2015 AAA Invited Session: ARE WE ANTHROPOLOGISTS…


– Thank you all for attending. My name is Katherine Bolton. The University of Notre Dame
and I organized this panel. Are We Anthropologists or
Are We Emergency Responders? As a way of kind of drawing
together and meditating on the experience of a group of
anthropologists in the U.S. Europe and abroad on the
Ebola epidemic that began in December 2013 in Guinea and is coming to a close now, and it’s
actually a very good time to meditate on this now that Sierra Leone has just been declared Ebola
free and Guinea is very close. Liberia did declare its epidemic over, even though this sort of
periodic flare up of cases is something that we need to be
continually vigilant about. So in November of last
year, the AAA convened an emergency workshop
of anthropologists in Washington D.C., sort of
put our heads together and come to grips with
the epidemic and see how anthropological knowledge,
anthropological methods, and just the years and years and years of experience and knowledge
of this region might help inform the Ebola
response in West Africa. And over the course of the
next year up to this point, we have been working on this
with the United Nations, with European anthropologists,
with various anthropological platforms for knowledge
production and dissemination. And we thought this
panel be a very good way of kind of bringing all of this together. Not necessarily bringing it to a close but just sort of meditating on the conversations that we’ve
had, the productive activities that we’ve engaged in. And to think about how
anthropological knowledge can start to translate across boundaries and be
part of a sort of larger world of knowledge production around epidemics
without privileging too much the sort of anthropological experience
or anthropological expertise. So our panel today originally
had seven panelists on it. There is as much to say
about Ebola as there are As there are people
who are happy to do the work and to have
something valuable to say. But unfortunately, two
of our panelists for family reasons couldn’t be here today. That’s Janice Graham and
Fredly McCormick Hale. Both were detained by family emergencies. So we’re going to organize the
panel slightly differently in that we will still go in order
with our presenters, but each one will have 18 minutes rather
than 15 minutes, which will leave us about 15 minutes
at the end for discussion. So on that note I’d like
to introduce our first panelists, Sharon Abramowitz,
whose presentation is titled, But I’m Just An Anthropologist, Shifting Hierarchies of Knowledge
in the Emergency Response. – So I want to thank Katherine
Bolton and Susan Chapler for organizing this important panel. I think that at this particular
moment when the Ebola epidemic is still not fully
resolved in West Africa. There were just three new
cases reported in Liberia today and there’s ongoing cases in Guinea. It’s important for us to recognize that the epidemic continues. But for us to also take a
moment to reflect upon the nature of anthropology’s
involvement in the Ebola bowler response, as
anthropology’s collective involvement is progressively
coming to a close. So the title of my talk is called, But I’m Just An Anthropologist, Shifting Hierarchies of Knowledge
in the Emergency Ebola Response And this is very much
drawn from my own personal experience of anthropological
formation as a graduate student and also as
a professional anthropologist and as a professor of anthropology at the University of Florida. And I have to say that
my roots in this talk come from learning about
engaged anthropology or the principle of using
anthropology for political purposes in order to
mobilize social change. As a graduate student just at the time when I was watching the country where I had done Peace Corps
service, Cote d’Ivoire, move into a state of civil war. As an anthropologist
in training, I was very much without resources to impact what was going on in that situation
even though I had substantial local knowledge. This experience kind of was revivified with the West African Ebola response. After eight to nine months of watching the unfolding of the Ebola
epidemic from December 2013 until August 2014, I found myself in a situation where I was soliciting the American Anthropological Association, the Wonder Grant Foundation, and a number of other partners to mobilize anthropology collectively
to engage from the United States in some sort of a focused response to the Ebola epidemic which was at that time aggressively
increasing the number of cases on a day to day basis, and very much lacked ethnographic representation. At that particular time I decided to work to organize a forum of
anthropologists in Washington D.C. The first call that I
made was to Mary Moran of Colgate University, a long time friend. And when I asked her to join me on the steering committee for organizing this event her response to me was, “But I’m just an anthropologist. “What do I know about Ebola” right? And my response to her
at the time was, “Mary, “you’ve been studying women
in Liberia for 30 years. Don’t you think you know something about care giving” right? And as it turned out, Mary
Moran ended up digging up one of the most significant
ethnographic facts that anthropologists were
able to mobilize into the collective Ebola response
by going into her field notes from I believe1984? – [Mary] Two. – 1982 and finding out really significant details about
funerary practices that took place in the village
where she had been conducting research as a graduate
student in anthropology. So this provokes really
important questions about the nature of ethnographic information as it’s applied to global health and emergency events, right? At the same time that Mary was expressing to me her uncertainty about the appropriateness of her engagement with an Ebola response,
anthropologist collectively were confronting the crushing failure of the global Ebola response
to prevent the deaths of Liberians, Guineans, ends
Sierra Leone eons, right? And on a one to one basis
many anthropologists found themselves shy to
engage, myself included. It was just really unclear
what it is that ethnography could bring to the unfolding
of an epidemic, right? What ultimately happened
was anthropologists globally mobilized to do something. And what we did was what
we knew how to do we. The leaders among anthropologists in the region were starting to be included in e-mail circulations with colleagues from the World Bank, and people from the I.M.F. and people from the United Nations and the W.H.O., right? And we were so eager to
engage in the debate that we had started cutting and pasting 200 email addresses into our e-mails. And we started circulating would probably appeared to be slightly mad arguments, thesis, literature summaries and anthropological critiques, right? To all of these global
health and humanitarian experts in order to try
to introduce something anthropological into the response. And we were doing so very much on an individual basis, right? And once it became clear
that these point by point e-mail distributions just
kind of weren’t working we started to organize
as best as we could. And at this time, Melissa Fairhead and Melissa Leech, Vin Kimun, Alice Discloud, myself
and many, many others convened several transnational platforms in order to make ethnographic facts accessible to humanitarian and medical responders who are acting in the region. This resulted in the formation
of three key platforms. The U.K. based Ebola Response
Anthropology platform. The winner grant American
Anthropological Association at the Ebola Anthropology Initiative, and the Francophone S.H.S.
Ebola Network, right? And very, very early on
we made an agreement, An informal agreement together that we would do the best that
we could to not compete for authority in humanitarian space about what the role of anthropology was, and then instead, we
would seek to collaborate. So we arrived to some
common points of agreement. We agreed that we would
do the best that we could within the constraints under
which we were operating to share information
and resources as freely as we possibly could, right? We kind of situated our
engaged in the context of a first now than later timeframe,
and the first now part was focused on providing constructive
information that could help a humanitarian and a
global health response. And holding on to the right to engage in shall we say aggressive critique later when the time was
more appropriate, right? We were operating on a
premise of open access. So in a context of a massive
data collection gaps. Embargoes on the release
of reports and shall we say obsessive confidentiality practices around field based research. Anthropologists used an ethos of open source access to share information, disseminate confidential
reports and provide feedback to those reports and get them
back into the hands of key deciders who were
involved in the response. These conversations provoked very uncomfortable conversations about what we in anthropology like to call the global hierarchy of evidence. That was then an operation in the context of the Ebola response. And at that time, immense financial and human research capabilities were pouring into geospatial mapping and epidemiologic modeling and clinical guidance. And almost no resources
were being allocated towards anthropological information which ultimately was determined to be one of the key touchstone of guiding the response principally through the mode
of understanding community is treating them with
respect and facilitating this concept which is not un-problematic in and of itself, this concept
of community engagement. It’s important to note that there were significant differences in the
ways that specific countries engaged with their
anthropological experts. The U.K. Mobilized a select group of anthropologists and
gave them a significant authority over specific
tactical choices that were made in the Ebola response. Very early on, the French government allocated an enormous amount of resources to ensure that there was a substantial ethnographic presence in Guinea where they were operating. The United States government
allocated pretty close to zero resources to anthropological
knowledge and I think that this begs some really significant
questions about whether or not at this time the United States government recognizes the anthropologic community
to actually be a national resource. And I think that it also
begs a question about whether or not the anthropological
community wishes to be recognized as a national
resource and I think that this is a conversation that we
desperately need to have. So moving on, we need to think about the kinds of contributions that anthropologists made in
this Pacific context, right? And a key question that
emerged very early on was whether or not
anthropologists who were not in a position to be able
to do field work could in fact have an impact
on the situation, right? Collectively as a discipline,
we’ve become so persuaded of this concept of the
anthropologist sitting in the village as being our principal
purpose and our modality for data collection, that
anthropologists who could not be in the village in the
midst of the Ebola epidemic didn’t exactly know whether or not the information that they had
was in fact relevant, right? We weren’t sure that if
we couldn’t be in the village what it was that
we could bring to bear. We didn’t know the value of past research. And we certainly didn’t
know if research that we had collected 10, 15, 20,
30 or forty years ago was in fact relevant for
the current context, right? Field work itself had become a kind of totem for the anthropological community. And it made it a bit timid. It made us a bit timid about asserting our own scientific authority at the same time that it made the humanitarian and global health communities that has become persuaded that what apologists do is sit in the village a little bit distrustful of people who weren’t sitting in the village, right? And so we sought alternative
ways to frame our insights. We sought alternative models for moving ethnographic information into the context. We sought alternative relationships between the academy in the field. And we sought to mobilize
the global resources of information technology, data
analysis and publication. And we also took advantage
of the fact that people who weren’t in the field had a
different relationship with time and analysis than people who were working in the context of an emergency, right? And we tried to connect
