TABLE OF CONTENTS
Coverage Page – – – – – – – – i
Title Page – – – – – – – – ii
Certification – – – – – – – – iii
Quotation – – – – – – – – iv
Dedication – – – – – – – – v
Acknowledgements – – – – – – – – vi
Contents – – – – – – – – – viii
List of Figures – – – – – – – – xii
List of Abbreviations – – – – – – – xiii
Abstract – – – – – – – – xvi
CHAPTER ONE
INTRODUCTION
1.1 Background to the Study – – – – – – 1
1.2 Statement of the Problem – – – – – – 10
1.3 Justification of the Study – – – – – – 13
1.4 Objectives of the Study – – – – – – 15
1.5 Research Methods – – – – – – 17
1.6 Scope and Limitation of the Study – – – – 18
1.7 Definition of Operational Terms – – – – – 20
1.7.1 Nexus – – – – – – – – 20
1.7.2 Leprosy – – – – – – – 20
1.7.3 Ebola Virus – – – – – – – 21
1.7.4 Pandemic – – – – – – – 23
1.7.5 Disease – – – – – – – 23
1.8 Organization of the Study – – – – – 24
CHAPTER TWO
LITERATURE REVIEW
2.1 Leprosy – – – – – – – – – 25
2.2 Ebola – – – – – – – – – 51
2.2.1 History of Ebola Virus Disease Outbreak – – – 53
2.2.2 Cure – – – – – – – – 55
2.2.3 Prevention – – – – – – – 57
2.2.4 Examining the Concept of Stigma – – – – 59
2.2.5 Factors that Promote Stigmatization – – – 67
2.2.5.1 Fear – – – – – – – 67
2.2.5.2 Ignorance, Religious and Cultural Misconceptions 68
2.2.5.3 External Manifestations – – – – 71
2.3 Summary of Literature – – – – – – 75
CHAPTER THREE
AN EXAMINATION OF LEPROSY IN LEVITICUS 13 – 14 AND EBOLA VIRUS DISEASE
3.1 Introduction – – – – – – – – 78
3.2 The Title of Leviticus – – – – – – 80
3.3 The Authorship and Date of Leviticus – – – – 81
3.4 The Purpose of Leviticus – – – – – – 84
3.5 The History of Leviticus – – – – – – 85
3.6 The Structure of Leviticus – – – – – 86
3.7 The Theology of Leviticus – – – – – 88
3.7.1 The Presence of God – – – – – 89
3.7.2 Holiness – – – – – – – 91
3.7.3. The Role of Sacrifice – – – – 102
3.7.4 The Sinai Covenant – – – – – – 106
3.8 Hebrew Texts of Leviticus 13 – 14 – – – – 112
3.8.1 Hebrew Text of Leviticus 13 – – – – 112 3.8.2 Hebrew Text of Leviticus 14 – – – – 118
3.9 A Translation of Leviticus 13 – – – – – 124
3.10 A Translation of Leviticus 14 – – – – – 128
3.11 Exegesis of Leviticus 13 – 14 – – – – – 133
3.11.1 An Exegesis of Leviticus 13: Diagnosis of Disease – 133
3.11.2 An Exegesis of Leviticus 14: Cleansing of Disease – 141
3.11.3 A Summary of an Exegesis of Leviticus 13 – 14 – 151
3.12 History of Ebola in Nigeria – – – – – 155
3.12.1 The Spread of Ebola Virus in Nigeria – – – 158
3.12.2 The Role of the Nigerian Government – – – 159
3.12.3 Containment – – – – – – – 160
3.12.4 Quarantine System – – – – – – 161
3.12.5 Public Health Response – – – – – 163
3.12.6 Role of the Media – – – – – – 172
3.12.7 Role of the Faith Organizations in the Control
of Ebola Virus Disease in Nigeria – – – – 175
CHAPTER FOUR
THE NEXUS BETWEEN LEPROSY IN THE OLD TESTAMENT AND THE EBOLA VIRUS DISEASE IN CONTEMPORARY TIMES
4.1 Introduction – – – – – – – – 177
4.2 Examining the Political Structure of Mosaic-Israelite Nation and
the Nigerian State and their Response During Outbreak of Disease 178
4.2.1 The Structure of Ancient Israel – – – – 178
4.2.2 The Structure of the Nigerian State – – – – 184
4.2.3 Applicable Law – – – – – – 185
4.2.4 Powers of National Public Authorities – – – 186
4.2.5 Transparency of the Public Health Management System – 194
4.2.6 Cooperation with the World Health Organization (WHO)- 196
4.3 Nexus Between Leprosy in Leviticus 13 – 14 and Ebola in Nigeria 202
4.3.1 Guidelines on Symptoms and Early Detection – – 202
4.3.2 Legislation on Separation – – – – – 206
4.3.3 Quarantine System – – – – – – 206
4.4 Guidelines on Isolation – – – – – – 211
4.5 Laws on Clothing – – – – – – – 213
4.6 Laws on Houses – – – – – – – 216
4.7 Cure – – – – – – – – – 218
4.8 Law on Re-admission – – – – – – – 220
4.9 Role of the Suspected Victim – – – – – 224
4.10 The Role of the Priest and the Modern Day Healthcare
Practitioner – – – – – – – – 226
4.11 Role of the General Public – – – – – – 230
4.12 Attitudinal Outcomes – – – – – – 233
4.13 Comparative Analysis – – – – – – 235
CHAPTER FIVE
SUMMARY, FINDINGS, CONTRIBUTIONS TO KNOWLEDGE, CONCLUSION AND RECOMMENDATIONS
5.1 Summary – – – – – – – – 241
5.2 Findings – – – – – – – – 243
5.3 Contributions to Knowledge – – – – – 244
5.4 Conclusion – – – – – – – – 245
5.5 Recommendations – – – – – – – 247
Works Cited – – – – – – – – 249
LIST OF FIGURES
Figure 1: Statistics of Spread of Ebola Virus in Nigeria – – – 159
Figure 2: A Quarantine System Set Up in Lagos State, Nigeria – – 162
Figure 3: A Quarantined Patient Being Examined – – – 162
Figure 4: Organizational Structure of the Ebola Response Incident
Management Center-Nigeria – – – – – 164
Figure 5: Medical Practitioners Getting Kitted for Operation – – 171
Figure 6: Medical Practitioners Providing Assistance for Infected Patient 171
Figure 7: Isolation Ward – – – – – – – 213
