The effect of COVID-19 public health guidelines on the funeral traditions and burial rituals among the Baganda, a tribe in Central Uganda

¹School of Nursing and Midwifery, Wakiso Comprehensive Institute of Health Sciences, Wakiso District, Uganda, ²Buganda Broadcasting Services (BBS) Television, Kampala, Uganda, ³School of Education, Nkumba University, Wakiso District, Uganda, ⁴School of Nursing and Midwifery, Aga khan University, Kampala, Uganda

^&Corresponding author
Martin Lubega, School of Nursing and Midwifery, Wakiso Comprehensive Institute of Health Sciences, Wakiso District, Uganda

Introduction    

The Coronavirus disease 2019 (COVID-19) that has rapidly spread globally affecting almost each and every country remains one of the greatest public health threats ever recorded in this century. The disease that was recognized as a global pandemic in March 2020, has caused unprecedented socioeconomic disruptions and its associated with a high fatality incidence [1]. By 2^nd July 2021, over 3,975,928 deaths had been reported globally and of these, 1,111 were reported in Uganda alone [2,3]. As the world continues to battle the pandemic, a number of public health guidelines have been established by World Health Organization (WHO) and the National COVID-19 taskforce in Uganda to mitigate its spread. According to the current evidence, the virus spread primarily when droplets from the mouth or nose of an infected person are released via coughing, sneezing, or talking. These may drop on a surface and then spread to another person who touches that surface and later touches the eyes or nose with the contaminated hand [4]. Many of these guidelines like wearing of face mask, quarantines, social distancing, staying home, avoiding handshakes and hugs, suspension of public transport, curfews, lockdowns among others have resulted into unprecedented changes in the sociocultural fabric and interactions among people[5,6]. Among the many public health measures designed to control spread of the disease and reduce interactions among people, were also guidelines on handling of bodies that have succumbed to COVID-19 and their burial management [4,7,8]. Some of these include restricting the number of mourners, wrapping bodies in plastic body bags, health workers taking over the responsibility to prepare the body, denial to view the body among others. These guidelines have greatly disintegrated and suppressed the African traditional rituals associated with funerals and burials [9,10] and changed the entire experience of handling the dead, mourning, burial and bereavement [11]. In Africa, funeral and burial rituals are communal, express the cultural blueprint and are anchored on cultural beliefs and values of a given society [12]. These rituals offer social and psychological support to the bereaved creating a safe and positive way for mourners to express grief and emotions, staying connected to family and friends [13]. Traditional funeral ceremonies provide an opportunity for the living to express their love and respect for the deceased [14]. The psychological impact of death is irrefutable therefore, the inability to honor a loved one with an appropriate burial and funeral is causes untold distress for the deceased´s family and community, affects the healing process [15]. This trauma is ritualistically addressed through rites of mourning and burial. However, many of these practices are associated with mass gathering of people and defy the scientific evidence in regards to COVID-19 transmission thus likely to be super spreaders of the pandemic [16].

