Introduction
Methods
Study design and setting
Sampling approach
Data collection
Data processing and analysis
Ethical considerations
Results
Demographic characteristics of respondents
No. | Pseudonym | Sex | Age | Occupation |
---|---|---|---|---|
Family Members
| ||||
1 | Afia | Female | N/A | Teacher |
2 | Mensah | Male | 43 | Lecturer |
3 | Bob | Male | N/A | Unemployed |
4 | Egya | Male | 60 | Accountant |
5 | Main | Male | 75 | Pensioner |
6 | Yaw | Male | N/A | Driver |
7 | Papa | Male | 43 | Surveyor |
8 | Kojo | Male | 66 | Pastor/Proprietor |
9 | Pee | Male | N/A | Pensioner |
10 | Kwabena | Male | 63 | Pensioner |
11 | Efua | Female | 51 | Model |
12 | Kweku | Male | 58 | Entrepreneur |
13 | Prempeh | Male | 37 | Unemployed |
Health Workers
| ||||
14 | May | Male | 35 | Clinician |
15 | Joe | Male | 41 | Mortuary staff |
16 | Oboy | Male | 60 | Mortuary staff |
17 | Kobina | Male | N/A | Mortuary staff |
18 | Yaw | Male | 60 | Environmental Officer |
19 | Williams | Male | N/A | Environmental Officer |
Emerging themes
Overarching theme | Subthemes | Sub-categories | |
---|---|---|---|
‘Uncultural’ connotations ascribed to the COVID-19 burial protocols/guidelines | Sub-theme 1 | Varied depths of knowledge of Ghana’s COVID-19 burial protocols | |
Sub-theme 2 | Perceived cultural aberrations of the COVID-19 burial protocols/guidelines |
Perceived neglect of Culture in COVID-19 burial processes
| |
Implications of the ‘uncultural’ burial practices
| |||
Sub-theme 3 | Attitudes towards COVID-19 burial protocol implementation |
Resistance amidst compromise of COVID-19 burial protocols
| |
A negotiated compromise of COVID-19 burial protocols
|
SUB-THEME 1: varied depths of knowledge of Ghana’s COVID-19 burial protocols
“The way they [health workers] bury the dead when the person dies of COVID-19, they didn’t educate us on that. So, when it happens like that, what you will hear is that you will not be allowed to see your deceased when they want to bury him. All that you will hear is that, they have gone to bury him and even the place they went to bury him, you won’t even know. So, with that, they didn’t really educate us on that”(Kweku, male, family member)
“Hmmm, for the COVID-19, it is the government who buries those bodies. You [families] don’t have the right to do whatever you want to do… Even when they are going to bury your deceased, they can call you or they can ignore calling you. So, if the family wants to do something [funeral], they will have to do it without the body”(Yaw, Male, family member)
SUB-THEME 2: perceived cultural aberrations of COVID-19 burial protocols/guidelines
Perceived neglect of culture in COVID-19 burial processes
“The government employed some people to issue [a statement] that the burial of these bodies [persons who died from COVID-19] should be done in a particular way to prevent the spread of the disease. But… our traditions and culture don’t say or support the new way”(Kobina, Male, mortuary staff)
“With COVID-19, what I saw wasn’t good. It’s not something that we should do. We have our culture and the Whites have their culture. In our culture... the way they buried our loved ones isn’t good. How they buried my brother was a disgrace and disrespectful, and it disgraced the town too”(Papa Kweku, male, family member)
“…pouring of libation which is mainly done, first of all, to pray that the dead who are transiting to the other world should pave way for those who are still alive when their time is up and also to intercede for them so that the ancestors will protect them and make their works successful”(Egya, male, family member)
“And before you could bury a Muslim, there is special bath done for the deceased…and the bath goes with some level of hope and belief… it is a special bath for Muslims…but my brother didn’t have that opportunity”(Bob, male, Muslim, family member)
“Well, I come from a Christian background… we [families] dress the deceased and put it in the coffin chosen by either the wife or the children, we lay the person in state overnight and in the morning, we take the person to the church for the burial service and then the minister of the church will bury the person and we are there to see the coffin is covered”(Main, male, Christian, family member)
Implications of the ‘uncultural’ burial practices
“In our culture, if they [the family] don’t perform any service or [traditional] rites for you when you die, then you’re the same as an aborted child. That is to say that you were of no value”(Efua, female, family member)
SUB-THEME 3: attitudes towards COVID-19 burial practices implementation
Resistances amidst compromise of COVID-19 burial protocols
“…the majority of them [families] were not in agreement with the laid down procedures; that the body cannot be released to them, they cannot bury at the site they prefer and the date they prefer so usually that was the major difficulty or challenge”(May, male, pathologist)
"After discussions with the family and giving them the necessary rules, you [health worker] get to the point and the family wants to [physically] attack you, thinking that it is the Environmental Health Officers who diagnosed the deceased as COVID-19 patient" (William, male, environmental health worker)