that up with really increasingly expansive local
resources of proximity, access, and the concentration of financial and program resources. Now in the midst of this I think that there was you know one national entity that really set a key… I don’t know how to say they’re really kind of established sort of a role model for how anthropology could be engaged in future emergency responses. In the U.K. the Sage Scientific Advisory Committee made
a formal to decision to give qualitative and
quantitative evidence parity in the development
of plans and priorities for the Ebola response, right? In the United States, this did not happen. Let me make it clear, it is
not for lack of trying, right? The American Anthropological
Association and myself and other key individuals
who are involved in this side of things tried to contact the White House Office of
Science and Technology Policy on numerous occasions in
order to facilitate an open conversation between the White House, the Department of Defense,
USAID, and the State Department, all of which were key factors in critical aspects of the Ebola response. Not being able to do that we made a point of trying to crowd source expert information across the region. We developed political points
of inflection and influence. We liaised with people
working in country to get data out and analysis
and critique in, right? And again, we tolerated
the restrictions of the situation in order to
restrict our own critiques. So ongoing epidemiological and clinical and community engagement work, rather than engaging in far
more wide sweeping critiques that we are all well capable of, right? I think that a key issue that was guiding the
nature of our intervention and actually made it quite powerful was a fundamental understanding of culture as being something that was much more obdurate and sticky than humanitarian and global health understandings
of culture, right? Anthropologists understand culture as being something that is reproduced through generations, even in
the context of emergencies. And humanitarian and
global health responders were wondering whether
or not the demand to change particular kinds
of social practices were going to completely
change culture altogether. And much of our understanding
of culture comes out of a fundamentally compassionate
stance of anthropology towards people in local communities and a concern with fundamental
human dignity, right? And it turns out that this
very, very simple analysis proved to be an incredibly important and effective argument with humanitarian response agencies that were not being asked to think about compassion. They were principally being asked to focus on epidemiological containment. Okay? So I believe I only have
about three minutes left. But I think that there’s
a few questions that I have about what it is that we did here. Were we in fact engaged
in anthropology when we were engaged in this process of moving anthropological research
into advocacy and politics? Was it effective for us
to be trying to build relationships with key organizations at the same time that we were trying to move information into
those agencies, right? It turns out that one of our principal roles was to be teaching upwards to the humanitarian
establishment, right? Humanitarian responders
had an expectation that the role of the anthropologist
was to be teaching technically downwards into the community and we fundamentally rejected that. Okay? We believed that the community actually had a fairly solid and capable grasp of what was going on, and that the people who needed to be educated were the people in key decision making roles. And we push that forward
pretty aggressively. We had the attributes of a 21st century political resistance or protest movement. And we were heavily dependent
on the mobilization of email, Skype, social media,
list serves and web sites, but we lacked critical
political capabilities that exist in far more traditional
political mobilizations. Like we lacked a formal
grassroots political structure. We had an ephemeral duration. We lacked resources and really to be honest we lacked an agenda, right? We just wanted the representation
of communities to be a real thing and we strove
to be advocates for that without a clear sense of focus. And I would say that as
the emergency stabilized the demand for and the access of anthropologists declined dramatically. As much as many of us wanted
to direct anthropological insights towards post epidemic
recovery issues like health system strengthening,
our feedback was either unwanted or it could not be accessed through existing structural
mechanisms that are regularly deployed in humanitarian programming. So I just want to mention
in my last minute and a half a few of the legacies
of this initiative, and some of the ongoing
challenges that we face. I’m happy to say that as
of today there is a huge demand from global health
and humanitarian bodies for anthropological engagement
at the highest levels. Unfortunately that demand keeps taking place in rooms where we
are not present, right? In the last three months
alone, I’ve heard of several different occasions
where high level meetings are taking place, and the entire first day of conferences is spent with people saying, “We really need the anthropologists here, “but where are the
anthropologists?” right? To date we have established one single precedent for demanding qualitative data parity with quantitative data. We need to sustain this demand in our scientific institutions. We did effectively
create a climate of moral accountability for humanitarian response. And we demanded attention to basic human dignity and a respect for communities. And I think that that’s not something that can be overlooked, right? And we applied every mechanism that we could in order to do so. Now let’s talk about our challenges which are not insignificant. Frankly and I’m surprised
to say this myself, I think that our principle challenge. As the American
Anthropological Association is that the American anthropological community’s relationship with the United States government is in a state of complete disarray, right? Even almost abandonment and
mutual rejection, right? And significant steps need to be taken to repair that relationship in order to bring the
collective wisdom and insights and research of this community
to bare on US foreign policy. I also just want to
mention that we are still struggling to define what the collective contribution of anthropological research is to specific sites of emergency. We’re still dependent
upon a star model that focuses on the wisdom
and insights of a few key individuals rather than
on the collectivity of our research over a long period of time in particular context. And I think that revisiting and understanding of what constitutes evidence what constitutes culture and what constitutes research can have a significant
impact on how we think about engaging with future
humanitarian crises. (applause) – Thank you, Sharon. Our next speaker is Susan
Shepherd, American University, and her talk is We Know Who
Is Eating The Ebola Money, Political Effects Of Perceived Corruption In The Ebola Response. – Thank you to Cat for
organizing this panel. Thank you to Sharon for all of her leadership over the last couple years now. And also I want to say and I don’t think we did say that many of these papers are in a special issue of an anthropological quarterly, on Ebola and knowledge production. So look for that hopefully
sometime in the future. – [Sharon] Next year. – [Susan] Next year. And so I also wanted to
say I’ve done more applied work about Ebola with a public health colleague at my university. But what I’m presenting here
today is sort of where I’ve gone with the more
anthropological side of the work since we’re room full of anthropologists. I hope that’s all right. They both Ebola crisis revealed certain underlying power relations. And I’ve chosen to think through what is revealed by the Ebola crisis by focusing on money as one site among many
possible sites for engagement. How money came into the
countries to address Ebola crisis reveals facts about international
priorities of course, but I’m interested in what
Ebola money and Sierra Leoneans in particular beliefs about Ebola money reveal about their relationship to the state and about governance on multiple levels and scales. So it maybe a little perverse
to be thinking about money at a time when so many
lives were on the line, but really so much in the Ebola response turned on funding flows. At the top levels but also at very small level is food getting
to quarantined homes, our burial teams and SWAT teams getting paid money and it’s flows and blockages was a huge part of the
story of the Ebola response. And following that money was a key way that many Sierra Leoneans created knowledge about it and
its impact in their country. So this is a 30page paper a lot of which I’ve cut a lot, so I hope I didn’t cut the wrong things. In the sections to follow I will review some theories of state fragility and formality and corruption. I’ll then trace people’s responses to the Ebola crisis through a number of different moments, at each point reflecting on how their concerns about how Ebola money was being spent illuminate their
expectations of the state. And I’ll argue that the Ebola crisis reveals people’s
contradictory relationships to their states wherein
they simultaneously completely mistrust their
politicians and look to politicians for more for
addressing the crisis. So the question is sort of how can they simultaneously both completely distrust and only think to look to politicians for guidance. And then finally I’ll
turn to Sierra Leone’s relationship to the
international community, and how the Ebola money
flowed at that level. Concluding that the states
weakness is produced in part by its place in
an international system. So very briefly on corruption
and state weakness. Corruption or state fragility or weakness is used to explain in part why Ebola was able to take hold and spread in the region as it did. In addition to the slow
response by the W.H.O., there’s a lot of blame
cast on the Ghanaian, Sierra Leonean, and Liberian
ministries of health for downplaying the threat at
the beginning of the outbreak rather than admitting the danger. So this is certainly
become a common way of thinking about the role
of the three weak States as factors contributing to
the spread of the disease. The international community’s
general approach to these weak West African States is to claim that local institution and structures are not to be trusted and therefore need to be strengthened
by outside interventions. In contrast to this
very common discourse of West African state weakness and corruption is a large more anthropological body of literature that talks
about state informality. Something like Africa works et cetera that demands that African States be understood on their own terms rather than as always falling short of an ideal. That is it’s more
important and interesting to describe how African states actually function than to continuously talk about what they are not. And in addition the
post-war Sierra Leonean and Liberian states have very
different relationships to the international community because of the massive post conflict interventions both of them received. This has affected ordinary
citizens understandings and expectations about
how donor money works. More than most people on
the planet I would argue, Sierra Leoneans and Liberians are well acquainted with the network
of intergovernmental organizations, international
N.G.O.s their national and local governments and
local N.G.O. partners. That whole system. And they have some well
established views about how donor money works or does not
work in their communities. And then it’s precisely the past decade of postwar international engagement that has created the expectation
among Sierra Leoneans and Liberians particularly,
that government and N.G.O. personnel were
in fact enriching themselves off of international health related funds, or what I’m going to call Ebola money. The system has created both trust and mistrust and has engendered very specific ideas about the nature and practice of African sovereignty. It’s these very relations
and expectations that I claim Ebola has revealed and tested. So I’m going to go through a couple different moments that I was in the field. I was actually in Sierra Leone or Liberia in April 2014, July August 2014 and then again and January 2015. And those different moments have shown me that circumstances