Although there is very limited published data about funeral and burial ceremonies among the Baganda, death is a socio-cultural event with rituals that have been practiced for decades among the Baganda of Buganda Kingdom in Central Uganda [17,18]. Like many other societies in Africa, burial and funeral rites symbolize a deep connection between the living, the dead and their socio-cultural networks [12,17-21]. Therefore, Baganda believe that the living have the responsibility to give the dead well organized befitting burial ceremonies in accordance with the traditional rituals for them to maintain good relationship with the spirits of their dead relatives. Among the Baganda, funerals and burials are communal and attract mass gatherings at which friends, family members and well-wishers pay their last respect to the dead and mourn with the bereaved. Actually, the success of a funeral in Buganda largely depends on the number of people and dignitaries who turn up. As part of mourning with the bereaved, the sympathizers hug, shake hands with members of the deceased family. The preparation the corpse is performed according to the social status, gender and role of the deceased in the society. The body is bathed, prepared and wrapped by family members. During the vigil, the mourners sit around the body to pray and have an opportunity to view and pay last respects to the dead. Through these and other practices, social relations are reinforced between the deceased´s family, the community and ancestors. It is believed among the Baganda that failure to perform such ceremonies could have negative effects in the spiritual connection between the living and the dead. This causes distress among the relatives potentially increases the risk of complicated grief [11]. With current COVID-19 death tolls reported in the country, the restrictions were put in place to mitigate the spread of the disease. However, these have potentially suppressed the cultural rituals and the mode of mourning among the Baganda. In a society like Buganda, that is keen on maintaining its culture and traditions, the restrictions are likely to exacerbate guilt, trauma of surviving a pandemic and coping with death and grave emotional and mental health consequences that can delay recovery and undermine community resilience [1]. Therefore, this study was conducted to explore the effect of the COVID-19 public health guidelines that were instituted by the government of Uganda on the funeral traditions and burials rituals among the Baganda, an ethnic group with deep rooted traditions and culture in central Uganda.

Methods     

Study design: the study adopted a cross sectional qualitative approach to collect data from five adult individuals of Buganda ethnicity whose relatives had succumbed to COVID-19. A qualitative approach was chosen for the study to provide the investigators a deeper understanding of the effect of the COVID-19 public health guidelines on the traditional and cultural funeral and burial rituals among the Baganda.

Study setting and study population: the study was conducted among the Baganda of Buganda kingdom in central Uganda. Buganda is one of the ancient kingdoms, and it is the biggest and most grounded in Uganda. It has a deep-rooted culture and the Baganda are so bound to their cultural rituals, especially in traditional ceremonies like funerals and burials. The choice of this tribe was further made because it is in central Uganda, which has reported the biggest number of COVID-19 deaths. Five key informants with a good understanding of the funeral and burial rituals and the Baganda having attended these ceremonies before and after the COVID-19 pandemic. The study was conducted during the second national wide COVID-19 lockdown between the months of March and June.

Eligibility criteria: only elderly participants of Buganda ethnicity who have lost close relatives and that have witnessed several funeral celebrations in both pre-COVID-19 and COVID-19 periods were recruited in the study.

Sampling technique: all key informants were chosen through a non-probability purposive sampling method to ensure that only expert informants matching the eligibility criteria were selected and interviewed. This was done until saturation was noted during data collection.

Study variables: the dependent variables in this study are the various COVID-19 public health guidelines like lockdown, social distancing, restricting mass gatherings among others that were enforced by the government of Uganda to limit the spread of the pandemic. The independent variables in this study were the various effects of the public health guidelines on the funeral traditions and burial rituals among the Baganda, an ethnic group in central. Data on these was collected using qualitative approach to explore the experiences of the bereaved ones.

Data collection tools: data were collected via face to face, video interviews and telephone interviews with key informants. The study used semi-structured interviews to obtain data for the research.

Data management and analysis: the raw data was transcribed and analyzed using document analysis to familiarize with data, generated initial codes and themes, reviewed them, defined and named themes and finally producing the report. To ensure trustworthiness, transcripts were independently coded by both the researchers. Although the codes generated were quite consistent, where differences emerged, they were resolved by consensus. In order to minimize bias, all the authors were involved in group analysis of the documents; differences in coding and themes where resolved by consensus.

Ethical consideration: the study was approved by Wakiso Comprehensive Institute of Health Sciences Research and Ethics Committee. Formal consent was received from all the participants before starting of interview. In order to maintain privacy, every participant was assigned a number and names were not disclosed.

Results     

The study recruited five participants of 36 to 54 years with an average of 44.4 years. Of these, three were female, two were male and all had lost very close relatives who had succumbed to COVID-19 Table 1. The experiences shared in the interviews indicate that there are unprecedented changes in the traditional and cultural funeral and burial rituals among the Baganda. Many of these have disrupted the cultural norms of mourning, funeral and burials. The effects based on the reported experiences were categorized into three themes that is uncultural handling of the corpse, mourning in isolation and undignified burial of the dead.

