Welcome to Bones, Stones, and Human Evolution: The Start of the Story

Last week was the beginning of our Fall term. Instead of the typical first day of college class, the dreaded and boring Syllabus Day, I decided to finally do something that had been kicking around in the back of my mind for a couple years... I decided to just tell a story.

Woodland Grassland (K. Hinde)

Welcome to Bones, Stones, and Human Evolution. I am Professor Katie Hinde and I have been studying and researching in this field since 1996. I work in Evolutionary Anthropology and Global Health. You will hear more about me and my work (and the research of our kickass TAs) in the next lecture. But that isn’t the plan for today.

Today I am going to tell you a story of humanity. 

Not “the” story of humanity, because there is no one story of humanity, but a story of humanity. And in doing so, I will tell you a story of Anthropology. I will describe an interrelated set of academic approaches- from paleoanthropology to genetics to primatology to human behavioral ecology to bioarchaeology to medical anthropology to cultural anthropology. I will touch on where anthropology intersects with psychology, nutrition, wildlife biology, sociology, global health, virology, applied math, and about 3 dozen others research areas. And today, there will be few slides, no readings, no advanced preparation.

Just a story.

Some of this story is devastatingly heartbreaking, some of this story is irretrievably macabre. Some of the story is about the tiniest pieces of genetic code and some of this story is about the interconnectedness of far-flung global networks. Some of this story is about the landscapes of an ancient past walked by a long-ago ancestor. For some of you, some aspects of this story may make you feel confronted and uncomfortable, while the same parts of this story may make others of you feel vindicated and empowered. Some of this story is unimaginable as real life. Some of this story won’t make any sense until later in the term. And some of this story is still unknown and is awaiting future researchers to tackle new, emerging questions.

But all of this story is anchored to reliable journalism and scientific research. And this is the first time the story has been told this way, because I wrote it yesterday, piecing it together from years of following the different elements from a variety of resources (sources listed below).

Sierra Leone - The road from Kenema to Kailahun District (Lindsay Stark)

In 2013, on December 2^th, a little boy got fretful. His body ached, he spiked a fever, and he grew increasingly lethargic. His mother and sister must have cuddled and snuggled him, but he got sicker and sicker. Puking dark vomit, shitting streams of diarrhea, he became dangerously dehydrated, and his eyes would have become sunken and glassy. On Dec 6th, the virus replicating through his body overwhelmed his immune system… and he slipped away.

This two-year-old boy was the index case, the patient zero, of the 2013-2016 West Africa Ebola Hemorrhagic Fever epidemic. The largest Ebola epidemic ever documented since the disease was first monitored in the 1970s.

Just two weeks before he was likely a typical toddler, running after his sister and friends, playing in the edges of the forest that surrounded his village of Meliandou, Guinea. Maybe he spent time waving sticks and climbing in hollowed out trees like I did as a kid. In his village such things can be contaminated by urine and guano from a colony of insectivorous free-tailed bats, Mops condylurus, that roosted there. And those little bats can carry the Ebola virus.

Photos from index case investigation: 
index home was on outer edge of village, 
bat roost trees with intentionally placed sticks
(Figure from Saéz et al. 2014)

Outbreaks of Ebola come initially from exposure to an infected animal- known as zoonotic disease transmission. Approximately 75% of emerging infectious diseases that threaten human health are caused by pathogens or infectious agents from animals. These are known as zoonotic pathogens. HIV, influenza, Ebola, Nipah, SARS are all pathogens that jump, or jumped and subsequently evolved, from animals to us. These disease jumps from species to species can be from domestic species to humans- like the prion disease scientists named bovine spongiform encephalitis (what is more dramatically called MAD COW DISEASE).  Or from wild animals to domestic animals to humans. This was the emergence in 2012 of MERS- Middle East Respiratory Syndrome Coronavirus that jumped from bats to camels to humans in the Arabian Peninsula. Similarly in 1994, in a suburb of Brisbane, flying foxes, some of the largest bats in the world, roosted in trees above horse pastures. The horses became acutely ill, dying within days and transmitting the virus to their trainers.

