Professor Genese Sodikoff in Madagascar

Tracing the Bubonic Plague in Madagascar

Associate Professor Genese Sodikoff is a cultural anthropologist who focuses on biodiversity loss, conservation and restoration. She’s been conducting ethnographic and historical research on labor and rainforest conservation in Madagascar—an island nation off the coast of East Africa—for 25 years and has also studied biotic and cultural extinction, tracing how these events play out in popular and political culture, and how they shape perceptions of time and being.

Of late Sodikoff has been doing an ethnographic study of the bubonic plague and rabies in  Madagascar, looking at how land degradation, climate change and deforestation are intensifying zoonoses—or diseases transmitted to humans from animals—as shrinking habitats bring humans and other species into greater contact. Recently she published a paper in the journal Medical Anthropology Quarterly that explores the challenges of retracing a 2015 outbreak of pneumonic plague in rural Madagascar villages. In that paper Sodikoff highlights the differences in the “outbreak narratives” that emerged from scientists and survivors—and the factors responsible for that discrepancy—as the medical community tried to reconstruct the disease transmission chain to help prevent future outbreaks.

We sat down with Sodikoff recently to discuss her research.

What originally drew you to issues of the environment and extinction, touching on medicine and disease as well?
I became interested in environmental problems in college. After graduating I joined the Peace Corps and was assigned a teaching post in the Comoro Islands (East Africa), where I developed an environmental education project. My interest in deforestation and species endangerment grew in graduate school while doing ethnographic fieldwork in Madagascar. Peace Corps and NGO workers implement strategies to solve these problems, but as an anthropologist in Madascar I focused less on how we fix these problems than on the conditions that compel people to degrade the environment, and asked whether the experts’ solutions are effective and sustainable. If not, I needed to develop a theory of a particular society that explains why not.  

Madagascar, which has remarkable biodiversity and significant deforestation, is also a hotspot for plague. Why is this?
Answering why is not easy. Rats are the main reservoir of plague bacteria, and humans get infected when they are bitten by fleas that carry the blood of infected rats. Climate change appears to have an impact as heavier rains lead to moister environments and more flea reproduction. Rats are becoming increasingly resistant to plague bacteria as well: They can carry it in their bodies for longer periods without getting sick, giving them more time to infect other rats. Deforestation also causes greater numbers of rats move into villages and rice fields. Madagascar’s weak transportation and medical infrastructures are also factors, since getting to hospitals when gravely ill is difficult for rural villagers, and infection spreads quickly when outbreaks are not controlled immediately. Finally, cultural and class influences have led to many rural people distrusting medical authorities and fearing hospitals: The history of rulers and their subjects in Madagascar has shaped these beliefs.

The Malagasy plague scientists working in the capital have found [our] information useful and sometimes surprising. 

Speaking of that, in your paper you found that survivors’ recollections of the outbreak differed greatly from medical accounts. How did they differ, and to what do you attribute this?
A team of medical scientists visited the affected rural district immediately after the 2015 outbreak to determine whether and where dead rats may have been sighted, since they’re a key clue of bubonic plague. They found a man who remembered having seen a few dead rats off a footpath just before the outbreak, but a year later in our ethnographic interviews, neither I nor my Malagasy colleague found a single person who remembers having seen dead rats or rats acting strangely, another clue. And although villagers understand doctors’ explanations about germs carried by rats and fleas, they believe the trigger for this outbreak was a curse placed on a family by a man who had been jilted by a woman in that family. During the outbreak, the family relied only partially on medical treatments. They also consulted a diviner for traditional cures, including medicinal plants and spiritual intervention.

Though the medical community usually marginalizes survivor accounts, they also derive insights from them. Can you elaborate on this?
Scientists want to know is where an outbreak started, who was patient zero, and with whom that person came into contact. Medical anthropologists dig deeper into other questions, and the answers can be very useful to scientists as well. In this case, my Malagasy colleague and I learned that 2015 survivors identified a different patient zero than the medical team, a man who presented plague symptoms and died months earlier than the others. We learned that he self-medicated with antibiotics, which can complicate things: People often take insufficient doses that suppress symptoms, and they may or may not infect others. We also learned that people were combining biomedical and traditional medicine to handle the plague, and that hospital staff did not follow the guidelines in burying plague victims, which call for a 36-foot depth, where the earth is so hard that rats cannot burrow. But this is impractical for villagers to follow, and they dug a grave for four victims that was far too shallow. Most importantly, we learned how devastating it is for families to have their loved ones buried in plague pits, far from family tombs. This is so awful for people that some choose to die in their villages, rather than go to the hospital, for fear of dying there and being exiled to a pit.

The Malagasy plague scientists working in the capital have found this information useful and sometimes surprising.  Since they are also Malagasy, they know a lot more about the culture than I ever could.  Yet they still discover new details about what is happening on the ground from our ethnographic data.  The scientists don’t believe in the power of curses to cause outbreaks, but they learn about how the outbreak can spread by people’s actions that are motivated by certain beliefs.

Fascinating. Thank you very much for sitting down with us.
My pleasure.