“The family members resist and fail to accept that the relative died of COVID-19. So, they won’t allow such burial [COVID-19 Burial protocol] of their relatives. This led to a conflict between the hospital staff and the family. As a result of that, those who are quick tempered start to curse us” (Kobina, male, mortuary staff)
“So, they [family members] attacked, saying that the person did not die from COVID-19 but because we have an interest that’s why we declared the deceased a COVID-19 victim”(Yaw, male, environmental health worker)
“…I was told that the World Bank donated some money which could only be used on condition that you [health workers] testify that A, B and C tested positive… So, they wanted to use the money, so, if you’ve contracted COVID-19 or not, they record that the person died of covid” (Mensah, male, family member)
“Following the death of my brother, the doctor directed us to the Environmental Health Officers to discuss the procedure for burial. When we went, we got to know that they [Environmental Health Officers] had called the deceased’s next of kin that had a similar name to mine but the phone number they used and the surname were not mine. So, my relatives and I were confused. They interchanged someone with us. We argued our case but there was no change. So that was what happened the very day”(Pape Kweku, male, family member)
“They [mortuary workers] were not in any face masks… If they say that the deceased died of COVID-19, and they say it is an infectious disease, and the dead person is still contagious, how come they don’t wear face masks and they are not infected”? (Bob, male, family member)
“When we went for the death certificate, that’s when we found out he died of COVID-19. But we didn’t get any report that the COVID-19 test they did was positive. That’s why I was challenging them” (Mensah, male, family member)
A negotiated compromise of COVID-19 burial protocols
“I’m a Muslim, so we gave them a white cloth to wrap my brother. One of my uncles also gave them instructions during the bath. They [morticians] accepted our demands and wrapped him with the cloth as we wanted and put him in the body bag. We pleaded with them to give us some five minutes, relatives, friends and sympathizers were all there [at the morgue and we prayed. After that we followed them [COVID-19 team] with our cars to the burial site…. At the cemetery, we stood at a distance but showed them that the head should be at their left and other rites according to how Muslims bury their dead. So, we prayed for him and then returned home” (Bob, male, family member)
“If you [family] want to be involved, then you have to provide the necessary things for the transportation. You need a police escort, fuel the vehicles and you also need to make sure that when we get to the place, nobody handles the body. It should be done like how it is stated in the protocol … and we don’t want too many people around; only selected family members. And then, we made them sign a document”(William, male, environmental health worker)
“The COVID-19 burial protocol was strictly according to Ebola protocols. However, when new discoveries were made, it was somehow relaxed so that families’ requests for family burial were accepted. We sort of compromised with them under strict supervision because we realized that it [COVID-19] isn’t as fearful as Ebola. So, we put some protocols in place for the transfer of the body to that district”(William, male, environmental health worker)
“So, I had to do whatever was necessary to just give my sister a befitting burial. In short, the body was released to us. Yeah. We did that…we went through the state processes of getting permission to bury my sister - pay the prescribed fees…we satisfied all the conditions and they gave us a space…so in the end the environmental officers were not there”(Kweku Mensah, male, family member)
“The thing [COVID-19] is there but at some point, it was used for personal gains. They took money from me and then released the body to us. It’s not good” (Kweku, male, family member)
“For some they even came with letters asking for the body to be released. I remember there was one case that the letter came from very high above so the body was just released the same day to the family” (May, male, pathologist)
“They said my elder sister died of this disease [COVID-19] … So, I said, master I won’t believe whatever you are saying because I know that my sister has a problem, hypertension. So, he [health worker] said, we beg you just listen to whatever we are saying. Because if you try to stretch the issue, they will use their power because of the President’s directives… So, if we want to behave this way, they will also make it very rigid for us which will cost us not having access to the body of my sister and will bury her strictly in accordance with the directive”(Kweku Mensah, male family member).
“They [health workers] are the experts and they are telling you that this is the condition. I only received a report when they gave me the death certificate and they indicated that it was a severe COVID-19”(Yaw, male, family member)