LIST OF ABBREVIATIONS
ABC American Broadcasting Company
AD Anno Domini
AIDS Acquired Immune Deficiency Syndrome
Am J American Journal of Pubic Health
BC Before Christ
Bull His Med Bulletin of History of Medicine
CDC The Centres for disease Control and Prevention
cf Compare
Ch Chapter
CNN Cable News Network
CRM Critical Reviews in Microbiology
Deu Deuteronomy
Disabil Rehabil Disability and Rehabilitation
DNA Deoxyribonucleic Acid
DSS Dead Sea scroll
DRC Democratic Republic of the Congo
Eg For example
EHF Ebola Hemorrhagic Fever
EPWG Ebola Preparedness Woking Group
EVD Ebola Virus Disease
Exod Exodus
EOC Emergency Operation Centre
f Following
ff To the End
Gen Genesis
Heb Hebrews
HIV Human Immune/Immunodeficiency Virus
HD Hansen’s disease
HHS Hyperosnolar Hyperglycaemic State
ie That is
IHME Institute for Health Metrics and Evaluation
IRH International Health Regulations
IM Incident Manager
IMS Incident Management System
ISDR Integrated Disease Surveillance and Response
IV Intravenous
IVP Inter-Varsity Press
Lam Lamentations
Lepr Rev Leprosy Review
Lev Leviticus
LXX Septuagint
MDH Maritime Declaration Health
Mic Micah
MSF Medecine Sans Frontiere
NCDC National Committee on Disease Control
N.D No Date
NIMR Nigeria Institute of Medical Research
NFELTP Nigeria Field Epidemiology and Laboratory Program
NIH National Institute of Health
NJ New Jersey
NT New Testament
Num Numbers
OT Old Testament
Perspect. Biol. Med. Perspectives of Biological Medicine
PEQ Palestine Exploration Quarterly
PCR Polymerase Chain Reaction
PPE Personal Protective Equipment
PUI Patients Under Investigation
RT Reverse Transcription
SARS Severe Acute Respiratory Syndrome
Soc. Sci. Med. Social Science and Medicine
SP Samaritan Pentateuch
TB Tuberculosis
UK United Kingdom
UNICEF United Nations Children’s Fund
U.S United States
V Verse
VT Vetus Testamentum
Vv Verses
Web Website
WHO World Health Organization
ZAW Zeitschrift fur die Alttestamentliche Wissenehaft
& And
ABSTRACT
Often times, contemporary issues provide us a new perspective on Biblical happenings, giving us better insights into the realities of that time. The foremost basis for this study is the misconception of certain school of thoughts that the book of Leviticus also known as the Book of the Law provides the foundation for certain discriminatory practices in the Biblical era. Several scholars in the past have often viewed the laws of Leviticus as discriminatory since it introduces the ‘isolation system’ for certain group of individuals (the infected). The overall objective of this study therefore is to reread/reinterpret the Hebrew text of Leviticus 13 – 14 in the light of contemporary Ebola disease in Nigeria. To achieve this objective, the study focuses on the forms of Biblical leprosy stated in Leviticus 13 – 14. In gathering the data for this work, we relied heavily on secondary sources, given the fact that our study of leprosy was limited to Biblical records while in the case of Ebola, primary respondents are not accessible to the general public. Method of data analysis of leprosy in the Old Testament takes both a historical and exegetical approach. The theoretical framework adopted for this work is the comparative model which is concerned with the systematic comparison of the doctrines and practices of the world’s religions. From this study, we have been able to establish a nexus between the guidelines instituted by God on leprosy and the steps adopted by the Nigerian government in tackling the spread of Ebola. This has helped to highlight that God in His infinite wisdom (even in the Old Testament) laid down basic principles for tackling an epidemic such as leprosy which are in line with today’s WHO best practices adopted by the Nigerian government in handling Ebola. Our findings show that the essence of creating the ‘isolation/quarantine’ system by God (in the Old Testament) and the Nigerian government is not to foster discrimination but to ensure that outbreaks of such epidemics like leprosy and Ebola were stemmed. From this work, we see that attitudinal problems of fear and ignorance are key issues that foster stigmatisation which advertently encourages the spread of diseases. This study develops a Biblical basis for fighting against Ebola stigma by highlighting the fact that in times of epidemics, individuals, institutions and nations are to provide support, aid and care for infected/affected persons or nations rather than abandoning them. This will encourage infected persons to observe the necessary regulations in ensuring that they do not spread the disease. This study has shown that the scripture provides age long insights and practices which are very relevant in addressing contemporary issues as such, it recommends that some very vital lessons which have significant importance should be adopted from it for the resolution of problems in the modern world.