Camels in Jordan (K. Hinde)

Or the disease jumps can be directly from wild animals to humans. Hunting of wildlife by humans is an ancient practice. From the earliest days of Homo sapiens, stretching back 200,000 years ago in Africa, humans have hunted for animal protein. Even further back, 2 million years ago, Homo erectus was a capable hunter. The inter-connections of energy rich diet, big brains, bipedal running, complex stone tools, and extended development– among other things – are key foundations of being human.

And we can look at one of our closest living cousins- the chimpanzees- with whom we share up to 99% of our genetic code and last shared a common ancestor between 5 and 7 million years ago. Chimpanzees are avid monkey hunters. At Gombe, the chimpanzee research site made famous by Jane Goodall, chimpanzees hunt regularly, both males and females, but they target different prey. In Uganda, at the long-term research site of Ngogo, chimpanzees have nearly hunted out red colobus monkeys. These chimps hunt together and share meat across family, friendships, and alliances, cementing the bonds of their social relationships. Chimpanzees and humans both shared a last common ancestor with the red colobus monkeys 25-33 million years ago. (sidebar: go have some fun with TimeTree!).

But hunting carries a substantial risk for cross-species transmission. Although the cultural practice of cooking can kill many pathogens and make meat safer to eat (and provide more net energy gain!), the hunting and butchering of animals can expose people to pathogens. A little cut on the hand while butchering an animal becomes the bridge of zoonotic disease transmission.

Sidebar: Ever notice that there are two terms for wild caught animal protein? ‘Bushmeat’ and ‘game.’ Apparently white people hunt game, but Black and Brown people eat ‘bushmeat.’ These different terms reflect the problematic legacy of colonialism that perpetuates racism and prejudice today. Indeed that racism and prejudice likely influenced how the world responded to the West Africa Ebola epidemic in 2014, slow to send sufficient supplies to effectively get ahead of the epidemic.

Sofia Loren Side Eye

Where were we… oh right... What the environment is like, how the plants and trees grow, what animals are present, whether domestic animals are exposed to wild animals, how the wild animals are interacting with one another, whether the landscape is intact or logged, mined, or otherwise disturbed... this is known as the ecological context. All of these can influence how people live, eat, and how healthy they are. 

Leo the Lop, Bovid Version (K. Hinde)

Another aspect of humans is our culture- how our cultural practices shape how we interact with one another and our local ecology. Meliandou Village, Guinea, is in Guéckédou area, in the forest region at the present-day border of Guinea, Sierra Leone, and Liberia. Here in the Southwest United States we have 4 corners, where you can put a limb in 4 separate states at once. In the region of West Africa where the 2013-2016 Ebola epidemic emerged, people can stand in two nations and reach into the third. Many of the people living in this region share a cultural heritage, and couples marry across borders, folks walk, motobike, & drive to visit their families, celebrate weddings, take care of sick relatives, and attend funerals.

In the local Kissi culture women primarily care for the sick within their families, and women prepare bodies for funerals. They ritually wash the body and dress the loved one in a favorite outfit. Similar practices are shared with other local cultures among the Mende, Sherbro, and Kona and even after people have become Christian or Islamic, adherence to these practices are sustained. The landscape of the afterlife and transitions to the "Village of the Dead" are made possible by complex burial practices. For example, because of cultural constructs of generations, if a woman is pregnant when she dies, her fetus must be removed from her body before she is buried. "Mortuary practices are not simply concerned with the disposal of a body. They are fundamental to the future of the deceased, their relatives, the wider community, and the environment" (Fairhead 2016).

