ebola outbreak, given that their study was designed and conducted previous to the outbreak,

data collection ended at approximately the same time that Ebola hit the country. How ABCs were

8

affected by the EVD outbreak were of interest for the long-term operational success in hopes for

a transition from subsistence to market farming in Sierra Leone. One recommendation by

Mwesigwa (2014), Head of Programme Implementation at FAO Sierra Leone, during the height

of the epidemic was to “improve farmers’ purchasing power by capitalizing the current

Agricultural Business Centres (ABCs) to be able to buy part of the current rice and cassava harvest

from the farmers” (Mwesigwa and Sheriff 2014: 26); to my knowledge, this was never completed.

The state of the ABCs during the Ebola outbreak and how they did or did not play a role in

community or individual food security or resiliency throughout the epidemic was unknown at the

time of this research.

The Koinadugu Women’s Vegetable Farmers Cooperative had a contract with the United

Nations World Food Programme (WFP) under the program called Purchase for Progress (P4P).

This contract was shut down by WFP after the women failed to deliver the amount of rice

promised in the contract due to EVD losses in harvest. However, it was unclear when or how this

occurred.

1.4 Research Population

The Koinadugu Women’s Vegetable Farmers Cooperative (KWVC) was an umbrella

farming organization formed in 1994 as a women’s empowerment program. KWVC started with

six groups who were supported by the United Nations Food and Agricultural Organization (FAO).

In 2015, it was comprised of thirty coordinated groups, with approximately twenty-five members

each, within the Koinadugu district covering eleven Chiefdoms. KWVC developed into a

marketing cooperative, an umbrella organization coordinating, managing, and monitoring

farmer-based organizations (FBOs).

9

KWVC was “headquartered” in Kabala, Koinadugu and had a group farm at this location,

farmed by their leader and other members. The entire group co-located there for organizational

meetings and one of the thirty cooperative groups utilized the space as their meeting space and

headquarters. KWVC supplied vegetables, rice, maize, groundnuts, cow peas, pigeon peas,

sorghum and benni to periodic (luma) markets in the 11 chiefdoms in Koinadugu, as well as in

Makeni, Bo, and Freetown markets. The primary vegetables that were produced include cabbage,

carrots, green beans, hot peppers, chili peppers, sweet peppers, lettuces, eggplant, squash,

radish, okra, tomatoes, spring onions, and bulb onions. The organization was registered with

Ministry of Agriculture, Forestry and Food Security (MAFFS) and the Ministry of Social Welfare,

Gender and Children’s Affairs.

Previous to the EVD outbreak, KWVC leadership bought seeds in Senegal and Mali for its

members located within Sierra Leone and collectively secured loans for its members to increase

the volume of production. In 2009, the group started to focus some of its efforts on producing

rice for the steady and readily available market created by United Nations’ World Food Program

(WFP) initiative called Purchase for Progress (P4P). The group had dedicated rice and cereal

production to P4P, in addition to their main activities of vegetable production and selling in the

Koinadugu district and beyond.

Over the five years previous to my fieldwork, KWVC members received a series of

trainings by FAO, MAFFS, SNAP, and WFP, ranging from Farmer Field School trainings for best

practices in the production of the above mentioned value chain crops, governance, store

management, agribusiness and financial management skills, record keeping, and quality control

techniques. The members of KWVC have been trained by NGOs and governmental organizations,

10

including FAO, on farming as a business and had a successful record of contract management

with WFP and large vendors in Freetown.

1.5 Deliverables

My deliverables for this project included a verbal presentation, data, several issue briefs,

assistance and commentary on working disaster policy, such as Early Warning Systems (EWS),

participation in Food Security Working Group meetings, and grant writing. I presented to the

Food Security Working Group, founded in 2015 by David Mwesigwa and coordinated by FAO with

over 25 coalition partners in the sectors of agriculture, nutrition, food security and natural

resource management in Sierra Leone. Additionally, I provided all data and field notes to Paul

Richards, the lead consultant on this project to UN FAO SL. Lastly, I co-wrote and submitted a

grant to MAFFS narrating KWVC losses during the outbreak with my research assistant Bernard

Kamara for remittances to the Koinadugu Women’s Vegetable Farmers Cooperative, the main

group with which I worked and studied.

11

CHAPTER 2

CONTEXT OF WORK

2.1 Theory of Methodology

Lila Abu-Lughod (1996) advocates for writing against culture and ethnographies of the

particular, in which anthropologists write about particular people and their stories in great detail

while assuming no objective knowledge. To Abu-Lughod, culture can only be discussed after

detailing the daily realities of those whose culture is being studied, meaning that any analysis

that includes culture as the object of focus can only be done once a thorough description of

people’s everyday realities is completed.

Similarly, Clifford Geertz (1973) developed the concept of thick description, as opposed

to thin description, or description without significant detail and context. A human behavior or

phenomena being studied should be described not only by the behavior itself, but by its context

in significant detail, or using thick description. Geertz points out that one of the limitations of

thick description is that these details are limited to that which an observer can capture, or

extrovert expressions. In other words, culture can only be interpreted on the basis of what

informants tell us. If realities are adequately thickly described, this detail can help to decode

social events by anthropologists and then be disseminated to a broader community. The detail

that makes up thick descriptions provides a sort of external validity by allowing readers to trace

the logic of the anthropologist.

This thesis attempts to collect, and, ultimately, thickly detail the experiences of the people

I spent ethnographic time with, as a sort of “tactical humanism” (Abu-Lughod 1996: 466), before

it theorizes or situates their realities culturally. This work inductively offers translated narratives

12

of the people involved in agricultural value chains in and around Kabala, Koinadugu, Sierra Leone

during and after Ebola-time, in hopes that their stories can be situated within anthropological

work on the topic.

2.2 History of Ebola

Ebola virus disease (EVD) is an infectious viral hemorrhagic fever in humans and other

primates caused by ebolavirus with a high risk of death and a reported case fatality rate in Sierra

Leone of around twenty-eight percent (“Ebola Virus Disease” 2018). Symptoms include fever,

sore throat, muscular pain, vomiting, diarrhea, and a rash. Ultimately, the kidneys and liver start

to dysfunction and people often begin to bleed both internally and externally. If patients do not

recover, death occurs six to sixteen days after symptoms appear, due to low blood pressure from

fluid loss. The virus is spread via contact with an infected person’s or animals’ bodily fluids. In

Sierra Leone, the R0 rate, or the basic reproduction number (the number of cases one case

generates on average over the course of its infectious period in an otherwise uninfected

population) (Fraser et al. 2009) was 1.492 (Khan et al. 2015).

EVD is a highly contagious disease, categorized as requiring Biosafety Level 4 handling.

A biosafety level is a set of biocontainment precautions required to isolate dangerous biological

agents. The levels of containment range from the lowest biosafety level 1 (BSL-1) to the highest

at level 4 (BSL-4), with Ebola requiring the highest level of biosafety procedures when handling

the virus in a lab. This designation is correlated with how infectious or damaging a biological

specimen is, highlighting the seriousness of EVD.

Clinical diagnosis of EVD in past outbreaks has been difficult due to its similarity to other

diseases, particularly malaria, which was endemic in every place Ebola had appeared previous to

13

2013. Diagnostics have developed significantly over the last 30 years with several niche academic

and other groups studying hemorrhagic fevers. Diagnostic tools were quickly adapted and used

during the 2013/16 outbreak. Treatment was solely supportive before this outbreak, but

experimental treatments and vaccines have since been developed and are being actively used in

the current (2018/19) outbreak in the Democratic Republic of the Congo (Hayden 2018).

Prior to the 2013/16 outbreak, there were 35 recorded outbreaks of EVD in Africa. The

virus first appeared in 1976 in two simultaneous outbreaks, one in Nzara, South Sudan, and the

other in Yambuku, Democratic Republic of Congo. Case fatality rates have varied from twenty-

five to ninety percent in past outbreaks. The 2013/16 outbreak in Sierra Leone, Guinea, and

Liberia had significantly more cases than any outbreaks in history, with 28,610 documented

cases, and 11,308 recorded deaths from the disease. Previous to this outbreak, the largest

documented outbreak was in Uganda in 2000, with 425 documented cases and 224 deaths

(“Ebola Virus Disease Fact Sheet” n.d.) The 2013/16 EVD epidemic was remarkably different than

prior outbreaks due to the number of cases, geographic spread, duration of the outbreak, and

international attention and the size of the response. The 2013/16 outbreak spread into the

“Global North” across national borders into highly populated urban centers for the first time in

history, with one case in Spain, one case in Italy, one case in the United Kingdom, and four cases

in the United States. The epidemic also spread to other places in West Africa, with one case in

Senegal, eight cases in Mali, and twenty cases in Nigeria.

2.3 Anthropology of Ebola

The recent Ebola outbreak set the stage for a new anthropological engagement with

global public health emergency response. At a United Nations All Staff Event I attended in

14

Freetown in November of 2015, shortly after the first declaration of the end of the epidemic in

Sierra Leone, anthropologists were listed in a long list of professions involved in the humanitarian

response and thanked for their work. The definite figure of how many anthropologists were

working in an applied capacity during the EVD epidemic of 2013/16 is unknown, but there was

significant engagement by anthropologists in the epidemic in what was likely the most

involvement by applied anthropologists in a public health response ever. Scholarship about Ebola

and the 2013/16 and current DRC outbreaks is still a growing body of work, both academic and

applied, that explores community history, knowledge, and experience of local West African

populations, as well as critique of the humanitarian response and the interface between that

response and culture. Concerns have included how failed development policies have limited the

ability of public health response, local reactions to the disease and the response, the role of trade

networks in the spread of Ebola, how cultural institutions and rituals like funerals and burials may

play a role in the spread or containment, local understandings of the ethics of vaccine trials, and

Ebola’s effects on reproductive health.

Anthropologists’ history of engagement in West Africa proved important to the epidemic.

Anthropologists who had done longstanding work in the region, nearly explicitly unrelated to

epidemics or EVD, were seen as a natural tool during the epidemic, in part due to the animosity

that occurred between locals and international aid workers. Internationals perceived

communities to be non-compliant to Western biomedical approaches to managing the epidemic,

and communities were, in some instance, resistant to responders. Anthropologists, as mediators,

as knowledge holders about local culture, and possessing methodological skills as listeners, were

seen as a logical group to engage in a high-risk epidemic. Prior to the recent epidemic,

15

anthropological engagement on the topic of Ebola was fairly limited. The most notable

anthropological work on Ebola prior to the 2013/16 outbreak was Ebola, Culture and Politics: The

Anthropology of an Emerging Disease (Hewlett and Hewlett 2007). The Hewletts were invited to

join an Ebola-focused medical intervention team, joining the World Health Organization (WHO)

in the Uganda EVD outbreak of 2000-2001. They were brought in to answer questions of social

resistance, such as why people were running away from ambulances, why people stopped

seeking treatment, and to understand if healers were amplifying the outbreak. Anthropologists

were similarly engaged during the West African EVD outbreak.

The WHO and other major responders during high-risk epidemics try to find a way

“around” or to “fix” what are seen as local and inflexible customs. During an EVD outbreak in

2000-2001, Hewlett and Hewlett are critical of the approach taken by the Western biomedical

international public health response. The Hewletts criticized mainstream international

responders, calling them “medical cowboys” and positing that responders think they are saving

the “third-world” from themselves. The Hewlett’s attempted to subvert this more conventional

top-down approach to epidemic control by creating and applying novel methods for dealing with

Ebola in the specific contexts it occurred in, specifically advocating for local perceptions to be

considered in the planning of Ebola responses. For adequate control of Ebola, the Hewlett’s

argued that there must be bidirectional trust between communities and internationals, flexibility,

and the space for multiple medical models within clinical biomedical settings.

Anthropologists were engaged similarly to the Hewlett’s, as cultural intermediaries,

during the more recent outbreak in 2013/16, but to a much greater magnitude than in any

previous acute epidemic. Exploration of local concerns and offers of potential solutions were

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discussed by anthropologists during the epidemic. In December 2014, I attended a panel

organized by Doug Henry, titled “Averting Chronically Acute Crises: Bringing Anthropology to and

from the Global Ebola Response” at the annual American Anthropological Association (AAA)

meeting in Washington, DC (Edmonds and McLean 2014) . Major names in Disaster and African

anthropology were present, such as Adia Benton (Brown University), Sharon Abramowitz

(University of Florida), Patricia Omidian (WHO LIBERIA), Mark Nichter (University of Arizona),

Julienne Anoko (WHO, UNICEF Guinea, Niger) and Fernanda Falero (MSF Spain). Preceding this

event, there was an Ebola Emergency Response Workshop co-sponsored by AAA and the

Wenner-Gren Foundation on November 6-7, 2014 led by Sharon Abramowitz. The U.S.

Department of Defense, the Centers for Disease Control and Prevention, the Carter Center, the

Open Society initiative, the World Bank, UNICEF, the Embassy of Sierra Leone,

and representatives from the U.N. Mission for Emergency Ebola Response (UNMEER) were

present. The two aforementioned meetings produced a guidance and recommendations

document titled Strengthening West African Health Care Systems to Stop Ebola: Anthropologists

Offer Insights, produced on November 18, 2014 (American Anthropological Association 2014).

This report details anthropological recommendations that consider local histories and culture,

covering topics of care of the sick, health communication, health and state systems, local and

national response, risk factors, food security, children, gender, age, attending to the dead,

surveillance, identification, diagnosis, quarantine, militarization, security, and military

coordination.

Other organized efforts by anthropologists during EVD outbreaks include The Ebola

Response Anthropology Network, a collective in which “anthropologists provide advice on how

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to engage with crucial socio-cultural and political dimensions of the Ebola outbreak and build

local-appropriate interventions” (About the Network | Ebola Reponse Anthroplogy Platform

2016). The online platform details diagnosing Ebola, management of the dead, caring for the sick,

clinical trials and research, preparedness, risk communication and community engagement. This

group provided applied work in the form of “rapid responses by e-mail, conference calls and web-

based dialogues to operational questions raised by those working for NGOs, government and

international agencies to contain the epidemic or care for those affected,” as well as

“develop(ing) policy briefings that are rooted in both the historical and rapidly changing

contemporary context of affected communities by drawing upon existing anthropological

expertise within our networks and undertaking targeted fieldwork” (“About the Network | Ebola

Response Anthropology Platform” 2016).

Some specific instances of engagement by applied anthropologists in the response was

the negotiation of burials between locals and public health responders. One anthropologist,

Julienne Anoko, worked for WHO, UNICEF, and UNMEER during the outbreak and has outlined

how Ebola Treatment Centers (ETCs) could circumvent social isolation by creating a welcoming

Ebola Care Unit (ECU) design that would enable families to participate in their loved ones care

(Julienne N Anoko, Epelboin, and Formenty 2014). In addition, Anoko wrote about working with

rebellious communities in the Guinean Forest (Julienne N Anoko 2014). Anoko and Henry (2019)

worked to advise on how to enable respectful burials and negotiate with locals for both

biomedical and local needs to be met (Anoko and Henry 2019). Richards (2016) and Anoko and

Henry (2019) both highlight the flexibility within local population traditions surrounding burial,

which were seen as inflexible local rituals by international responders. There was a call for locals

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to be part of intervention teams by nearly all anthropologists specifically discussing Ebola,

(Abramowitz 2014; American Anthropological Association 2014; Anoko and Henry 2019; Hewlett

and Hewlett 2007; Richards 2016a; ), as failure to achieve Western medical objectives of

epidemiological control in past outbreaks have been detailed at length in medical anthropology

literature. During Ebola outbreaks, anthropologists detail how international aid actors ignored

local or cultural understandings of EVD, and in its place, justified a routinized, top-down, non-

contextually localized, international response (Caremel, Faye, and Ouedraogo 2017). The cases

detailed here of anthropological involvement are a non-exhaustive snapshot of the work done

by anthropologists in the field, in a real-time applied capacity during the 2013/16 outbreak.