Uncultural handling of the corpse: among the Baganda, the dead body is prepared, bathed, cleaned up, well dressed and later wrapped in a bark cloth. The current restrictions that hinder the family members from touching the bodies of those that have succumbed to COVID-19 deny such families the opportunity to perform such cultural rituals. One of the participants stated that: “Our mother was buried dirty; I doubt if the burial team combed her hair or even made any make up for her. She was buried in the same clothes she was in while on the hospital bed. It´s so traumatizing I do not know if she will ever forgive us for accepting to bury her like that. We also had nothing to do, the team would not allow us to touch her” (participant 1). “We don´t know how the wrapping was done, we insisted that our uncle should be wrapped in a bark cloth which we gave the burial team but those people chased us away” (participant 2). “We were not allowed to bath the body of our mother or even change the clothing. The burial team from the hospital came with the body ready inside sealed coffin. We were not allowed to open it at all” (participant 3). Viewing the dead body has been one of the traditional norms among the Baganda as a way of paying last respects and saying good bye to the deceased. However, the participants report that this has been limited as reflected in the statements below. “The funeral home team took over the entire responsibility of preparing the body. She was put into the coffin at the hospital just the way she was at her time of death. It was completely sealed from the hospital, we had no chance to view the body at all. This still feel the pain of not viewing my mom” (participant 4). Among the Baganda, the body of the family head is laid in the sitting room until the day of burial as a sign of respect and authority as the head of the family. “As the head of the family and a senior clan leader, his body is traditionally supposed to rest in the sitting room for at least a night as people mourn. We did not have that opportunity; we were not allowed to take the body into the house. He was treated like a stranger in his own home” (participant 5).

Mourning in isolation: all the participants lament the unusual experience of having to mourn as close family members without friends and most of the relatives. In Buganda, the sad news of death attracts people to gather at the family of the deceased to console and morn them. This way, neighbors express love and stand with the bereaved. In this period, what happens is contrary to the traditional norms as noted by the participants below. “It was a very frightening moment for us, we were only twenty people at home including the few neighbors that managed to come and we spent the whole night at the fire place mourning. This is something I had never seen. Our mother was a very social woman but with this lockdown, even relatives did not attend her burial”- (participant 1). “Our father was a senior member in our clan, by the nature this position alone, many people would have wanted to attend his funeral but this was not possible. The funeral was attended by only us the family members that where home and a few neighbors. The other relatives staying outside the district wouldn´t come to the funeral. It was very painful” - (participant 5). Prayer is a very important component of the mourning process that facilitates the healing process for the bereaved [22]. However, the traditions of prayer during funeral have greatly been disrupted by the social distancing restrictions as noted below. “Our brother was a very prominent doctor, he had very many friends. We expected many of them to come but they wouldn´t, even some family members failed to make it here. So what we did was to organize prayers via zoom. We had service and prayed for him via zoom. This is something I had never seen and never expected to happen in our family. As much we did that, I still believe that physical prayers would be better for my brother” (participant 4). Among the Baganda, mourning is an avenue for the well-wishers to support and stand with the family of the deceased. However, the mourning has nowadays has been characterized with stigma in the fear of contracting the disease. “The moment the neighbors learn that your loved one has succumbed to COVID-19, they tend to distance themselves from you. For example, none of our neighbors spent the night at our home, they were all scared, we spent the entire night at fire place alone” (participant 2). According to the culture of the Baganda, as part of the mourning process, mourners have an opportunity to view and pay last respects to the body of the deceased before burial. However, due to the COVID-19 restrictions, this ritual has been defied. “There was no chance to view the body of our mom, she was brought from the mortuary wrapped in a big polythene bag and we were not allowed to open it at all.” (participant 3).