change very quickly over the months of the Ebola crisis. The system put in place
to respond to Ebola was built from scratch and was
changing throughout the response to the spread of
the disease and to other lessons learned about best
practices in other places. People’s reactions to Ebola
changing throughout as well as they slowly came to believe
that it was a real threat. Therefore to forward my goal of looking at the Ebola crisis with respect
to money and the state, I’m going to focus on a
number of different moments roughly corresponding to
my periods in the field. So in and my very earliest interactions, so this is April 2014. there was a great deal of doubt about whether Ebola even existed at all. And Sierra Leone had heard that it was in Guinea and weren’t
sure what that meant. After all most people
have never heard of this disease and money was a
big part of their doubt from the very beginning, Many people assured me that
Ebola was made up as a way for politicians and their
allies to enrich themselves. I believe that their
certainty that elites would make up a story to fool
international donors was a direct result of their experience during the post-war years. In Liberia I heard very specific stories about doctors who were infecting people with Ebola in order to increase the number of cases they could report. I also heard stories about specific numbers of dollars that the Ministry of Health officials had already eaten behind this Ebola. I argued in a blog post
at the time that this disbelief was not based on people’s ignorance but rather on long experience of a government
that traded on people suffering to enrich themselves. That the rumors were plentiful and targeted many different groups for blame. Some thought Ebola was a US bio weapons program gone awry. The other side it was
started by pharmaceutical companies in order to test new vaccines. There were also rumors with
the spiritual dimension. Some said that Ebola was God’s punishment and only praying and washing with salt water could protect the faithful. Some said Ebola was a
new kind of witchcraft, and that maybe a particular packet of fatalities import local district was caused by the crash of a witch plane. But you will notice that
in all of these rumors, the punitive motivation is greed, whether for money, whether for worldly or other worldly power or most relevant to my
argument here, money. Those early days also
made very clear to me the informality of the state
and its response to Ebola. So I’m going to give a brief little ethnographic vignette here. One day in August, I visited the UU building in Freetown which is where many of
the main ministries are located including the Ministry of Health. I was accompanying a friend of mine who’s the director of an Association of N.G.O.s and who’s trying to resolve an issue with the government’s quarantine Of Kenima district. One of her member N.G.O.s ran a poultry farm that was just
outside the city line and she knew that, that person needed permission to cross in order to feed a building
full of hungry chickens. If you couldn’t get there all
the investment would be lost. At the time people were worried about food shortages in the face of Ebola, so part of the argument was the necessity of keeping up food production. Our visit around the
building was like many other visits I’ve made their, though frustrating inefficient to an outsider, but made up of long greetings and personal connections. We got to the Ministry of Health section, we’re told the minister was in a very important meeting offsite which is hardly surprising at the time. So we asked who else we could talk to but nobody knew the answer. The system was brand new, some of the secretaries were complaining to my friend that even with the Ebola the building was dry. That is they were expecting Ebola money to be coming in and it
wasn’t trickling through. So something was up and they were right. Not long after this point
the Ministry of Health was removed from the task of coordinating and a military man was put in charge of the national Ebola response with headquarters elsewhere. Someone suggested that since
our issue involved chickens maybe we should try the
Minister of Agriculture. So we went to a different
floor of the building, we were directed to the sub minister
for animal husbandry. And again the official rules for the court did not seem to be in evidence, and the informality of the state is the way things happened. The resolution of the
problem finally involved finding someone in the office who knew the guy who was running the checkpoint. And he had his mobile number called him and said, “Oh, remember me from “that wedding, I was
the uncle of the bride?” And through that kind of connection they were able to get an exception for my friend’s client N.G.O. I laughed to my friend just
how typical this seemed to me. And she said, “Well, this is Sierra Leone, “(foreign language), and afterward she was rightfully proud of her work resolving the issue for her member. So at this stage in the outbreak that is early on, the state
ran in it’s usual manner. It was generally informal
networks that helped solve problems and allowed things to run. Except for a few transparency campaigners, I believe that most yearly only and understand that mode of operation as the mode of governance in the country. I know there’s some
frustration with corruption, especially when funds are
not circulated properly. There is also a certain expectation that informality is how things are done. And in the case of Ebola that meant that some people would have to eat some of the Ebola money in order for the system to function. So now a later moment, it’s at the peak. And I call this section,
You Don’t Pass Much. It’s too much. The Ebola crisis is an important juncture, and I think it will continue
to be in people’s relationship to the state and to their
expectation of good governance. So after that all those initial doubts about whether Ebola was even real, at a certain point it became clear that people were dying in large numbers, and that the government, their own government was not up to the task of addressing them. After people realized that danger, this is when we saw the interesting shift to the simultaneous
distrust of the state and desire for the state to do more. At the height of the crisis
resources were a primary need, people needed things like
soap, beds, hospitals. They realized they needed
international intervention. In order to keep the system
working there was a need for hazard pay for health
workers and burial teams. And as more and more
international money flooded in there was an appreciation
of the engagement of the international
community and a debate about the proper role
for national government. Again this was conditioned by the experience of a post-war period. People saw some evidence
of Ebola money around town, but were never really sure if
it was being spent correctly. We interviewed a group of women selling fruit on a main road in Freetown. We didn’t ask them about money but that’s what they wanted to talk about. So one said, “Some people are using
this Ebola to make money. “Yes. “Let us not forget that the
higher rate of Ebola cases, “the more income is
coming into the country. “It is very bad. “Some deaths are not
Ebola related but they’re “all counted as Ebola to inflate the count “in order to get funding. “Some people don’t want Ebola to go away “because they don’t want to
lose their jobs as many workers “are paid like 200,000
(foreign language) a week. “They inflate the number of
cases so that the United Nations “will keep pouring money into the country. “We don’t see how that money is utilized, “nothing, not even sanitizer or buckets.” Then I asked, “Well who’s squandering this money?” And she said, “We don’t know, we hear
that thousands of dollars “are sent to the country to fight Ebola.” “But we don’t see the money “and how the money is used. “Those responsible are chopping
the money or eating the money. “Many nations are already
here to help for example “the Cubans, the British
Nigerians, and many others “but the sickness has not
been brought under control. “The government of the day is responsible “and they are accountable for all “of the funds that come into the country. “It is the government
that eats the Ebola money. “The money doesn’t come to me
or to any ministry directly. “All monies are sent
directly to the government “and they are responsible
for disbursing money. “But we don’t see how this is done.” So although people saw some evidence of how the government was spending the money there was still always doubt about whether it was being done properly. Notice that even though they had very little trust in their government, they still looked to the government
as the appropriate place, the appropriate institution to control how international money would be spent, and even during
the height of the outbreak the belief that there was
corruption in the system led to doubts about all different aspects. So one example is a building
contractor, Enbo, who said, “Even the tests they do, I’m not convinced “they follow the instructions. “I think they do it in order to increase “the number of Ebola patients. “I don’t really believe in the tests. “I think it’s a way of
getting more money coming in.” Okay. In the US when we think of
the impact of corruption on the fight against Ebola we think about supplies gone missing, maybe hospitals not built. But Sierra Leoneans expected a
certain amount of corruption, and that expectation led them to doubt a great deal about the response and yet at the same
time yearn for the state in times of extreme duress and loss. Cutting another great vignette, you guys are just going to have to read the journal article. So finally international community. I’m sort of pivoting
now from what happened within the Sierra Leonean state to looking at how that’s related to the international community’s engagement. The millions of dollars
in the Sierra Leone government’s Ebola budget pale in comparison to the
billions in the budget of the international community actors. And here I want to turn to questions of who ate the money at a different scale. In an article for Newsweek and elsewhere, journalist, Amy Maxmin, We were just talking about her, reported that the worldwide
budget for the Ebola outbreak was 3.3 billion U.S. dollars. And she found the majority of that money went to international staff rather than to frontline health workers. In fact she reported less than 2%
Of the 3.3 billion in donations to fight Ebola were in
market for frontline staff. Instead the vast majority of
money donated from taxpayers of the U.K., the U.S., and
two dozen other countries went directly to Western
agencies and more than 100 non-governmental
organizations and the U.N.. So in a way, the Sierra Leonean
public was right to doubt who was eating the Ebola money. Simons and Abdulla reported that the priorities of donors were not always the same as the people of the affected countries or their governments. The United Nations budgeted more to fly aid workers around West Africa than to pay Sierra Leonean health workers. 96.3 million just to fly
aid workers around compared to 23.7 million to
frontline health workers. It was also reported that Save
the Children spent 12 million on Ebola treatment centers that
ended up serving 280 people versus state nurses who cared for
the vast majority of Ebola cases and who were desperate for their
extra $80 a week in hazard pay. So the key point I want to make is that although there’s more
expectation of corruption in West African governments, the international community’s
money is much bigger and actually faces less accountability in how it is spent. So what do we call corruption and why? The Sierra Leoneans I’ve met I think have a better understanding
of the complexity here whereas the default Western
casting of the situation is that African governments
are not to be trusted, but international agencies are
motivated by good and their expertise includes knowing
the right ways to spend money. And so there’s the sort of corrupt below and then the you know couldn’t possibly be
corrupt international. And yet some African
observers were very critical of how Western agencies
were spending their money, including complaining about how white aid workers were spending their allowances publicly enjoying themselves on the beaches, and they thought how
uncalled for this was. And this also repeats
some of the critiques we heard about U.N.
