How should we tackle deadly diseases?
In today’s world, infectious diseases are the still a major cause of human mortality.
However, when looking for global trends, developing countries are the most at risk.
On the 28 th January, Stuart Allen, a researcher at Warwick University, gave some answers to
His talk followed the work of Dr David A. Agom, whose PhD involved the researching of
palliative care in Nigeria. His work combined cultural, socio-political, environmental and
organisational dynamics, which all fall under the umbrella term of Ethnography. From
observations and interviews with hospital staff and patients, he concluded that there was a
need for a cultural shift towards a mindset that values palliative care, to enhance its
Palliative care should be a human right. It is something supported by global bodies such as
the WHO and the UN.
In Nigeria however, there is a resistance to this. The reasons were numerous, but to name a
few they involve inadequate health education, use of ethno-religious knowledge for
decision making, deep rooted belief systems and the insensitivity of bureaucrats linking to
lack of funding.
And the changes needed to overcome these issues? Acceptance of the benefits, willingness
to change cultural beliefs and commitment for action by bureaucrats, doctors and service
But, regarding cultural tendencies, can you get people to change their beliefs? Is this
morally right? And if so, how?
In the West African context, diseases are generally perceived to be a result of natural and
metaphysical causes. Interestingly, progressive attitudes to cultural changes in Nigeria have
been seen in the past. For example, following the Ebola outbreak in 2014, there were only 8
deaths in Nigeria, despite 894 contacts being traced. Nigeria dealt with the outbreak
significantly better than neighbouring West African countries due to early detection and
constant surveillance. Nigeria was effectively prepared. What’s more, certain cultural
practices such as touching the dead during burials were altered, reducing infection and
showing how deep-rooted beliefs can be changed, and perhaps, in a medical context and
regarding life, for the better. These practices have existed for generations, descending from
the Caribbean and the Americas, yet when education is given and trust is developed, lives
can be saved, showing a willingness to change throughout Nigeria. In contrast, following the
Ebola outbreak in Ghana, 60% of deaths were linked to burial practices. Even the R 0 , a
mathematical term indicating how infectious a disease is, varied throughout Africa. From 0.4
in Nigeria, considerably low, to 1.5 and 2 in Sierra Leone and Liberia respectively. How much
is this to do with differences in cultural attitudes? How much of a role do services, funding
and education play in these variances?
This area obviously raises some difficult questions as it sees the worlds of science and social
science collide. But, regarding palliative care, there is evidence that Nigeria has the ability to
change cultural practices, and there is hope that palliative care provision can be achieved…
a necessary step if we are to reach to UN’s SDG of Universal Health Care by 2030.
Cicely Day, Talks Team
Agom, D.A., Neill, S., Allen, S.C.H., Poole, H., Onyeka, T.C. and Ominyi, J. (2019)
Understanding the organisation of hospital-based palliative care in a Nigerian Hospital: an
ethnographic study. Indian Journal of Palliative Care 25: 218-223.
Agom, D.A., Neill, S., Allen, S.C.H., Poole, H., Sixsmith, J., Onyeka, T.C. and Ominyi, J. (2019)
Social and health system complexities influencing decision-making for utilisation of oncology and
palliative care in a Nigerian context: a qualitative study (accepted for publication in Journal of
Fasina, F. O., Shittu, A., Lazarus, D., Tomori, O., Simonsen, L., Viboud, C., and Chowell, G.
(2014) Transmission dynamics and control of Ebola virus disease outbreak in Nigeria, July to
September 2014. Euro Surveill. 19(40):pii=20920
Manguvo, A. and Mafuvadze, B. (2015) The impact of traditional and religious practices on the
spread of Ebola in West Africa: time