Hewlett and Hewlett (2007) systematically point out the shortcomings and failures of

clinical medical staff, epidemiologists, and public health educators that have good intentions but

often fail to realize that they are working under different cultural models than the communities

within which they usually work. Much of the anthropological work on advising how to prevent

transgressive or non-culturally salient situations and work towards mutual solution was ignored

by aid workers (Le Marcis 2015).

Within the humanitarian response, there was significant work done by internationals to

educate locals about the risk of Ebola and transmission, in hopes that this would lessen the

behaviors that led to infection. In response, anthropologists cited decades old research (Yoder

1997) to question the limits of improving people’s biomedical knowledge of Ebola via traditional

public health education campaigns, in which the stated goal was behavior change and lessening

disease transmission. Members of the Ebola Response Anthropology Platform published a piece

in the Lancet titled Ebola: Limitations of correcting misinformation calling for “all organisations

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involved in the response to the Ebola outbreak to question the assumption that biomedicine

must correct local logics and concerns, and the effectiveness of using standardised advice for

non-standardised situations.” (Chandler et al. 2015: 1276)

Scholars have detailed examples of when well-intentioned international public health

actors had less than their desired effect of controlling EVD. Hewlett and Hewlett (2007) describe

situations in the Ebola outbreaks pre-2008 in which failure to understand local concepts led to

reduced care and, in some cases, further spread of the disease. Similarly, James Fairhead (2016)

details how Ebola and its associated response disrupted social practices in the Forest Region of

Guinea causing “transgressive situations,” or situations in which international aid workers

perceived locals as being resistant to their help (Fairhead 2016a). Fairhead details local customs

of burial, political power, business and commerce, and occult activity and how these local beliefs

logically led to transgressions, or acts of violence against aid workers or a rejection of health

advice. These acts of violence can be understood as logical given cultural norms, even given that

the disease is highly contagious and of international public health concern. Ebola “disrupted…

precarious social accommodations that had hitherto enabled radically different and massively

unequal worlds to coexist” (Fairhead 2016: 7). Paul Richards’ central thesis about the 2013/16

epidemic in his book How A People’s Science Ended an Epidemic (2016) is that the international

humanitarian response may have actually extended the epidemics duration due to slowing the

natural or uninterrupted development of local, culturally salient, logical behavioral adaptation,

particularly with caring for the ill and burials towards the epidemiological control of the disease.

Like others, Richards critiques the top-down logic of humanitarianism in place of developing

novel strategies given the social context of the outbreak. West Africa was “represented as

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unknowable from the outside, nonsensical from within. Its forests… too deep to truly know the

terrors that lurk there. Its peoples’ practices are inscrutably archaic and irrational” (Moran and

Hoffman 2014a). Eventually, locals did join intervention teams via social mobilization campaigns

in an attempt to abate some of the trangressions, but not until late in the epidemic (Abramowitz

2017).

2.4 Anthropology and High Mortality Epidemics

Pre-2007 African Ebola international responses have been compared to other responses

to acute high-mortality epidemics and evolutionary behavior (Hewlett and Hewlett 2007).

Spanish flu and other historical epidemics shared many characteristics with the recent Ebola

outbreak, such as a lack of respect for mores relating to burial practices by international aid

workers, a lack of trust in government and public health officials, a lack of precise and reliable

information, and assigning blame to others (Markel 1999; Markel and Stern 2002; Markel 2005;

Hewlett and Hewlett 2007). The flight response, the desire for information, implementing

epidemic cultural models, cooperation (or lack thereof), lack of trust in government officials,

conflicts, stigmatization, and public media perception are all typical of highly contagious, high-

mortality epidemics (Hewlett and Hewlett 2007). Anthropologists have cited responses to

epidemics, including flight from the epicenter of an outbreak, implementation of extraordinary

therapies and preventive measures, blaming and scapegoating, resignation, ostracism of the ill,

regular therapy response after prolonged death, and ultimately flight, rejection, blame, or

despair. Cultural shifts from regular illness explanations to epidemic models are typical once

significant amounts of death are realized (Hewlett and Hewlett 2007).

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2.5 Fear, the Media, Securitization, and a State of Exception

Ebola is a hemorrhagic fever, during which intense bleeding from orifices sometimes

happens-- this bleeding and the magnitude of pandemic risk is often sensationalized and

overstated. Thomas Eric Duncan was a Liberian who traveled with the disease from Liberia to

Dallas and inadvertently transmitted the virus to two nurses. This event was of limited

epidemiological threat, with any sort of severe outbreak unlikely in Dallas or the United States.

However, news coverage perpetuated fear that there could be a catastrophic outbreak, with local

and national news stories running hourly about the local Dallas cases. Proportionately, there was

very little attention or news coverage about the West African outbreak. In response to the

handful of Dallas cases of Ebola, primary schools that were very distant from the site of the

Duncan case closed, fearing public gathering of students in school would be a risk to a possible

Dallas-based outbreak. A news article by the Washington Post titled “An Epidemic of Fear and

Anxiety Hits Americans Amid Ebola Outbreak” details this seemingly reactionary fear. This fear

contributed to airline stocks falling due to fears of travel and children meeting with psychologists

to manage their fears of deadly infection. Epidemiologists were playing the role of psychologist

to the masses, calming fears that they were most likely never going to be at risk for coming into

contact with EVD (Harlan 2014). Western media coverage and reactions to Ebola in the United

States was highly criticized by anthropologists as sensational and opportunistic, minimizing real

risk, and magnifying risk of those with little chance of being infected.

Another case of over-reactionary fear-motivated response to Ebola was evident in the

case of an abuse of the civil liberties of Kaci Hickox. Hickox was an American nurse who traveled

to Sierra Leone working for Médecins Sans Frontières to care for infected Ebola patients. Upon

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arrival back to the United States, an asymptomatic Hickox was questioned at the airport and her

fever taken multiple times with a forehead thermometer. Known to be unreliable, the

thermometer eventually gave a false-positive fever reading, and Hickox was detained per

mandate from New Jersey governor Chris Christie and put into quarantine, where she tested

sero-negative for Ebola, was still afebrile and asymptomatic. Upon her release, then governor of

Maine, Paul LaPage, on an antiscientific and fear-motivated basis, intervened to quarantine her

to her home (Miles 2015).

2.5.1 “Bushmeat” in the News

Wild game hunting and non-domesticated meat is incorporated into the diets of Sierra

Leoneans, especially in rural areas. The term bushmeat is a catchall term developed by

Westerners. There are semiotic differences between the terms “wild game” and “bushmeat”

worth highlighting. The term bushmeat has been discussed in the literature as being inherently

racist, portraying those who consume it as distant African others (Benton 2014; Seay and Dionne

2014). In August 2014, Newsweek ran a widely criticized article in an issue with a cover that

featured a chimpanzee on the cover with the words “A Back-Door Ebola: Smuggled Bushmeat

Could Spark a U.S. Epidemic.” The vast majority of non-domesticated meat consumed in West

Africa is not chimpanzee, and further, the outbreak is not thought to have anything to do with

chimpanzees. Bushmeat is sometimes called “bushbeef,” but often times just called simply what

animal it is bush or cane rat, grasscutter, red-backed duiker, fruit bat, wild boar, monkey, or

simply “beef.” These terms are used interchangeably in this thesis, referring to a specific animal

when possible. Spillover events are defined as a single event in which a pathogen moves from

one species to another, often causing outbreak. The initial zoonotic spillover event in the 2013/16

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epidemic is thought to be from a child who brought home a bat that was harboring EVD in

December 2013, to his family deep in the forest of Guinea in Meliandou (Saéz et al. 2015).

Jared Jones (2014) critiques the international and popular discourse surrounding

bushmeat as “culturalist epidemiology… [insinuates]… that Ebola is the result of African

ignorance and backwardness.” The discourse around bushmeat as a causal mechanism in EVD

transmission is not representative of the context of “structural forces, global, national, or local,

which have conditioned the emergence and spread of Ebola.” (Jones 2014). Further, Jones calls

the blame on bushmeat a techno-scientific discourse that is not firmly rooted in science:

The Bushmeat Hypothesis, which posits that hunting, slaughtering, and eating infected gorilla or monkey meat is the primary cause of the virus’s entrance to a new population, is among the dominant explanations for Ebola outbreaks, and typically these accounts attribute bushmeat consumption to African culture. Rural Africans sometimes eat these animals; this fact is reconfigured into near-certain proof of a causal mechanism. Academic studies deploy a techno-scientific discourse to mask this simple cultural logic in advancing the hypothesis. (Jones 2014)

Sierra Leone enforced a ban on eating bushmeat even though spillover events are considered

rare and are almost always isolated instances and animals do not play a significant role in

outbreaks once EVD starts to spread among humans (Food and Agriculture Organization of the

United Nations 2018; FAO 2015).

Richards (2016) critiqued how prevalent messages were about avoiding consuming

bushmeat, compared to how few messages there were about more salient forms of epidemic

control, such as avoiding contact with sick individuals. There was a dissonance between how

prevalent public health messaging was about avoiding bushmeat consumption and how relevant

it was to epidemic control (Bonwitt et al. 2018). Recently, Bonwitt et al. published work (2018)

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that studied community perceptions of bushmeat messaging in Southern (Bo) and Eastern

(Kenema), Sierra Leone and came to conclusions similar to mine:

the ban on wild meat ran the risk of eroding public confidence in the response efforts and fueling rumors as to the cause of EVD. At the very least, the ‘bushmeat’ ban negatively impacted livelihoods, placing additional and unnecessary stress on communities. (Bonwitt et al. 2018)

2.5.2 Impacts on International Travel

Motivated by the fear of a global Ebola pandemic, during the height of the epidemic

airlines around the world cancelled a large majority of flights into Sierra Leone, Guinea, and

Liberia, against advice from WHO and other international experts. At one point, a medical

delegation from the United States was nearly blocked from flying into Liberia. Some countries

adopted national policies of closing their borders completely, sometimes blocking the refueling

of planes, in response to the perceived risk of an EVD import in the absence of any WHO public

health advice (York 2014). Ultimately, medical efforts, including the provision of medical supplies,

fuel, and food were disrupted by these flight cancellations. An analysis using airline

transportation network data compared entry and exit screening for EVD assessing for relative

inefficiency compared to risk of EVD spread, and found that exit screening in affected countries

would be more beneficial (Bogoch et al. 2015), yet this is not what was represented in

international flight closures.

The 2013/16 oubreak is an excellent illustration of how misconceptions, often introduced

by the media, can directly affect economies on a large scale and, through the domino effect,

cause issues on smaller scales. For example, during this outbreak, for the first time in history,

international humanitarian workers, including frontline healthcare providers, were not

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guaranteed a medical evacuation (“medivac”) if they became ill. Air crews were unwilling to

transport potential EVD patients, nations were unwilling to allow planes in airspace, and there

were technical issues with post evacuation plane decontamination, all largely motivated by fear.

As such, it was necessary to inform international staff before departure to the region that “there

was no certitude of medical evacuation… there was no 100% guarantee.”” (Miller 2017:243).

Ultimately, the lack of political will and failure of cooperation among international actors in the

European Union to resolve the evacuation issue reflected a fear of political backlash from

constituent populations and led to infighting and a deferral of responsibility (Mclean 2017).

2.5.3 A Breakdown of the Logic of Control of Movement

The Ebola epidemic was framed as a humanitarian crisis, a public health emergency, and

a threat to regional stability (“With Spread of Ebola Outpacing Response, Security Council Adopts

Resolution 2177 (2014) Urging Immediate Action, End to Isolation of Affected States | Meetings

Coverage and Press Releases” 2014). The fear of an Ebola pandemic, often overstated and over

reactionary, was rampant, but does fall in line with epidemiological logic and fear about

contagion, represented in books like Richard Preston’s 1994 non-fiction thriller “The Hot Zone: A

Terrifying True Story” (Preston 1994). In the recent epidemic, quarantines were considered the

only viable public health option for containment of this fear-mongering virus. Since the West

African outbreak, a vaccine was successfully developed and mass deployed in the current

(2018/19) outbreak in the Democratic Republic of the Congo (Hayden 2018).

The aforementioned vignettes highlight how the logic of quarantine was abused. The

system acted illogically, ultimately hampering efforts towards halting secondary infections by

creating rebellious communities. The actions of the news, international air transport agencies,

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air transport contractors, governors, and military personnel were motivated by fear and a need

to implement as much epidemiological control as possible.

The EVD epidemic has been discussed in terms of securitization, or how issues become

understood intersubjectively as threats and matters of security (Balzacq 2010) both to national

and international actors (Allcock 2016; Schroven 2017; Benton 2017a). The theory of

securitization highlights how issues that get “securitized,” or constructed as threats to security

(Waever 1995), receive a disproportionate amount of attention and resources due to motivations

of international security. Ultimately, this securitization can cause more human damage than

protection. The governments of Liberia and Sierra Leone consistently portrayed Ebola to both

national and international audiences as a threat to the international community and as a threat

to the collapse of their own states (Allcock 2016). Adia Benton explores Médecins Sans

Frontières use of the military during the recent outbreak in her chapter “Whose Security?:

Militarization and Securitization During West Africa’s Ebola Outbreak,” arguing that the military’s

medical capacity could not be separated from its use of force and coercion to achieve its zero-

casualty goal (Benton 2017b). Benton asks whose security was prioritized and what dangers the

military was protecting them from:

The conscious coupling of military and humanitarian approaches demands that we ask whose lives are amenable for protection and rescue through the threat of force, which people may demand obedience from Ebola-affected communities, and on whose terms these demands can be made. (Benton 2017a: 31)

Ultimately, Benton argues that public health prioritizes securitization through its health security

approach over humanity.

Public health measures during any outbreak tend to be coercive because they often require that people prioritize community protection in relation to public health messages over conflicting community priorities and individual concerns. (Benton 2017a: 31)

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One of the clearest incidences of securitization in the epidemic was in August 2014, in the

midst of the outbreak, when soldiers and police officers in riot gear cordoned off West Point,

Monrovia, Liberia, an extremely poor, densely populated slum in an attempt to control the

disease. This quarantine ended in clashes with security forces, leaving many civilians wounded

and one dead from a gunshot wound (Onishi 2014). Danny Hoffman (2017) explores the role of

the military as “armed first responders” in humanitarian intervention, using the outbreak for

analysis. A shift towards increasingly militaristic approaches of “armed social work” and

counterinsurgency against social problems was evidenced during the Ebola outbreak by the

military response in Liberia and by the United States military partnership more broadly in West

Africa. Hoffman (2017) considers the events of local military intervention with international

support a reflection of how Washington thinks: “African partners should… solve their own

problems” with more narrow and militaristic approaches (Hoffman 2017).