CHAPTER ONE
INTRODUCTION
- Background to the Study
Living in good health is a legitimate concern of people all around the world. In fact, many people regard illness or disease as a misfortune. As a common maxim goes, “health is wealth”; this means that only healthy people can contribute meaningfully to the socio-economic growth of the society. The issue of good health is therefore vital to mankind, regardless of race or level of technological advancement.
The World Health Organization (WHO) defines health as a “state of complete physical, mental and social wellbeing and not merely the absence of disease and infirmity”. This definition gives a growing consciousness that health involves more than the control of disease and that ill-health may also be caused by emotional, social and economic factors. For example, if there is lack of good food, justice, freedom or peace, there cannot be a state of wellbeing which invariably may translate to ill-health. Generally speaking, the term sickness describes a state of being ill or unhealthy. However, Marshall Marinker characterizes “three modes unhealthy” as follows.
Disease… is a pathological process, most often physical as in throat infection, or cancer of the bronchus, sometimes undetermined in origin as in schizophrenia. The quality which identifies disease is some deviation in biological norm. There is objectivity about diseases which doctors are able to see, touch, measure, and smell. Diseases are valued as the central facts in the medical view. Illness…is a feeling, an experience of unhealthy which entirely personal, interior to the person of the patient. Often it accompanies disease, but the disease may be undeclared, as in the early stages of cancer or tuberculosis or diabetes. Sometimes illness exists where no diseases can be found. Sickness…is the external and public mode of unhealthy. Sickness is a social role; a status, a bargain struck between the person henceforward called ‘sick’ and a society which is prepared to recognize and sustain him. The security of this role depends on a number of factors, ranging from the contagious nature of the disease to the availability of cure. (82-83)
Irrespective of whether it is a disease, illness, or sickness, unhealthy people usually require help, support and care from family, friends and other members of the society. However, as already stated, the nature of the disease always invariably determines the nature of relationship that exists between sick people, their family, friends and other members of the society. Oftentimes people with contagious diseases are usually required medically, to minimize contact with others in order to prevent the spread of such diseases. Again, diseases without a known cure seem to create fear among the uninfected members of the society and as a result create a gap between the infected person and members of their families, friends and the society at large.
From time immemorial till the present day, human societies in all ages have been ridden with series of outbreak of deadly diseases. According to the Institute for Health Metrics and Evaluation (IHME), a deadly disease is a disease likely to cause or capable of causing death. It states further that amongst these classes of deadly diseases are communicable diseases, that is, diseases that are transferable, either through air, exchange of bodily contact or bodily fluids. IHME cite examples of the five deadly disease outbreaks in the history of mankind to include; the plague outbreaks in Paris (1464-1466), London (1664-1667) and Egypt (1791) which was responsible for the death of millions of people. Next on the list of the five deadliest diseases is small-pox which has been around for at least 10,000 years until the disease, according to the World Health Organization, was irradiated in 1976. Like the plague it is passed from human to human without contact. It is estimated that 300 million people died of Smallpox in the 20th Century. Another disease on this list is Ebola; “one of the most virulent viral diseases known to humankind” according to the WHO. Since its outbreak in parts of West Africa till date, the disease has been responsible for the death of thousands. It is transmittable through exchange of bodily contact or bodily fluids with patients, and till date it has no known cure. Severe Acute Respiratory syndrome (SARS) and Human Immune Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) are also included in this list. As a result of the nature of these diseases, people who suffer from them are usually objects of stigma and discrimination from both close relatives and the larger society.
In the Old Testament era, leprosy was known to be life – threatening. People were scared of contracting the disease. It was regarded as a terrible skin disease. Skillicom maintained that “among all the communicable diseases, leprosy is the least contagious” (1). Irrespective of this fact, the lack of understanding of the nature of the disease in the Old Testament times evoked a lot of fear, thereby triggering stigmatisation of lepers. The nature and attitude of people towards others living with leprosy in the Old Testament were such that the latter were treated with disdain. In those days the cause of leprosy was unknown and the cure was by spiritual cleansing (Leviticus 13, 14 and 15). As Agbo puts it, the disease of leprosy was shrouded in mystery and had serious religious implication or undertone (1). In this regard, those who were infected with the disease were adjudged to be under the spell or wrath of Yahweh for flouting his laws. No wonder lepers were regarded as social untouchables mainly because of the nature of their affliction which supports the belief that they were serving punishments from Yahweh. Religious authority in Israel during this period was so much involved in the matters of the disease of leprosy; the nature, treatment and the attitudes towards the lepers ‘so that it was the duty of the priests and some special people to diagnose the disease of leprosy’ (David 2, Gustav 19).
