Storygram: Amy Maxmen’s “How the Fight Against Ebola Tested a Culture’s Traditions”
The Storygram series, in which professional writers annotate award-winning stories to illuminate what makes a great science story great, is a joint project of The Open Notebook and the Council for the Advancement of Science Writing. It is supported by a grant from the Gordon and Betty Moore Foundation.
Amy Maxmen’s story, which recounts how anthropologists worked with aid workers and residents to reconcile management of Ebola patients with the culture’s customs, won NASW’s Science in Society Award in 2016. Maxmen is a full-time reporter at Nature.
A great quarrel followed the death of a pregnant Guinean woman in June.Ledes can sometimes feel formulaic or overwrought in detail. For instance, they can have too much of that predictable “It was a dark and stormy night” feel, or they can feel too indulgent, luxuriating for too long in cinematic detail when the reader just wants to get to the point. But this opening sentence immediately grabs our interest without being wordy or contrived. The brevity has a punctuated feel that is impactful. And the phrase “A great quarrel” captures such depth and intensity, as if we’re about to sit back in a comfortable chair and hear an ancient tale. It also immediately establishes the enormity and gravity of the situation at hand; we would never write, “A great quarrel followed my husband’s decision to leave his socks on the floor—again.” Mourners refused to allow a team of outsiders dressed in what looked like white space suits to bury her Ebola-infected corpse. If she was to be saved from eternal wandering and reach the village of the dead, they insisted, her fetus must be removed.
NASW SCIENCE IN SOCIETY JOURNALISM AWARD
|These awards honor and encourage outstanding investigative reporting about the sciences and their impact on society. This story was honored in the Science Reporting category in 2016.|
Impossible, the outsiders said.Maxmen is artful with her use of short sentences, which make for pleasing changes in rhythm. These four short words convey a great deal without bogging the story down in quotes and longwinded explanation. Her virus-laden blood was far too contagious for anyone to cut into her body.Maxmen takes us straight to the heart of the story in the first couple of paragraphs. It’s a refreshing way into the narrative; in contrast to the common anecdotal lede, which can sometimes take longer to tell readers what the central tension of the piece is, we get a glimpse at the tension and complexity of the story right up front. In two brisk paragraphs, Maxmen hooks us on the conflict behind this heartbreaking situation and gives us a light dose of the biology behind the virus. This is a model lede.
Yet the villagers would not relent. In their traditional Kissi culture, a woman buried with her fetus disturbs the world’s natural cycles—beginnings and endings among humans, animals, and plants. In the same way, it is said, mixing the seeds of last year’s harvest with this year’s complicates the fertility of the crop, as well as the fertility of women. Even if the surgery was as dangerous as the outsiders suggested, the villagers worried that the results of disrupted natural cycles could be worse.Only three paragraphs in, readers already know that this is so much more than a story about infectious disease; this is about people, culture, tradition, spiritual belief, and more. And we begin to understand how much is at stake—it’s not solely the individual and cultural beliefs of the people in the region that are being threatened, but a people’s entire set of values and origin stories, and their livelihoods. Maxmen’s writing is so fluid and vivid that it’s easy to miss that she’s not describing a scene that happened while she was there; it occurred several months earlier.
Exasperated, the district medical officerJust the use of this one word—“exasperated”—breathes humanity into the officer’s character and puts us there, almost. It also gives us a window into the tension between the cultural concerns of the locals and the very real medical emergency that health workers were facing. called an anthropologist originally from Cameroon to help him find a solution. From decades of experience in West Africa, Julienne Anoko knew there must be ways to make reparations to the spirits for ceremonies that could not be performed as tradition demanded.This introduces a protagonist and throws in an element of surprise—a researcher who is straddling these two worlds, from academia to full immersion in the cultural milieu of this region. The introduction of Anoko here helps keep the reader reading. And by alluding to the unresolved idea that “there must be ways to make reparations,” Maxmen signals that we are going to be taken on a journey. We get a real sense of dynamics high in the story—that the situation is changing rapidly. This piece already has all the elements of story, and we’re only a few paragraphs in. I was interested to learn in my interview with Maxmen that she had not been able to reach Anoko until very late in her writing of this piece, and that she added Anoko’s character in just before turning it in—a fortuitous addition that was key to the narrative.
