This is Part II of our two-part look at Famadihana. Read Part I here

While forces have been at work for some time trying to kill the lively and joyous practice of Famadihana, they have done little to dampen the practice in the highlands; what may prove the death nail, however, is the pneumonic plague.

All of what we call the plagues are infections of the bacteria Yersinia pestis.Bubonic plague infects the lymphatic system, pneumonic the respiratory system and septicemic plague infects the blood.

Pneumonic plague is the rarer but far more virulent big sister of the bubonic plague. It is almost always fatal and is the only form of plague that can pass person to person. Also unlike the bubonic plague, pneumonic plague is airborne, and therefore, can infect through the coughs of the sick or dust from disturbed remains that still have bacteria present.

Outbreak

In 2014, an outbreak of pneumonic plague in Madagascar led to 119 infections and 40 died. This epidemic is especially nasty as this strain of plague proved highly resistant to antimicrobial treatment.  Most infections were in cities where poor sanitation led to the plague spreading quickly. However, at least, ten of those infections occurred at a Famadihana ceremony.  The infecting body in question had recently died in the capital and moved to a communal crypt in his hometown. Though he was not brought out for the ceremony, his remains were disturbed enough in the exhuming to cause particles of infected material to become airborne and thereby infecting participants.

A lot of the advocacy I do around death acceptance is about engaging in the process of mourning and not being afraid of a dead body. Most dead bodies will not get you sick provided you don’t put them in your mouth, but when people die of highly infectious airborne illnesses, precautions need to be taken.

This brings us to uncomfortable territory in the developing world. No one wants to die of the plague, but when doctors and institutions come from developed countries and say, “Hey, ya that thing that brings your community together and helps comfort mourners….ya we are going to need you never to do that again….kay?” It can’t help but ring of cultural imperialism.

Western Sensationalism and the Famadihana

In fact, a large amount of the Western press on the outbreak focused on the more sensational Famadihana story than the fact that rampant corruption, poverty, lack of development, insufficient medical infrastructure, and poor sanitation are the real causes of the outbreak.

Famadihana was referred in Benjamin Shapiro’s Vice piece on the epidemic as  “chilling” and “ensure[s] that the plague can continue to spread”. Grizzly, macabre, barbaric and primitive were just a few adjectives used to describe Famadihana in my research of the press coverage. The Malagasy people, as reduced by the Western press, were spooky children too dumb not to give themselves the plague, unlike us smart white folk.  The plague is quite active in areas of the Midwest United States, but no one calls them a”backwater,”, “whose primitive customs are causing them to face Medieval pestilence.”

The Balancing Act

At first, there were talks about outright criminalizing the practice, but despite the risks, Famadihana still happens every day in Madagascar. The government realized that criminalizing would be useless, they couldn’t enforce it in rural areas, a ban would just drive it underground and make people less likely to ask for help to practice it safely.  Instead of outlawing a beloved custom, Famadihana’s practical nature has been utilized for the betterment of public health.

Longer waiting periods of 7-10 years (instead of 5-7) between ceremonies would significantly reduce the risk of infection and are being promoted by health services. Likewise, body bags and face masks became available in some areas in 2015 to contribute to reducing possible particle infection. Another valuable tool is education. By teaching people how to treat the remains of those that die of highly infectious illnesses, the community is given tools to make their choices on balancing safety and culture, instead of having it dictated to them from the WHO. Partial cremation (cremating remains to bone fragments, but not pulverising) has been carried out on some plague victims rendering their remains safe. While other families have agreed to carry effigies of plague victims when it’s time for their Famadihana and bury them in separate crypts were their remains won’t be disturbed.

There are ongoing dialogues between health workers and communities about creating a new custom specifically for the plague victims that could operate as an alternative to the Famadihana. It might one day supplant the Famadihana, making it safer but also lower cost, which will appeal to poorer families who want also to honor their dead, but can not afford it.

It is important when we talk about customs like this, as outsiders, that we don’t disregard the power of traditions or write them off as superstition. In my experience, the people of Madagascar have a far stronger grasp of the concepts of life and death than the average Western. People of the developed world can go well into adulthood without seeing a terminally ill person, going to a funeral, seeing a dead body, or thinking of their death. It is important not to take away agency from the local community, who in the end, are going to be responsible for preserving both local public health and culture. When we engage as allies, we build capacity where there wasn’t before. When we dictate behavior from on high, we create a situation that is destined to fail as soon as the aid trucks pull out.

There are plenty of ways to keep the spirit of Famadihana alive without risks to public safety.

After all, the dead will understand.