In the context of an Ebola outbreak, these cultural practices make exposure to the virus practically unavoidable. Importantly, Ebola is not airborne like the common cold, the virus passes from person to person through contact with body fluids in which the virus is shed- saliva, mucus, sweat, tears, blood, semen, vaginal fluids, diarrhea, and breastmilk. And Ebola, as a virus, is particularly virulent in humans and other primates, the virus replicates quickly and it takes very few virus particles to become infected. A person sick with Ebola, sheds copious amounts of virus from vomit, a bloody nose, diarrhea splatter and even after death the body remains infectious for several days. 

Ebola Virus Particles by NIH National Institute of Allergies & Infectious Disease

Just days after little 2-year-old patient zero died, his mother fell ill, who was likely cared for by her mother, patient zero’s grandmother. The mother died Dec 13^th, exactly a week after her son. His 3-year-old sister died December 25^th 2013. Maybe she got sick from her brother, or contracted the virus from her mother’s breastmilk. But during this time, the grandmother contracted Ebola, she died on Jan 1^st. The grandmother’s sister, patient zero’s great aunt, had traveled from Dawa Village with another person, just a few miles away, for her sister’s funeral. After returning to Dawa, on January 20^th, the Grandmother’s sister was feverish, began to vomit, have diarrhea… and died Jan 26^th. Others from Dawa contracted the virus.

This was the beginning of the epidemic. As the virus spread along kinship lines within and across villages following patterns of family; family by blood (consanguinuity) and marriage (affinity). People taking care of their loved ones who were ill. This degree of care-giving is not unique to our species; the fossil record shows that Neanderthals would take care of injured members of their social groups. We know this because skeletons have been found after major injuries have healed- crushed skulls, broken legs and arms- injuries that would have kept someone from getting enough food to feed themselves. Someone else must have brought them food, and nursed them through injury until they recovered. We’ve even seen survival of an Neanderthal infant after early weaning in the fossil record. Helping and caring for others is hundreds of thousands of years old.

Neanderthal Family Museum Exhibit

Back in Meliandou Village, the village nurse and the village midwife, having helped with patient zero’s family, both became sick in late January with Ebola. When the midwife fell sick, she went to the hospital in the larger township of Guéckédou. And her sister came from Dandou Pombo Village because in this region typically family members of a hospitalized patient take care of their basic needs- cooking, feeding, and laundry- a synthesis between traditional and Western hospital practices. After the midwife died, her sister returned to Dandou Pombo and succumbed to Ebola. That was February 11th.

And as people cared for the sick and the dead, traveling across borders and returning, the virus spread throughout the region. Pregnant women were particularly vulnerable in part because their immune system is suppressed during pregnancy. Once patients ended up in clinics and hospitals, the virus quickly began to infect doctors and nurses. In Liberia, although only ~0.1% of the general population died from Ebola by May 2015, over 8% of all health care workers had died from Ebola. Who takes care of the care-takers? Who is left to take care of others when care-takers die?

By March, the World Health Organization was notified of an outbreak of a communicable disease characterized by fever, severe diarrhea, vomiting, and a high death rate. Within several months there were hundreds of new cases each week. International Aid and Research Teams were deployed to the area, and dozens of virologists and geneticists frantically worked to identify the virus, quickly confirming that it was Ebola Hemorrhagic Fever. By the decline of the epidemic a year later, over 28,000 people would contract the disease and ~11,000 would die in equatorial West Africa in Guinea, Liberia, and Sierra Leone. Additional cases occurred in Mali, Nigeria, and Senegal.

Hospital in Kenema, Sierra Leone, West Africa (photo by Leasmhar)

Air travel and privileged access to medical evacuation would bring the virus to Italy, Spain, the United Kingdom, and the United States. In the United States two nurses contracted the virus while treating Thomas Eric Duncan, a patient who was in Texas from Liberia to visit family. Twelve days before in Liberia, Duncan had reportedly arranged a taxi for his pregnant landlord to go to the hospital. She had Ebola symptoms and he was unaware that he was exposed to the virus during the taxi ride. Two days after arriving in Texas he got a headache and abdominal pain and had sought care the day after developing these symptoms. The clinicians at Texas Health Presbyterian Hospital reportedly did not ask about his travel history, despite the wall-to-wall coverage of the Ebola epidemic in West Africa. He was sent home with antibiotics, that can be great at fighting microbial infections, but do nothing for a viral illness. He returned as he worsened, and the delays in care may have played a role in his subsequent death. The details of how the nurses were exposed to Ebola and contracted the virus is unclear. The hospital reportedly settled lawsuits for insufficient care, training, and personal protective equipment supplies. Because the most effective way to prevent contracting the Ebola virus is barrier methods. A method embraced by PLAGUE DOCTORS in the 1600s and continuing through to today.