“Eventually, I found a very old man whose grandfather was one of the ritualists in charge of reparations,” she says. “He had inherited the reparation ritual, and told us how it was to be done.”
The villagers would need a goat, 12 yards of white tissue, salt, oil, and rice.The narration here is so subtle: We aren’t being told about these people’s cultural traditions—we’re being shown, up close. And this list is beautifully vivid and charming. A goat, of course! Anoko, who was working for the World Health Organization, provided each item, and the community accepted them.Maxmen has left out unnecessary details that would bog down the story, such as Anoko’s specific title at the WHO, and how Anoko actually learned that these were the correct ingredients—much less how she tracked them down. Maxmen keeps us anchored there in time, providing just enough detail to keep the story moving. At sunset, she watched the ceremony begin with the distribution of smooth kola nuts, symbols of respect. A world away, burial workers in sweltering hot Tyvek suits hygienically laid the pregnant woman to rest.Maxmen’s writing masterfully demonstrates the old adage about showing—through actions and scenic details—rather than telling. Brief as it is, the comparison between the sunset ceremony and the workers’ sad undertaking makes for a powerful juxtaposition.
Anoko’s solution was the exception until recently. Scenes of conflict were frequent in Guinea, Sierra Leone, and Liberia—the three countries hardest hit by Ebola—Here Maxmen brings us essential context.as medical authorities tried to separate the dying and the dead from their communities.This image is so evocative and visceral—we can feel the dead and dying being torn from their loved ones. Ambulance drivers and burial teams were pelted with stones.
In the worst attack, eight people distributing information about Ebola in Guinea were killed. Villagers often retreated with ill relatives into the forest, where they could hide—and where the deadly virus then quickly spread.This line helps readers understand the scope and seriousness of the problem, and how interwoven the cultural aspects are with the spread of the disease—the anthropology angle of this story isn’t simply a quaint or convenient sidebar to the disaster.
“The problem was that the people handling the intervention only looked at this as a health issue; they did not try to understand the cultural aspects of the epidemic,” Anoko says.This quote is well-timed; it summarizes the conflicts that the story presents and serves as a smooth entry point into the billboard / nut graf of the story. And it gives us a human voice and a breather at the very point we need it.
But Anoko and others familiar with local customs helped health officials realize that they could not curb Ebola until they found ways to accommodate deeply held beliefs about the obligations of the living to the dying and the dead. As health workers and burial teams have altered their procedures, and as political, tribal, and religious leaders pressed people to adapt their traditional ceremonies, the spread of Ebola has begun to slow.This is a classic nut graf, crafted subtly enough that it doesn’t give too much away, doesn’t slow the story, and yet telegraphs where the story will take us—to the idea that there is a direct link between respecting cultural practices and slowing the spread of the disease.
Science Confronts Culture
In the three countries hit hardest by Ebola, preparations for burial typically are carried out by community members who handle the dead with bare handsa staggeringly telling detail, rather than by doctors, morticians, and funeral home directors. People were unwilling to have those practices casually tossed aside. That worked in Ebola’s favor. As death approaches, virus levels peak.Ebola is personified here as a Grim Reaper of sorts, making the part about molecular biology feel personal, at our fingertips. And Maxmen’s use of short, almost choppy sentences lends cadence and suspense. Anyone who touches a droplet of sweat, blood, or saliva from someone about to die or just deceased is at high risk of contracting the disease.
To health authorities, the solution was simple. With so much at stake, science eclipses religion: Risky rituals must end.Here the tension peaks—we understand how deeply held these rituals are, and how deadly and contagious the disease is. At this point in the piece, it’s almost tempting to feel hostile toward the people in space suits. If I had been editing this story, I would have liked to see the perspective of the health workers included—to understand their points of view and what it’s like to be in their shoes. But as Maxmen notes in the Q&A, their absence from the story works, in that it serves to amplify the starkness of their role as health workers who must treat the bodies of Ebola victims in a methodical, cautious, routine way.
“People were expected to go from one end of the spectrum to the other; from washing the bodies by hand, dressing them, and holding elaborate ceremonies, to having a corpse in a body bag and no goodbye,” says Fiona McLysaght, the Sierra Leone country director for a humanitarian organization called Concern Worldwide.This quote sums up the conflict and is utterly heartbreaking.
