By Anab Mohamed
Email: anab.mohamed87j9@gmail.com
“This is such a huge insult to the family! What do you want the people to say? That we
did not show up? We have to go to attend the funeral! All my neighbors are
going, and this is our culture and tradition. What will people say about me if I
don’t go and it is right in the neighborhood? My other neighbor just came from
the funeral and she told me that they were asking about me. Many people have
shown up and gone. Why should I not go? This is shameful! Utterly shameful!"
“ I don't care what the blasphemous FCC1
folks are saying. I am still going to go to the mosque to pray! I am a Muslim
man, and can’t miss prayer in the mosque. What would Allah say of me on
Judgement Day? This is just a trick from those blasphemous folks! They want to
ruin our traditions and culture and now they are after our faith. They are using
the virus as a trick. If I am meant to die and it is Allah’s will then nothing
will stop it”
“Mafi Corona!2 You keep
saying Corona this and Corona that but there is nothing. There is nothing out
there. I bet this is just a trick”
“ We, those who are hungry can’t just stay at
home. I need to make a living. It is already challenging as it is for us. They
want us to stay at home so we can just die of hunger? I can't watch my children
go hungry”
These are the statements that represent the majority of the voices
that are echoing in a COVID19 stricken society. Each of these sentiments pieces
together the concerns and worries of everyday citizen’s struggles. The COVID19
pandemic has imposed a new set of rules and global order. On one hand, the
social language of Sudanese society with the cultural constructions that are
centered on guests and hospitality is all of a sudden facing a new kind of
guest. On the other hand, the economically challenged and vulnerable are
suddenly facing two threats: the threat of losing livelihood and the
coronavirus.COVID19 has imposed a new set of social and economic challenges that
go far beyond what existing systems can handle. Across the world, as developed
countries struggle to maintain current order and flow as much as possible to
circumvent the constraints that COVID19 has imposed, the prevalent inequalities
and disparities in developing countries, as in the politically and economically
challenged. Reinforcing factors to the COVID19 situation in Sudan which make
adherence to social distancing measures a seemingly insurmountable challenge is
seen in the following elements: the cultural and social norms that are rooted in
social and physical closeness, the prevalence of poverty, distrust of the
government, weak government, collapsed health systems, and fragile health
governance. Together, all of these factors contribute to the continued increase
in COVID19 cases. The threat that COVID19 pandemic poses is manifested across
intersecting economic, political, social, and cultural levels.
In Sudan, particularly Khartoum, the lockdowns and social distancing measures to combat COVID19 control has proved to be challenging across social, cultural and
economic levels, and their effectiveness and validity for controlling the spread
of the virus have been largely contested, and even doubted, underpinned by fears
of further economic instability, threats to livelihoods. From an economic
standpoint, in a country of a population of 41.8 million in which 7.1 million
people were estimated to be in need of humanitarian assistance, and 5.5 million
people are facing the threat of starvation from food insecurity, lockdowns and
social distancing measures have not been greatly welcomed, and this has been
perceived as an imperilment to the already fragile livelihoods and economies.
Simply put, the fear of losing livelihoods outweighed the fear of COVID19. In
light of the prevalence of poverty, those attitudes are quite justifiable.
Lockdown and social distancing measures have set an unprecedented challenge for
people who earn wages on a day-to-day basis and literally cannot afford to miss
a day’s worth of earnings. The menacing threat of COVID19 threatens a disastrous blow to impoverished communities and economically disadvantaged populations.
Sudan’s long history of epidemics, such as the most recent malaria and dengue epidemics in North Darfur, paralleled by a fragile political state is mirrored by the
diminished capacity to address political and economic constraints as reflected
in the current and past states of the healthcare system. Sudan’s ReadyScore®️
3, indicates that there is a considerable amount of work that is yet to be done
in terms of the country’s readiness to respond to outbreaks, citing Biosafety,
Biosecurity, Realtime surveillance, and Emergency Response Operations as the
gaps that should be prioritized to ensure epidemics response preparedness.
Although Sudan has made a significant lead in breaking the shackles of a
three-decade dictatorship, it has inherited a collapsed health system. For
Sudan, the struggle to face a global pandemic such as the COVID19 outbreak
carries the ordeal of bridging the divides in broken systems, often requiring
additional resources to fight the pandemic. As countries across the globe have
imposed lockdowns that have paralyzed economic movement, restricting travel,
crippling economies, and overwhelming healthcare systems, the Sudanese the government attempted to follow suit by imposing similar measures of lockdowns
and shelter-in-place orders, and even asking citizens to follow social
distancing and self-isolation, to bring under control the threatening pandemic.