Similarly critiquing a use of coercion to demand local populations obey public health

protocols in the interest of public health and international security, Paul Farmer states “an

approach which puts physicians and public health personnel in the position of border guards

undermines the kind of solidarity and mutual support required to bringing an epidemic under

control” (Farmer 2001).

Mark Honigsbaum (2017) argues that Ebola used to be seen as a problem for global health

security, but in the years leading up to the West African outbreak, had been dismissed as a threat,

therefore having a “fluctuating medical identity” between “securitization and neglect.” As such,

the outbreak was a “missed alarm” and was a consequence of WHO’s reactionary pandemic

preparedness systems that only rationalize securitization to the emergence of new disease

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threats. WHO has been critiqued for failing to respond until MSF sounded alarms that the disease

was “totally out of…control”. (Honigsbaum 2017)

Similar to securitization, legal scholarship explores the concept of “the State of

Exception,” first by Carl Schmitt and then refined primarily by the political philosopher Giorgio

Agamben in his book aptly titled State of Exception (2005). Agamben’s central thesis was that a

government’s power increases during a state of emergency via the suspension of laws to respond

to some threat, rendering “the political body...(to) become a criminal body" (Agamben 2005).

This analysis has been primarily applied to war, in particular 9/11, rather than public health

emergencies. The 2013/16 EVD epidemic was declared a public health emergency by the WHO

in March 2014 and in the first International Health Regulations (IHR) Emergency Committee

meeting, WHO called for heads of state of the affected countries to declare national emergencies.

Ultimately, Sierra Leone, Liberia, Guinea, and Nigeria did all declare states of emergency. To date,

there has been no analysis of the EVD epidemic specifically utilizing the theory of a “State of

Exception.” In the book chapter “The “Humanitarian” Response to the Ebola Epidemic in Guinea:

Between Routines and Exceptions,” Jean-Francois Caremel et al. (2017) question the

exceptionality of the outbreak, stating that while the epidemic was an exception in some ways

(number of cases and deaths, size of area affected, fear caused, delay in response, size of

proceeding response, methods used in the response, and the disease’s visibility in the media),

the international response actors, NGOs and multilaterals, used exception as an “essential

framework of interpretation.” Ultimately, the epidemic resulted in major trust issues with

communities and international institutions (Caremel, Faye, and Ouedraogo 2017).

the “exceptional” nature of the epidemic resulted in major mistrust by international players regarding local “state” capacity and led to rationalies and to structure the

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response with routines and aid bureaucratization, that were not remotely exceptional. Exceptionality also led to mistrust among international players in how to manage “evil” (Ebola) whose etiology and causality were disputed. (Caremel, Faye, and Ouedraogo 2017: 62)

Arguably, how internationals in public health thought about the risk of the epidemic was

constructed on two logics: one of biosafety and one of humanitarian objectives.

2.6 Anthropology of Development

The anthropology of development is a vast body of work that challenges the fundamental

assumptions of the concept of “development” that posit that humanitarian intervention is good

at all cost. Seminal works include Arturo Escobar’s 1995 poststructuralist book Encountering

Development: The Making and Unmaking of the Third World, which argues that international

development is ultimately exploitative, as it is a way for the global North to maintain control over

the resources of former colonies. Fundamentally, Escobar (1995) asserts that development

creates the problems it claims to be aiding. Scott (1998) highlights governments use of

authoritarian state power to enact large-scale interventions, including those in the interests of

public health, in ways that disregard “practical knowledge, informal processes, and improvisation

in the face of unpredictability” (Scott 1998: 6). Similarly, pointing to the consistent failure of

humanitarian agencies to bring about economic stability, James Ferguson (1994) critiques the

concept of development, utilizing a case study of the implementation of a large development

project in Lesotho which ignored political realities of people while strengthening the state. Mary

Moran and Daniel Hoffman (2014) attribute the severity of the outbreak in countries like Sierra

Leone to the lack of developed governmental healthcare structures post-war. “The role of

multiple and diverse external humanitarian organizations in managing health care in the post-

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war period, effectively removes more centralized local governments from the responsibility of

monitoring and coordinating a single health care policy,” which is a result of centralizing efforts

of development. (Moran and Hoffman 2014).

Similarly, anthropologists have explored how the International Monetary Fund’s (IMF)

structural adjustment programs have affected public health in the global South. The IMF is an

international agency that plays a large role in the management of debts of countries. In turn for

loans received by the IMF, country governments are required to agree to particular and general

conditionalities, which started with Structural Adjustment Policies (SAPs) in the 1980s. In Sierra

Leone, the IMF has been active for around two decades, providing loans to the country. There

has been a wealth of analysis about how these have historically obstructed investment into public

sector services, in return for prioritizing debt and interest repayments by recipient countries to

the IMF and the World Bank (Biney 2009; Cunningham and Rau 1999; Danaher 1994; Pfeiffer and

Chapman 2015; Sadasivam 1997; Schoepf 2001; W. Bello, Payer 1982, 1974; W. Bello 2008; Yapp

2014). A review of the work anthropologists have done towards “an Anthropology of Structural

Adjustment and Public Health” covers the work from dozens of anthropologists demonstrating

the impacts on local contexts of IMF and SAPs market fundamentalism (Pfeiffer and Chapman

2010).

Robinson and Pfeiffer (2015) explore the role of the IMF in creating the Ebola epidemic

via financial austerity, positing that conditionalities have effectively prevented Sierra Leone from

developing its public health system. Prior to the epidemic, Sierra Leone had 136 doctors for its

approximately six million persons population yet was directed by IMF to cap wages for physicians

and other healthcare workers to meet broader policy directives. IMF mandated policies in Sierra

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Leone to reduce public sector employment and place a limit on public sector wages as a whole.

Kentikelenis et al (2015) note that in Sierra Leone:

Between 1995 and 1996, the IMF required the retrenchment of 28% of government employees, and limits on wage spending continued into the 2000s. By 2004, the country spent about 1·2% of GDP less on civil service wages than the sub-Saharan African mean. At the same time, figures supplied to WHO reported a reduction of community health workers from 0·11 per 1000 population in 2004 to 0·02 in 2008. In 2010, as the country launched its Free Health Care Initiative, IMF staff “stressed the need to carefully assess the fiscal implications” and favoured “a more gradual approach to the [associated] salary increase in the health sector. (Kentikelenis et al. 2015) Robinson and Pfeiffer describe how the conditionalities in West Africa, put in place by the

IMF, led to a weak public health system, which allowed for the Ebola outbreak; one that was

uncontrolled, messy, and lacked the capacity for national public health infrastructure to

adequately contain the outbreak:

The problem is, the IMF requires cuts to the same public systems that could respond to a health crisis before it sweeps across the country. When countries sacrifice budget allocations to meet macroeconomic policy prescriptions, as per the IMF’s decree, it is at the expense of social spending. Without money to fund basic infrastructure, health facilities are left crumbling, sometimes without access to water or electricity, and completely unprepared for complex emergencies. Few health workers are trained in infectious disease control, and those that have received training lack protective equipment and materials due to non-functioning supply systems. It is no wonder that when a truly serious epidemic such as Ebola entered the scene, the West African countries, which have had to deal with IMF conditions for decades, found themselves struggling to respond… IMF conditionalities must end, debt cancelled, and health systems built – no strings attached. (Robinson and Pfeiffer 2015)

2.7 Disaster Anthropology

Disasters work well as an anthropological site of study due to “disasters provid(ing) a

moment of inquiry in which this process of adaptation to an environment is both manifested and

tested in an immediately observable way” (Oliver-Smith and Hoffman 2002: 7). Similarly to the

anthropology of development, disaster anthropology recognizes that all disasters both influence

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and are products of human systems, rather than by products of spontaneous, natural events

(Henry 2005). At a basic level, disasters are created by two factors: human populations and a

potentially destructive agent that is part of a total ecological system (A Oliver-Smith and Hoffman

2002).

Seminal scholarship in disaster anthropology include Oliver-Smith’s 1996

“Anthropological Research on Hazards and Disasters,” the 1999 edited volume The Angry Earth:

Disaster in Anthropological Perspective, the 2010 edited volume Contemporary States of

Emergency: The Politics of Military and Humanitarian Interventions, and the 2002 edited volume

Culture and Catastrophe (Anthony Oliver-Smith 1996; Anthony Oliver-Smith and Hoffman 1999;

Fassin and Pandolfi 2010; A Oliver-Smith and Hoffman 2002). These works explore the various

interconnections between physical and social structure through the exploration of how risk,

vulnerability, and disasters are disproportionately experienced, the social and political factors in

which disaster occur in, the long-term impact of disasters on culture and society, and the logic of

intervention and aid in disaster. Particular attention is paid by disaster anthropologists to

weather events and war, rather than epidemics. However, given that their analysis includes the

“unexpected” nature of the events, work by disaster anthropologists can easily be applied to

recent Ebola outbreaks. Significant anthropological work has been done on pre-disaster risk and

vulnerability (see Henry 2005 for review), however, this review will focus on the anthropology of

disaster response.

While all “disasters” and epidemics that were deemed “emergencies” have a biological or

natural cause, anthropologists explore how the outcomes of disasters are disproportionate in

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certain populations and contexts. With specific reference to the recent Ebola outbreak, Mike

McGovern (2014) simply states, “out-of-control Ebola is a thoroughly human-caused disaster.”

Anthropologists have ethnographically detailed local coping or adaptive strategies to

disaster that were hampered or interfered with by international aid agencies (Torry 1978a,

1978b, 1986; Tobin and Whiteford 2002). Richards (2016) illustrated that locals were relatively

quick at adapting to managing Ebola, demonstrating a flexibility of local customs when an

unexpected epidemic with a high mortality rate occurred.

Within discussion of power in relief and responses, anthropologists have criticized the

external management of disasters as being “non-participatory or for failing to recognize and

affirm local institutions or skills with which communities might be involved in the management

of their own disasters” (Henry 2005: 12). Henry (2005) in his review of anthropology of disasters

points to Malkki, in her work with Rwandan refugees in the Congo (1996), noting that

“humanitarian knowledge is discursively powerful, and may operate to silence local agendas that

run contrary to its own, leading to political consequences” (Malkki 1996).

2.8 The Anthropology of Humanitarian Intervention

Alex De Waal has concluded that there is “no such thing as humanitarian intervention” as

is the title of his 2007 essay on Harvard International Review, citing that any principle for

intervention has the potential to be abused (De Waal 2007). Alex De Waal’s book Famine Crimes:

Politics and the Disaster Relief Industry in Africa (1997) asserts that famine is actually the

outcome of the failures of western donors and international relief agencies, not a result of the

common narrative of ecological degradation or due to an economic failure of a region (De Waal

1997). As the presence of United Nations agencies and international NGOs grows in the Global

34

South, the opportunity for local solutions diminish. In his book Indigenous Agricultural Revolution

(1985), Richards focused on Sierra Leonean agriculture and warns against glib generalization of

agricultural or environmental issues that were “apparent in journalistic accounts of African

famine” (p. 13). Richards calls for an ecological particularism via a local, ecological responses to

famine, similar to his call for a people’s science during Ebola outbreaks (Richards 1985: 12,

2016a).

International relief specific to agriculture often focuses on ecological solutions, that are

often large scale engineered solutions that have adverse effects on ecology (Shaw 1989). Large

scale solutions and a top down approach are often seen as necessary in agriculture

humanitarianism, without taking into account the effect on small scale societies, or those that

bear the brunt of emergency events.

Some argue that international aid responses that are ineffective in supporting local

structures or building capacity can be countered by work that targets the structural forces of

vulnerability. Pathologies of Power: Health, Human Rights, and the New War on the Poor (2004),

by Paul Farmer, is a dedicated theory to why international aid and charity is not enough to fix the

inequality experienced by the poor in terms of health equity. In replacement of the typical model

of aid, Farmer dedicates his life and writing to strengthening health care systems through

partnership with his organization, Partners in Health, which was central to the response and EVD

recovery, particularly in Sierra Leone.

2.9 Traditional Ecological/Local Knowledge, Resilience, and Value Chains

Local or traditional ecological knowledge is defined as “any knowledge held collectively

by a population, informing interpretation of the world” and is “conditioned by socio-cultural

35

tradition” (Sillitoe 1998: 204). Traditional knowledge is known locally, is general and holistic,

based on observational learning, and cannot transcend time and place. Resource utilization in

traditional systems is dependent on local resources, requires low input, is land extensive, and

labor demanding. Those who work in these systems possess diverse adaptive strategies.

Traditional systems have little outputs compared to labor inputs, and these outputs are culturally

compatible, usually have subsistence goals, a low potential for degradation, and are sustainable

for low population densities. The value of these indigenous knowledge systems, and the

downfall, is that they are local (DeWalt 1994: 124). Through the Smallholder Commercialization

Programme by FAO, the farmers in KWVC were moving away from subsistence farming, yet still

largely operated in a traditional system.

Co-management of land by local communities and scientists or those who do not have as

deep an experiential knowledge of land is preferred. This co-management of the land involved

leaving local communities in control, such as the FBOs, and left their traditional strategies intact,

while more “modern” actors (FAO and MAFFS) assisted the locals with some aspects where

modern biology is useful (Anderson 2007). This was the approach that FAO utilized with the

Koinadugu Women’s Vegetable Farmers Cooperative.

Traditional management and modern systems should be integrated, but Anderson (2007)

warns to carefully consider the inclusion of bureaucracies that can “co-opt or subvert almost

anything” into traditional farming systems (Anderson 2007). Local experimental knowledge and

rationalized bureaucratic knowledge must be complimented for a sustainable approach to

agriculture with co-management that is ongoing and flexible, not frozen in a way that sets

farmers up for failure. (Anderson 2007)

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Dewalt argues that agricultural science or traditional knowledge systems should not be

independently relied on, but rather advises to “take advantage of the creativity and

innovativeness of both groups” (Dewalt 1994: 127). Both agricultural science and traditional

knowledge systems in farming are constrained on their own; however, these knowledge systems

can complement each other by informing and stimulating the other. Scientific systems can

broaden base understanding and provide options; thus, farmers must come first, and then

participatory development perspectives that are iterative can be developed (DeWalt 1994:127).

Risk averse, flexible adaptive strategies are needed within farming. Generating synergy between

these two views, perhaps the aim should be “equitable negotiation” in participatory research,

since conflict is inherent in a negotiation process between the two knowledge systems (Sillitoe

1998:206). Grounded knowledge and situating experiences in relation to others is a participatory

method that is necessary in developing policy surrounding issues pertaining, but not limited to,

agriculture (Ashwood, Harden, and Bell 2014).

2.10 Definitions of Concepts: Value Chains and “Resilience”

Value-chains are a set of linked activities that work to add value to a product and provide

all resources needed to produce and move agricultural products from a farm to a final customer,

including flows of products, knowledge, finances, and social capital (Norton 2014). “Traditional”

value chains are generally governed through spot market transactions involving a large number

of small retailers and producers (Bolzani et al. 2005). KWVC would be considered a traditional

market, given a lack of centralized production or end markets. FAO advocated for the “inter-

institutional coordination and collaboration on policy development, legislation and

implementation…from the ministry to the district level, to create the enabling environment for

37

sustainable agribusiness and food value chains,” in effect working towards the autonomy of small

shareholder farmers in their commercialization (Galvez Nogales 2015).