Technically here the 2014 Ebola Healthcare Worker does not have a patient contact stick
it's a disinfectant spray wand.

Before when there had been an Ebola outbreak, it had “burned out” fast; people got sick and died so quickly there were limits in how many others they could have contact with. Typically previous Ebola epidemics had been limited to a few dozen or a couple hundred people. The 2013-2016 epidemic, however, got a foothold unlike previous epidemics. Over the course of the outbreak, the Ebola virus was rapidly replicating in thousands of hosts, and replication is when random mutations occur. This allowed geneticists to investigate how the virus was evolving- could it become airborne? (IT DID NOT). But researches have detected that in a few genes, involved in host-virus interaction, a hint at selection to work against the human immune response. Over the course of the outbreak, Ebola, in a very small way, was adapting to human hosts.

Public Health Message

Back in West Africa, cultural and religious practices for honoring the dead are pretty much the opposite of the World Health Organization recommendations to stem the Ebola outbreak. And tensions were escalating. Conflicts arose as medical teams and government authorities arrived at households to separate the ill and the dead from their families and communities.

Just imagine. 

Imagine your loved one is sick and outsiders show up in “space suits” to take them away. Your child, your mother, your brother, your auntie. And you never see them again. You are denied mourning or the religious practices that allow their soul to be at rest, to transition to a peaceful afterlife. You don’t get to say goodbye, are stopped from touching them, and strangers are “stealing” them as they are dying or shoving them into body bags after they die. Think of the anguish. Against a backdrop of colonialism, exploitation, and other elements of "structural violence," there is little trust, and false information flourishes- "Ebola is a hoax," "the government is stealing organs," "they are doing testing on people." Humans engage in social learning, but access, trust, and prestige all shape what and who we learn from.

During the epidemic, the situation was escalating. Medical team vehicles were torched. Villagers threw stones at ambulance drivers and burial teams to keep them out of villages. People were taking sick relatives into the forest to hide them from doctors. In one village, eight health workers, local officials, and journalists were killed by villagers wielding machetes and clubs. The villagers hid the bodies in the local school's latrine. Anthropologist Julienne Anoko identified hostility toward Western medicine emerged in part due “to rumours, to fear, to mistrust and lack of confidence in the authorities, to denial of the biomedical” expertise, and outside contamination. Before you scoff at these fears, rumors, and attitudes, understand that Western, white doctors have intentionally harmed and sickened Africans in Zimbabwe, Zambia, Namibia, and South Africa. These and other atrocities of Apartheid and colonialism are well-documented and continue to haunt people throughout the African continent. This legacy continues to impact global health interventions to this day.

Sharpeville Massacre (by Godfrey Rubens)

Increasingly, Public Health and Global Health Organizations turn to anthropologists who have knowledge of cultural practices and rituals, their meaning and importance, to facilitate community partnerships and guide culturally appropriate interventions. Officials and health care workers approached village “chiefs, imams, pastors, and traditional healers for help and advice on how to change people’s minds about burials” (Maxman 2015). Dead body management teams adopted "safe and dignified burials," during which people could briefly pray, while standing several arm lengths apart from the deceased. Community liaisons were hired who would effectively communicate with the bereaved about precautions and discuss and facilitate requests for mourning accommodations. The folks handling bodies started to put the deceased in outfits selected by the family before being placed in a body bag or placing special objects with the deceased.