Spirituality runs wide and deep in Sierra Leone, Liberia, and Guinea. The population consists mainly of Christians and Muslims. Christians close the eyelids of the dead, wash and dress them. Muslims wash the dead as well, but wrap them in a white cloth. There are also rituals particular to ethnic groups—such as the Kissi, the Mende, the Sherbro, and the Kona—as well as secret societies.In one sweeping paragraph, Maxmen highlights the religions and spiritual beliefs that coexist throughout the region. This treatment provides readers with essential context.
The details of tribal and secret society ceremonies are closely held, but some hints come from locals and anthropologists with regional expertise.
According to anthropological accounts, the Kissi, for example, sacrifice an animal over a stone at the dead person’s tomb and then place the stone at an altar devoted to ancestors. The Sherbro may examine the body to determine whether the deceased had been a witch who caused harm. If so, the spirit must be rendered innocuous before burial, lest it cause crop failures and other misfortunes.
A third layer of ritual comes in with secret societies, groups that conduct clandestine ceremonies throughout the region. Secret society leaders must be buried in a particular manner to transfer their powers to a successor. Unwilling to go into detail, Sidikie Sankoh, a youth leader in Freetown, tells me gravely, “If these rituals are not done, there are consequences.”This quote comes not a moment too soon; up until this point, we’ve only heard from experts. The people being affected by Ebola still feel largely distant. The quote from Sankoh conveys more than just what it says—it telegraphs how suspicious the locals likely are of outsiders, and how intimate and culturally valued their secrets are.
These layers of belief mean that death in West Africa is accompanied by a complex and sacred blend of rituals. If they are ignored, the dead are thought to wander the Earth eternally and plague the community. To Westerners, the rituals ring of a forgotten past. But they serve the same purpose as death rituals around the world: closure through saying goodbye to loved ones before death, and paying respect to the deceased.This sentence serves a critically important function for Western readers—it reminds us that these strange rituals aren’t so foreign, that we have our own rituals that would seem foreign to outsiders. This also serves to make the piece personal—to prompt readers to empathize and put ourselves there. Through this, Maxmen also effectively avoids the trap of characterizing West Africans as exotic to Western readers.
Distrust Thwarts Compromise
Neither of these tenets was respected in the Ebola response until recently.This sentence gives the story immediacy—it tells readers why they’re reading it now.
Throughout most of this outbreak, there were not enough beds and staff to care for the sick, so overwhelmed nurses sent the ill from one hospital to another—without keeping track of who went where. Those who died were often whisked to unmarked graves. Families were left not knowing whether their loved ones were alive or dead—and, if they were dead, where they had been buried.This information feels a touch buried in the story—it would have been helpful for the piece to nod at these issues higher up, while we are learning about the deep skepticism that the locals feel towards outsiders and authorities.
These disappearances stoked conspiracy theories that Ebola was a hoax. In one, doctors were said to be killing patients to steal their organs. The less people believed that Ebola was real, the less likely they were to bring deathly ill relatives to clinics and to stop honoring their dead relatives in the traditional way.This section adds another rich layer of complexity to the story: Up until this point, the story has been about religious beliefs, rituals, and burials. Here we learn that there are other forces at play—deeper misunderstandings and misgivings. Not only are the health workers up against suspicion from the locals, they are dealing with a dangerous disease that some don’t even believe is real.
In September, October, and November, governments and international aid agencies ranted and raved about stubborn villagers.Note the smooth conceptual transitions that Maxmen uses to link the end of one paragraph to the start of another. In the preceding paragraph we learn that the villagers have deeply ingrained suspicions, in some cases for good reason; naturally, in the next paragraph, we hear that the authorities are understandably exasperated with the locals’ unwillingness to cooperate. The juxtaposition is lovely and satisfying. Meanwhile, anthropologists pressed them to understand the beliefs of the people whose attitudes they wished to change.The anthropologists, personified by Julienne Anoko and others, are the protagonists in the story, helping to mediate and bring a shift of perspective on both sides. Maxmen captures the dynamic of a changing situation, which further serves to put us there.
“You have to take into account a history in which local people have learned to distrust the government,” says Paul Richards, an anthropologist at University College London who has worked in Sierra Leone for 40 years. “It’s a situation not unlike that in Ferguson, Missouri, where a legacy of slavery, exploitation, disregard, and abuse leads people to think their own solutions are better than those from the outside.”This analogy hits home in a very personal way—helping us to empathize and relate with how such deep distrust was bred.