Figure 1: Agricultural Value Chain Resilience (Vroegindewey and Hodbod 2018)

The idea of community resilience has gained much attention in the social sciences, and in

particular, by disaster scholars. To define resilience, I rely on Roberto Barrios’ (2014, 2016) review

of the terms use. Multiple definitions exist. Resilience has been defined as “the qualities or

characteristics that allow a community to survive following a collective trauma” (Sherrieb, Norris,

and Galea 2010), the adaptive capacity of communities to evolve alongside social and

environmental changes (Robards and Alessa 2004), “the ability to survive and cope with a disaster

with minimum impact and damage” (Cutter et al. 2008), “a system’s capacity to continue

providing a desired set of services during shocks to a system and adapt to ongoing to change”

(Biggs, Schluter, and Schoon 2015), and “the capacity of a system, community, or society to adapt

to hazards by resisting or changing in order to reach and maintain an acceptable level of

functioning and structure” (International Strategy for Disaster Reduction 2005). Agricultural

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value chains, specifically, have been thought to have qualities of resilience, noted to be “essential

to food system outcomes in developing countries because stable value chains are key for

employment and income growth” (Vroegindewey and Hodbod 2018), as well as diverse and

nutritious food availability (Tendall et al. 2015). See Figure 1 for an illustration of the

conceptualization of agricultural value chain resilience.

From the perspective of anthropology, Barrios (2014, 2016) has critiqued the utilization

of resilience frameworks. Resilience definitions do not originate in anthropology and thus, have

multiple underlying assumptions about social systems. First, communities are not stable or

unchanging and therefore definitions of resilience that privilege a return to a “preshock” state

ignore that communities are not static objects that can “return to a state of equilibrium” (Barrios

2016). Barrios (2016) highlights the work anthropologists have done to highlight that disasters

have changed communities, particularly through novel relationships formed with communities

by outsiders, like non-governmental organizations, activists, and governmental actors that

produce differential recovery outcomes. Second, Barrios (2016) notes that the concept of

resilience is an “antipolitics machine,” due to concepts of resilience depoliticizing disasters, which

at their core are political, as social scientists have come to understand disasters as socially and

politically produced through colonial and development processes (Hsu, Howitt, and Miller 2015;

Anthony Oliver-Smith 1999). Barrios asks, “if resilience is indeed about the capacity of a system

(social or ecological) to recover, then are we ignoring that the reason a disaster occurred because

such a system made it?” (Barrios 2016: 32).

Some resilience scholars have moved beyond resilience as a return to pre-disaster states,

in favor for a definition of resilience that considers the capacity for adaptation and flexibility.

39

With this definition, Barrios (2016: 22) questions “what are we to build resilience to?,” calling for

success measures to be determined by polyvocal, local knowledge and voices “of people who

directly bear the brunt of disasters” (Barrios: 35). In terms of disaster recovery, Barrios notes,

Relatedly, their recovery process is often hindered not through a lack of resilience on their part, but through the creation of bureaucratic obstacles, disaster capitalisms, and reconstruction initiatives that are not of their design. Ethnographic work reveals that the voices of disaster survivors provide informative critical insights into the bureaucratic, technocratic, and institutional practices that engender disaster and complicate an affected community’s ability to recover, making them an indispensable element of effective policy making. (Barrios 2016: 35-36)

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CHAPTER 3

METHODS

3.1 Evaluation

Since there is a strong pressure from bureaucracies to improve and prove effectiveness

and appropriateness of interventions or policy, measures of evaluation are needed. However, in

most evaluations, there is a tendency to universalize and decontextualize indicators. These

often-quantitative indicators do not consider rationales in local situations of history, cultural

beliefs, or politics. Culturally relevant indicators of sustainability and quality of life have the

potential to shape agricultural development. These indicators should be ones that local people

can identify with and benefit from in the short and long-term and need to be developed in ways

that consider the environment and culture they will be used in (Nazarea et al. 1998). An

evaluation should be developed from a local population’s internally defined standards, which are

often “qualitative, non-monetary, non-material, and long-term” (Nazarea et al. 1998: 160).

Resource management, including aid, should be fine-tuned to local perceptions of what makes

life, society, and the environment worthwhile to a local population. Oral histories and traditional

ethnography are ways to elicit successful, contextualized, models for assessing sustainability. I

particularly use this engaged inquiry to investigate and understand food and seed management

during the Ebola outbreak/crisis/emergence.

Rapid Assessment Procedures (RAP) or Rapid Ethnographic Assessment is an

ethnographic method for “quickly gathering social, cultural, and behavioral information relevant

to” specific agricultural or health programs (Kari et al. 1997: 375). RAP was developed to address

issues with historic anthropological methods, such as the amount of time it takes to do full

41

ethnographic research. Historically, this became particularly important in emerging crises such

as those involving HIV/AIDS, refugees, disease outbreaks, disasters, and the need for responding

to rapidly emerging health problems. While RAP is different than traditional ethnography, largely

due its degree of higher focus from the outset, it does share an emphasis with ethnography on

understanding local beliefs and cultural perspectives that are needed for an effective applied

intervention (Kari et al. 1997). Given that this work only spanned a few months and was done

within the context of the Ebola outbreak, this research utilized the framework of RAP.

It was hoped that the methods used in this project can counter universalized metrics of

success and gather the real stories and lived experiences of some food producers of Sierra Leone.

Ultimately, this approach is based on engaged and community-based methodologies and stresses

collaboration between aid agencies and local peoples for the sharing of knowledge and

strategies. Drawing heavily on theories of politically engaged research, this project hopes to

explore the activist dimension of research, considering a method of conversing with groups of

people in their struggle (Hale 2006: 97).

3.2 Study Site

This study focuses on the Koinadugu region in the Northeastern part of Sierra Leone (see

Figure 2). For some time, Koinadugu was the only district without any Ebola cases. The lack of

EVD infections was assumed to be, in part, due to the district’s Paramount Chief Ali Balansama

Marrah closing the borders and enforcing strict restrictions on movement of people and goods

in and out of the district’s borders, as well as the low population density of the region. As

mentioned, this district only recorded 142 total cases of Ebola, considerably fewer than other

districts and, and reached zero cases in April 2015; thus, it had been Ebola-free for over five times

42

the incubation period of Ebola (21 days) upon my arrival. High regulation within Koinadugu

coupled with a low EVD incidence made it easier to parse real versus perceived risks. However,

it was impossible to know how Ebola would have impacted the region without such restrictions,

so I sought to understand how the regulations on movement and thus trade impacted the

everyday lives and livelihoods of people living within Koinadugu’s borders. Koinadugu was also

selected as a site of inquiry to understand the food market because of the high degree of non-

subsistence, market-driven farming.

Figure 2: Map of Study Site, Districts

3.3 Preliminary Investigation

Before going to Sierra Leone, I spent approximately twelve weeks language training to

learn Krio, the lingua franca of Sierra Leone. Additionally, I spent time reading the available

reports and news on Ebola for the 6 months prior to entering the field in order to situate my

research questions. The work NGOs and multilaterals do is often produced in technical reports

not always released publicly, so at times it was difficult to gain the scope of work within

43

agricultural markets during Ebola time before my arrival.

3.4 Data Collection Methods

The primary data used in this document were collected over the course of three months,

from November 2015 to January 2016, in villages across Koinadugu. My data collection was

focused on several groups that all had stake, participation, or an active decision-making role

within a) the agricultural supply chain or b) Ebola regulations.

My primary data included participant observation, ethnography, and focused group

interviews with the leadership and, when available, members of the Koinadugu Women’s

Cooperative Vegetable Farmers in 15 villages across Koinadugu. Koinadugu Women’s Vegetable

Farmers Cooperative (KWVC) is a cooperative of 30 groups with 25 members each, totaling 750

members. I also met with approximately fifteen women on multiple occasions at their farming

cooperative “headquarters” in Kabala to observe monthly meetings and engaged in regular work

on their farm. I had access to their recordkeeping books as well, which were used as a source of

data and for triangulation.

Additionally, I interviewed three butchers in the daily downtown Kabala market to

understand availability and price trends of meat during the epidemic. These men, all of Fula

ethnicity, were part of a value chain of cattle that was near the border of Guinea, about a four or

more-hour bike ride on a rough road. In addition to interviews with the butchers, I spent two

field days in a cattle market during market day, talking to drovers (those that drive cattle), cattle

dealers in a border market North of Dembelia-Sinkunia, cattle corral owners, and various men,

including traders, buyers, and men who run the market. Some communities did not believe Ebola

actually existed, sometimes referred to as Ebola denialism. This was particularly prevalent in

44

Guinea and one of my goals was to find out if this was the case in families that dealt in the cattle

market with cross Sierra-Leone/Guinea border relationships, as this market commonly attracts

cattle warehs from Guinea.

Wild game hunters were largely inaccessible to me after much effort, and I failed to ever

see bushmeat in a regular or periodic (luma) market. I talked extensively with “big men” in certain

villages about the state of bushmeat hunting before, during, and after “Ebola-time.” However,

reliance on this data is minimal. I also met with the “big men” and “big women” (chiefs, town

chiefs, section chiefs, mommy queens, youth leaders, etc.) in many villages when possible to

understand how quarantines were implemented in each village and what their relationship was

to District and National Ebola response and quarantining efforts. Data was collected by asking

anyone in a decision-making position within each village to join a conversation and then

conducting an impromptu f focused group interview. I visited most of these villages multiple

times to continue to build rapport, as well as to gain more insight towards a cohesive narrative

of the region.

I conducted one focused group interview (n = two) with the driver’s union in Kabala, who

was regularly hired by the women in these groups to transport their produce to markets in the

capital, Freetown. I also had one focused group interview (n = five) with the trader’s union of

downtown market in Kabala, Koinadugu. One of my key informants, and ultimate research

assistant, was the secretary, who helped out in various ways with KWVC and held a position at

the Ministry of Agriculture, Forestry, and Food Security (MAFFS). His position there granted me

access. I conducted two focus groups (N= ~ten in each focus group) with staff at the Koinadugu

MAFFS office.

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Additionally, interviews were conducted with the leader and head physician and other

leadership of the District Ebola Response Center (DERC), who made many decisions about the

KWVC member’s access to the Freetown market. Lastly, I conducted two interviews with the

police chief of Kabala who worked with DERC on enforcing restrictions.

Other secondary data I accessed included data on Ebola cases, FAO reports, and

conversations with FAO staff. A complete national Ebola registry, which included the name and

date of EVD cases and their associated contacts, was obtained and used to help me understand

where and when the epidemiological threat was and to analyze real versus perceived risk. I had

access to many FAO reports on their own operations, interactions, and activities. These

documents, along with conversations in the HQ office, helped me understand FAO’s response to

and understanding of KWVC.

3.5 Data Analysis

This work assessed two value chains: vegetable farming and beef, including wild game,

goat, and cattle markets using the above data. Interview transcripts were analyzed using a

grounded theory approach, in which text data were analyzed for themes and themes and then

were conceptually related in a theoretical model that were “grounded” in the data (Glaser and

Strauss 2000; Bernard 2006). All field notes and experiential data were synthesized and

triangulated to produce a narrative style ethnography.

3.6 Limitations

There are several limitations to this work. Primarily, I was not in-country during the peak

of epidemic and thus am limited in offering a true ethnographic narrative of what happened

46

based on observation. My data is primarily retrospective narrative from the community in and

around Kabala. While this does highlight issues of importance to the community, as is a major

role of anthropology, it fails to precisely triangulate these voices with concrete timelines of

epidemiologically motivated quarantines and restrictions on every day gathering and movement.

As Oliver Smith and Susanna Hoffman note:

Just as the spatial dimensions of some disaster’s present challenges to anthropological research, temporal dimensions can prove equally problematic. Disaster rarely conform to personal, academic, or funding agency schedules. Most anthropological research is planned out considerably ahead of actual entry in the field. Proposal preparation and review is a lengthy process, typically locked into a schedule of deadlines that is not responsive to such contingencies as a disaster. (A Oliver-Smith and Hoffman 2002: 13)

Given that I had to obtain special permissions from two universities to enter the field, obtain IRB

approval, as well as make personal, travel, and funding arrangements, I was not there at the peak

of the epidemic. However, the effects from the epidemic were still being felt by communities

while I was in the field. The perspective from one year later in an agricultural cycle potentially led

to greater validity due to the longitudinal perspective.

Secondarily, while I did language train before arriving in Sierra Leone, I never became fully

fluent in Krio. While I was able to converse in most high-level conversations on my own, I did

utilize a research assistant who is a native Sierra Leonean that had significant rapport within the

community I was working in, due to his position of working at MAFFS and directly for one of the

groups within KWVC. He often acted as my entrée into communities, as well as my translator.

However, I was working primarily with women farming groups and some depth of detail was

likely lost by having a male present during my interviewing and ethnographic inquiry. I am also

sure that some detail and cultural nuance was lost in translation.

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Lastly, the scope of this work is limited. This is a limited narrative of one region in Sierra

Leone during an epidemic that spanned three countries. After this research was completed, FAO

produced a larger report from their headquarters in Rome that reflected the impact of the

epidemic on agricultural value chains in all three countries for many different crops and value

chains. I came to many of the same conclusions in a general sense as that report but seek to

differentiate my work from theirs in two ways: 1) the locality of this work and ability to detail

more context and 2) situating these events in the broader context of anthropological work.

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CHAPTER 4

RESULTS

This work assessed the impact of Ebola on two value chains: vegetable farming and beef,

both wild game and goat/cattle markets. The forthcoming results of this research are organized

to highlight the “normal” operations of vegetable farming within the KWVC, the impact of Ebola

quarantines on movement generally, the impact that Ebola quarantines had on KWVC

operations, and the adaptive strategies the group used. Similarly, beef value-chains will be

explored, first in discussing a cattle value chain in “normal times,” describing the impact of Ebola

quarantines on those operations, and the adaptive strategies of participants of the value chain.

I conclude this section with a short discussion of the impact of Ebola on “bushbeef” markets,

which (as mentioned earlier) became a topic of much concern in the international media.

4.1 The Koinadugu Women’s Vegetable Farmers Cooperative

KWVC operated as 30 distinct farmer-based organizations (FBOs) across the Koinadugu

district, with a chairlady leading each group and one central chairwoman heading all of KWVC.

Most FBOs have access to an Agricultural Business Centre (ABC), a building in which there was a

drying floor and meeting place for the women, and sometimes other farm assets, such as a rice

miller, huller, and de-stoner machines. In some cases, the ABC was located near the farm land,

but in most cases, the farm(s) were some distance away, ranging approximately from a mile to

ten miles. The collective farm and “headquarters” of KWVC was located at “One Mile,” near the

main road coming into Kabala from Makeni and Freetown. There was a youth and women

education program run at this farm, in which the main chairwomen teach women to farm and

49

connect their product to a market to aid them in becoming economically independent and “leave

bad men.”

Before EVD, KWVC estimated that they moved 1,317 tons of vegetables per year to

Makeni, Freetown, and Bo luma and town markets. Due to EVD, the volume of sales dropped

dramatically. During this time, the organization suffered huge losses of vegetable consignment

through spoilage and other means, worth their own estimates of four hundred and fifteen million

Leones (Le 415,000,000, ~USD 83,000) of profit losses due to national and local restrictions on

public gathering and movement throughout the country and Koinadugu in particular. All

participants when asked openly about “Ebola-time” discussed the restrictions enacted that had

a dramatic effect on their typical activities involved in their work as food producers.