Undignified burial: in Buganda, dignified burials are determined by the number of people and dignitaries in attendance. However, the limitations on the number of people who attend burials and having family members not participate in the burial process have been major causes of undignified burials as reflected in the statements below. “Our father was a senior clan leader but none of us was allowed to participate in burying him. I am worried the ancestors may to not be happy with us, it´s the strangers alone that buried him. To make matters worse, the other clan leaders were not around, the burial team just did what they wanted” (participant 5). Prayers and other rituals are always performed before the body is lowered into the grave and completely buried. However, with the restrictions, some burials are not attended by cultural and religious leaders to pray for the deceased before being buried in the grave as reflected in the responses below. “There was no priest during the burial, when the burial team reached here with the body, they asked us where he was to be buried, thereafter, it took them like thirty minutes and the burial was done. I feel so bad that we had no chance to pray for our uncle” (participant 2). “Here in Buganda, I had never seen a burial done in privacy. Many of the family members, relatives, friends and well-wishers were not around. It was only the four men of the burial team that went to the grave yard. The rest of us remained standing in the banana plantation.” (participant 4). “We thought that the team would allow us to at least carry the coffin to the graveyard, this wasn´t accepted. The team carried the body to the graveyard and lowered it into the grave themselves without any relative around the grave. I had never seen this. It was so disrespectful and embarrassing to us as a family.” (participant 2).

Discussion     

This study reveals unprecedented changes in the traditional and cultural funeral and burial rituals among the Baganda. These include; uncultural handling of the dead, mourning in isolation and undignified burials. The WHO guidelines recommend integration of appropriate cultural practices with in the public health measures for burials and funerals in order to reduce the chances of infection as well as sustain safe and dignified burials [4]. However, the current COVID-19 public health guidelines in Uganda have limited the ability of families among the Baganda to perform the traditional and cultural rituals to offer dignified burials to their loved ones. This study, like many others conducted across Africa, reflects that these guidelines have greatly changed the traditional norms of mourning, funerals and burials and there are a lot of psychosocial suffering families go through due to impediment to performing familial farewell rituals [12,13,23]. Failure to fulfil these rituals causes psychological torture, guilt and dissatisfaction among family members as they worry about their loved ones in the afterlife [1] and potentially increasing the risk of complicated grief [11]. Although having online prayers have been reported elsewhere in the world [14,24], it´s a novel practice among the Baganda as many still believe in the traditional physical prayers where the deceased is directly prayed for and blessed by the priests and the mourners. The suppression of funeral rituals causes feelings of disbelief and indignation [10].

Study limitations: although the Baganda predominate the central region of the country, Uganda is a multi-tribal country and very many intermarriages have happened in the region. Intermarriages often interfere with the cultural and traditional practices among the people. This may affect the generalizability of the study findings. The emotional attachment the prospective participants had for their relatives hindered many from participating in the study, as many would break down and withdrawal from the study.

Conclusion     

In summary, this study documents evidence of interrupted cultural practice of funeral and burial rituals among the Baganda and this is attributed to the current public health restrictions in the fight against COVID-19. Nontraditional handling of the dead, nontraditional mourning practices and undignified burials have been reported. Cultural rituals ought to be integrated in the management of funerals and burials of COVID-19 victims in order to promote positive grieving and recovery among the bereaved.

Funding: this work did not receive any specific grant from any funding agencies in the public, commercial, or not -for-profit sectors. It was the authors that individually sponsored the entire study.

Competing interests     

The authors declare no competing interests.

Authors' contributions     

All authors actively participated in the conduction of this research and manuscript writing. Martin developed the concept paper, participated in data collection, analysis and report writing. Culton collected data from the field where burials took place, participated in data analysis and script proofreading. Josephine and Esther participated in data analysis, report writing and script proofreading. All the authors have read and agreed to the final manuscript.

Acknowledgments     

We acknowledge the tremendous support from our research assistants and nurses at Mulago Sickle Cell clinic during data collection.

Table     

Table 1: characteristics of the study participants

References