He adds, “It doesn’t help that outsiders are dressed in astronaut suits.”The space-suits visual is so stark, serving to emphasize just how alien these outsiders seem to the locals.
Richards knows compromises could be reached. He remembers that ceremonies were altered during Sierra Leone’s brutal “blood diamond” civil warThis provides important historical context, demonstrating a precedent for compromise and coordination between locals and health authorities. and suggests those same ceremonies might be revived now. Back then, people found ways to honor the dead they had abandoned as they fled their villages.
“Burial rituals were flexible,” he says. “The spirits are totally practical!”A brilliantly charming quote that leaves us to wonder whether Richards himself feels torn between the two worlds.
One hot afternoon in eastern Sierra Leone, Haille James, of the Kissi tribe, tells me what his people did when a body could not be found.This is the first time that Maxmen inserts herself in the story. Reconstructing scenic and anecdotal details to unspool a narrative when a writer isn’t present is a weighty responsibility, and it’s important to not try to “trick” readers by making it sound like we’re present when we’re not. Maxmen accomplishes this so skillfully and artfully that I was surprised—in a very good way—to realize that much of the narrative that’s woven through the story up to this point occurs prior to her December 2014 arrival in Sierra Leone.
“You would go to the place where you think the person died and leave a piece of metal—four days for a man and three days for a woman,” he explains. “After that, you hold the metal on your head and bring it to your home, where you cover it. Then you can cry, bury it in a place, and pray.” Tamba Aruna, a mental health counselor in Sierra Leone and a member of the Kono tribe, says similar rituals occurred in his community during the war, only with a stone instead.
Pastors, Imams, Chiefs Stop Rituals
Nearly five thousand people had died of Ebola by November in the three hardest hit countries, and the contagion was still rising in Sierra Leone.Here, Maxmen gives us essential statistics to show us the gravity of the situation. This could have come higher up in the piece. Organizations involved in Sierra Leone’s Ebola response claimed that 70 percent of new infections in that country stemmed from funeral rituals, although they cited no particular study.This is a staggering number, and it elicits a sense of alarm and gives us a deepening understanding of the problem’s magnitude. Erring on the side of caution, the government mandated that in Freetown, the capital city, all corpses had to be buried in body bags with sterile procedures—whether or not they were known to be infected with Ebola.
Finally, officials reached out to chiefs, imams, pastors, and traditional healers for help and advice on how to change people’s minds about burials.
By then, many of these community leaders needed little convincing. In Freetown, at the modest headquarters of Ahmadiyya, an Islamic sect, Munnirou Abyusuf explains how he came to believe the disease was real. Ebola could be a curse or some kind of witchcraft, he thought at first, when the outbreak began in the east of the country. But then it killed dozens of health workers, including virologist Sheik Umar Khan.Here the story comes full circle. We now learn just how rampant Ebola was, and we see a layer of the onion being peeled away. It’s no longer the locals versus the outsiders.
“When Dr. Khan died,” he says, “I thought, ‘Oh, this is a very serious thing.'”
Abyusuf consulted his holy books for guidance on how to handle burials given the danger. In The Life and Character of the Seal of Prophets, he learned of a leprosy contagion in ancient times.Maxmen’s story contains a rich plethora of cultural anthropology, infectious disease, history, and a nod to ancient prophets. And through it all, Maxmen subtly makes us feel like we are seeing it all in real time. For example, she takes us into the thought process of Abyusuf, making him feel personable and approachable, and we can almost picture him leafing through his holy books—but she does this in just a few sentences, without excess detail.
“When the epidemic started, the holy prophet of Islam said that people should stay put,” he says, explaining that Muhammad advocated prayers for the deceased in absentia. Abyusuf went to his congregation and explained what he had learned: “I told people, this is not the first plague. You do not need to wash the corpse. You can pray in absentia. The rules are not absolute.”Here again, Maxmen’s access to Abyusuf and his succinct, plainspoken language give this story a very intimate quality.
Pastors promised their congregations similar forgiveness, and chiefs asked their people to cease all secret society rituals. Meanwhile, humanitarian organizations and the government enacted “safe and dignified burials,” during which people could pray briefly for their loved ones, while standing two meters (6.5 feet) from the white body bag.The structure of this narrative unfolds in a fairly linear way, with no fancy structural devices, because the story is impactful enough on its own. And using a chronological structure works well for this piece because it plays into Maxmen’s strategy of making readers feel present as the epidemic is unfolding and the burial rituals are changing.