peacekeepers during the war . I’ve argued before so far
about these Ebola money flows, and particularly about how
regular people in Sierra Leone saw and understood these flows
in relation to the state. And this discussion brings us finally to the questions of sovereignty. Almost done. Lino argued that the sovereignty of weak states was created more by
their position within an international system of
states than through any supposed contract between
the state and the people. But I want to argue for another role for the Sierra Leonean weak state as revealed by the Ebola crisis. I believe Sierra Leoneans
understand their state’s relationship to the international system more than the international
interveners do. They know that their state is defined by it’s relationship to richer more powerful states and donors. But they also realize the
unique role that their state can and must play
as an intermediary. Indeed I believe that this
is I’ve argued for local understandings of corruption
as the way that Africa works to Sierra Leonean, stateness to them means that something which serves as an intermediary
to powerful and well funded international groups. I’m out of time so I won’t
give you my conclusions. Thank you. (applause) – Thank you so much, Susan. And I’m still hoping we’ll
have time for questions at the end so hopefully there will
be a question about (mumbling). So our next speaker is Mary
Moran of Colgate University and her talk is titled Missing
Bodies and Secret Funerals, Discourses of Safe and Dignified Burials in the Liberian Ebola Crisis. Thanks, Kat, and thanks again. We keep thanking each
other, but the past year of being pulled into this
response Even Though I’m Just An Anthropologist has really been
transformative in many ways, and I think we all have Sharon
Abramowitz to thank for that. Anthropology as a domain of knowledge production is notoriously particularistic. But even within that domain one of the few acknowledged universals is that all human societies mark the threshold between life and death. And indeed archaeological evidence of intentional burial grounds, mortuary rituals are considered
a signature of our species. So it’s not surprising that
the treatment of the dead emerged as a central
theme of the new knowledge about Ebola that came
out of this outbreak. Over the past year. The greatest danger of contagion comes from late stage bodily fluids and the corpse itself. On requiring innovations and how the dead are handled to dispose
of them thought about. Early contests in the initial cases in the 2014 outbreak made it clear that there was a connection between attendance and participation in funerals and emerging clusters of the disease in dispersed rural communities. Western media reports very quickly focused in on traditional burial
practices as a site of contagion of danger
and some fairly important voices on the biomedical
research side echoed that. One well cited study that was published in Science described funerals as super
spreaders of the disease. When reports began coming in that people in the affected areas were resisting attempts to
properly dispose of dead bodies, even to the point of
attacking and killing public health officials or that
they were holding secret in defiance of national policies, this proved irresistible to reporters looking for an angle on the story. This paper considers how knowledge about traditional funeral practices was produced by a diverse group of actors, united by the desire to
stop the spread of Ebola, but often in uneasy alliances and collaborations with each other. These factors included
biomedical research, medical professionals, public health authorities, anthropologists, national leaders. And oops, what did I do now? And journalists. And they were all collaborating on trying to produce this new knowledge. Specifically, And I did a sort of content
analysis of both official reports and newspaper
reports, press reports, the practices defined as
traditional were washing or bathing, kissing and touching the corpse of someone who had died of Ebola. And these three activities
mentioned in nearly all the reports emerged
as exotic, mystifying, practiced by superstitious
people who lived in fear of retribution from the dead. Public health officials
in the three affected countries and their international partners asserted that in the face of a potentially global public health emergency, local sensibilities would
have to be subordinated to the more privileged knowledge
of biomedical expertise. Anthropologists including this one participated in… What we did was we sort
of resorted to what we always did which was we tried to place the practices that were
identified as dangerous in their context, right? We always go to local context. We tried to de-mystify them by pointing out that open casket funerals and the kissing of bodies goes on in the United States today although
it’s becoming less common. And we tried to emphasize
the flexibility and creative innovations of communities on the ground. We tried to demystify the static notions of culture that most of the officials were in fact working with. But it’s still, and what I’m going to describe in the rest of the paper is the outcome of that negotiation between those various positions. I like others on this panel
have cut down my 30 page journal article so I’m trying
to not lose my place in it. In this paper I make
two related arguments, one that not the knowledge
produced about traditional funerals in Liberia and
elsewhere in the region focused on these few key practices
which had been identified as the super spreaders rather than
on the aspects of funerals, which might in fact be most meaningful to the populations involved. And second that a
peculiarly recent and middle class Western understanding
of how dead bodies should be handled and by whom
underlies much of the journalism and some part of the
scientific discourse as well. These key elements of washing, kissing, and touching the corpse were treated by journalists,
public health specialists, and anthropologists as
rituals rather than as their aspects of bereavement and grieving. Most young journalists seem to
have little to no familiarity with funerals and mortuary
practices in their own society let alone in others and have little historical
understanding of how recently the care of the dead became
professionalized in the West. A journalist who contacted me by phone to inquire why, and this is a quote, “Why Liberians would risk “their lives doing secret burials.” Admitted that United States
Army Rangers and Navy SEALs take pride in risking their lives to recover the bodies of fallen comrades. By rendering basic almost universal aspects of respect for the dead as strange, exotic,
dangerous and irrational, all of the different
constituencies participating in this knowledge production obscured the similarities
between these practices, and what constitutes
dignified mortuary practice in their home communities in addition, a generational distance from direct experience with death and dying noted by Renato Isaldo
in his classic article, Grief and a Headhunter’s Rage, accounts for some measure of
the bafflement which created evidence that Liberians
and other West Africans objected to the suspension
of local funerals. Okay, I am skipping. In late October of 2014 after numerous reports of physical attacks
on space suited burial teams, the World Health Organization issued new guidelines for safe and dignified burials of a person who has died from confirmed or suspected Ebola virus disease, and it was announced with great fanfare. According to the W.H.O. media center, the protocol was developed by an interdisciplinary team in partnership with the International Federation of the Red Cross and Red Crescent, the World Council of
Churches, Islamic Relief. Karatas International, and World Vision. In addition, this is a quote, “A team of “unidentified medical anthropologists, “also contributed
meaningful safe alternatives “for touching and bathing dead bodies “developed from research into
the cultural significance and “values of burial practices
in the affected countries “consultation with religious
leaders resulted in “separate guidelines for
Christian and Muslim burials. “An emphasis was placed
on working with local “definitions of what is
meant by a dignified burial.” The new procedure was published as a series of PowerPoint slides illustrated with pictures clearly as part of a training
intended for burial teams, but also as kind of
publication by the W.H.O. And an attempt to communicate their efforts to work with the information that anthropologists were being asked to provide. The introduction to the PowerPoint presentation notes that obtaining the cooperation of the bereaved family is of utmost necessity and in bold type the introduction states no burial should begin until family agreement has been obtained. The next two consecutive sentences underscore the contradictions embedded in the protocol. The handling of human remains should be kept to a minimum. Always take into account cultural and religious concerns. So the PowerPoint outlines 12 steps for burials and rural communities, clearly incorporate suggestions
made by anthropologists including some of us at our conference. A little over a year ago in Washington, items like allowing family members to take photographs of the deceased
from a safe distance, describing procedures for a dry ritual which could
substitute for the normal washing of a corpse required
by Muslim burial practices. One could argue that a
whole new man of knowledge comprised of a combination of
anthropological sensitivities with biomedical and public health practice had emerged in producing a
model of a safe and dignified burial and this house that was out and available by October. It’s clear that the medical professionals were responsible for the safe, while the anthropologists
provided the dignity. I’d like to move on now
to talking about dignity. I’m skipping all my
kissing and washing and touching part which is
the really good part. Minimal definition of
dignity and for this I am going back to those
30-year-old field notes to observed in Southeastern
Liberia back in the eighties. A minimal definition of
dignity I’d like to illustrate here with a case in which
it was almost abrogated. I observed this in detail when an elderly woman in Southeastern Liberia died unexpectedly, leaving
no children no husband. She had spent, like many librarians of her generation she had spent much of her life outside
of the country as a labor miner in Ghana and had returned to find most people she knew gone, dead. She was living kind of precariously with matrilineal relatives. But they really were not taking a lot of responsibility for her. When she passed away very suddenly the elder man of the family gathered. They had been this particular family had had a number of other deaths. Unexpected deaths in the recent past. The financial outlay for a
funeral is considerable and this family was close to
impoverished by this time. So they decided there was no money to hold a wake to casket to do
all the normal things, and they just said we’re going to have to. We can’t have a weight because we can’t pay for a casket