The feasibility of lockdown measures amidst Africa's ailing economies has been
debated while non-compliance with social distancing due to poverty and social
norms in addition to the diminished capacity of the government’s readiness to
fight disease breakouts continue to challenge the containment of the spread of
COVID19.
 |
| According to the latest updates from the Africa Centers for Disease Control (Africa CDC), as of June 4th 2020, Sudan currently has the highest number of cases in the Eastern Africa region |
In the context of Sudan, COVID19 has challenged people’s
perceptions regarding their own health, challenging their long-held cultural and
religious beliefs. Communities across Sudan, with the aid of the diaspora,
public-private partnerships, and the government have collaborated to ease the
economic tensions and alleviate food insecurity for the poorest families and
vulnerable populations, through community-mobilized programs and initiatives.
Some private businesses such as insurance companies were able to digitize their
services through the use of mobile apps to support social distancing, while
other businesses have continued to open their doors for flocking customers in
fear of losing their earnings. Many other businesses were not able to have the
digitized privilege to deliver services to needing customers, and they continued
to open without ensuring safe social distancing measures, as customers continued
to flood the vicinity. Markets continued to bustle with frantic citizens, as
warnings of rising cases fell on seemingly deaf ears. Thus, there remains a considerable gap in adhering to social distancing measures, overshadowed by a
diminished capacity in addressing the existing inequities, which contribute to
the sustained economic despair.
Those who can afford to stay at home, call for a complete lockdown enforcement
mechanism, but on the other side, Sudan’s most vulnerable populations rely on
day-to-day wages from their jobs in the informal sector. These include tea
sellers, street vendors, and small shop owners, who cannot risk affording
missing a day’s worth of earnings. To the struggling segments of the population,
‘dying of hunger’ is a far worse predicament than dying of COVID1. The degree to
which compliance with social distancing is achieved continues to be questionably
very low, and when combined with the rise in daily reported cases of COVID19
infections, doubts arise as to whether these measures are steering the country
in the right direction. If there is anything that can be discerned from this
situation is the glaring link between social distancing and the spread of the
virus. That is, the health outcomes in a given community are for the most part
determined by the way members of the given community behave.
Public health researchers have drawn the link between behavior and health,
citing the role of individual and community practices in influencing public health
outcomes. The COVID19 pandemic poses an unsurpassed challenge when viewed from
socio-cultural and economic standpoints. The once familiar rituals and
traditions that are intimate parts of culture and identity are all of a sudden
the worst enemy. Gatherings, religious rituals, social bonding, and even the way
people comfort each other during times of loss have become a possible death
sentence. This is such a hard reality to grasp considering the fact that social
glue that keeps people together in Sudanese culture hugely relies on social
closeness and physical expressions of social bonding. It is the social closeness
that shapes the identity of Sudanese culture and society but in the times of
COVID19, social distancing is the antithesis of Sudanese culture. Even houses of
worship that people flock to in times of hardships, spiritual sanctuary and
prayer are now closed. It has become evident that adopting social distancing
measures while navigating the new social terrain mapped by the COVI19 pandemic
has become the challenge for advancing public health while maintaining the
social and cultural integrity of Sudanese society. Yet, only through adopting
healthy behaviors can any given society survive the pandemic and continue to
thrive.
Against the backdrop of a fragile health system faced with increasing confirmed cases of COVID19, ordinances such as government
pleas asking people to stay at home, refraining from attending gatherings or
prayers, or taking part in activities in which there is a high risk of
transmission, do not fulfill the purpose. This is because of innate anti-persuasion mechanisms coupled with adherence to social norms, result in the dismissal of instructions, even if
that would result in dire consequences. This mechanism is even heightened when
low government legitimacy stirs sentiments of distrust, compounded with feelings
of economic anxieties, food insecurities, and adherence to social norms. Despite
this, it is still possible in the Sudanese context, for people to change their
behavior, and here is how4 :
1) Understand the socio-cultural and economic determinants that constitute the barriers to
behavior change
The cultural norms and practices pose a significant barrier to
the adoption of social distancing and thus underpin one of the behavioral
determinants that constitute a barrier to adopting social distancing.
Additionally, economic concerns add another barrier to social distancing. It is
important to clarify and effectively convey that social distancing is meant to
slow down the spread of the disease and to ensure that communities stay healthy.
Using this understanding to guide behavior change, helps in tailoring behavior
change interventions to match the characteristics of the intended community, and
mirror their cultural practices and beliefs. Furthermore, this strategy can help
reaffirm the link between the relevance of remaining healthy to the overall
socio-cultural and economic pictures. A behavior change intervention that
utilizes this understanding should mirror social distancing as a way to promote
healthy and thriving communities, stressing the value that families are happier
when they are together and whole and that social distancing is meant to maintain
the integrity of families by ensuring that individuals are healthy and
disease-free.
