Medical Anthropologist Studies Skin Disease Transmission In West Africa

Medical anthropologist James Kennell, an SMU adjunct professor, took this photo in Benin, West Africa, of school children lining up to receive measles vaccinations.

By Margaret Allen

For several years James Kennell has studied the efforts of global healthagencies to vaccinate the Aja people in Benin, West Africa. As a result, Kennell ’11 has been invited to join a global initiative to prevent the debilitating skin disease Buruli ulcer.

A tropical disease that historically hasn’t been studied, Buruli ulcer is caused by a germ in the same family as leprosy and tuberculosis. The disease severely incapacitates and often kills people worldwide every year, but especially in Benin, according to the research initiative’s sponsor, the World Health Organization. Because the neglected disease is largely found in rural areas, the exact number of cases worldwide isn’t known, but it’s a growing problem in tropical and subtropical countries, WHO reports.

Kennell, a medical anthropologist and now an SMU adjunct professor, went to Benin in 2009 and 2010 as part of the WHO’s Buruli ulcer team. He’ll return for another six-week stint this summer, joining teams of scientists to pinpoint how the disease is transmitted.

“My job is to look at the particular ways the Aja are interacting with their environment – such as farming or other outdoor activities – that put them in contact with a very high concentration of the pathogen in the environment,” he says. Once the method of transmission is established, WHO researchers can devise strategies to combat the disease.

Kennell has logged numerous field seasons with Benin’s Aja people, research that helped him earn his doctoral degree in cultural anthropology from SMU in 2011. That research focused on the barriers encountered by global health organizations and the Aja to prevent polio, measles, chicken pox and other dangerous skin diseases, among them the refusal to be vaccinated.

Historically, Western aid agencies have attributed widespread refusal of vaccines to a lack of knowledge among local people. The agencies then attempt to bridge this “knowledge gap,” as they call it, by educating the Aja and other local groups about the benefits of vaccines from a Western viewpoint.

But in his doctoral dissertation, “The Senses and Suffering: Medical Knowledge, Spirit Possession, and Vaccination Programs in Aja,” Kennell reports that the Aja refuse vaccines for a number of reasons that aid efforts don’t address. Some refuse on religious grounds; others because they fear infertility, sickness or government control.

“It’s really not an issue of a knowledge gap,” Kennell says. “We’re talking about very different, very complex world views related to health and disease among the Aja that are as established as any Western medical tradition.”

The problem, he says, is a cultural disconnect between global health organizations and the Aja people. Stuck in the middle are the local health officials who are hired, trained and supplied with medicine to achieve one goal – vaccinate large numbers of people.

Kennell has followed four different vaccination campaigns in Benin, observing health workers as they move through scores of Aja villages. He interviewed villagers before and after the visits, and found that up to 25 percent refuse vaccinations, including entire villages. For vaccination campaigns to protect a community against disease, a significant percentage of the population must be protected. For example, measles requires from 85 percent to 95 percent immunization to be effective, he says.

Kennell observed that the imperative to vaccinate drove local providers to extreme measures. “Very often, instead of really trying to educate in a positive, productive way, the conflicting knowledge traditions of the two cultures are pitted against one another and manipulated by interested parties to achieve a particular result, in this case, the number of individuals vaccinated,” he says.

Kennell witnessed health workers trying to convince villagers that a vaccine would prevent an illness other than the one it protects against. Other times, health workers would call in the head physician of the main regional hospital to persuade villagers.

“I think local health care workers wouldn’t have to resort to manipulating knowledge so strongly if there wasn’t such a disconnect,” he says.

The blog Anthropologyworks.com selected Kennell’s dissertation as one of the best 40 cultural anthropology dissertations in North America for 2011.

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