4.2 EVD Quarantines and Restrictions on Movement in Koinadugu and Beyond

Quarantines and regulations on daily activity took form in a multitude of ways during the

outbreak. The most obvious way in which top-down quarantines occurred was when there was

an EVD case and epidemiological contract tracing was completed. Following this, the coordinated

response actors, government, and police enforced a quarantine of the potentially exposed

contacts, consisting of either a few households, or, at times, an entire village.

Figure 3: Quarantined Home (BBC 2015)

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However, there were many other restrictions on movement and public gathering outside

of quarantining contacts of EVD positive patients. Checkpoints, started on August 6, 2014, by the

national government, were maintained on main roads by national soldiers. Local governance

bodies, such as paramount and town chiefs, also maintained checkpoints and monitored activity

in, out, and within their boundaries, in a military-civilian joint decentralized operation. Many of

these checkpoints were previous checkpoints used during the civil war or checkpoints utilized by

the police in non-Ebola times. In Kabala, the checkpoints were managed by the District Ebola

Response Center (DERC), which operated in communication with and in partial direction to the

National Ebola Response Center (NERC). Checkpoints were also commonly maintained by youth

groups, which were a common group present in smaller villages, at the direction of elders to

maintain the flow of people and goods into their township.

Checkpoints consisted of a hand washing station with bleach and a temperature check at

minimum. On main roads, travel was restricted past certain times, usually around sun down. My

host recounted having to sleep at checkpoints several times when making what would usually be

a few hours trip to the nearest town for fuel or other supplies. Some would use fever reducers to

get past the checkpoints, and others would avoid them completely by using “bushpaths,” paths

that were not near the main road and walking by foot when possible. However, checkpoints did

not apply to everyone; keenly pointed out by the women’s group, those in NGO vehicles or with

white skin were immune to checkpoints. Bach (2014) has pointed out that checkpoints were used

for extortion, not an uncommon approach at police checkpoints, unless the person attempting

to pass had a connection to someone controlling the checkpoint. In Kabala, there was also

regulation on getting out of the township, not just in.

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In addition to checkpoints, no-movement “lockdowns” were mandated from the national

level under the National Ebola Response Center (NERC) when there was a flurry of new cases.

This meant that all people were mandated to stay inside their homes for a period of three to five

days. Similarly, Koinadugu authorities would decide to close its border to any movement into the

district at particular times. People were sometimes free to leave but would not be let back in.

The first national lockdown occurred September 19 to 21, 2014, which coincided with the

beginning of the most active period of disease transmission during the outbreak. For reference,

see Figure 4 below.

Figure 4: The Frequency of New Cases in Sierra Leone during the Ebola Outbreak from March 25, 2014 to April 13, 2016 (CDC: 2014 Ebola Outbreak in West Africa Epidemic Curves | 2014-2016 Outbreak West Africa)

Koinadugu, in particular, had a different approach to restriction on movement, with the

Paramount District Chief implementing restrictions on movement as early as July 2014, previous

to any national mandate and zero cases in the region. The police and military, as well as civilians,

described that “Koinadugu was the hardest district to get into.” Incidentally, Koinadugu was the

last district in Sierra Leone to report an EVD-confirmed case, on October 14, 2014.

It was unknown if the preemptive restrictions were responsible for Koinadugu having no

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cases for approximately the first five months of the epidemic in Sierra Leone. Some correlation

between the local restrictions put in place and controlling disease spread seem likely. In support

of this, the total number of EVD cases to be reported within the district’s borders that occurred

due to transmission of the infection from people traveling into the district was only four.

Transmission chain or spreader events that occurred within Koinadugu led to 138 cases, totaling

142 cases in the district from October 2014 to April 2015 (Muoghalu et al. 2017). This was a

relatively low incidence rate compared to the total of 14,124 reported cases in the country (“2014

Ebola Outbreak in West Africa Epidemic Curves | 2014-2016 Outbreak West Africa,” n.d.),

especially given that Koinadugu is geographically the largest of the 12 districts in Sierra Leone.

In addition to checkpoints, nightly curfews were imposed, and schools, churches, and

other places of public gathering were shut down. Restrictions were also placed on periodic

markets, lumas, that typically occur on one day of the week every week or bi-weekly in the same

location. In Kabala, there was a daily market that was mandated to be closed when three to five

day national lockdowns occurred during “superspreader” events, or when a person transmitted

an infection to a significantly greater number of other people than the average infected person

leading to high incidences of new EVD cases. Otherwise, this market remained open with

regularity. According to the Trader’s Union that operated the Kabala town market, business was

slow due to general economic depression. Getting products into the market from vendors in cities

like Makeni or Freetown, or vendors not having money to buy products to stock the market,

proved difficult. Paired with a stated lack of economic security by many households, vendors

experienced a decline in sales. Given that commerce was slowed down by restrictions, there was

significantly less money flowing into markets, and when not completely shut down by country or

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district wide mandates, were open less frequently than under “normal” circumstances, all further

contributing to regional economic depression.

Another widely implemented protocol was a restriction on touching, traveling, or

gathering in groups. While the market was often open during Ebola time, what was usually a

lively place in Sierra Leone full of music and dancing was described by locals as a market with

little vibrancy where people went to do business and did not spend much time socializing. While

Sierra Leone, including the district of Koinadugu, was under some restriction from September

2014 to November 2015, the intensity of the regulations on lack of movement and other

epidemiological controls were variable in relation to what was occurring during the outbreak at

the time.

4.3 The Impact of Ebola on Vegetable Farming

4.3.1 Collective Funds

KWVC ran its operation utilizing funds, contracts, and inputs from multiple groups,

including NGOs, multilaterals, MAFFS, and the members of the cooperatives. It was unknown

exactly how much money was coming from each group, as the amount changed annually based

on programmatic changes. At many of the ABCs or meeting buildings for the FBO groups were

log books, including visitors’ logs. Individual donations to the organization by its members are

stored here. This money was centrally controlled by the chairlady of the organizations in a

“Village Savings Account” that the chairwoman used to negotiate larger purchasing contracts for

farm inputs such as seeds and fertilizers. This fund also operated as a source of community safety

net through a sort of risk pooling. When a member needed money for non-normal farm

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operations or for non-farming costs, like a school fee for their child or an acute or long-term

illness in their family, they went to the chairwoman of the organization and asked for the money.

Previous to Ebola time, the majority of the 30 chairwomen would meet at One Mile once

per week and donate 5,000 Leones, approximately 1 USD, to the collective fund, as evidenced by

pages and pages of regular monthly donation logs. Sometimes members of the groups would

come to the meetings and donate in addition to the typical chairwomen donations. Women said

they struggled as a group financially during the EVD outbreak and that the group stopped

functioning as whole. In further support of this, according to the One Mile log books, members

had been contributing every month from January 2013 to August 2014. When looking at the dates

on entries in the log, there were no contributions from August 2014 until May 2015, when

members started contributing to this general fund again, albeit less often and with less money

than previously. November 2015 was the first month that the KWVC chairwomen met

consistently, and as of then contributions were regularly occurring, but most were 2,000 Leones,

less than half of the previous regular donations. FBOs worked cooperatively, and if a person did

not want to contribute to the general fund or manage a group farm they were removed from the

group. However, this “rule” was suspended during the EVD outbreak given the circumstances of

economic depression.

4.3.2 Farming Inputs and Loans

The chairwoman of KWVC took out loans from the bank in Kabala for distribution of

materials and farm inputs to the group. The group obtained a 50 million Leones (Le 50,000,000),

approximately $5,800 USD, credit from Union Trust Bank Account, with an 18% interest rate, for

procurement of seeds, processing and transportation and marketing of seeds and fresh

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vegetables before the EVD outbreak. In addition, the chairwomen of the FBOs took out loans for

their own organizations. Both sources of loans, taken in early 2014, were outstanding for groups

within the cooperative as of January 2016, and had made minimal, if any, payments on them.

This outstanding debt prevented groups from taking out any further loans and start farm

activities and ultimately reentering into markets to sell their product and normalize their

incomes. The KWVC had, as of February 2016, an outstanding debt of 25 million Leones (Le

25,000,000 or approximately $2,800 USD) to the Union Trust bank.

The bulk of the fertilizer used by KWVC was provided by Kabala MAFFS, while seeds were

sourced primarily from Senegal. In normal times, the chairwoman of KWVC traveled across the

border to Senegal to meet one particular seed vendor who most farmer-based organizations

proudly knew. Chairwomen collectively signed for a large loan from the bank in Kabala, ensuring

that they could buy bulk inputs, in particular seeds, as well as pay for labor until they harvested

and took their produce to market. The seeds were given to the chairwoman of KWVC with a down

payment and expected full repayment after harvest. Given that the relationship between the

chairwoman and the aforementioned particular seed vendor has been long standing, there was

considerable trust between the two parties. Previous to the EVD outbreak, the group had taken

a 3 million Leone loan from this seed vendor and still owed them the money as of February 2016,

even though they did not earn much, if any, money off the harvest due to Ebola impeding normal

operations. One KWVC woman details this:

So, we are still facing problems... the seeds we got before the Ebola, we still have to pay credit, I still have to pay that man, that [seed/fertilizer vendor], that agent, up to 3 million Leones… it's still a problem. Now, we are open [available] to get [earn] money now because [the chairwoman] has given us some seeds that we have planted, even though we have not yet harvested it… But at least when we do harvest those seeds, those vegetables, we will have some money. But we still have credit to pay.

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Acknowledging this problem, seeds, as well as money to purchase seeds, were given to

KWVC by FAO in mid 2015, but some KWVC members expressed dissatisfaction with their quality.

At the time of January 2016, many had successfully produced fields of cabbages and were

delivering them to markets using the seeds FAO provided; however, some seeds sat unused and

there were still complaints overall. New seed had not been obtained from Senegal with their

typical vendor due to the outstanding debts.

4.3.3 The Difficulty of Farming Under Restriction: Lack of Labor and Access to Farms

KWVC members had both collective and individual farms that were usually quite far from

their homes. In normal times, laborers were hired for a day rate, while women went to the farms

to supervise their labor, sometimes aiding in small, less labor-intensive tasks, and cooking for the

laborers. When general maintenance of vegetable gardens was needed, often one or two people

went to the farm to water. For example, when growing cabbage, one of the major crops grown

for KWVC, watering needs to be done twice daily. Given that there was a ban on public gathering,

as well as multiple checkpoints, finding and getting multiple laborers to an actual farm or

attending to a garden frequently proved to be quite difficult, as traveling in groups was forbidden,

not to mention labor shortages. One groups farm was 3 miles away, and between their homes

and the farm were 7 checkpoints on the main road path.

To circumvent the issue of multiple checkpoints to get to farms, people in good-enough

health accessed their farms via “bushpaths,” or non-main roads. For some, this was how they got

to their farm anyway, but for most, it was a longer journey to use a bushpath than a main road.

These bushpaths would be walked and if available, via hiring an okada (motorcycle) from their

local village. Hiring okadas costs money and that cost increases by distance, representing a

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further drain on monetary resources. Some described a fear of getting caught utilizing

bushpaths, but despite this fear, there was movement to farms even among public restrictions.

When explicitly asked if women obeyed restrictions on movement when quarantines were

mandated, most women, while not directly stating they ignored directives, insisted on discussing

the economic imperative to get to their farm(s).

Given the difficulty of access to farms and finding labor to maintain and harvest produce,

much of the crops that had been planted spoiled in fields, especially at the height of Ebola time.

4.3.4 Getting Product to Market

Markets for KWVC were nearly always explicitly outside of Kabala, in Bo, Makeni, and

primarily Freetown. Once crops were harvested, they got to market two ways: via hired vehicles

or via the one vehicle that KWVC owns. Given the volume of product this group operates in, they

primarily hire a combination of trucks and cars from the local Driver’s Union, based in Kabala,

and sometimes independent drivers. Before “Ebola-time”, costs to KWVC of transporting product

was 10,000 Le (about one dollar) per 50kg bag of produce. On average, the Driver’s Union was

helping KWVC to transport approximately twelve to fifteen trucks per week out of Koinadugu,

often carrying upwards of one-hundred 50 kg bags.

The cost of transport and hiring drivers was more expensive during Ebola time, in part

due to the price of fuel rising both nationally and locally due to difficulty of transport. A group

interview with two men at the Kabala Driver’s Union informed me that for approximately eight

months during the height of the epidemic, vehicles were parked in the union yard and not moving

at all. Drivers let their licenses lapse during the outbreak due to lack of funds or motivation

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stemming from the lack of business or inconsistency in ability to leave the confines of the town

or district.

Figure 5: Loading of Driver’s Union Truck

At periods of perceived low-to-moderate epidemiological risk, the town leadership and

DERC were allowing cars to take vegetables to Freetown; however, they were not allowed to take

any passengers. In Sierra Leone, to ride in a car, someone pays for their seat, not for the whole

car. The chairwomen usually pay for a seat to go to Freetown to do business with their vendors,

but were not able to go with the drivers, effectively grounding the bulk of an effort to move

produce that was able to be harvested to markets. At other times, the District Ebola Response

Center (DERC), the local governance in Koinadugu surrounding Ebola movement regulations, was

allowing Driver’s Unions to take five people in a car, versus their typical nine.

Given that crops were perishable and restrictions on movement were unpredictable,

KWVC members said that the Driver’s Union and independent drivers preferred to deal in non-

perishable goods so that they were more likely going to be paid. While this was noted as a

problem pre-Ebola, the women cited it as an increased problem during the epidemic due to

increased uncertainty of impediments on transport due to checkpoints.

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Now, one of the reasons why the drivers are preferring the timber transportation [rather] than the vegetables, there are times, some of the times these vehicle[s] will break down along the way and timber will not spoil, but vegetables will perish, and they will not pay the driver unless the driver take those vehicles to the traders and the traders will now pay them. So, if those vegetables will not reach, do not reach to the traders, then they [the traders] will not pay. So, they [the drivers] want to have their money, so there is that risk. That is why they are preferring to transport timber and animals [rather] than vegetables. If they are able to get [a] vehicle on their own, that will help their situation. But since, before the Ebola, we had that problem, up to now. That problem has started coming up again. When the group was able to get product harvested, hire drivers, and get on the road,

there was still a chance that they would not reach their destination of wherever they were

intending to sell. The women and drivers feared the checkpoints, and the main reason was that

they were unpredictable. Sometimes authorities would let you pass, sometimes they would

accept the “pass” (to be discussed below) from the DERC in Kabala, sometimes they would be

required to pay, or they would have left “too late” for the curfews and be forced to sleep in their

cars. It would take many days to get from Kabala to Makeni or Freetown to the “market,” a trip

that they would usually make in a day during normal times. During the period of the heaviest

travel restrictions (July – December 2014), post-harvest losses were estimated at over 70% of the

total volume of vegetables harvested by MAFFS (personal communication).

When KWVC was able to successfully get their product to the destination of the “market,”

buyers were buying less than usual. Purchasing power was depressed due to a general lack of

economic activity to give capital to buy produce, as well as less of a demand by typical markets.

Just past the height of the epidemic, KWVC members, especially those closest to Kabala,

became frustrated with their inability to successfully move to their farms and to end markets.

