WUNRN
EBOLA – AFRICA FEMALE HEALTH WORKERS & CAREGIVERS FACE COMPOUNDED RISKS
Patriarchal gender roles leave the riskiest tasks to female health workers.
By Ndana Bofu-Tawamba, Executive Director Urgent Action Fund
Africa
November 7, 2014 - Nearly a year into the Ebola crisis
ravaging West Africa, the deadly disease has spread far beyond the region,
reaching Spain, Germany, France, Australia and the United States. As Mali
becomes the latest nation to record a death from Ebola, at least 4,951 have
perished, and 13,567 cases have been reported, almost all in Liberia, Guinea
and Sierra Leone. Buried in the media reports on the staggering infection rates
and deaths is the plight of Ebola’s voiceless victims: African women.
To be sure, front-line responders, regardless of gender, have
fallen victim to the Ebola epidemic. But female nurses have become the
disease’s invisible prey. Women account for 55 to 60
percent of the deceased in the current epidemic,
according to UNICEF. The percentage of female victims
in Liberia stands at 75 percent.
The feminization of epidemics is not new to African female
caregivers. For example, African women have been disproportionately affected by
the HIV/AIDS epidemic. As a result, today more women than men are living with
HIV/AIDS, accounting for nearly 60 percent of infections. Women and girls
shoulder the bulk of the burden in caring for people living with HIV/AIDS, accounting for two-thirds to 90
percent of caregivers for people living with HIV in Africa.
Similarly, women were disproportionately affected during
previous Ebola outbreaks. A 2007 study by the World Health Organization on the
2003 Ebola outbreak in the Congo and Gabon found that men deliberately made use
of the social custom that women care for the sick in order to avoid
contact with patients.
Cultural
Expectations
The stubborn intersectionality of disease, female caregivers and
culture is rearing its head once more. As with HIV/AIDS, Ebola is
disproportionately killing our grandmothers, mothers and sisters, in part
because of their cultural roles and expectations as caregivers.
African women are culturally revered, honored and almost
glamorized for their caregiving roles. As a result, the social burden of
caregiving falls solely on their backs. They are expected to trade at the
market and across borders and perform household duties such as cooking,
feeding, bathing and cleaning open wounds and washing soiled clothes and
linens, all while not wearing any form of protective clothing. In remote areas,
where there is a lack of information about the disease, when Ebola patients
die, women still perform the traditional rites of preparing the corpses for
burial — a high-risk activity that is mostly conducted with bare hands.
That’s not all. African women are also traditional birth
attendants, putting them at a greater risk of contracting the deadly virus.
These caregiving roles naturally extend to the hospitals where women
predominantly serve as nurses and cleaners. Unfortunately, even at these
institutions, women are not provided with sufficient protective gear compared
with the protection given to male doctors and other high-ranking hospital
personnel, who are widely considered the experts, thus deserving more
protection (and visibility).
It is imperative that
caregiving responses to Ebola are gender-sensitive and recognize the value of
women’s lives over the misplaced dictates of our cultures.
In September, Urgent Action Fund–Africa,
a pan-African feminist and women’s-rights organization, conducted a rapid
assessment survey in Liberia to explore the effects and gender dimensions of
the Ebola epidemic. The survey was critical to gaining a gendered perspective
on some of the psychological, social and economic shifts that Ebola has created
and on the local responses to the outbreak. Our assessment confirmed high rates of female
caretakers.
Conducted by Florence Baingana, a Ugandan feminist, physician
and psychiatrist, the survey paints a grim and troubling picture of the
unspoken narrative of the triple jeopardy of Ebola, female caregivers and
culture. Her dispatches highlight harrowing stories — narratives of phantom
homes, of entire families’ demise, of bereaved families’ desire to
traditionally bury and honor their loved ones and of women seeking
cultural recognition for their caregiving roles.
To be sure, the traditional notion of female caregivers is not
an exclusively African phenomenon. Around the world, there are more female
caregivers than male ones. For example, more women than men provide caregiving
in the United States. More than 90 percent of registered nurses in the U.S. are
women, according to the U.S. Department of Labor.
Ebola’s effect on female caregivers is not limited by culture or
geography either. Last month two female nurses in Texas — Nina Pham and Amber
Vinson — contracted the deadly virus after treating Thomas Eric Duncan, the
first Ebola patient diagnosed in the United States. Similarly, Teresa Romero
Ramos tested positive for Ebola in early October after caring for two infected
priests at a hospital in Madrid.
Gender-Sensitive
Response
In the past, African women have used their position as
caregivers to demand rights and privileges that uplift their status and
conditions. In the current epidemic, however, cultural expectations have gone
too far assigning value to caregiving, at the expense of the women’s lives. In
most African countries, culture and patriarchy reinforce each other. For
example, it is a taboo for men to care for the sick when there are women
around. Division of labor is so ingrained in people’s way of life that it’s
impossible to dislodge and to have whole societies unlearn values that dictate
the order of their lives. In fact, our assessment found that male doctors often
left the most infectious tasks female nurses to handle, such as cleaning
patients’ vomit, blood and urine.
Female caregivers understand the priority placed on eradicating
the disease. However, it is imperative that caregiving responses to Ebola are
gender-sensitive and recognize the value of women’s lives over the misplaced
dictates of our cultures. Women are already facilitating dialogue between
global health experts and local caregivers, including traditional healers,
using indigenous knowledge, wisdom and their unique status. These skills and
agency should be encouraged. Organizations working to combat the Ebola outbreak
should employ various modes of communication — including community dialogues,
radio, television and social media — to involve women in the effort to raise
awareness about the disease and to share risk mitigation measures. Global
health officials must also engage the majority of caregivers in ongoing
discussions about prevention and eradication.
Education campaigns should take into consideration cultural
norms, values and practices on the care of the sick and dead. Authorities must
provide proper guidelines on how to go about caring for the sick and how to
protect against the virus without disempowering the community. Caregivers must
also be given appropriate community-based psychosocial and reintegration
support. While there is a need for psychosocial support to the isolated and
quarantined, more attention should be given to the overburdened mostly female
caregivers who have been working nonstop throughout this crisis.