It is very pertinent to note here that the command by God in the book of Leviticus (13 and 14) was to ensure that infected persons do not transmit the disease to the rest of the Israelite community, given the fact that at that time, they were still on their way to the Promised Land and therefore lived a communal life. The essence was to prevent an outbreak of an epidemic by creating a quarantine system for people who were suspected as having the disease and not to create discrimination. To further assert this fact, God gave precise instructions and guidelines on how to handle such disease situation which ensured that people were properly diagnosed, quarantined when suspected, and treated when confirmed to have the disease. Also to show that the legislations in Leviticus were not meant to be discriminatory, there was a stipulated guide of accepting people who were later found not to have the disease or were later made whole into the general population after being certified clean by the Priest. Worth noting is the important role of the member of the society as stipulated in Leviticus. The Priest performed the role of doctors or health practitioners in this contemporary time. Sick people were charged with the responsibility of presenting themselves to the Priest for proper medical attention and if need be spiritual purification, during which period, they were quarantined. The rest of the population was also charged with the responsibility of accepting people who have been once sick but were later certified whole. As succinctly put by Christina Landman, there are three aspects of the law in Leviticus that are particularly relevant for dealing with disease outbreak. First, infected people are included in society, but forced to take responsibility for not spreading the disease. Again, the interrelatedness of people in society is respected. People take responsibility for their own health and that of others. No hierarchical distinctions are being made. Everybody is equally responsible for everybody else’s health. Finally, after purification, re-entry to full communal life is possible without stigmatization (274).
Recently in the world, especially in Africa, there is an outbreak of Ebola pandemic which has resulted in the death of many. Ebola virus disease (EVD; also known as Ebola hemorrhagic fever, or EHF), or simply Ebola, is a disease of humans and other primates caused by Ebola viruses. Signs and symptoms typically start between two days and three weeks after contracting the virus with a fever, sore throat, muscle pain, and headaches. Then, vomiting, diarrhoea and rash usually follow, along with decreased function of the liver and kidneys. At this time some people begin to bleed both internally and externally which eventually leads to death. Ebola is a severe and fast-growing illness concentrated in West Africa. According to the World Health Organization (WHO), it has a mortality rate of approximately 70 percent.
The Centers for Disease Control and Prevention (CDC) report that the Ebola virus is transmitted among humans through either direct contact with the bodily fluids of an infected and symptomatic person or through contact with contaminated objects, such as needles or syringes (CDC fact sheet on Ebola). The first known outbreak of Ebola virus disease was identified only after the fact, occurring between June and November 1976 in Nzara, South Sudan. The Sudan outbreak infected 284 people and killed 151. The first identifiable case in Sudan occurred on 27 June in a storekeeper in a cotton factory in Nzara, who was hospitalized on 30 June and died on 6 July.
Although the WHO medical staffs involved in the Sudan outbreak were aware that they were dealing with a heretofore unknown disease, the actual “positive identification” process and the naming of the virus did not occur until some months later in the Democratic Republic of the Congo. The recent outbreak in West Africa, (first cases notified in March 2014), is the largest and most complex Ebola outbreak since the Ebola virus was first discovered in 1976. There have been more cases and deaths in this outbreak than all others combined. It has also spread between countries starting in Guinea then spreading across land borders to Sierra Leone and Liberia, by air (one traveller only) to Nigeria, and by land (one traveller) to Senegal. The most severely affected countries, Guinea, Sierra Leone and Liberia have very weak health systems, lacking human and infrastructural resources, having only recently emerged from long periods of conflict and instability. On August 8 2014, the WHO Director-General Margaret Chan declared this outbreak a “Public Health Emergency of International Concern”. Urging the world to offer aid to the affected regions, the Director-General said, “countries affected to date simply do not have the capacity to manage an outbreak of this size and complexity on their own. I urge the international community to provide this support on the most urgent basis possible.” Outside Africa, cases of Ebola virus have also been reported in Spain, United States of America and the United Kingdom.
According to UNICEF Nigerian Ebola Humanitarian Situation Report 2014, the Ebola Virus Disease (EVD) outbreak was declared in Nigeria by the Federal Ministry of Health on 24th July 2014 following the arrival of a male passenger from Liberia whose condition degenerated in-flight and necessitated evacuation to a hospital on arrival in Lagos. Laboratory tests subsequently confirmed that the traveler from Liberia had Ebola Virus Disease. Dan Nwomeh reports that as of September 23, 2014 the Federal Ministry of Health reported a total of 19 confirmed Ebola cases in Nigeria including the imported case from Liberia. Of the 19 cases, 15 were from Lagos while four cases were reported in Rivers State. Since the first case was reported there, a total of 891 contacts have been listed; 365 in Lagos and 526 in Rivers. The number of contacts that have completed the 21 days monitoring and have been discharged total 847: 349 in Lagos and 498 in Rivers. The remaining 24 contacts are under observation; zero in Lagos and 24 in Rivers. Since the beginning of the epidemic, there have been seven deaths (five in Lagos and two in Rivers), 11 survivors that have been discharged in Lagos and one in Rivers with no confirmed cases currently in isolation. There has been no more confirmed cases in Nigeria in the last 18 days and the remaining contacts being following up will have completed the 21 days by the 24 September 2014. By October 19, 2014 Nigeria was declared free from Ebola by the World Health Organization. The international community praised the effort of the Nigerian Government in their decisive and prompt effort in tackling the Ebola virus outbreak. As observed by Hanibal Goitom,
In addressing the outbreak in Nigeria, the Federal government of Nigeria took some notable steps such as the setting up of isolation centers (quarantine) in different states to observe persons who are suspected to have had primary contact with victims of the virus, setting up of emergency care unit in various affected zones in the nation for the treatment of infected persons, public enlightenment campaigns through various media to update people on precautionary step to prevent the spread of Ebola (use of hand sanitizers, minimizing human contacts, abstinence from the consumption of certain animals, maintaining proper hygiene), identifying and quarantining suspected persons and most importantly ensuring that people who are certified free from the virus after the period of observation are fully assimilated into the general population without any form of discrimination or stigmatization, while proper medical care is provided for infected persons.(165)
From the foregoing discussion, we can observe a correlation between the models instituted by God in Leviticus 13 – 14 in tackling leprosy outbreak in the Old Testament and the steps instituted by the Nigerian government in tackling the Ebola virus. As noted by Samuel Balentine, the intention of God while instituting those guidelines in Leviticus 13 – 14 was not to foster discrimination or stigmatization as some may perceive, but rather they were guidelines in preventing outbreak of epidemics (101). The institution of a quarantine system (both in Leviticus 13 – 14 and in the case of Ebola outbreak in Nigeria) ensured that spread of diseases is properly curtailed.
