‘The one who hides their sickness will not get medicine’ (Swahili Proverb): The need for ethnography to understand Neglected Zoonotic Diseases

By Bex Thompson (Staff Writer)

From outer space this world appears borderless, a vast expanse of land populated by organisms ranging from the microscopic to the gigantic. Sharing the same space, it is easy to imagine how humans, animals, and pathogens are intertwined in a perpetual cycle of life and death. Given the proximity within which we live, it is unsurprising that an estimated 60% of human infectious diseases originate in animals[1], with the recent Ebola epidemic in West Africa a particularly virulent example. Despite their prevalence, many diseases shared by animals and humans, otherwise known as zoonoses, continue to be neglected. 

Major health afflictions, which mostly affect those living below the poverty line, have been recognized through initiatives such as the Millennium Development Goals (MDGs), with MDG 6 focused towards the ‘big three’-HIV/AIDs, tuberculosis and malaria. This focus, nonetheless, has left a shadow of ‘other diseases’ within which all neglected zoonotic diseases (NZDs) have fallen. Despite remaining peripheral to development priorities, NZDs cause significant illness in humans and animals, and their burden maintains a cycle of poverty that is ultimately catastrophic for development.

As Barad argues, ‘diseases are relational; a mix of dense intra-actions of animals bodies, human bodies and disease agents’[2]. The way in which animals, humans, and pathogens interact has become clear through my research on the taeniasis-cysticercosis complex. Caused by the tapeworm parasite Taenia solium, this NZD is one of seven listed by the World Health Organization (WHO). Both pigs and humans host Taenia solium, and therefore recognizing the complex relationship between the two species is fundamental to controlling the parasite.

During the past decade, a ‘One Health’ approach has flourished, generating collaboration between human, animal, and environmental sciences. However, research concerning ‘One Health’ is regularly limited to the inclusion of veterinary and medical professionals[3]. This resulting absence of anthropologists is in my opinion due to ethnography being the primary method of anthropological research. A method focused on extended participant observation within a given setting, ethnographic reports are often overlooked in favor of epidemiological data from large-scale studies. Working on a smaller scale, it could be argued that ethnography misrepresents the views of the general population. Yet, if as Nading claims, disease is ‘co-produced’ and ‘constantly changing’[4], then there must be a move beyond viewing life as static, or that disease in one setting retains the same form in another.

The need for contextual research has become clear throughout my current study in Central Uganda. While there has been extensive sampling for NZD in pigs and humans throughout Uganda, the data is generally produced for a scientific audience. Thus, it is not reflective of the way in which many individuals perceive and attend to NZDs locally.

In Central Uganda, combining quantitative data with qualitative reports therefore presents a much more nuanced understanding of NZD in pig farming and pork butchery. To illustrate, scientific reports do not demonstrate how pork is being consumed by the kilo, as it is believed to reduce the symptoms of HIV. Data from surveys will highlight that farmers are deworming their pigs but overlook that the use of incorrect drugs is extremely common. Moreover, doctors would never advise pork eaters to intentionally order undercooked meat to cure a hangover, nor veterinarians advocate the use of Aloe vera or papaya seeds for deworming pigs. However, for many individuals this is a part of their everyday life in which disease is ever present. Medical and veterinary professionals can map, diagnose, and treat many NZDs, but it is the anthropologist who can explain why and how NZDs are interwoven into human and animal relationships.

NZDs do not exist in a vacuum; they live within the humans and animals that make up this planet. Accordingly, research should be intrinsically interdisciplinary, with anthropology pivotal to the understanding of NZDs from any given context. As the Swahili proverb ‘Mficha ndwele hapati dawa’ illustrates, the one who hides their sickness will not get medicine. Hence, the cure for NZD will be found through the words and actions of people. It is only once this is realized that NZD will be made visible, and the neglect of zoonoses long forgotten.

[1] Taylor LH, Latham SM, Woolhouse ME. (2001) ‘Risk Factors for Human Disease Emergence’, PhilosTrans R Soc Lond B Biol Sci, 356:983-9.

[2] Barad, K. (2007) Meeting the Universe Half Way: Quantum Physics and the Entanglement of Matter and Meaning. Durham: Duke University Press.

[3] Gibbs, P. (2014) ‘The Evolution of One Health: A Decade of Progress and Challenges for the Future’, Veterinary Record, 174:85-91.

[4] Nading, A. (2013) ‘Humans, Animals, and Health from Ecology to Entanglement’, Environment and Society: Advances in Research, 4:60–78.