JBI Dialogues: Episode 4

JBI Dialogues: Episode 4

Gambling with COVID-19 Makes More Sense: Ethical and Practical Challenges in COVID-19 Responses in Communalistic Resource-Limited Africa – Eunice Kamaara & Ross Upshur

In this episode of JBI Dialogues, Professor Ross Upshur, one of the co editors of the journal’s COVID-19 symposium, talks with Professor Eunice Kamaara about her paper “Gambling with COVID-19 makes more sense: ethical and practical challenges in COVID-19 responses in communalistic resource-limited Africa, co-authored with Dr David Nderitu. Eunice is Professor of African Christian Ethics at Moi University in Kenya with a doctorate in African Christian ethics and a Master’s degree in international health research ethics. Ross is a physician and bioethicist and heads the division of clinical public health at the University of Toronto in Canada.

Informed by evidence from past studies and experiences with epidemics, an intervention combining quarantine, lockdowns, curfews, social distancing, and washing of hands has been adopted as “international best practice” in COVID-19 response. With massive total lockdowns complemented by electronic surveillance, China successfully controlled the pandemic in country within a few months. But would this work for Africa and other communalistic resource-poor settings where social togetherness translates to effective sharing of basic needs? What ethical and practical challenges would this pose? How would communalism be translated in special contexts to be useful in contributing to the ultimate common good? This paper uses examples from the current situation of COVID-19 in Kenya to address these questions.

[Music] [00:00:06] Edwina: [00:00:06] Hello and welcome to JBI Dialogues. My name’s Edwina Light and I’m the digital content editor at the Journal of Bioethical Inquiry. JBI dialogues is presented as a space to connect academic professional and community voices in conversation about the journal’s published research and up and coming issues and practices in bioethics.

[00:00:31] In this episode of JBI Dialogues, Professor Ross Upshur, one of the co editors of the journal’s COVID-19 symposium, talks with Professor Eunice Kamaara about her paper “Gambling with COVID-19 makes more sense: ethical and practical challenges in COVID-19 responses in communalistic resource-limited Africa, co-authored with Dr David Nderitu. Eunice is Professor of African Christian ethics and Moi University in Kenya with a doctorate in African Christian ethics and a master’s degree in international health research ethics. Ross is a physician and bioethicist and heads the division of clinical public health at the University of Toronto in Canada.

[00:01:08] Ross Upshur: [00:01:08] So welcome to, I’m delighted to welcome Professor Eunice Kamaara, who’s a professor in the department of philosophy, religion, and theology at the Moi university in Kenya. And she specializes in ethics and has a particular interest on the interface between African ethics and Christian ethics. And she contributed a paper to our recent symposium, and I’ve invited her for a conversation to reflect on her paper and to add any thoughts she has on the ethics as this COVID-19 pandemic evolves. Welcome Eunice. Thank you very much for taking time from your busy life to speak with me today.

[00:01:46] Eunice Kamaara: [00:01:46] Thank you. Thank you lots for the opportunity. Yes, I did contribute a paper in the symposium on COVID  in the Journal of Bioethical Inquiry. And in the paper, we co-authored with a colleague David Dneritu, and in the paper, we were looking at the concept of, into the concept and practice of international best practices in responding to COVID-19. And trying to understand how they apply in the context of resource poor communalistic communities like Kenya.

[00:02:25] And in the paper, we argue that those practices are not international, where they apply in certain contexts, but in other contexts, we probably need a different set of best practices. So we’re looking at each of the various responses that were recommended by the World Health Organization and consequently by our local ministry of health.

[00:02:51] And we were looking at how practical they are and how ethical they are in the context of Kenya, specifically in the context of poor contexts in Kenya, because in Kenya, we also have the global North and the global South. So we were specifically thinking of the global South in Kenya. So we argued that for poor families in Kenya it’s easier to gamble with COVID and it makes more sense to gamble with COVID than to follow some of those international practices, because they would actually translate to death. They would translate to lack of basic needs. So it’s way easier to, to disregard the international best practices and hope that you won’t get infected with COVID, than to stay at home and you don’t have the next meal.

[00:03:51] So that’s basically the argument that we’re putting across. And we were saying, we probably need to have learned from COVID, not from COVID, but from Ebola in West Africa, which told us that we clearly need to engage local communities to tell us how to address emergency, emergencies such as pandemics, health pandemics.

[00:04:14] Ross Upshur: [00:04:14] Great, thanks. So you wrote that paper several months ago and much has changed since then. Reflecting back on the arguments you made, how have they played out as the pandemic has evolved? And is there anything that you would change in the way you’re thinking about the pandemic?