The economic determinants of behavior change are far more complex
and difficult because, in this context, impoverished communities are placed
between the hammer and the anvil when it comes to poverty and COVID19. Requiring
those communities to adopt social distancing measures raises ethical concerns
because it adds another burden. It is then safe to assume that people are most
likely to adopt behaviors if they are assured that no harm will occur if they do
so. Barriers to behavior change that are underpinned by economic determinants
are better addressed when they are accompanied by mechanisms that reduce poverty
and food insecurity. A data-driven approach to the community needs assessment
that can be utilized in a targeted approach for assessing the needs of
communities and responding to their needs. Stronger economic policies are
important for alleviating the burden of poverty. These combined approaches would
facilitate social distancing in a way that also minimized the concerns for
adopting it.
2) Strengthen positive cultural and religious attitudes and
associations
By using existing cultural and religious messages and beliefs, a
behavior change intervention can introduce new beliefs and attitudes regarding
social distancing, which would weaken negatively held ones. In Sudanese society,
sustained strong systems of social solidarity and social support networks
contribute to social cohesion. While it is this very aspect of culture that
makes social distancing a challenge, it can also be harnessed to convey the message that social distancing is a positive act, and is actually beneficial to
the individual’s own health and the safety of others. Similarly, religious
beliefs can be used to support social distancing as an act of virtue, citing
existing teachings about the preservations of life, and doing no harm.
Consequently, negative behaviors can be linked to dire consequences and loss of
life if the right action is not taken. These approaches, when mobilized through
the right social actors and stakeholders ( such as religious figures, tribal
leaders) is key to the gradual change in behaviors when newer beliefs are
internalized.
3) Utilize Positive Deviance to encourage and promote positive
behaviors
In the context of the Sudanese culture, one of the factors that
influence adherence to established social norms is the fear of ostracism in the
event of deviating from those norms. Positive Deviance or PD is based on the observation that In every community in which there is a negative prevalent
practice, there are families or individuals that utilize successful behaviors,
despite being under the same constraints and circumstances. For example, the family that refrains from attending large family gatherings, Applying the
positive deviance in this context means that the community already has the
ability and readiness to adopt social distancing, and not fear being ostracized
by other members of the community. Using the PD approach utilizes the concept of the cultural similarity to design behavior change intervention to enhance
receptivity to social distancing, and reduce inner anti-persuasion mechanisms.
Sudan's economy and healthcare systems have endured a long time of institutional
insecurity and fragility. COVID19 has not only strained those systems, but it
has also tested the limits of traditions inherent within the social fabric. The
emergence of the COVID19 outbreak underscored the importance of re-examining and
re-evaluating social norms especially in light of the link between behaviors and
public health. ِThe precariousness of health and economic systems, along with
adherence to cultural beliefs, practices, and fears of loss of livelihood,
create a set of behavior change determinants that in light of the COVID19
pandemic creates a perilous situation that makes it difficult for people to adopt
new behaviors. That is why it is important for behavior change to take place in
a manner that facilitates this process to ensure that health outcomes are
achieved. Within the context of international development, particularly public
health interventions, behavioral change work should be strategized as an
integral part of initiatives and programs and should be included in the design
and implementation of international public health interventions. Most
importantly, it should incorporate sufficient socio-cultural knowledge to
understand the complexity of the determinants that constitute barriers to
behavior change. In the long run, once positive behaviors are incorporated, the
results are healthy and thriving communities that can sustain their own health
and contribute to better economic outcomes.
1Forces of Freedom and Change, a Sudanese political alliance of civilian and rebel groups who have endorsed the Declaration of Freedom and Change which called for the ousting of the former ruler Omar Albashir, ending his three-decade dictatorship. ↩
2This is a denialist expression, which means “ There is no Coronavirus”↩
3The ReadScoreⓇ is an indicator of a given country’s ability to respond to outbreaks, where a score of 80% and above indicates that the country is ready to respond to an epidemic. Sudan’s current score is at 57%↩
4Adapted from Kok, Gerjo, Nell H. Gottlieb, Gjalt-Jorn Y. Peters, Patricia Dolan Mullen, Guy S. Parcel, Robert AC Ruiter, María E. Fernández, Christine Markham, and L. Kay Bartholomew. "A taxonomy of behaviour change methods: an intervention mapping approach." Health psychology review 10, no. 3 (2016): 297-312↩
Very useful
ReplyDeleteThanks
Thank you Mai!
DeleteThanks Anab for this very insightful and practical piece!
ReplyDeleteThank you!
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