While in isolation, infected people are well provided for, with care, spiritual attention (such as cleansing in the case of leprosy in Leviticus) or medical attention (as in the case of Ebola) but never abandoned. To ensure the security of the entire nation, persons who were once suspected and quarantined but were later certified free from the diseases, after the period of observation, are fully assimilated into the general population without any form of discrimination. On the other hand persons who were once infected with the virus but were later cured were also released into the general population without discrimination. These similar practices between Leviticus 13 – 14 and the recent case of Ebola in Nigeria informs the fact that contrary to what most scholars suggests, the guidelines instituted by God (Leviticus 13 – 14) were not discriminatory but rather in line with the best practices in handling the outbreak of such epidemics. This forms the basis of this thesis.
1.2 Statement of the Problem
In the Old Testament (Leviticus 13 – 14) when much was not known about nature, treatment and control of epidemic diseases such as Leprosy, God in His infinite wisdom instituted guidelines which today we find consistent with the measures used in tackling the Ebola virus outbreak especially in Nigeria. However, in carrying out the instructions of God in the Old Testament, we observe that lepers were not properly taken care of. They were seen as outcasts and social misfits, which was not the original intention of God. Lepers were to be isolated not ostracised, taken care of, not abandoned and when eventually they were certified healed, were to be assimilated into the general public without any form of stigmatisation. This fact is brought to bear by comparing the God’s model in Leviticus 13 – 14 and the commendable legislation implemented by the Nigerian government in successfully tackling the Ebola virus in Nigeria.
This attitude in the Old Testament is however not unconnected with the fact that in the Old Testament, leprosy (Hebrew tsara’ath) was a disease thought to be deadly and infectious, hence it provoked stigmatization. Lepers were taken through various screening exercises and stages to determine whether the disease was malignant, curable or not. Should it be found to be malignant, the diseased person was quarantined from the general population. Before they are re-admitted into the society, they are also put through comprehensive screening test to ascertain that they are perfectly whole. Otherwise they would remain in isolation. Thus contrary to viewing Leviticus 13 – 14 as discriminatory like some scholars such as Mary Douglas and Samson Olasebe have done, it is evidently presented in this work as a necessary guideline for controlling the outbreak of pandemic diseases by bringing to bare its relatedness with the contemporary issue of Ebola in Nigeria in particular (Mary Douglas 732; Samson Olasebe 111-112).
Again in the Old Testament, the action of some Jews towards persons living in the other divide with leprosy would have led to an increased number of people with the disease. A critical examination and exegesis of part of the Old Testament particularly the book of Leviticus reveals something interesting. It is most probable that the real nature of the disease of leprosy eluded the people to a very large extent. No wonder some people could unwittingly expose themselves to the pathogenic and contagious strains of leprosy as they attacked and destroyed the houses of suspected lepers. The supposition that some people would have contracted the disease – leprosy through this process is not out of place afterall. Similarly, initial reports on the Ebola virus also suggest cases of people infecting themselves by associating to potential carriers of Ebola virus (such as bush animals like bat) and by using contaminated objects such as syringe. In Nigeria for instance Premium Times and Vanguard Newspapers reported that there was a national case of citizens bathing with salt and in some cases creating other health issues. There were cases of three people losing their lives due to the salt incident. From the foregoing, we can deduce that certain diseases are spread through mere ignorance and lack of proper knowledge about them. To this end, it is therefore reasonable that this study examines the synergy between Leprosy in the Old Testament and the Ebola virus disease in contemporary human society.