Discussions were initiated with DERC by KWVC leadership in an attempt to loosen restrictions on

KWVC movement. The medical director of DERC Koinadugu, based in Kabala, described much

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frustration about KWVC, expressing that he was sure they did not understand the risk of Ebola

and unmonitored movement. KWVC went to DERC to ask them to do something. Ultimately,

KWVC leadership was able to pay DERC for a “pass” to be able to leave the district, which was to

be honored by other checkpoints. The pass allowed the women to get past the checkpoint exiting

Kabala township for a small window of time in the morning. Ultimately, this caused much conflict

between KWVC and DERC, as KWVC had to harvest their produce that morning, functionally

leaving not enough time to get to the checkpoints at the time the “pass” allowed. Because I did

not witness the timeline of events and was provided these narratives retrospectively, it was

unclear what information was communicated to whom and at what time. Potentially KWVC

leadership was not told about the time restriction, or potentially they were told, but counter

negotiations with DERC about a time for permissions that worked for their operation was not

received well.

Multiple truckloads of vegetables perished in downtown Kabala after arriving to

checkpoints after the allowed time. This event was cited in some way by every member I spoke

with about farming in Kabala during Ebola time, including people in the local markets, drivers,

and the town chief. One member recalls her experience in purchasing peppers from her FBO

cooperative members and putting them on the trucks, only to have them ultimately spoil in

downtown Kabala:

The worst period during the Ebola was [the] August, September months… more especially when they turned back those trucks not to go. By then, I was having an account where I took money to purchase a bag of pepper, by then, it was 200,000 Leones. I bought up to 20 bags at 200,000 Leones per bag. And all those peppers went down the drain, so I nearly died. There was no money. I have 6 kids; I couldn't feed them.

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KWVC went back to DERC, this time protesting with many more members. Ultimately, some

negotiation was reached that placated members enough.

4.3.5 School Fees and Unwanted Teenage Pregnancy

The group said, “we went bankrupt and couldn’t help each other.” Echoed both inside

and outside of farming communities, many could not afford to send their children back to school

once the bulk of the epidemiological risk was contained due to economic depression, as a result

of slowing of markets for a multitude of a reasons. In particular, within KWVC, the women

farmers started to utilize their school-aged children more often than in non-Ebola times to do

farm labor, as they could not afford laborers or to send their child(ren) to school. While this does

happen in Sierra Leone generally, participants noted a differentiation in their use of children for

farm labor, specifically related to both school closures and lack of finances to pay laborers.

Schools were shut down during the epidemic due to a ban on public gathering, and when schools

were reopened, many did not have the funds to pay school fees for their children. Many older

women expressed that they believed going to school was a good abatement to teenage

pregnancy, due to the focus on school by young girls and a lack of free time to engage in sexual

activity. To the extent this is true was unknown, but participants described that the lack of funds

for school fees were leading to an increase in teenage prostitution in order to gain money for

school fees, and in turn increased the rate of unwanted teenage pregnancy. Specifically, in one

of the larger FBOs, two daughters of members got pregnant during the downturn of Ebola, and

it was blamed on either a lack of schooling or a lack of funds for schooling leading to prostitution.

To the degree this was causational is unknown.

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4.4 Adaptive Strategies by KWVC

There were multiple adaptive strategies used by the women of KWVC in response to the

dynamics of movement restriction and general economic depression. Produce was sold

differently, crops were repurposed for use, and women fled to farmhouses.

First, produce was sold to the local market for lower prices. There were only small

successes with this effort, given that KWVC largely produced vegetables that locals do not eat at

high volumes. Locals did not have money to spend due to generalized economic depression,

much less on expensive vegetables that were atypical for their diet. Many of the large contracts

these groups have were with hotels in the capital city that cater to Westerners and international

aid workers. Additionally, the women would eat the product (rice and vegetables) themselves

and feed it to their families before it spoiled. However, while KWVC members were able to utilize

some of this food for themselves, many participants spoke of general food insecurity in their

families. In addition to eating crops intended for market, women gave up on their current

harvests and repurposed their fields to plant sweet potato seeds they had on hand and knew

would store well for their families and communities.

In multiple villages, participants discussed that people who were presumed or identified

to have had contact with an EVD patient or had EVD were leaving Freetown and other urban

areas of Sierra Leone to come to villages. Behavior of those sick seeking local healers was

commonly documented during the outbreak, so a combination of seeking traditional treatment

and the company of families was likely motivating this travel to remote areas. Several KWVC

women detailed leaving to stay at their farm houses, houses that were also used as refuge during

war and to treat smallpox due to proximity to food and quarantine from infection (Paul Richards,

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personal communication, 2017). The women would travel to farms, in part, to avoid rejection

from any family members that would potentially come to their homes in the villages, as well as

to not encourage fleeing behavior, while simultaneously protecting their families from any actual

medical risk. Another reason that women cited for leaving to farms was because they had small

children whom they could not control their touch or exploration with other people. Stays at farm

houses primarily occurred for approximately two months (September and October 2014), around

the height of the cases in Koinadugu. When asked why they were going to the farms, one

participant said:

Because of the Ebola. So, one of the reasons why we migrated from our houses to the farms, we have large families… for our family not to come to our houses, so we can drive them away. We have large families that are living in different areas, and some of these people, and during the Ebola, when they contacted Ebola, they will migrate, they will leave that place and come to another place, to home or family. Some of the people, that's why they, what I was saying when people, like if they are living in Freetown, they contracted the Ebola, some of them runaway, they will hide and runaway and come to another place, if they know that he or she have Ebola, you have spread that Ebola, that virus to people. So, that is why, because of the Ebola, it was at the peak period, so we decided to migrate from here to our farms, so that if we stay, so as not to say no don't come to my house because of the Ebola. So, if I'm in my farm, I'm not at my house, that when you come to meet me, you go back to where you come from. So, that was one of the strategies we used… So, the majority of us women went to the farms… we were doing it because we have little children. They are (not) able to contain themselves, less contact, they can't contact anybody, so that's why we ran away, we isolated ourselves. We don't want them to mix, to interact, so we ran away.

4.5 The Impact of Ebola on Beef Value Chains: Markets, Transport of Cows, and Butchers

There was a major cattle market in Gbindi, near the Guinean-Sierra Leonean border. This

market drew people from several hours by car and foot. This market closed due to national

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mandate of weekend market closures around September 2014 and did not reopen until

November of 2015.

Figure 6: Cattle Market in Gbindi

People who owned herds of cattle, warehs, described having cattle like having a “bank,”

in that they “cashed in” by selling a cow. In normal times, they then would replace cows as they

were killed, but this was impossible during and after EVD due to restrictions on movement to

obtain the cattle and a slowdown in selling. Cattle warehs also described being too “afraid to

move” with cattle due to the restrictions on movement, impeding butchers from buying cows for

slaughter.

Due to the general economic depression, there was a drop in frequency of selling cows

due to lack of demand. However, the price that a wareh could get for a cow actually went up

during EVD due to the difficulty of transport, lack of centralized market, and the inability to

maintain a steady herd and income due to economic instability in the region.

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How a cow was priced depended on its size, age, and overall health. The “best cow”

costed about 1,000,000 Le, about $115 USD, (for two consecutive years) before EVD. During the

outbreak, the selling price rose to about 1,300,000 to 1,400,000 Le, and after the height of the

epidemic was hovering around 1,200,000 to 1,300,000 Le.

Given that economic activity was slowed everywhere, butchers noted that less meat was

sold previous to Ebola. Butchers in the downtown Kabala market were slaughtering

approximately 7-21 cows per week, or 1-3 per day, and selling out before two o’clock in the

afternoon. However, during the height of Ebola-time, butchers were slaughtering only one cow

per day at maximum, and sometimes not selling all of one cow. In addition, they would often sell

meat to caterers on credit, but due to an inability of those caterers to sell their product, butchers

were often not paid back. Some of the large cattle vendors did shut down their operations near

completely.

4.6 Adaptive Cooperation in the Cattle Market

Because the Gbindi cattle market was closed, butchers and warehs met at different

places, such as places more convenient for them, or off main paths to avoid checkpoints.

However, most did not describe much difficulty with checkpoints, as the road were much more

rural with less checkpoints between cattle markets.

Butchers used multiple strategies during the height of EVD to maintain their livelihoods

during an economically depressed time. At times, when selling was really bad, butchers in town

would cooperate to rotate which shop would sell for the day so they could all sell at least one

day in a week. Butchers also raised their prices during Ebola time. Before Ebola, a pound of beef

would cost was 8,000 Leones, approximately USD 1.65. During the height of EVD restrictions, the

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price went up to 10,000 Leones, and as of January 2015 was at 9,000 Leones. The fluctuations in

prices were simply noted as due to price and demand; demand was lower and butchers had to

pay more for cattle, so the price went up so butchers could make money. Lastly, butchers would

find a refrigerator in town and refrigerate their meat overnight if they did not sell a full cow. This

was a new practice for butchers, as they rarely ever had beef past noon or 1:00 PM in normal

times and refrigeration was very scarce in Kabala, as there is no central power grid and very few

generators.

4.7 “Bushbeef”

“Bushbeef” was eaten semi-regularly in Sierra Leone, as locals often see this meat as

“swit” or as a sort of delicacy, particularly cane rat. Most families in rural Sierra Leone maintain

gardens to feed their families. To prevent animals from scavenging their crops, traps are set to

detain animals and then they will be eaten

On the radio, there was national messaging that bushmeat was what caused Ebola and

people could be fined for selling or eating bushmeat. Messaging around bushmeat during Ebola

led to a fear that hunters would be fined if they hunted, which local governance structures in

Koinadugu did carry out. Likely as a result of the stigmatization, very few locals would discuss

bushbeef with me. I searched markets for any sign of sellers but could never find any. In addition,

I asked local friends to keep an eye out, and tried to make it known that I was not there to

persecute them. Every person when asked where to find bushmeat or if it was still around in the

markets repeated that it was nearly impossible to find bushbeef in markets unless you had a very

long-standing connection and knew who to find. A friend promised to connect me to a local

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hunter, but never did, even after much prodding and conversation, and I believe it was due to

fear of persecution.

Several villages vehemently denied they ever ate meat other than goats or cows, or that

they were scared to eat it now. I thought it illogical that active hunting would have slowed down,

but I wondered if people would eat any animals, they “accidentally” caught in the traps

surrounding their gardens. When proposing these scenarios and asking about any desire they

might have for the particular “switness” (goodness) of some animals, such as cane rats or grass

cutters, village members would agree that bushbeef is swit, but that they valued their “life over

switness.” One person asked me, “If they tell you a bomb is in that house over there, would you

walk into that house? Of course you wouldn’t,” signaling that they believed the risk being

conveyed by international actors and propagated by local governance was real. Another said:

They tell us that protein, you get it from the bushmeat, but the meat is spoiled, so if the meat is not there, you can get it from flesh. If it's going to kill you, I value my life over any taste. So. I'm patient for now. One proud hunter showed me what looked like an antelope head that he had butchered

in the past 24 hours. He claimed to have stopped hunting smaller rodents, but he preferred

larger animals anyway. The degree to which hunting larger animals versus smaller rodents

changed overtime due to EVD is unknown. The ways in which food security was impacted by

messages of fear surrounding eating wild game and rodents is unclear from my research, but

many in rural areas were, at least, aware of the messages of bushmeat causing Ebola, regardless

of my lack of understanding how this impacted consumption patterns.

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CHAPTER 5

DISCUSSION

In my first interview with any agricultural actor in Koinadugu, and on my first day at my

fieldsite, one farmer told me, “Ebola is worse than the (civil) war.” When asked to explain why,

this woman told me that during the war the terror at least came and went, and otherwise, they

were free to move about; during Ebola, they were not allowed to touch, were not allowed to

move around, were not allowed to celebrate, and worst of all could not make money and eat.

Surely this woman’s comment was relative to her own subjective positionality during both the

war, given the notable brutality of it, and during the EVD outbreak. However, it does represent

that Ebola kills through love (touch) as others have mentioned and as Lindis Hurum, former

Médecins Sans Frontières emergency coordinator, describes:

Do they not understand that at this very moment, the virus is looking for new, unsuspecting bodies in which (Ebola) can live and thrive, while the body dies? And while the victims are dying, the virus spreads to the next of kin who love the bleeding and dying victims so deeply that they cannot resist holding and hugging them. Ebola is the mass murderer that kills through love. (Hurum 2017: 59)

5.1 Economic Livelihoods and Adaptive Strategies

EVD severely impacts, the less newsworthy, but still overwhelming, economic livelihoods.

As of February 2016, 12 months after the major downturn in cases in Sierra Leone and also when

this field research was completed, a loss to security was still being felt. From the above narrative

of the experiences of Koinadugu locals during and after EVD in agricultural value chains,

quarantines and restrictions on movement, motivated by the goal of epidemiologically

controlling EVD, led to lesser discussed consequences of economic depression and market

disruption. To assist in recovery from this, FAO Sierra Leone began making payments to the

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KWVC. FAO Sierra Leone was appealing to UN (Geneva) and FAO (Rome) Headquarters for a total

of USD 12.75 million to assist nearly 70,000 farming households affected by the outbreak in Sierra

Leone (Food and Agriculture Organization of the United Nations 2015). Given that the KWVC

needs for recovery were not simply farming inputs, but cash for repayment of debts, money could

directly be funneled to debtors in order for the farming cooperative to resume its previous capital

reserves, and thus more normal operations and stability. In order to do this, a more thorough

survey of debts would be necessary.

The examples of adaptation to the movement restrictions enacted on Koinadugu farmers

shown in this work were in a similar vein to Paul Richards’ details of adaptation to the disease

itself. Paul Richards (2016) suggests that Sierra Leoneans adapted their practices of caring for

patients infected with an unknown pathogen based on their own observations and logical

behavioral changes. Richards describes how locals were actually responsible for much more of

the downturn of the epidemic than was represented or popularly known, and before outsiders

with extensive medical knowledge, skills, or supplies arrived en masse. There were many

adaptive strategies to the harsh regulations on movement put into place, from cooperative

selling by butchers, to circumventing checkpoints for low-risk financial, labor, or goods exchange,

and by going to live at farm houses to escape both disease and increase immediate food security.

Similar to Richards, I demonstrate that culture was not inflexible; it responds to the changes in

ecology, social experiences, and sometimes disease and its associated quarantines, by logical

local actors. Butchers cooperated with competitors for less product waste and farming families

used their product differently via selling to different markets or eating their crops, demonstrating

the ability of locals to change their behavior based on what was logically necessary for meeting

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basic economic or subsistence needs. My work echoes Richards’ analysis, which critiques the

assumption by international actors that locals were inflexible, immovable actors that cannot

adapt to a rapidly changing high-risk environment (Richards 2016).

It was impossible to identify only one reason that the incidence rate of EVD was so low in

Koinadugu compared to other Sierra Leonean districts. Was it, in fact, the preemptive

quarantining by local governance that the medical director of DERC assured me it was? Was it

the collaboration of paramount chiefs and town governance, such as mommy queens and youth

groups, with international actors leading to restricted movement? Was it a difference in adaptive

health behaviors by locals, akin to Richards’ findings? Or was it simply that the population was

sparse and of low density in Koinadugu?