[00:04:33] Eunice Kamaara: [00:04:33] Well, if it was writing another paper today, I’d probably not write the way I wrote, the way we wrote then. It would probably be more priority, to be priority, to write about how we should be responding to the epidemic, you know, rather than just talking about these are not working, these are not international practices. We probably should have done some quick, probably even community engagement practices, to establish exactly how we should have responded and even how we should be responding. It’s very interesting that we are all talking about COVID-19 in the past. You’re saying, you know, COVID was, COVID has been, you know, if, if COVID was still there, you know. And it amused me that even at the MSF meeting that we had a while back, we were talking about COVID in the past tense as if it’s gone. I don’t know how that has come to us, but it’s an interesting perspective.

[00:05:40] Ross Upshur: [00:05:40] It’s, it’s certainly not gone in Canada because we just recorded our single day record high since all of this started. So it’s by no means in the past here.

[00:05:50] Eunice Kamaara: [00:05:50] Very interesting actually. So before the meeting with them, I said, well, actually both it’s Kenyans and Africans in general, who are talking in the past tense because we in Africa have a tendency to hope and make hope practical.

[00:06:05] So we have a way of thinking, this is what you’d wish to be, and we begin living what we wish to be. So we are really believing post COVID because that’s what we hope for. And I was thinking probably these are some of the things that, that we probably could donate to the global, global North, because when you have little else to work with, then hopes become a big resource.  It becomes a huge resource, which tells me about spirituality, African spirituality. And how we could have grown a lot more from, uh, African spirituality to combat COVID-19 without creating so many anxieties like we did, or we continue…We don’t continue to do it, probably that’s why we are talking in the past tense because when COVID was at its height in Kenya, if your relative died of COVID, the government would take over, ensure that the body does not take longer than a day to be buried. And the public health of issues from the ministry of health and many other government ministries would come and take over the burial. They would pick [up] the body and come and bury it. Sometimes in very depressing ways. Like I remember many of them would be buried either very early in the morning or very late in the night with very few family members present. And it was like throwing away the bodies. And that was very traumatizing for many Africans because we are not used to that. We are used to staying with the body and mourning around it and dancing with it, you know, and literally mourning and coming to terms with the fact that the person has died, even though they have not died, they’re still present. And we have to do certain rituals around their transition from this life to another label , the living dead. I don’t know if you’ve heard of the concept of the living dead. Yes.

[00:08:18] So that was quite troublesome and I keep thinking perhaps it would have been possible to have a different way of doing it if a few people took opportunity to engage communities and understand in situations of crisis like these, what do you do in situations where you have a body here and the body is infectious, at least that is what was understood at that point, uh, how do you deal with it? And probably communities would have given us a way forward, a better way than what was happening at the time. So I keep thinking that, uh, as researchers, we probably could have done better rather than just commenting on situations in terms of providing some solutions. 

[00:09:07] Ross Upshur: [00:09:07] Well it’s remarkable, you know, when, when you, when you point this out, because of course, one of the key lessons that we learned in Ebola, was the need for community engagement, particularly around such profound life events as death and managing the dying and the rituals of family members passing.

[00:09:30] And, uh, part of the obstacle to managing Ebola was this resistance, that was finally, when we started to engage communities and understand practices, we were able to find a way to make a common ground that would serve the goals of public health and at the same time, uh, allow families to understand and partake in the rituals to the best possible way. Even if you had to sort of move it a little bit to the future.

[00:10:01] I do want to pick up one point that you mentioned, which I think is really important. Bioethics doesn’t talk a lot about hope. And, you know, and all of, so I’d like to, just to sort of expand a little bit on how you see hope playing a role in our future reflections in bioethics

[00:10:20] Eunice Kamaara: [00:10:20] Science generally doesn’t, natural science generally doesn’t talk about hope. In bioethics as a branch of science is quite, you know, it’s, it’s, it doesn’t talk about hope, like you’ve rightly observed. And yet I’m literally a student of spirituality and health and I’ve come to understand that these are close relationship between our perspective, our , not perspective, but our spirituality, the way we see things, our world views, the way we see the world and the way we interpret it has a lot to do with our health. And there are actually some studies, not so many, especially in Africa, they are not so many that lead it or link spiritual issues like hope with physical health.  They give you enough hope, you probably, you have better immunity. I’m propounding some hypotheses. I’ve [inaudible] from some literature, ideas from some literatures here and there, especially from America. I’m sure you’ve, you’ve, you’re familiar with the works of Professor Harold Koenig…