At this point, it is pertinent to observe that in implementing the dictates of God in the Old Testament, there seems to be a deviation especially when it came to the attitude of the society towards lepers. As already stated, the essence of creating an isolation system was not to abandon infected people but to ensure that the uninfected population was kept safe while at the same time providing care and possible means of healing to the infected. In the Old Testament, people with leprosy were seen as sinners who were under the curse of Yahweh and as such even family members disassociated from them (Samson Olanisebe 112). Paulinus Agbo observes that this negative attitude of stigmatization could either be as a result of fear, ignorance or lack of empathy for the sick (17). So also in modern societies, epidemics such as Ebola and HIV/AIDS elicit almost the same response. Once people are screened and their Ebola statuses are ascertained to be positive, they are consequently regarded as ‘victims of life and circumstance’. They are abandoned by their families and caregivers (and in some cases victims are denied medical help) for fear of contracting the disease and so do all they can to avoid any form of contact with them. This tendency to cut tiers with infected persons by families and care-givers eventually develops into stigma. This definitely has a lot of implications for them and the society. Primarily stigmatisation paves way for infected individuals to tend to conceal their status. In some cases victims have been seen to exhibit anger and vengeful feelings. For example the Liberian (Mr Patrick Sawyer) who brought Ebola into Nigeria was reported to be very much aware of his condition and yet by his actions resorted to infecting some medical staff who tried to provide him with medical assistance. To some persons such actions were viewed as an ill attempt to elicit global sympathy, given the place of Nigeria in the global radar. Some others viewed it as vengeful given the fact that he was fully aware of his actions. This study therefore seeks to highlight the connection of stigmatization of lepers in the Old Testament and that of Ebola patients in modern societies. By doing so, it would be necessary to find ways both from Biblical sources and also from contemporary societies in addressing the issue of stigma against people living with diseases such as leprosy, Ebola and even HIV/AIDS. These form the problem of this study.
1.3 Justification of the Study
Some researches in the past have often viewed the laws of Leviticus as discriminatory since it introduces the ‘isolation system’ for certain group of individuals (the infected). As Matson highlights,
the laws in Leviticus in some way are seen as separating the ‘good’ from the ‘bad’, given the fact that as at the time the laws in Leviticus 13 – 14 were being given by God, the very nature of the disease was not well known. Rather, the general belief was that people who suffered from this skin disease were under some sort of punishment from God and as such were to be totally avoided; seen as unfit to live among the general population (by God’s law). (41)
However, as this work suggests, this is not the case; the laws were guidelines which were set in place by God to prevent the outbreak of leprosy (a communicable disease). The rereading and exegetical interpretation of Leviticus 13 – 14 is therefore necessary as a way of establishing the relatedness between the laws in Leviticus 13 – 14, and the World Health Organisation best practices adopted by Nigeria in successfully combating the Ebola disease outbreak, this work throws a different light on the essence of dire need for the law. We present the laws in Leviticus as necessary measure that need to be implemented in times of disease outbreak. It is also important to note that this study goes a long way to address the issue of discrimination which is seen as a catalyst for the spread of contagious diseases such as Leprosy.
In his study on some of the causes of HIV spread in South Africa, Davidson notes that the contemporary disease of AIDS has attracted sentiments and actions that are similar to those common in Old Testament society against people living with leprosy. Furthermore he notes that AIDS pandemic no doubt has spared off many issues in the minds of many, so there is the growing belief that some people living with the disease are suffering some form of chastisement from God (25). To this end, many people have chosen to inflict both physical and psychological harm on people suspected to be living with the disease. The resultant effect is so worrisome as some carriers aside concealing their status have resorted to unhealthy behaviours such as suicide, rape and even wishfully infecting others with the disease.
Agbo in his own study examines the role of ignorance in the spread of HIV in Nigeria. According to him, people tend to ignorantly view people living with HIV/AIDS as sexual immorals, neglecting the fact that the disease can be transmitted through several other means. Again he reveals that many people living with AIDS are ignorantly spreading the disease, believing that sex with a virgin could be the magical drug of AIDS. At first this belief was peculiar to the South Africans especially to the black community, but now there is the great fear that other Africans will imitate and practice this evil in the near future if they are not dissuaded and properly informed (17).
Ebola outbreak in today’s world is relatively new as such no much literature (aside medical and statistical report) exists on this subject. There is need to properly understudy this epidemic both religiously and otherwise, in order to provide a way of proffering solutions to countries where it still exists. In the light of this, a research work like this is deemed necessary to cover this obvious gap by providing a Biblical basis for addressing issues of stigma. Ebola being a very deadly disease with a high rate of spread, there is need to be well-equipped intellectually and well-informed about this deadly disease and various means to manage it. Creating a synergy between God’s law in the Old Testament and that of modern government creates a better understanding of how pandemic situations are to be managed, especially to ‘men of faith.’
1.4 Objectives of the Study
The overall aim of this study is to reread/reinterpret the Hebrew text of Leviticus 13 – 14 in the light of contemporary Ebola pandemic in West Africa, particularly in Nigeria. The specific objectives of this study are to:
- establish the nexus between the guidelines instituted by God on leprosy and the steps adopted by the Nigerian government in tackling the spread of Ebola;
- highlight that God in His infinite wisdom (even in the Old testament) laid down basic principles for tackling an epidemic such as leprosy which are in line with today’s WHO best practices adopted by the Nigerian government in handling Ebola;
- show that the essence of creating the ‘isolation/quarantine’ system by God (in the Old Testament) and the Nigerian government is not to foster discrimination but to ensure that outbreaks of such epidemics like leprosy and Ebola were stemmed;
- also to show that infected persons, once cured, are to be assimilated into the society without any form of stigmatization;
- show that leprosy and Ebola virus, although originated at different ages are both dreadful diseases that are transmitted through almost the same means;
- highlight that the cure for both cases under examination are unknown and cases of recovery are attributed to nature;
- develop a Biblical basis for fighting against Ebola stigma by highlighting the fact that in times of epidemics, individuals, institutions and nations are to provide support, aid and care for infected/affected persons or nations rather than abandoning them. This will encourage infected persons to observe the necessary regulations in ensuring that they do not spread the disease; and
- evaluate the problem of fear and ignorance as key issues that foster stigmatisation which advertently encourages the spread of diseases.