and you can’t have a wake without the body and if
we didn’t have the body, that would be undignified. So they were just going
to bury her in the ground. Now several women in the family, Again, sort of tension, afar away related decided
this was intolerable. One took some of her own savings
went to a local carpenter commission to plain
wooden box, but this time. the body was beginning to smell. So the next problem was
how to make time for the box to be finished and
another woman went with a bottle of (mumbling) her to
a local part time embalmer and got him to involved
in the body for two days so in a dignified way could
be held a local church donated the services in their
facility in their choir. So a wake was very
quickly cobbled together rapidly and efficiently. Dignity was constructed
out of a network of female friends for a person with
no resources of her own. Now, in this situation
many of the features mentioned as culturally central to the systems of traditional
West Africans during Ebola epidemic were just not present. There were no concerns about
the spiritual protection of the larger community
from intentional ghost, which was emphasized in a lot
of the response or of concern with clarifying linage property rights and marriage payments. The woman was had been poor and harmless in her life and no one to express the opinion that she would become less so in death. She was simply recognized
just a fellow human being and as such her remains could not
be treated like an animal. The important issue
was that she be present at the commemoration of
her own life and that presence required a few
things like a coffin and so that question of human
dignity in many cases I am arguing here that we’ve been focusing sort
of on the wrong things in his classic essay Headhunters Rage. When I reflected on his own understanding of the anthropological creation of knowledge about death was changed by the tragic loss of his wife, Michelle. Quoting one should recognize
that ethnographic knowledge tends to have the strengths
and limitations given by the relative youth of
field workers who for the most part of not suffered
serious losses and could have for example no
personal knowledge of how devastating the loss of a
long term partner can be for the survivor obviously
we can include all of the participants in this
conversation in that category. He was talking about young field workers. Result continues. Ritual itself is defined by
its formality and routine. Under such descriptions, it more nearly resembles a recipe, a fixed program or a book about it than an open ended human process. It’s not that in this manner eliminate intense emotions, not only distort their descriptions but remove potentially key
variables from their explanation. What would it look like or
what would it have looked like if we use anthropologists
privilege the process of mourning over the ritual process of us? Would we find the dignity that came so naturally to the women
who patched together? A good enough way can
feel normal for a virtual stranger back in 1903. With this new knowledge be helpful in interpreting the resistance to safe and dignified burial protocols that continue in this day and some parts of the region. Would there be a way of making the body or it’s symbolic equivalent present. That could be consistent with the biomedical standards of safety? Perhaps transparent plastic body but bags or some other alternative. If anthropologists attempted
to rewrite those W.H.O. God lines from a perspective
of rather than ritual, what would they look like in proposing modifications to ritual. as the solution to the non-compliance of Liberians and their neighbors? With biomedical practices
of Ebola containment, anthropologists help to create a specific kind of knowledge about us, but perhaps also help to obfuscate certain kinds of knowledge about emotional responses
to sudden devastating loss. Our emphasis on flexibility and innovation in local practice. A position that Tariq that taken to directly confront
the mainstream understanding of African cultures a
static tradition bound has resulted in welcome new perspectives for our colleagues on biomedical fields, and for our collaboration
with them in future outbreaks or humanitarian challenges. But has it gotten us any closer
to the experience visited upon Liberians and their
neighbors more last year. Again result reminds us funeral rituals do not contain all the complex
processes of bereavement. Ritual and brave much should
not be collapsed into one another because they
neither fully in capsule it, nor fully explain one another
instead of rituals are often put points on a number of longer perceptual trajectories. Hence my image of ritual as a crossroads where distinct life processes intersect. How different would
our knowledge about the process is in the West
African able a epidemic if we had paid as much
attention to emotions as we did to ritual practices. And what the Western, two sentences with the Western public’s understanding be altered if journalists had
reminded their audiences that in the not so distant past. American and European families process their dead at home,
washed them dress them, pose them for weight keeping
in their own parlors, and sometimes even
included them in lifelike table with living family members for cherished photographic keeps could knowledge about traditional African funeral practices be there for humanized and generalized, rather than reduced to an
inferior form of knowledge. These of the biomedical truth. Or when the next break occurs as it inevitably will with the protocols on rituals developed in 2014, the PowerPoint Training protocol has now. that now exists that didn’t exist before, well that provided the template upon which the next
wave of rage and despair is to be safely contained
within ritual parameters. Thank you.
(applause) – Thank you very much, Mary. Our next speaker is an aid to show off and from the Max Planck Institute for Social Anthropology and her talk is titled Almost There and Back Again, Knowledge Production and Translation During the Ebola Outbreak. – Thank you cats, Kat.. Thank you so much. I thank this panel. Thank you previous speakers I have changed my presentation around
a little bit with me. The bow out Ebola outbreak
in West Africa changed many relationships between researches and informants between academic institutions and humanitarian agencies. Or did it? Hence my title, Almost There and Back Again with media ties need for anthropology and a willingness
among spent anthropologists engaged with global health. Machineries a new professional match seems to have been made
it seems a very powerful two or a phenomenon that
redefines relationships. A colleague who has just
come back from a study of borders and Central African Republic relates to me the information that while the different warring factions in the country raid their border posts regularly. They do not raid the equipment that they have to check, travelers who come into
or leave the country, although these this
machinery has long run out of out of juice if you will of batteries. Of doesn’t effect and
et cetera, et cetera. These remain symbolically rated. But to come back to the region are Interested a of which you have heard a lot from my previous predisposes many things have been on sewage and at the beginning of the outbreak. Amongst them there was a
certainty about medical knowledge. While a lot of information
has been collected how much more robust medical knowledge. Is there on a boat
epidemic, epidemiology call. Questions of transmissions in general and survivors in particular have received. Researchers and international
media as recent tensions. Another of uncertainty
however was identified as the so-called local
social cultural practices. As the speakers before
me have so eloquently Explored the problem
identified called for cultural experts and anthropologists to help. But what challenges exactly Could be addressed by such an intervention and what kind of expertise was sought by those organizations and what kind of questions were posed that needed this sort on system straightforward. As a key problem was identified
to be cultural anthropologists as the experts would come
in so they were recruited to U.N. organizations or
transferred within larger aid organizations to suddenly
work in the West African area. Or they were hired from
universities to conduct. specific research, Obvious participated remotely in ways that Sharon has sketched out for us in the
first talk of this panel. To explore this context today
I will talk to you a little bit about who is an expert and on
and watched an expert can speak about and can speak to in contrast
and contrast that with the anthropological experiences in
the larger about our response. Part of the incur inquiry will be into different perspectives into crisis and exceptionality as perceived by some actors involved in the production intervention. And hence I will start
to restructure my talk. I have been working for a
very different talk big. In this area and unique called for my in 2007 I spend Classic year
of field work in that area and was lured back there
if you will by initiative of the Washington meeting in 2014. So I’m not going to give you a little bit of an example from my work that I tried
to do in this context. So context is us had
anthropologists are really good in looking at that
embedding the phenomena into the larger context to yield
a deeper understanding (mumbling) show would be
complexities of real life. This however is a question of priority and negotiation as well as I can illustrate with the following context that addresses the so-called
resistance of communities. There are maps like this showing the intensity of community resistance across the countries as well. Community resistance became
very quickly a key word in the challenge to end
the about the epidemic. And this was based on harsh categorize (mumbling) categorizations off conforming with epidemiology
call and medical information in the processing of
the sick or dead bodies. And categorize (mumbling) off community to politics in times of
crisis that should warrant exceptional behaviors, and hence to categorization of events that may have multiple routes and know you
need a linear explanations. Especially after the attack on woman in September 2014, the worry
of violence against Ebola workers was very high in Guinea. So when discussions on violence, events and with informants in this area very far removed from home a few will didn’t these anywhere
I was really wondering. I was calling these
people that I have been keeping in touch with from 2007 on was remotely by
telephone later by Skype and email as technology pro
progress in that area. And with this concern of the
about the outbreak I was very much biasing our conversations
towards this idea of the able outbreak and
the crisis that was there where is my informant in various
communities in this perfect to relay very different
stories mainly contextualizing information about some violent
incidents for example that had very different explanations
very different causes, whether this was killing
of politicians or military personnel in the area of the put it to or. The killing of or attack
