Reflections on my first Clubhouse chat: Eco-social model for factors making Zimbabweans vulnerable to Covid-19

Introduction

On 25 Jul 2021, I found myself in the very first Clubhouse chat room. Even though I had been a host on TwitterSpaces for some time by then, I found the experience quite bewildering. Some of the things I was anxious about included how to get myself noticed by the host, and subsequently how to turn on my mic. Anyway, in the end it all worked out like a charm.

Culture, religion and Covid-19

The discussion centered around the things in our culture and religion, Africans, perhaps Zimbabweans in particular, make us vulnerable to Covid-19. While I did not ask what motivated the host and moderators to talk about this subject, I think that the “U-turn” by popular Zimbabwean pastor cum Papa had something to do with it. Apparently, Mr. Makandiwa recently refuted claims that he had encouraged members of the UFIC flock to not take the anti-Covid-19 vaccine as he considered it to be the mark of the beast. The point of this short blog is to apply the eco-social model to extend the conversation about our vulnerability to Covid-19. 

The eco-social model

The eco-social model is a popular way to organize one’s thoughts about determinants of health. To do this the model helps one to systematically think about factors that contribute to or diminish a health problem at several levels: Individual; Interpersonal; Community, organizations, and/or Institutions; policies; and culture. As the goal of this blog is to simply extend the discussion, I outline some of the factors in the paragraphs that follow. But there is a caveat: Some of the factors I outline below may fit into a different category than the one I put. This may indicate my own biases and/or the lack of fit between the eco-social theory and the task of identifying factor that make us vulnerable to Covid-19. However, I believe that the theory is a good starting point for extending this very useful discussion.

Individual level

• Biology of the individual which encompasses one’s susceptibility to Covid-19
• Attitudes, behaviors and practices that may include one’s belief about the risks and what they do to protect themselves and others
• 
  Here we could also include means – What resources an individual can draw on while complying with Covid-19 measures. I imagine that individuals who work from hand to mouth may be less inclined to self-isolate, endure long periods of lockdown or even procure needed protective equipment

Interpersonal

• How acceptable is it for members of our communities to keep social distancing – Can we really do away with affectionate ways of greeting our close relations with handshakes, hugs and kisses?
• What stories do people share about covid-19? I imagine that conversations about conspiracy theories weaken the resolve of interlocutors to abide by Covid-19. The example of prophet Makandiwa can fit here or later in culture which I will bunch with religion. Similarly, one recalls a tarmac rant by Prophet Java where he dissed the mask and the condom

Community, organizations,  and/or institutions

• Issues of stigma can fit here – Stigma may encourage those with Covid-19 symptoms to hide them, thus maintaining a reservoir for onward transmission and/or leading to late presentation or even death.
• Collective ignorance may lead community members to attend and bury members with true or suspected Covid-19.
• Communities may distrust government and or scientific organizations and thus not heed Covid-19 measures – This was a huge factor for the continued spread of Ebola in the 2014 outbreak in West Africa. In Zimbabwe a mutual lack of trust exists between the government and its people, given the polarized political environment and the unresolved political grievances around the 2018 election.
• Late presentations at hospitals may also be an issue driven by the public’s belief that the public system is collapsed, and the private health sector is simply a cash cow for the business owners.
• Here I can also add some communities who do not believe in modern medical care – choosing to rely on spiritual or African traditional healing.
• I think vaccine hesitancy is a product of communities, interpersonal interactions, and individuals but I will leave it here.

Policies

• Despite being signatory to the Abuja declaration Zimbabwe still allocates much less than 15% of its annual budget to the health sector. The result is weak health systems that were further decimated the emergence of Covid-19.
• Here I can also add the repressive application of non-pharmaceutical Covid-19 measures.
• The choice of vaccine and the rate of vaccination is a matter of policy that affects our vulnerability.
• Here I also place measures meant to cushion employees and citizens during extended lockdowns – In the absence Covid-19 measures may be disrespected resulting in further transmission

Culture 

• Our culture of ‘ubuntu’ may not allow our members to stay away from the sick and or follow Covid-19 burial procedures.
• People not reporting to workplaces, may use the extra time to visit each other more – flaming the cycle of transmission between family members and close friends

Reflections

The list above, which is far from exhaustive, illustrates the complex interplay of factors that make us vulnerable to Covid-19. More especially that one could trace the individual in all the levels of the model: An individual’s health, an individual participates in interpersonal interactions, individuals make up communities, individuals develop policies, and a culture is the collective behavior of individuals.  Thus, besides an effective response to Covid-19 in taking a multifocal, there is merit for such a response to recognize the agency of individuals. Much depends on them; therefore, government and health authorities need to adopt flexible approaches that center around individuals and communities. More importantly, not leaving them worse off, for solving the Covid-19 pandemic. 

I would be glad to hear your thoughts on this, so please leave a comment: Let me know what thing I talked about that you are inclined to agree with, and what I said that you tend to disagree. Let’s keep talking.