1.5 Research Methods
In this research, the area of study focuses on leprosy in the Israelite community of the Old Testament times and also the Ebola pandemic in West Africa, particularly Nigeria. In gathering the data for this work, we relied heavily on secondary sources, given the fact that our study of leprosy was limited to Biblical records. Again the nature of Ebola virus makes it difficult to adopt other methods such as conducting interviews. Some of these secondary sources include; the Bible (both the English and the Original Hebrew text), Journals (both electronic and print), textbooks, newspapers articles and other internet materials.
Method of data analysis of leprosy in the Old Testament takes both a historical and exegetical approach. By historical approach, we undertook a proper evaluation of events and occurrences which took place in the time past as represented in Biblical text and also in the expositions of some Bible historians. By undertaking an exegetical approach, Leviticus (13 and 14) was carefully interpreted and explained within the context of the original Hebrew text.
The theoretical framework adopted for this work is the comparative model. The major proponent of this model was late Sir Edward Evans-Pritchard, (1965) a social anthropologist. He advocated that if any general statements are to be made about social institutions, they can only be made by comparison between the same types in a wide range of societies. For Evans-Pritchard, the emphasis in comparison should be placed on differences rather than similarities, although he admits that institutions must be similar in some respects before they can be different from others. This leads him to suggest that comparison has the best chances of success in circumstances where societies have much in common, structurally, culturally and environmentally (Michael Adogbo and Crowder Ojo 16). Furthermore, the comparative model is concerned with the systematic comparison of the doctrines and practices of the world’s religions. In general the comparative study of religion yields a deeper understanding of the fundamental philosophical concerns of religion such as ethics, metaphysics, and the nature and form of salvation. Studying such material is meant to give one a richer and more sophisticated understanding of human beliefs and practices regarding the sacred, numinous, spiritual, and divine (Michael Saso 5). In relating the account of the events in the Old Testament with the contemporary issue of Ebola disease, the comparative method clearly highlights their significant interrelatedness while putting the legislations in perspective.
1.6 Scope and Limitation of the Study
The scope of this study is centred on evaluation of Leviticus 13 – 14 as it relates to combating disease outbreak. This study probes into the laws instituted by God in 13 and 14 to control leprosy epidemic in the Israelite nation in the Old Testament and synergise it with the guidelines adopted as the standards in contemporary times to address the outbreak of pandemic diseases in general and the Ebola virus in particular. This study particularly focuses on the Nigerian experience of the Ebola virus. Aside the fact that Nigeria is our nation (which is one of the reasons for focusing on Nigeria) the fact that the government successfully implemented guidelines which enabled them tackle the spread of the virus is commendable and worthy of emulation. No wonder the WHO after certifying Nigeria free from of Ebola virus gave the government high recommendation.
Although there are different instances of several skin diseases in the Bible (both in the Old Testament and New Testament), this study is limited to the study of Leviticus 13 – 14 as they concisely highlight God’s laws in the event of disease outbreak. A focus on these two chapters of Leviticus enables us to carry out a proper exegesis on the Hebrew text in order to relate it with the contemporary issues of Ebola virus in Nigeria.
The study also examines the attitude of the society towards those infected with diseases both in the Old Testament times and contemporary times. It investigates some of the factors that promote stigmatization as well as provides Biblical foundation for tackling stigmatisation in contemporary times.
In carrying out this research work, we have had to contend with certain challenges. One of these limitations is the huge financial commitment that is required for this research. The unavailability of materials also forms part of the limitation for this work; literature on this aspect of the Old Testament. The power situation in the town has been very troubling and the researcher has had to depend mostly on generators during the cause of this work there by accruing more cost in purchasing fuel.
1.7 Definition of Operational Terms
For proper understanding and avoidance of ambiguity, it is crucial at this point to define and explain the key terms used in this study. The concepts that needs to be defined includes:
1.7.1 Nexus
“Nexus” is a connection or series of connections linking two or more things. Macmillandictionary.com similarly defines nexus as a closely connected group of people or things, often forming the central part of something. Therefore it is conceptualised in this work to mean the ‘relationship’ existing between leprosy in the Old Testament and Ebola disease in the contemporary times.
1.7.2 Leprosy
Leprosy as shown in a WHO Document is a chronic disease caused by Bacillus, Mycobacterium leprae (1). Vorvick et al supports the aforementioned definition but adds that leprosy has two common forms, tuberculosis and lepromatous, and these have been further subdivided. Both forms produce sores on the skin but the lepromatous form is the severe one, producing large disfiguring lumps and bumps (nodules). All forms of the disease eventually cause nerve damage in the arms, legs and other parts of the body which further causes sensory loss in the skin and muscle weakness (105).