near a deadly attacks on back to priests on
the island of Kobach. Later on their explanations were not marrying my engagement with. Some of these events made it. Some of these events
of killings or violent attacks made it to the
international level. Being subsumed under the
larger Ebola resistant context. Revealing how powerful a machine are you a set in motion
relaying everything to Ebola. There was no space for
alternative narratives. Even though it specially in September 2014 when Ebola was already raging
in neighboring countries, it was not such a high concern in this specific area this method is a bit complicated as shows you the whole region three countries
by territorial units. The red colored territorial
units are those that have at least one case
of suspected or confirmed linked to them, so September 2014 you see in the second
row second to your left, second from the left that this area for a car is already read. There had been a few cases of a ball about there has not been yet. This idea that Ebola is a big
crisis here in this specific area it was constructed and
understood as being remote. MOTU forest Guinea, but also remote in the sense of international news filtering
sue to the area that it was a real concern
among Rovio in Freetown. A real concern in Liberia as a whole in Sierra Leone as a whole. But it wasn’t there in Fort Caria. So as I said there was no
specific reference in our conversations to about other than me trying to trying to engage
with the proper with the topic. The advent of institutions the advent of infrastructure that was willing to go like screening centers like
the later treatment center that came to the to the town was also contextualized in little bit
differently because of the experience that these people
have had from vertical medical health interventions that
happened in a coat type collaboration of government
forces and international N.G.O.s for example in 2012 Cholera outbreak that surpassed its season the occurrence in very particular areas of the perfect to a prompted large M.S.F. intervention. But again the understanding
was that it was. It was very specific areas within for a courier within the larger perfect. Again these local experiences and these reflections
between the perception of Colorado 2012 M.S.F. intervention. And 2014 Advent with the Red Cross and other organizations
later M.S.F. came as well had little space in what was actually brought into this area by the government or
international intervention. There was also not a lot of the village two such Bill Turner to have narratives. As many local communities
were disqualified from voicing their perspectives
to events on moral grounds of having failed to collaborate
with those so called rational and scientific
ways of the Ebola response. That had been worked
and had been working in the larger region in these three countries for such a long time and should have been already absorbed into
these local communities. Even when I was inquiring about ties in the into these violent events, people did not yet perceive
themselves and their lives directly dominated by a
bowl of a drug or by an international crisis that
was affecting national government and that was
affecting national economies rendering their lives very difficult but not very much
differently in quality then. What they had already been experiencing in the last ten or twenty years. So people were referring to familiar exceptionality as of it events. People’s motivations political politicians actions and finding my inquiries about potential
able the links rather strange. While there is a conceptual discrepancy between people’s perspective of that, an exceptional moment or event of Watch an exceptional moment or event is what a crisis is to watch the intense international intervention was projecting onto the whole region. There’s also a discrepancy
in the understanding of emergency crisis and
exceptionality between history, humanitarian organizations
and social science knowledge is of such periods in time. While interventionists
may believe that their routine work in crisis is normal to them it would constitute an
abnormal period, a real… Sorry, it would constitute
an abnormal period. A real exceptionality
to the local population hat is that this population
may perceive it as merely a nuance in a
notion of perpetual crisis, of a life that has been so familiar for such a long time has little relevance to these considerations of international interventions. And again I must recall that
these thoughts are directed to a particular time and
space in the Ebola outbreak. However it sheds light into the discrepancies between
crisis and normality. The fluidity of the familiar
and the strange because it also had and this is grave
because it also had practical, very practical consequences. In light of for example national and international
organizations not engaging with community
based organizations. In this area or not engaging with very specific ones who questioned. The larger narrative. And they were potentially too outspoken about other concerns than as such as. Then (mumbling) biomedical
dimensions of Ebola or home of the act is were
relegated to so-called community mobilization no contact
tracing it to the cheese, even though their capacities might have been much better employed elsewhere. So to come back o the larger reflections. I might as well. So in many instances
anthropologist became the in the larger in the larger response the assumed communicators and translators and similar tenuous interpreters
of knowledge into several directions as I sketched out my conversations with
informants in for a car. But trying to link up with these concerns and also these people the C B O O’s with other institutional structures that were newly coming in or that had already been established and you name. This happened just as anthropology was by some actors black box into being the discipline that translated across a cross language, across culture, across disciplines, across communities of practice, and across a lot political
lines of communities that were trying to protect themselves
communities that were afraid, and government machinery
that was very much pushed by international machinery kicking into crisis mode on
the on the national level such into lucrative positions. Throw into the under lying
assumptions of familiar and strange knowledge is of
anthropologists and their work with humanitarian or
emergency interventions which are not new at all
I want to highlight this. But nevertheless the intensity of engagement between these different groups was certainly much more relevant in the Ebola outbreak and intervention than in any other case before the hierarchies of Knowledge that. I sketched out in this example of resistance community resistance. So how much power
relationships play a role to defining categories defining events. Also the ensuing (mumbling)and activities as reactions to the aforementioned events to which maybe anthropological
knowledge can contribute. But it is a question nevertheless in the in the routines and familiarity over teens of these two minute Tarion and political activists. How much they can sink outside look frame logics that have been implemented to maximize efficiency in
a very Minaj aerial way. While the Ebola outbreak
provided for many a moment of strange encounters
with familiar faces, institutions and logics, then maybe a little new about
these dynamics after all. However anthropology is
a field of contribution contributing to human
Terry an intervention has become significantly more visible. Just as the recognition for the kind of information the kind of knowledge it can bring to an intervention again. While the intensity of recognition may be new was a call for such knowledge, for such kind of knowledgeable engagements is not new at all. Thank you very much for your intent. Thank you very much Anita now and because Fred Lane could not join us our final speaker is Juliet Bedford from the University of Oxford, the in-house anthropologist for unmarred negotiating the able response. Thanks. Kath and season for the panel
and thank you to all of you. I appreciate five o’clock
on a Friday afternoon when you’ve had several days of
a chip or a conference is a difficult time so we appreciate
your patience with us as a need to just touch
on the end of her paper there has been a long history
of anthropologists being engaged in different types
of humanitarian emergencies. And being in gauged in different types of ways as well and that has really led to the development of humanitarian anthropology, which rather like some
of the old debates in what is the difference
between anthropology in public health and
anthropology of Public Health. So unlike other colleagues
who were in the field during your polar response gathering data. I was in the field. But it was a different kind of failed hence my title of my presentation today, The On the House anthropologist for on may slightly with
my tongue in my cheek. Really a lot of them. The job that I had in this role was synthesizing and operationalizing material that was being gathered by colleagues on the ground. But also that was being provided remotely through the different platforms in the different types of engagements and I’ll touch on some of that later. So in my paper I really want to touch on three main sections. The first is to give you an overview of how and why it was set up what its mandate and objectives was, and then initially how it
was rolled out in the ground. The second section is
something about my role in it and you know anthropologists
love to be reflexive, and something about
actually deploying within a UN emergency mission and what that like in terms of something to
do within the positioning of being part of that kind of mission and then leading on for nothing with a few thoughts about
future considerations building on this experience. So on the 18th of September twenty fourth, the U.N. Security Council unanimously adopted Resolution 2177
determining the break was a threat to international
peace and security, and an upscale response from U.N. member states and from the system to address the about outbreak. The resolution acknowledge that actions that were already
being taken by countries by the three most affected
countries in the region, but stated that the
national governments may not have the capacity to
respond to the outbreak. So noting a letter dated
the twenty ninth of August to the UN Secretary General Ban Ki-Moon the presidents of the three most affected countries quote requested a comprehensive response to the outbreak, including a coordinated
international response. And the resolution stress that there was a need for all relevant UN and to coordinate the efforts to assess both the national regional and international
aspects of the response. Interestingly it’s worth
noting that the resolution had one hundred thirty four co-sponsors, which is actually the largest number of co-sponsors in the history of the U.N. The subsequent day in one thousand nine hundred twenty fourteen. The General Assembly then adopted Resolution sixty nine slash one on our actions about how
to defeat the a bowl outbreak. And the U.N. secretary general