[00:11:38] Ross Upshur: [00:11:38] No,  I’m not actually, so…

[00:11:40] Eunice Kamaara: [00:11:40] …from Duke university, from the university of Duke. Yes, he does a lot of work on spirituality and health. And religion also, you know, distinguishing religion from spirituality, but still talking about the implication of religious beliefs on health, they could be negative, but they could also be very positive. So when I think of hope, I’m like probably hope is what is keeping uh,  figures low for Africa because [laughter] we can’t test, we don’t have the capacity to do mass testing and that ignorance keeps us hopeful. When we think that our numbers are small, then we feel, Oh, we are fine. And probably because we feel we are OK and we are fine and we have hope for tomorrow, then we have better immunity and we are able to, to resist COVID, perhaps. I dont know.  Perhaps.

[00:12:33] Ross Upshur: [00:12:33] Perhaps yeah. So before we conclude our conversation, any last reflections on the pandemic and where you see it going and which major ethical issues we need to pay attention to.

[00:12:49] Eunice Kamaara: [00:12:49] COVID has been strange. Let me say that.  It’s been very strange, particularly for Africa. Yeah, in Kenya, we’ve been wondering, many of us have been wondering whether COVID is real? Interesting. Because we are like, uh, we don’t understand these science where we are expected to have gotten infected and thousands of us, millions, in fact, falling sick, and then it didn’t happen. So we are like, we are used to science predicting and getting it right. How come it’s not getting it right this time? So we are like, there’s something quite wrong. There’s something not, not known more about COVID. So COVID is also strange because we see, we hear certain things, but we see different things. So we hear, uh, people we expect to know and know best at telling us that we need to have our masks on, but at the same time we see them without masks. [ recording interrupted by alarm sound] [00:13:59] Ross Upshur: [00:13:59] Yeah, I think that’s a fascinating reflection. I mean, I have my own explanation for why we see differential impacts of COVID-19 around the world. And I’m not going to say I predicted it, but I did predict that Africa would not be as hard hit as northern Europe. And a lot of it has to do simply with demography, age dependency, and morbidity strand population. So, and I’m, I’m actually happy to know that it has not been severe up to this point, but we still have a long way to go with it.

[00:14:31] So I’m going to call us to, I’m going to thank you Eunice for your time and for this discussion, it’s been greatly informative and insightful, and I’m hoping that many of our readers will take the time to listen to the wise words and insights that you’ve provided for us. o thank you for taking time today.

[00:14:49] Eunice Kamaara: [00:14:49] I see our time is gone, but I would have liked to comment on your paper with Smith.

[00:14:54] Ross Upshur: [00:14:54] Sure. Why not? Go ahead.

[00:14:56] Eunice Kamaara: [00:14:56] It fascinated me. I was fascinated by the paper and your idea of moral failures. Because every [inaudible] too, that I can see how we’ve had great lessons in the past, but they don’t seem to have informed our action through COVID and, I like it that you led with as moral failure, because actually it is, it’s a moral issue. It’s a serious moral issue when we don’t take lessons and they are available. If the lessons are not available, that would be a different thing. So I was, stand by the very specific statement you made in the paper that we do not learn our lessons.

[00:15:45] Ross Upshur: [00:15:45] Oh, we are, we are good at that. The only lesson we learned is that we don’t like to learn lessons.

[00:15:51] Eunice Kamaara: [00:15:51] Yes. And I’m like, this is so, so true. Not just, not just  with COVID-19, but everything else, everything. In Kenya, you see us doing the very things we learned not to do. So I don’t know. I don’t know whether you’ll be able to find a drug to get us to…[laughter] learn lessons.

[00:16:13] Ross Upshur: [00:16:13] Something

[00:16:17] Eunice Kamaara: [00:16:17] Thank you for the paper. I really enjoyed reading it. And I got to learn quite a bit particularly because spirituality has a lot to do with morality. I mean, moral responsibility and so on. It’s got alot to do with spirituality [inaudible] spirituality, and health. Thank

[00:16:36] Ross Upshur: [00:16:36] you. Okay. Thank you. Once again. It’s been a great pleasure speaking with you.

[00:16:41] Eunice Kamaara: [00:16:41] Thank you very much. It’s been my pleasure. Thank you.

[00:16:46] Edwina: [00:16:46] Thank you for joining us for JBI Dialogues. A transcript of this audio resource is available on our website, bioethicalinquiry.com, where you’ll also find links to the articles discussed today, as well as other JBI articles and issues. For JBI updates, subscribe on the website to our email newsletter or follow us on Twitter @bioethicinquiry.  [Music]

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