Nonetheless, the meaning of leprosy in the Old Testament is poles apart from the above modern scientific interpretations but there are areas where they resemble. Insight on the Scriptures defines leprosy as a disease designated in the Bible by the Hebrew term tsa-rw’ath and the Greek word le’pra (237). A person afflicted with it is called a leper. In the scriptures, “leprosy” is not restricted to the disease known by the name today, for it could affect not only humans but also clothing and houses (Leviticus 14:55). The leprosy of today is otherwise called Hansen’s disease, so named because Dr Gerhard A. Hansen discovered the germ that is generally thought to cause this malady. However, though tsa-rw’ath applies to more than the leprosy of today, there is no doubt that human leprosy now called Hansen’s disease was evident in the Middle East in Biblical times (Insight on the Scriptures 237). Leprosy used in this thesis is conceptualised to suit the meaning of the disease in the Old Testament Jewish society, unless otherwise stated.
1.7.3 Ebola Virus
According to Kuhn Jens H, Becker Stephan, Ebihara Hideki, Geisbert Thomas W, Johnson Karl M, Kawaoka Yoshihiro, Lipkin W. Ian, Negredo Ana I (2083), Ebola Virus (EBOV, formerly designated Zaire Ebola Virus) is one of five known viruses within the genus Ebolavirus. Four of the five known ebolaviruses, including EBOV, cause a severe and often fatal hemorrhagic fever in humans and other mammals, known as Ebola virus disease (EVD). The first recorded case was Mabalo Lokela, a 44‑year-old school teacher. The symptoms resembled malaria, and subsequent patients received quinine. Transmission has been attributed to reuse of unsterilized needles and close personal contact, body fluids and places where the person has touched.
During the 1976 Ebola outbreak in Zaire, Ngoy Mushola travelled from Bumba to Yambuku, where he recorded the first clinical description of the disease in his daily log:
The illness is characterized with a high temperature of about 39°C, hematemesis, diarrhea with blood, retrosternal abdominal pain, prostration with “heavy” articulations, and rapid evolution death after a mean of three days. (Bulletin of the World Health Organization 275)
According to Na Woonsung, Ebola virus and its genus were both originally named for Zaire (now the Democratic Republic of Congo), the country where it was first described, and was at first suspected to be a new “strain” of the closely related Marburg virus. The virus was renamed “Ebola virus” in 2010 to avoid confusion. Ebola virus is the single member of the species Zaire ebolavirus, which is the type species for the genus Ebolavirus, family Filoviridae, order Mononegavirales. The natural reservoir of Ebola virus is believed to be bats, particularly fruit bats, and it is primarily transmitted between humans and from animals to humans through body fluids. Ebola virus has caused the majority of human deaths from EVD, and is the cause of the 2013–2014 Ebola virus epidemics in West Africa, which has resulted in at least 21,097 suspected cases and 8,293 confirmed deaths. Because of its high mortality rate, EBOV is also listed as a select agent, World Health Organization Risk Group 4 Pathogen (requiring Biosafety Level 4-equivalent containment), a U.S. National Institute of Health/National Institute of Allergy and Infectious Diseases Category A Priority Pathogen, U.S. CDC Centers for Disease Control and Prevention Category A Bioterrorism Agent, and listed as a Biological Agent for Export Control by the Australia Group (18).
1.7.4 Pandemic
The internationally accepted definition of a “pandemic” as it appears in the Dictionary of Epidemiology is a straightforward and well-known definition: ‘an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people’. It should be noted that this definition can apply to other infections subject to such global spread, for example, cholera and HIV. There is no element of severity in it: while some pandemics are severe in the disease they cause in some individuals or at a population level, not all pandemics are severe. WHO developed a more technical set of requirements for a pandemic based on the following criteria:
- Able to infect humans,
- Able to cause disease in humans,
- Able to spread from human to human quite easily.
Severity has never been part of the WHO definition of pandemic, although, the pandemic virus has to be able to cause disease in at least some people. Hence once a pandemic starts, it is important to assess the severity of the pandemic along a series of parameters, using a Risk Based Approach, such as the one developed by European Centre for Disease prevention and Control (Robert Clark 41).
1.7.5 Disease
According to US National Library of Medicine, National Institutes of Health, a disease is a particular abnormal condition that affects part or all of an organism not caused by external force and that consists of a disorder of a structure or function, usually serving as an evolutionary disadvantage. Also, White Tim opines that the study of disease is called pathology, which includes the study of cause. Disease is often construed as a medical condition associated with specific symptoms and signs. It may be caused by external factors such as pathogens or by internal dysfunctions, particularly of the immune system, such as an immunodeficiency, or by a hypersensitivity, including allergies and autoimmunity (34).
1.8 Organization of the Study
This thesis is divided into five chapters. The first chapter which is the introduction deals with some relevant background information on the objective of the work in general. The second chapter is comprised of the literature review of related works where different concepts which are relevant to the research have been clearly captured. The third chapter contains the exegesis of Leviticus 13 – 14 in the Hebrew and English translations, the structure and theology of Leviticus and also the relevant legislation on Ebola Virus as contained both in the Nigerian constitution as well as other health care emergency guidelines. The fourth chapter examines the interrelatedness between Leprosy in Leviticus 13 – 14 and the Ebola Virus Disease in Nigeria. The fifth chapter concludes the work by presenting the summary of findings and recommendations for necessary actions and further studies.
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