announced the formation of the first ever UN
emergency health mission. The United Nations mission
for emergency response. The S.D. stated quote that it was the S.G. stated that it was his quote intention that the mission will exist only as long as it is necessary to stem the crisis. When a virus disease
no longer poses a grave threat to the people of
the infected countries. The mission will have achieved its objectives and it will be disbanded. So unmissed central role
was really one of the lining and coordinating
the international response and support of the
national response plans. Its mandate was to focus on operations to provide overall coordination structure for all of the operational work within the UN across the three. most affected countries and it was tasked with I asked with
them to find priorities, meeting logistical needs, implementing activities at the request of the national governments, aligning support with
other actors and delivering affective analysis
reporting and communication. So the mission was led under
the strategic leadership of Dr, David Nabarro became
the U.N. special envoy and it was initially
headed by Anthony Bambery. He was appointed the
U.N. as our S.G. Special Representative of the secretary
general of the initial phase of the mission so
from the end of September through until the third
of January twenty fifth. The second phase was then
that by Ishmael Akhmed, led the mission from January
until the end of April before he moved to be the
U.N. special envoy to Yemen. And Peter Graph then took over
in the leadership role from April through into when I closed on the thirty first of July. Prior to that Peter
was actually the E.C.M. or the about a crisis manager in Liberia having moved over from the W.H.O. at the start of the outbreak. So the establish off was
actually unprecedented in several ways and I just
want to highlight for. It was the first of a UN health mission. Secondly for the first
time the mandate was actually given by the
UN General Assembly and the mandates are usually
given by the Security Council so that was a second difference. Thirdly the operational function of the mission was not a normal. U.N. operation based on decision making across the U.N. agencies and departments. Rather it was a mission
that was focused on decision and crisis management action. The mission was formally
established incredibly rapidly around five days which I
think is a U.N. record. In fact the deployment began
immediately after the twenty nine after that the Security
Council in General Assembly had met in West Africa on
the twenty ninth of September in advance teams were deployed
to the three countries. So that by the first
of October the mission headquarter had been established in Akron. And the country offices had been set up in Monrovia Freetown and clinically. So on May this new and
very strange animal was suddenly forms it was
suddenly on the scene. It was a difficult time because other agencies like M.S.F. see the W.H.O. had already been working on the response of the nine months at this point. There was no consensus
about what the objectives of what strategy was needed
how things were going to be implemented or who had
responsibility for what. So used to some degree
this was the purpose behind what came to be known as the
planning conference which was held in Akra from the fifteenth to the seventeenth of October. Until that meeting, many of the senior leadership
came to David was there. The chief the company
of the secretary general with the deputy director of
the W.H.O.I believe Margaret Chan was there at the beginning
of the opening as well. Cousin, the director of the W.S.P., plus participants from the
World Bank from C.D.C. to fade UNICEF and other agencies. So the conference produced
an operational framework which define the scope of the crisis and also assigned
responsibilities in the response. And you’re a member for
distinct pillows for five distinct police say was
given the leadership of a dead body management UNICEF
to the leadership for social mobilization and the three
countries were not invited to the conference and we
can talk about that the reasons why in the benefits
of negative sides to that. So after the conference, Tony Banbury actually three flew to three countries to
meeting consult with the president to get there by
and into the framework, and similarly to change the
framework so that it was properly aligned with the
National Response Plan. Now in the stocking report
is this of the W.H.O. in terms of their response to break the panel that if the W.H.O. had support from your and agencies and humanitarian act is including the UN agency standing committee. If Margaret Chan had actually announced a public health emergency of global concern. And I quote, “Then resources could have been made “available and known
systems put in place.” And these might have
a virtue of the crisis that led to the need to establish. So for all of a maze
flaws, and there were many. And so I’m sure you know it’s now being recognized that that sort of structure will not be adopted again in future health emergencies. We do have to remember that was set up at a specific time for a specific reason and much of that today was to do with a vacuum of leadership. Having said that people
recognize the need for sort of this command and
control the army was meant to bring actually in practice it was very difficult to get buy in from the from the different agencies
and the whole mantra of one U.N. really was very difficult
to get traction there was huge politics in territory and many of those issues resolved even until the end of. So how did I get involved in a non life. I run an organization called on to logic which focuses on applied
and global health. And a lot of the work that we do is working with communities looking at their perceptions next parents
is seeking health care. And then using that as
an evidence base to help agencies and international partners local N.G.O.s ministries of how specific hospitals so very multi level build an evidence based around the interventions with the ultimate objective
that it will increase eateries and have a positive
impact on health outcomes. So I was first contacted by the chief of staff on the twenty ninth of September asking if I’d be interested
in coming to work in. I admit I was at first very skeptical partly because many of
the initial conversations I had were with colleagues from the Boston Consulting Group who
were doing a lot of the strategy building around
our marriage that time. I then went to Somaliland
gagged in an ongoing project. And then I got another phone call on the fourteenth of October whilst I was in saying can I get to buy tomorrow for the first day of the of the conference. So just a word about deploying with this kind of emergency mission. Nobody bought me a plane take a I had to buy my own plane ticket. Getting out of her gaze A to West Africa is not a very easy thing to do the best of times let alone being given a twenty four hour window to do it. When I arrived in Africa, let’s just say that the human resource people were rather surprised to see that it was that even though the senior leadership knew that I was coming. Later on when I deployed to Liberia I basically had to sign a waiver that. If I got sick, because
I’m external to the U.N., they couldn’t guarantee that I was going to be looked after there was no Mecca. Actually when I landed in
Monrovia on a U.N. plane, one of the U.N. planes that
Susan mentioned earlier, I basically had to talk my way
into the country because the customs officials wouldn’t accept my official U.N. documentation. Just a note about deploying deployment. So in terms of the operational, the working environment in Accra, it was extraordinary. Just to give you a snapshot. A standard working day would begin about 5:00 in the morning with calls, with Skype
messages, checking in with Sharon and other colleagues, breakfast. 7:00 would be the school bus to the office which at that point was a
WFP forest logistics station based at the airport in Accra. We then worked the whole day
in an open plan office until about 7:00 in the evening with a highlight being the sandwich man arriving at 1:00 in the afternoon when
everybody would run down pick up their sandwiches and then go back and meet them at their desk. We got back to the hotel about 7, 7:30 and then generally work
until about midnight. And we were doing this day
in day out seven days a week until again the human
resource people became a little bit concerned
about this and says that nobody could come to
the office on a Sunday. Which of course meant we
all carried on working just as hard but from
the hotel on a Sunday. So from the start there was recognition from the senior leadership
in (mumbling) that they wanted to incorporate the knowledge of anthropologists, social scientists, regional specialists, into
the response but there was no real strategy about how to do this and no mechanism about how to bring that expertise to bear. I didn’t have a terms
of reference I didn’t get any formal briefing when I arrived. So it was a very steep
learning curve for all of us. Sharon has already spoken about how the different anthropology
platforms were set up. But I have to say that
I could not have done my work in the way that I
did without those platforms. The ability to crowd source
information from a large number of huge new
knowledgeable, very engaged, very committed to
professional anthropologists regional specialists and
other social scientists was invaluable, and I
can’t stress that enough. Plus the perspective that
the platform was able to give from trusted colleagues
who were working remotely. And again Sharon mentioned
this temple element provided a huge amount of insights and also great deal of support. So I know that there is this
tendency for anthropologists to be overly reflexive and
there were certainly many moments that were very
Woody Allen in terms of the angst that we were all feeling in terms of what we were doing. But I have to say that
that level of critique and the level of doubt was not just being experienced by us. It was being experienced by everybody in this response because of the unprecedented nature of the outbreak. So time is limited so I just want to highlight a couple of
different work streams. Firstly something just
briefly to speak about the briefs that we produced during this October to December period. We were recently at a conference and (mumbling) Anita Shoven and
Rosemary Beck had organized. And a colleague said that, related that a colleague
of hers who had been in a health facility in Sierra Leone had received one of
these briefs and thought, “What is this got to do
with me and my practice?” My response to that is
from my perspective, it’s fantastic that those briefs actually circulated as broadly as they did. But it’s worth remembering
that they were actually written with a very
specific remitting time, and that was to get key considerations to the right people at the
right time and in a way that could be readily
understood and absorbed. The one piece of advice
that I did get when I joined (mumbling)
was from Richard Reagan who is from the W.F.P.