5.2 Access to Institutional Spaces

The difficulty that KWVC encountered with the Koinadugu DERC in gaining permissions to

get past checkpoints for what could be considered reasonable commerce, along with the

difficulty of bypassing national checkpoints on main roads when on the way to markets,

compared to the experience of getting past checkpoints with white skin or NGO affiliation, was

clearly differential. It can be concluded that checkpoints meant different things to different

people, fundamentally structured on a system of privilege. An NGO vehicle, such as an FAO

vehicle, would easily get past a checkpoint to do what would be considered “non-essential” EVD

response work, while commerce by locals significantly less prestigious or powerful carried out in

order to secure a livelihood was routinely stopped. While the logic by multinational and EVD

response actors would likely retort that NGO vehicles were actually, in some way part of the

“response,” this represents the totalizing and all-consuming aspects of epidemics, which are

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perceived as high risk or as emergencies, even when the local or actual risk is low. Every member

in an NGO vehicle was assumed to be doing essential duties related to the epidemic response,

whether they were or not. The metaphorical alarms were sounded for Ebola with redirection of

international NGO and multinational efforts towards Ebola, arguably due to fear of a pandemic

or a lack of perceived local control disproportionate to actual risk. Seemingly, every aspect of

society in Koinadugu was impacted by the epidemic. NGO vehicles did not have to be part of a

response to get past checkpoints with ease, they were simply assumed to be part of the response.

Similar to other anthropologists’ work in disasters, this differential between the movement of

locals versus international aid workers represents how risk was culturally constructed and acted

upon.

There is a saying in Krio that goes “tok af, lef af,” which literally translates to “talk about

half, and leave half unsaid.” This phrase is used to indicate that knowledge is power, and people

do not always share knowledge very directly or willingly. DERC did not seem to disclose the

limitations on the KWVC movement out of the district when granting permissions to leave via the

checkpoints only at certain hours. Many thought that this was a symbolic action used to calm the

angry women of KWVC, as the “pass” this group received prevented KWVC leadership from

actually being granted access to roads in order to get their product to market, leading to a further

loss of income. There seemed to be little productive dialogue between the KWVC and town

leadership or DERC without protest and agitation. KWVC, and to my knowledge no agency or

group representing trade, agriculture, or commerce, ever had an active seat or meaningful

engagement with decision makers about checkpoints and other EVD regulations in Koinadugu.

As Barrios (2016) notes, the disaster recovery process is hindered, not by a lack of adaptive

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capacity by local communities, but by bureaucratic obstacles that are not the decision of the local

community that is impacted by the disaster. This was true for the KWVC when they were stopped

at local checkpoints, and especially when they were given a pass that did not enable them to get

their produce to an end-market, given that the pass did not account for time needed for harvest

in the mornings impeding their ability to be “adaptable” or “resilient”. In future epidemic

responses where control of movement is necessary in the name of limiting public health risk,

agencies representing and working with agricultural groups, such as FAO, should use their power

to influence the ability for farmers to directly represent themselves in places of decision making.

Given that quarantines or limitations on movement were often enacted in a non-specific

and non-localized way, these prescriptions of limitations can be analyzed as a demonstration (or

reassertion) of power, either by the state, international actors, or by locals already in power. The

fear of proliferation of a high-risk disease like Ebola led to an overreaction and securitization of

a weak West African and Sierra Leonean public health system with a lack of infrastructure to

measure and properly communicate localized and precise risk. This weak public health system,

which can be argued to be a result of the IMFs conditionalities, was the reason why a large

international and national militarized response occurred, assuming the role of a national public

health system. This securitization logic allowed those in power in the response to assert blanket

regulations on movement without respect for the particular ways in which the disease was

actually spreading. The securitization “state of exception” became the logic that privileged actors

used to assert their power against daily movement, ultimately affecting general movement in the

name of commerce and, thus, agricultural markets.

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The extent to which the EVD epidemic in 2013/16 impacted the health, food security, and

economics of Sierra Leone is largely unquantified, undiscussed, and under-researched. Some loss

of income and economic impact is still likely during an idealized “best” high-risk epidemic

response, given the emphasis on perceiving EVD as the most threatening to immediate public

health, over risk of losses to economic security.

Securitized quarantines affected downstream food security due to a disruption of

livelihoods; they also jeopardized future attempts at restarting livelihood efforts, due to the loss

of capital by small scale farmers. In order to merge public health protection from a highly

infectious biosafety level 4 disease (like EVD) with concerns for economic livelihoods, a different

approach is needed. Bottom up epidemiological surveillance should be coordinated to

strategically direct localized epidemiological motivated quarantines and limitations on

movement. People perceived as having little to do with EVD need to have a seat at the table in

future epidemiological efforts in order to prevent the sort of unintended consequences, such as

the ones that occurred in Koinadugu, on small scale agricultural markets. Utilizing local

community health workers should continue to be expanded upon by aid agencies.

Anthropologists should continue to be engaged with global health and response professionals in

order to help illuminate any potential unforeseen consequences of public health emergency

response on communities, and to help strategize how to mediate each groups values and needs.

5.3 Cultural Mediators vs Capacity Builders: What Is the Role of Applied Anthropologists?

As noted in the literature review of this thesis, the EVD outbreak response was at times

racist or culturalist, blaming locals for the positions they found themselves in. While it is too late

to go back and change the way EVD 2013/16 was responded to, there exist lessons for future

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public health emergencies, disasters, and high-risk epidemics, of which many anthropologists

have pointed out. When emergencies happen, large international agencies respond in ways that

sometime make the situations they are responding to worse. The ways in which large multilateral

agencies work is often non-particular, as demonstrated by general market closures in a district

with less than eighty households’ quarantines over the course of the two-and-a-half-year

epidemic. Anthropological work to mediate cultural values between international responders

and locals is becoming more normalized, shown by the sheer number of applied practitioners

employed in this outbreak response (myself included). However, while these efforts are

successful in hyper-localized ways, these practices of cultural mediation by applied

anthropologists’ do not shift institutions to respond in more structural ways, which underpin the

experience of disasters or uncontrolled epidemics in the first place. As the anthropology of

development demonstrates, Structural Adjustment Programs and development agencies are

under developing much of Africa, particularly Sierra Leone. Therefore, how do anthropologists

meaningfully engage in applied capacities? Highlighting the lack of focus on structural forces,

Jones (2014) critiques anthropologists engaging with epidemiological efforts in hyper-localized

ways:

In short, anthropology has been employed as the handmaiden of epidemiology. Its role has been circumscribed to identifying “beliefs” in order to help design education campaigns and implement “culturally appropriate intervention strategies.” Medical researchers ask anthropologists to deal with the “cultural issues.” In this light, the discipline has become little more than a specialist in local beliefs and customs. Anthropologists are presumed to have knowledge of culture which they can package into discrete units for international health experts in order to make outbreak control more effective…Certainly, there is a need for cultural awareness in any public health campaign or outbreak control. But anthropology discards its position as a contextualizing discipline by circumscribing its role to “explaining” the enigmatic beliefs of locals for use in a behavioralist epistemology…Epidemiology has almost always limited itself to an analysis of individual behaviors as “risk factors.” Indeed, these individualizing claims of causality

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may be useful for public health interventions because they allow for rapid targeting of risky behaviors or populations. Education campaigns…are easier to implement than wide-sweeping improvements to public health infrastructure. But anthropology cannot allow itself to be limited to serving as a handyman for “cultural problems” in outbreak control. It must reclaim [a]s broader role as a contextualizing discipline and lay bare the structural forces that influence disease patterns. (Jones 2014) Anthropologists have proven their effectiveness in negotiating specific conflicts of value

systems between international responders and locals in the name of public health control of

epidemics. While this work is genuinely beneficial in hyper-localized instances, it does not

address the reason that epidemic responses are poorly carried out in emergencies and the

systems of development in which they exist. Anthropologists may be more effective by working

to change the circumstances and institutions that create the problems they describe, by working

in a more embedded and long-term capacity with agencies to change discourses and practices

around epidemic control.

If anthropologists always have a role of mediation, the systems anthropologists are

critiquing are still perpetuated. There is nothing a priori that dictates that development cannot

build local capacity or participatory infrastructure. KWVC, as a community, was susceptible to the

“unintended downstream” effects of the EVD response, by not being involved in any local

decision making about commerce or regulations on movement with local governance and DERC.

A differential amount of power exists between FAO workers and KWVC farmers. As such, FAO

could have utilized that power to help mitigate the amount of damage felt in the first place. FAO’s

response to the KWVC losses from impacts of the epidemiologically motivated controls on

movement was to help KWVC bounce back financially, largely operating as with the goal of

humanitarian aid. FAO gave money to KWVC to recuperate some of their financial losses, as well

as provided them with a “cold room” for storage of their vegetables after hearing that their

76

vegetables perished; But to my knowledge, FAO never advocated for or worked towards women

in KWVC leadership to be involved in local decision making institutions. Given my observations,

my recommendations to FAO is to use their power to move cooperative farming groups into

democratic conversation with local decision-making bodies, so that in the future, they can be

more active participants in decisions that affect their lives, such as local checkpoints and

epidemiological quarantines.

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CHAPTER 6

PERSONAL REFLECTION

None of my participants suffered from EVD mortalities in their families or community, yet

it was evident that their way of life was significantly disrupted by the presence of international

organizations. Congratulatory messages from friends and family for “going to help” during such

a high-risk time (when in reality it really was not) felt wrong and deceptive. I struggle with this

today; the information highlighted in this thesis and the work of scholars much more experienced

than I explore the neoliberal imaginary’s horrific “unintended” effects from the “industry of aid”

on the Global South. Where is the correct place for someone like me, aware of these things, to

work? Is it within industry, within academia, public scholarship of some sort? I have yet to figure

it out.

Integrating into a team of scholars, professionals, and researchers who were highly

knowledgeable of Sierra Leone’s geography, language, and cultural nuance was difficult. This

project was conceived of and carried out partially under and partially separate of, Paul Richards

and his research team. Richards has been working in Sierra Leone as an anthropologist for over

forty years and his field team is explicitly made up of nationals. I am highly in support of

decolonizing anthropology and thus its research and increasing local capacity to study social

phenomena. Working in this team as a quasi-independent researcher, with this being my first

time in Sierra Leone, meant that I was always working overtime to situate myself culturally. My

work was, no-doubt, strengthened by my relationship to Richards and his team. My own lack of

historical and deep anthropological knowledge of the region proved difficult at times and

reinforced the need for an anthropological tradition of deep knowledge of a culture.

78

The 2013/16 Ebola outbreak in West Africa seems to have fundamentally changed the

engagement of international scholars on the topic of Ebola. Citations regarding Ebola have

exploded from 2014 until now, in biomedical, public health, and social science fields. This

proposes a unique problem when actively writing a thesis: keeping up with the literature is very

difficult. I would finish writing a section and then a newly edited volume would be released that

explored the very thing I just wrote about. As such, this thesis only begins to cover the social

science discourse that is actively growing every single month around the topic of the recent Ebola

outbreaks. Right now an outbreak is active in DRC, giving ripe opportunity for comparative

analysis, leading to further academic and public discourse about EVD responses. It has been an

ongoing battle to stop reading the plethora of interesting analysis and to actually write my own

ideas into this thesis.

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REFERENCES

“2014 Ebola Outbreak in West Africa Epidemic Curves | 2014-2016 Outbreak West Africa.” n.d. CDC.

“About FAO | Food and Agriculture Organization of the United Nations.” n.d. Accessed October 26, 2018. http://www.fao.org/about/en/.

“About the Network | Ebola Response Anthropology Platform.” 2016. 2016. http://www.ebola-anthropology.net/about-the-network/.

Abramowitz, Sharon. 2014. “Ten Things That Anthropologists Can Do to Fight the West African Ebola Epidemic | Somatosphere.” Somatosphere. 2014.

Abramowitz, Sharon. 2017. “Epidemics (Especially Ebola).” Article in Annual Review of Anthropology 13: 42.

Abu-Lughod, Lila. 1996. “Writing Against Culture.” In Recapturing Anthropology: Working in the Present, 137–62. School of American Research Press.

Agamben, Giorgio. 2005. State of Exception. University of Chicago Press.

Allcock, Simon. 2016. “Has the 2014-2015 Ebola Epidemic in West Africa Been Securitized?” E-International Relations Students. 2016.

American Anthropological Association. 2014. “Strengthening West African Health Care Systems to Stop Ebola: Anthropologists Offer Insights.” Workshop Recommendations.

Anderson, Gene. 2007. “Working with Local Knowledge: Environment and Anthropology.” American Anthropological Association Presentation.

Anoko, Julienne N. 2014. “Communication with Rebellious Communities during an Outbreak of Ebola Virus Disease in Guinea: An Anthropological Approach.”

Anoko, Julienne N, Alain Epelboin, and P Formenty. 2014. “Humanisation de La Reponse a La Fievre Hemorragique Ebola En Guinee: Approche Anthropologique.”

Anoko, Julienne Ngoundoung, and Doug Henry. 2019. “Removing a Community Curse Resulting from the Burial of a Pregnant Woman with a Fetus in Her Womb. An Anthropological Approach Conducted During the Ebola Virus Epidemic in Guinea.” In Pregnant in the Time of Ebola.

Ashwood, Loka, Noelle Harden, and Michael M Bell. 2014. “Linked and Situated: Grounded Knowledge*.”

Bah, Saidu. 2014. “Flaws Uncovered at Ebola Check Points.” Awoko, 2014.

80

Balzacq, Thierry. 2010. Securitization Theory: How Security Problems Emerge and Dissolve.

Barrios, Roberto E. 2014. “‘Here, I’m Not at Ease’: Anthropological Perspectives on Community Resilience.” Disasters 38 (2): 329–50.

Barrios, Roberto E. 2016. “Resilience: A Commentary from the Vantage Point of Anthropology.” Annals of Anthropological Practice 40 (1): 28–38.

BBC. 2015. “Sierra Leone Village in Quarantine after Ebola DeathTitle.”

Bello, Walden. 2008. “Manufacturing a Food Crisis | The Nation.” The Nation. 2008.

Bello, Walden, Shea Cunningham, and Bill. Rau. 1999. Dark Victory : The United States and Global Poverty. Pluto Press.

Benton, Adia. 2014. “‘It Don’t Take a Semiotician…’ Or, What We Talk about When We Talk about Bush Meat,.”

Benton, Adia. 2017. “Whose Security? Militarization and Securitization During West Africa’s Ebola Outbreak.” In The Politics of Fear.

Bernard, Russell. 2006. Research Methods in Anthropology: Qualitative and Quantitative Approaches. AltaMira Press.

Biggs, Reinette, Maja Schluter, and Michael Schoon. 2015. Principles for Building Resilience Sustaining Ecosystem Services in Social-Ecological Systems. Cambridge University Press.

Biney, Ama. 2009. “Walden Bello: Structural Adjustment Programmes Dictated by the IMF and World Bank Destroyed African Agriculture | Transnational Institute.” The Transnational Institute.

Bogoch, Isaac I, Maria I Creatore, Martin S Cetron, John S Brownstein, Nicki Pesik, Jennifer Miniota, Theresa Tam, et al. 2015. “Assessment of the Potential for International Dissemination of Ebola Virus via Commercial Air Travel during the 2014 West African Outbreak.” The Lancet 385 (9962): 29–35.

Bolzani, Daniela, Soline de Villard, Jennie Dey de Pryck, and Peter Wobst. 2005. “Agricultural Value Chain Development: Threat or Opportunity for Women’s Employment.”