They also hired liaisons to discuss the precautions with mourners. The liaisons try to honor reasonable requests. In some cases, that means burial workers in Tyvek suits dress the dead in outfits chosen by families before the corpses are placed in body bags. In other cases, money or jewelry is placed in body bags as a “toll” that the deceased must pay to cross over to the village of the dead.
When I visited the largest cemetery in Freetown, King Tom, it was mid-December and the problems with burials had shifted.This is the first scene that Maxmen sets in the story through her own eyes. According to government statistics, almost all corpses in the Freetown area were hygienically placed in the ground by burial teams.
In King Tom cemetery, about 50 bodies were planted in fresh, shallow pits each day. Dirt and hay particles hung in the humid air.This is a cinematic and sensory-filled section; we can nearly taste and feel the dirt and the hay, and the image of the freshly dug pits is so visceral. In the space of an hour, several vans rumbled over the dirt to deliver new body bags. Small groups of men and women on foot flowed into and out of the cemetery after quick prayers. They appeared bewildered by the overwhelming scene.
The landscape resembled a construction site, with mounds of dirt and constant digging. A tractor at the periphery cleared piles of bramble and trash to make room for new graves. Now, the city faced a new issue: The cemetery had expanded to three times its former size and was nearly out of space.
Andrew Kondoh, who had been hired by Concern Worldwide to be a liaison between burial teams and mourners, met me in the graveyard.It’s atypical, and usually inadvisable, to introduce first person so late in a story. But to my mind, the scene Maxmen describes here is so moving and personal that it works nonetheless. In fact, introducing herself into the narrative much earlier might have been intrusive, robbing readers of the opportunity to feel like they were sitting in the front row, watching the tensions play out between the locals and the authorities. There’s also an entirely practical reason why Maxmen could not have introduced first person earlier in this chronologically structured story: She wasn’t in Sierra Leone until midway through the story. His broad, easy grin belies the tragedy he’s witnessed.
At 13 years old, he handled corpses during Sierra Leone’s civil war. Massacred bodies piled up outside of his town in the eastern region of Kenema. Not wanting people to stumble over the dead, or dogs to pick them apart, he spent his days cordoning off the bodies. “It was born in me to do community work,” he says. “I know how to console people.”
Kondoh counsels the young men and women who carry bodies to the morgue and graveyard. Because they handle Ebola-infected corpses, many have been evicted from their homes by frightened landlords and abandoned by their partners.
“Women at the corner will not sell me water. They call us ‘Ebola people,'” one burial worker tells me. Kondoh pats him on the back, and the two chuckle at the term. Kondoh adds, “If we don’t laugh, we’ll cry.”This is a deeply moving scene. And Maxmen’s light use of humor feels touching, letting us share a bit in Kondoh’s vulnerability.
Ali Kamara, a burial team supervisor, says that families no longer fight with his team when they come for the dead.It’s an unorthodox choice to introduce a new source in the last paragraph. In journalism school, they might say that’s a no-no—that it can be clunky and jolting to introduce a new voice to readers as the story is coming to a close. But breaking that rule is worth it in this case, because Kamara’s quote brings the piece to such a satisfying ending, punctuating the total shift in people’s attitudes and behaviors that occurred as a result of Ebola’s devastation.“Before, people were hiding their corpses for two to three days,” while they washed the corpse and performed other rituals, Kamara says. “Now, it’s totally different. They call me at all hours and just say, take the body away.”Though Maxmen’s first-person reporting for this story took place over the month of December 2014, throughout the entire piece she deftly creates a sense of action and change, making us feel as if we’ve experienced the cultural shift that evolved over several months, and at different points for different people. This is a tricky feat, being true to a complicated timeline while also telling the story in a way that is comprehensible and engaging. In doing so here, Maxmen brings powerful, distant events to life in a way that feels immediate and accessible.
Amanda Mascarelli is the managing editor of Sapiens, an online magazine devoted to covering anthropology. Prior to taking on this role in May 2015, Mascarelli spent a decade as a freelance journalist. Her stories have appeared in Audubon, Nature, New Scientist, Science, Science News for Students, The New York Times, The Washington Post, Yoga Journal, and other publications. Follow her on Twitter @A_Mascarelli.