and at the time was the head of logistics for a mayor in Liberia. And based on his long experience of other crises and humanitarian
engagements said to me, “Write us two-page briefs. “If you can get it on one page great. “But otherwise two page
is an absolute maximum.” And so this is what we did. We’ve been criticized for
being reductionist and of course they had to be
reductionist to fit on two pages. But my counter argument
would be that they were based on a huge amount of
knowledge and expertise. The colleagues who have been engaged in the region for a long time had to offer. In Liberia lots of the work
that I was doing was actually in support of the national
government through Amir’s remit to support the
national response plans. Particularly through
the I.M.S. and the pace of the president’s advisory
committee on Ebola, it was very clear at that point that obviously the numbers weren’t telling us everything, so much of my work was to do about finding entry points for using qualitative data to
compliment and supplement the routine epidemiological data
that was being presented. And because I was
actually positioned within Amir remembering its remit to foster coordination and collaboration, I was in a very fortunate position that I was able to sidestep a lot of the inter agency politics, or at least negotiated a
way around some of them. But it wasn’t easy. Anthropologists were being
rapidly deployed to West Africa, and in Liberia we actually
managed to form a small group of anthropologists
who were on the ground. But to be honest it was a little like a microcosm of the whole response. It was difficult to get traction, as people were pulling in
different directions had different agendas and
different responsibilities. There was also question
about who was deployed in terms of working in an
emergency context and it certainly isn’t for
everybody not only in times of the pressure of the
operating environment, but also in terms of
being in a position to rapidly analyze and operationalize data and then to take responsibility the decisions that are being made on the base of the basis of the information that you’re providing. And this comes back to Anita’s critique about how the knowledge
was being packaged. We had colleagues who
were out on the ground doing really interesting
very important work, who weren’t able to even
share with us of their preliminary findings, and
eventually when their report came it was March by which time
Liberia had no cases anymore. So yes it’s great we’re building an evidence base for next time, but in my role it didn’t
help me operationalize that material to better shape
interventions on the ground. So just in conclusion, a
couple of quick points. We’ve been discussing a lot within anthropology as a
discipline about what Ebola and the Ebola outbreak has meant for us, and I think that many of
us have become much more articulate about what we
can and what we can’t do. There’s still a need
to manage expectations and of course this idea of sending out an anthropologist as a silver bullet to solve community resistance
is highly problematic. But there is momentum around
the value of our expertise, and I think this is borne out
in the ongoing discussions and recommendations that are coming
out to the various panels, evaluations and future planning exercises, including the stocking reports, the SG’s high level panel on global response to health crisis, the National Academy of
Sciences Commission on the Global Health Risk
framework initiative, and even on the external
evaluation of Amir itself. The trouble with lessons
learnt is that whilst they might be learnt
albeit to varying degrees, actually changing the
structure to ensure that lessons are applied remains
incredibly challenging. And I anticipate, sorry
I appreciate that many similar conversations as this happened after SARS, after H1N1. But for lots of reasons I
do think Ebola is different and we know that these kinds of complex challenges are not going to go away. It’s worth remembering
that the height of the Ebola outbreak, the UN
was dealing with six other level three emergencies
including Syria, Iraq, the Central African Republic,
South Sudan, Palestine, and then of course there
was the earthquake in Nepal. Undeniably we still have a lot to learn. There are many things that we
could have done differently, there are many things that
we could have done better. But I think that these debates
are actually wider than the role of anthropology in
the West African response. I was at the lunchtime session today of conversations around with
Nepal post the earthquake. And many of the issues that
colleagues were bringing up there were very similar
to the ones that we’ve been talking about over the course of the last 18 months about community
engagement, about resistance, rumors, the politics of aid,
the involvement of youth as first responders building back better, recovery, ongoing food and
security, how to monitor and evaluate the impact of anthropologists and anthropological knowledge in
these types of engagements. And interestingly they talked a lot about the use of social media, which is something I
think we could actually learn from in terms of
the West Africa response. Of course there is a
difference between natural disasters and public health emergencies. But I do find in my own
work that it helps to be a pragmatic optimist, and I’m
confident that anthropologists do have a very relevant role to play not only in development work, but in shaping future public health emergencies and other humanitarian crisis. Thank you. (applause) – All good intentions come to problematic ends when
you give panelists more time and they take more time,
they get even more time. So it was supposed to be 15 minutes for questions is now three
minutes for questions. So if you have any questions please direct them to the panelists. Yes? – [[Voiceover] Hi, I’m
going to be very quick. First of all I’m (mumbling). I’m native of Congo but I live in New York City where I was teach at the New York City College
of Technology, the CUNY. CUNY, the City University of New York. So first of all I want
to thank you so much. and I commend you for
all the work you did. (mumbling) apologies to
myself living in New York City and teaching a coursework
African government, I wanted to follow up the Ebola crisis and my work or my palate study had started following the discussion of President Barack Obama
at the United Nations, September 2014 at the General Assembly. He called on the African head of state to address the program and give them command them, urge them to
go and attack the problem. So from that time, myself and my students, we have been following the responses. My study is the responses
of African heads of state to the crisis, to Ebola crisis following their speech
with President Obama. So I can tell you that
sitting here this evening. I in my study saw different approaches. I saw political. We saw a political approaches to this and you have addressed that. And the money the money question, that’s the question I want to ask you now. The money approach. I also saw economic approach
to the Ebola crisis, okay? So now that you have identified these key issues of economic
and people making money, my question to you is what
type of recommendation, practical suggestions or
recommendation we can come up, way to solve that because you’re right. It’s the money problem (mumbling). And the other question
to the cultural aspect, or the questions that the speaker with the dignified feel, Ariel West, you raised so many
critical questions to this. Do you have some kind of
answers or suggestions to that? And thank you. – Practical recommendations, that’s hard. I was saying last night that I think my intervention is much
more about us understanding. I want to shift donors ways of thinking more than I am interested in shaping African polities somehow. So I think if my recommendation would be try to get people to understand that if people have critiques about the corruption of the response, not to just sort of shuffle that off but to take that as a central piece of why they are effective or
not, that it’s not just about why can’t ignorant Africans accept the germ theory of disease. And instead say why do they
believe the things that they do, and often it’s for very good reasons. I don’t know if that’s
a practical application but that’s my answer. – I guess I’m not sure
I’ve got a practical answer either except that I do think the tendency to focus on
ritual as just a set of repeated practices does
wash out the common humanity in the way that all
people respond to death and bereavement and grief and loss. This set of power points
that I analyzed a little more closely in the longer
version of the paper. As I said, it was a product of that moment that Juliet’s been describing them. Everybody’s been describing when of course she wants some way of stopping additional infections,
protecting people, some way of keeping those who has been caring for the sick and the dead safe. But I really think maybe those
before the next outbreak, that PowerPoint sequence
ought to be revised to really put less emphasis on ritual and steps of ritual and
more on bereavement. (mumbling) peace, in the longer version of the paper I talk more about observing Liberians who were
bereaved and their behavior that there’s a rage, there’s an anger. That’s kind of almost
directed at the person who’s gone for leaving on and that often that rage which may been a big
part of the response to burial teams that was
understood as motivated by fear. If we could understand that
is as motivated by grief, then there might be a more less of the distancing in othering and of treating the response
as well these are people in new rituals and more in terms of these are people who have just
suffered terrible loss. And how does any human
being respond to another who has suffered terrible loss? – We’ll take one more question (mumbling). – Hi I’m Robert Han and I work at the Centers for Disease Control and I’d like to thank you, Kat,
for organizing this panel . In particular Sharon and Julie and Anita for their incredible work keeping this project and anthropological
response going. I also think a couple comments I think the Ebola response has elicited the greatest request for anthropological input that C.D.C. has ever shown, and also the greatest response
from the AAA and other organizations to an international crisis and I think we should, and I think we all agree that we should carry this momentum forward and be an organizer proactive way of responding to these crises. I wanted to ask a question. I was particularly interested in what Anita you raised about resistance. I’d like to describe for you
the setting at C.D.C. where There’s a room full of
public health people, epidemiologists, mostly physicians, sitting around watching 30 screens of crises going on around the world, concerned with this crisis
in Ebola and West Africa and the United States that is explosive and threatening and difficult to predict numbers of deaths and horrendous suffering in these countries and internationally. And these people don’t have a very good understanding of the cultures and the settings and the beliefs of the people that, I don’t, but you all know about. And so when they see a village that does not accept our help and they see it as resistance and obviously there’s a lot going on there that they don’t understand but for them it’s an incredible anxiety provoking moment and they don’t want to do about it and it’s a threat to the project that they have. I think we share that project
of stopping the spread so just to give you a picture of
the other side of that powerful phrase resistance and there’s a lot behind it. For them it’s a powerful
threat to their project. – Briefly, thank you so much
for highlighting this because clearly it is not just a
phenomenon that happened in Guinea or in any of
the other two countries but something that is occurring worldwide in these kind of situations where crisis is happening. I referenced Central African Republic just now and there are
other things going on in the world that are quite remarkable. It is nevertheless maybe with this particular anthropological knack of pointing out contexts that I think it is important to emphasize that life is happening even when
there is an Ebola outbreak. And part of this life are
political tensions, family feuds, et cetera, et cetera, whatever
our normal life consists of, and that doesn’t go away, so
there is a nice expression, scary expression in
Guinea, (foreign language), And there is an experience of seeing moments when national political leadership is weak that local incidents of violence flare up because there is this
perceived opportunity of now acting out or now, (foreign language). And that is part of life that is not only part of life in Guinea,
it’s also elsewhere. But this has to be taken seriously how also the international intervention with its particular timing of crisis that covered the country,
that covered the region in a very different way
than local populations in their various locations actually experienced the timing of crisis and their own definition of crisis, how these interact, and how actually one can produce the other, and hence could contribute
to opening these spaces where accounts can be settled. So I think there needs to be a deeper understanding into these mechanisms of co-constructing crisis, co-constructing a deeper section of exceptionality. And that is something that we need to understand better for current and future engagements in these kinds of not only health emergencies
but general interventions. Thank you. – Thank my panelists
and please address any questions to the panelists
you have afterward. (applause) (background chatter)

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