Bonwitt, Jesse, Michael Dawson, Martin Kandeh, Rashid Ansumana, Foday Sahr, Hannah Brown, and Ann H. Kelly. 2018. “Unintended Consequences of the ‘Bushmeat Ban’ in West Africa during the 2013–2016 Ebola Virus Disease Epidemic.” Social Science & Medicine 200 (March): 166–73.

81

Caremel, Jean-Francois, Sylvain Landry B. Faye, and Ramatou Ouedraogo. 2017. “The ‘Humanitarian’ Response to the Ebola Epidemic in Guinea.” In The Politics of Fear, 63–84. Oxford University Press.

Chandler, Clare, James Fairhead, Ann Kelly, Melissa Leach, Frederick Martineau, Esther Mokuwa, Melissa Parker, Paul Richards, and Annie Wilkinson. 2015. “Ebola: Limitations of Correcting Misinformation.” The Lancet 385 (9975): 1275–77.

Cutter, Susan L., Lindsey Barnes, Melissa Berry, Christopher Burton, Elijah Evans, Eric Tate, and Jennifer Webb. 2008. “A Place-Based Model for Understanding Community Resilience to Natural Disasters.” Global Environmental Change 18 (4): 598–606.

Danaher, Kevin. 1994. 50 Years Is Enough: The Case Against the World Bank and the International ...

De Waal, Alex. 1997. Famine Crimes: Politics and the Disaster Relief in Africa. African Rights & the International African Institute in association with James Currey, Oxford & Indiana University Press, Bloomington.

De Waal, Alex. 2007. “No Such Thing as Humanitarian Intervention | Harvard International Review.” Harvard International Review.

DeWalt, Billie. 1994. “Using Indigenous Knowledge to Improve Agriculture and Natural Resource Management.” Human Organization 53 (2): 123–31.

Ebola Reponse Anthroplogy Platform. 2016. “About the Network | Ebola Response Anthropology Platform.” 2016. http://www.ebola-anthropology.net/about-the-network/.

“Ebola Virus Disease.” 2018. World Health Organization. 2018. https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease.

“Ebola Virus Disease Fact Sheet.” n.d. Accessed October 26, 2018. http://www.who.int/en/news-room/fact-sheets/detail/ebola-virus-disease.

Edmonds, Alex, and Athena McLean. 2014. “Second Opinion: Annual Meeting Preview: Emergency Ebola Roundtable Now Scheduled.” Society for Medical Anthropology. Vol. 2.

Escobar, Arturo. 1995. “The Making and Unmaking of the Third World through Development,” 85–93.

Fairhead, James. 2016. “Understanding Social Resistance to the Ebola Response in the Forest Region of the Republic of Guinea: An Anthropological Perspective.” African Studies Review 59 (03): 7–31.

82

FAO/WFP. 2015. “FAO/WFP Crop and Food Security Assessment — Liberia, Sierra Leone, and Guinea.”

FAO. 2013. “Our Priorities, The FAO Strategic Objectives,” 16. http://www.fao.org/docrep/018/mi317e/mi317e.pdf.

FAO. 2015. “Addressing Zaire Ebola Virus (EBV) Outbreaks: Rapid Qualitative Exposure and Release Assessment. Rome.” http://www.fao.org/3/a-i4364e.pdf.

Farmer, Paul. 2001. “Russia’s Tuberculosis Catastrophe.” Project Syndicate, 2001.

Farmer, Paul. 2004. Pathologies of Power: Health, Human Rights, and the New War on the Poor. University of California Press.

Fassin, Didier., and Mariella. Pandolfi. 2010. Contemporary States of Emergency : The Politics of Military and Humanitarian Interventions. Zone Books.

Ferguson, James. 1994. The Anti-Politics Machine: Development, Depoliticization, and Bureaucratic Power in Lesotho.

Food and Agriculture Organization of the United Nations. 2015. “Sierra Leone: Women Vegetable Farmers Face Huge Losses Due to the Ebola Outbreak,” http://www.fao.org/emergencies/fao-in-action/stories/stories-detail/en/c/276804/.

Food and Agriculture Organization of the United Nations. 2018. “Ebola Virus Frequently Asked Questions (FAQs) - FAO Emergency Prevention System for Animal Health (EMPRES-AH).”

Fraser, Christophe, Christl A Donnelly, Simon Cauchemez, William P Hanage, Maria D Van Kerkhove, T Déirdre Hollingsworth, Jamie Griffin, et al. 2009. “Pandemic Potential of a Strain of Influenza A (H1N1): Early Findings.” Science 324 (5934): 1557–61.

Galvez Nogales, Eva. 2015. “Sustainable Markets, Agribusinesses and Rural Transformations.”

Geertz, Clifford. 1973. The Interpretation of Cultures.

Glaser, Barney, and Anselm Strauss. 2000. The Discovery of Grounded Theory: Strategies for Qualitative Research.

Hale, Charles R. 2006. “Activist Research v. Cultural Critique: Indigenous Land Rights and the Contradictions of Politically Engaged Anthropology.” Cultural Anthropology 21 (1): 96–120.

Harlan, Chico. 2014. “An Epidemic of Fear and Anxiety Hits Americans amid Ebola Outbreak.” The Washington Post,

83

Hayden, Erika Check. 2018. “Experimental Drugs Poised for Use in Ebola Outbreak.” Nature 557 (7706): 475–76.

Henry, Doug. 2005. “Anthropological Contributions to the Study of Disasters.” In Disciplines, Disasters and Emergency Management: The Convergence of Concepts Issues and Trends From the Research Literature.

Hewlett, Barry S., and Bonnie L. Hewlett. 2007. Ebola, Culture and Politics: The Anthropology of an Emerging Diseases. Cengage Learning.

Hoffman, Danny. 2017. “Military Humanitarianism and Africa’s Troubling ‘Forces for Good.’” Insights from the Social Sciences.

Honigsbaum, Mark. 2017. “Between Securitisation and Neglect: Managing Ebola at the Borders of Global Health.” Medical History 61 (2): 270–94.

Hsu, Minna, Richard Howitt, and Fiona Miller. 2015. “Procedural Vulnerability and Institutional Capacity Deficits in Post-Disaster Recovery and Reconstruction: Insights from Wutai Rukai Experiences of Typhoon Morakot.” Human Organization 74 (4): 308–18.

Hurum, Lindis. 2017. “A Few Days in July.” In The Politics of Fear: Médecins sans Frontières and the West African Ebola Epidemic, 51–59.

International Strategy for Disaster Reduction. 2005. “Building the Resilience of Nations and Communities to Disasters Extract from the Final Report of the World Conference on Disaster Reduction (A/CONF.206/6).”

Irwin, Bronwyn. 2015. “Market Systems for Resilence.”

Jones, Jared. 2014. “Ebola, Emerging: The Limitations of Culturalist Discourses in Epidemiology.” The Journal of Global Health.

Kari, Jo, Norge W Harris, Stephen B Jerome, Kari Jo Fawcett, Stephen B Harris, Adrienne Paine-Andrews, and Jerry Schultz. 1997. “Rapid Assessment Procedures: A Review and Critique.” Human Organization. Vol. 56.

Kentikelenis, Alexander, Lawrence King, Martin McKee, and David Stuckler. 2015. “The International Monetary Fund and the Ebola Outbreak.” The Lancet. Global Health 3 (2): e69-70.

Khan, Adnan, Mahim Naveed, Muhammad Dur-e-Ahmad, and Mudassar Imran. 2015. “Estimating the Basic Reproductive Ratio for the Ebola Outbreak in Liberia and Sierra Leone.” Infectious Diseases of Poverty 4 (1): 13.

Le Marcis, Frédéric. 2015. “Traiter Les Corps Comme Des Fagots: Production Sociale de l’indifférence En Contexte Ebola (Guinée).” Anthropologie et Santé, no. 11 (November).

84

Malkki, Liisa H. 1996. “Speechless Emissaries: Refugees, Humanitarianism, and Dehistoricization.” Cultural Anthropology 11 (3): 377–404.

Marí Saéz, Almudena, Sabrina Weiss, Kathrin Nowak, Vincent Lapeyre, Fee Zimmermann, Ariane Düx, Hjalmar S Kühl, et al. 2015. “Investigating the Zoonotic Origin of the West African Ebola Epidemic.” EMBO Molecular Medicine 7 (1): 17–23.

Markel, Howard. 2005. When Germs Travel : Six Major Epidemics That Have Invaded America and the Fears They Have Unleashed. Vintage Books.

Markel, Howard. 1999. Quarantine! : East European Jewish Immigrants and the New York City Epidemics of 1892. Johns Hopkins University Press.

Markel, Howard, and Alexandra Minna Stern. 2002. “The Foreignness of Germs: The Persistent Association of Immigrants and Disease in American Society.” The Milbank Quarterly 80 (4): 757–88.

Mclean, Duncan. 2017. “Challenges of Instituting Effective Medevac Policies.” In The Politics of Fear Médecins sans Frontières and the West African Ebola Epidemic, 235–53.

Miles, Steven H. 2015. “Kaci Hickox: Public Health and the Politics of Fear.” The American Journal of Bioethics 15 (4): 17–19.

Miller, Duncan. 2017. “Challenges of Instituting Effective Medevac Policies.” In The Politics of Fear: Médecins Sans Frontières and the West African Ebola Epidemic, 235–53.

Mokuwa, Esther, and Paul Richards. 2014. “The Sierra Leone Agro-Business Centres: A Report on Research Findings.”

Moran, Mary, and Daniel Hoffman. 2014a. “Ebola in Perspective.” Cultural Anthropology.

Muoghalu, Ifeanyi-Stanley, Francis Moses, Ishata Conteh, Patrick Swaray, Anthonia Ajudua, and Anders Nordström. 2017. “The Transmission Chain Analysis of 2014-2015 Ebola Virus Disease Outbreak in Koinadugu District, Sierra Leone: An Observational Study.” Frontiers in Public Health 5: 160.

Mwesigwa, David, and Mohamed Ajuba Sheriff. 2014. “The Food Security Situation in the Context of Ebola Outbreak in Sierra Leone, A Rapid Assessment Report.”

Nazarea, Virginia, Robert Rhoades, Erla Bontoyan, and Gabriela Flora. 1998. “Defining Indicators Which Make Sense to Local People: Intra-Cultural Variation in Perceptions of Natural Resources.” Human Organization. Society for Applied Anthropology.

Norton, Roger. 2014. “Agricultural Value Chains: A Game Changer for Small Holders.” Devex. 2014.

85

Oliver-Smith, A, and S Hoffman. 2002. “Catastrophe & Culture: The Anthropology of Disaster.” School of American Research Press.

Oliver-Smith, Anthony. 1996. “Anthropological Research on Hazards and Disasters.” Annual Review of Anthropology. Annual Reviews.

Oliver-Smith, Anthony. 1999. “What Is a Disaster?: Anthropological Perspectives on a Persistent Question.” In The Angry Earth, 32–48. Routledge.

Oliver-Smith, Anthony, and Susannah M Hoffman. 1999. The Angry Earth: Disaster in Anthropological Perspective. Routledge.

Onishi, Norimitsu. 2014. “As Ebola Grips Liberia’s Capital, a Quarantine Sows Social Chaos.” The New York Times, August 28, 2014.

Payer, Cheryl. 1974. The Debt Trap: The International Monetary Fund and the Third World.

Payer, Cheryl. 1982. The World Bank : A Critical Analysis. Monthly Review Press.

Pfeiffer, James, and Rachel Chapman. 2010. “Anthropological Perspectives on Structural Adjustment and Public Health.” Source: Annual Review of Anthropology 39: 149–65.

Pfeiffer, James, and Rachel Chapman. 2015. “An Anthropology of Aid in Africa.” Lancet (London, England) 385 (9983): 2144–45.

Preston, Richard. 1994. The Hot Zone: A Terrifying True Story.

Richards, Paul. 1985. Indigenous Agricultural Revolution : Ecology and Food Production in West Africa. Unwin Hyman.

Richards, Paul. 2016. Ebola : How a People’s Science Helped End an Epidemic.

Robards, Martin, and Lilian Alessa. 2004. “Timescapes of Community Resilience and Vulnerability in the Circumpolar North.” Arctic 57 (4): 415–27.

Robinson, Julie, and James Pfeiffer. 2015. “The IMF’s Role in the Ebola Outbreak.” Bretton Woods Project. 2015.

Sadasivam, Bharati. 1997. “The Impact of Structural Adjustment on Women: A Governance and Human Rights Agenda.” Human Rights Quarterly 19.

Schoepf, Brooke G. 2001. “International Aids Research in Anthropology: Taking a Critical Perspective on the Crisis.” Annual Review of Anthropology 30 (1): 335–61.

Schroven, Anita. 2017. “Remnants of Ebola: Contemporary Repercussions at a Former Centre of the Outbreak.”

86

Scott, James C. 1998. Seeing like a State : How Certain Schemes to Improve the Human Condition Have Failed. Yale University Press.

Seay, Laura, and Kim Yi Dionne. 2014. “The Long and Ugly Tradition of Treating Africa as a Dirty, Diseased Place.” The Washington Post, 2014.

Shaw, Rosalind. 1989. “Living with Floods in Bangladesh.” Anthropology Today 5 (1): 11.

Sherrieb, Kathleen, Fran H. Norris, and Sandro Galea. 2010. “Measuring Capacities for Community Resilience.” Social Indicators Research 99 (2): 227–47.

Sillitoe, Paul. 1998. “The Development of Indigenous Knowledge.” Current Anthropology 39 (2): 223–52.

“Socioeconomic Effects of Ebola in Africa.” 2015. Population and Development Review, 372–75.

Tendall, D. M., J. Joerin, B. Kopainsky, P. Edwards, A. Shreck, Q. B. Le, P. Kruetli, M. Grant, and J. Six. 2015. “Food System Resilience: Defining the Concept.” Global Food Security 6: 17–23.

Tobin, Graham A, and Linda M Whiteford. 2002. “Community Resilience and Volcano Hazard: The Eruption of Tungurahua and Evacuation of the Faldas in Ecuador.” Disasters 26 (1): 28–48.

Torry, William I. 1978a. “Bureaucracy, Community, and Natural Disasters.” Human Organization. Society for Applied Anthropology.

Torry, William I. 1978b. “Natural Disasters, Social Structure and Change in Traditional Societies.” Journal of Asian and African Studies 13 (3–4): 167–83.

Torry, William I. 1986. “Morality and Harm: Hindu Peasant Adjustments to Famines.” Social Science Information 25 (1): 125–60.

Vroegindewey, Ryan, and Jennifer Hodbod. 2018. “Resilience of Agricultural Value Chains in Developing Country Contexts: A Framework and Assessment Approacho.” Sustainability 10 (916): 1–16.

Waever, Ole. 1995. “Securitization and Desecuritization.” In On Security , 46–87.

“With Spread of Ebola Outpacing Response, Security Council Adopts Resolution 2177 (2014) Urging Immediate Action, End to Isolation of Affected States | Meetings Coverage and Press Releases.” 2014. United Nations. 2014.

Yapp, Rhiannon. 2014. “The Body Economic: Why Austerity Kills.” Critical Public Health 24 (3): 381–82.

87

Yoder, P Stanley. 1997. “Negotiating Relevance: Belief, Knowledge, and Practice in International Health Projects.” Medical Anthropology Quarterly 11 (2): 131–46.

York, Geoffrey. 2014. “Isolation, Cancelled Flights Hamper Ebola Efforts in Africa.” The Globe and Mail, August 25, 2014.