Guinea Red Cross volunteers travel door-to-door sharing information about Ebola 

(CDC Global)

As the epidemic spread public health workers were condoned… but stigmatized. The Dead Body Management Teams were the (often young) folks whose job was to be in close contact with people who had died from Ebola. They were responsible for transporting bodies to the fast-filling morgues and graveyards. Because "they handled Ebola-infected corpses, many were evicted from their homes by frightened landlords and abandoned by their significant others" (Maxman 2015). One Dead Body Management worker reportedly said "Women at the corner will not sell me water. They call us 'Ebola people.” Similar experiences happened to the clinicians- the nurses and doctors who took care of the sick and dying were ostracized within their communities. They were seen as contaminated and potentially dangerous.

But these people working at the front lines were instrumental at ending the Ebola outbreak before it became a pandemic. Indeed in 2014 The Ebola Fighters were named the Time Magazine “Person of the Year” because they were the ones most effective at slowing and eventually stopping the Ebola epidemic. Nurse Salome Karwah was one of the featured Ebola fighters on the cover of Time Magazine. At age 26 she nursed both of her parents, who died of Ebola, then got sick herself. But she recovered. She then dedicated herself to nursing other victims of the epidemic as she thought she had better immunity against the virus. Improved immune response after exposure to a pathogen is known as “adaptive immunity" and underlies how vaccines work.

In previous epidemics the fatality rate of Ebola strains was much higher- between 75% and 90%. In this epidemic more people who became infected survived than died. The fatality rate was just below 40%; over 60% of people who were infected with Ebola survived. This means that thousands of survivors give new insights into this pathogen and the human immune response- do they have antibodies that make them more resistant if there are future outbreaks? Is the virus still active in their bodies that they could have a relapse? (Spoiler alert: virus has been detected in their eyes, but does not shed live virus in tears). Other than the speed and magnitude of medical care, was there anything about these individuals that affected who survived? There is variation among humans, among the people sitting in this room, as to whether your body is slightly better at fighting viruses or slightly better at fighting microbes- it’s an immunity tradeoff- Could that play a role? These are all questions that human biologists and medical doctors are investigating.

But the stigma remains in their communities for Ebola survivors and the Ebola fighters. In February 2017, Salome Karwah delivered her son by C-Section, was discharged early despite elevated blood pressure, and at home developed an infection. When her husband brought her to the hospital, they were reportedly compelled to wait in their car for 3 hours. Eventually her frantic husband took a wheel chair from the hospital and wheeled her into the emergency room on his own. Nurses were seemingly scared to care for Karwah- her symptoms of abdominal pain were too reminiscent of Ebola. Her husband was convinced that her care was insufficient because she was stigmatized from being an Ebola Survivor. Salome Karwah survived Ebola… but she did not survive the complications from her C-Section. 

Salome Karwah became one of the 800 women who die from complications of pregnancy and child birth globally each day. As a person who studies and advocates for maternal and child health, I am all too aware of the deficits in health care within the United States and in the Global South. But even worse, the high mortality of health care-workers during the Ebola epidemic is expected to have lasting impact on health care delivery in these regions. The loss of skilled health care workers directly impacts the care provided to communities even after the epidemic ended. Maternal mortality is expected to increase by the thousands in this region, reversing decades of improvement toward World Health Organization millennium development goals. 

But without confronting and understanding the historical, sociopolitical, cultural, biological, and medical context of all of this, without embracing the anthropology of it all, I posit that we can not effectively address, heal, solve, and prevent these and other challenges of the human condition. Let any despair and sadness you feel from this story motivate doing the most good that you can.

 Cape of Good Hope (K. Hinde)

Addditionally, in the preceding narrative I wove together the themes of that will be key topics of this course:

-How our shared biological heritage with other animals is why we are vulnerable to zoonotic diseases.

-How mutations being favored by natural selection underlie some aspects of evolution.

-How our hunting and other cooperative behaviors have ancient roots.

-How the human capacities for social behavior and culture underlie both generous care and grievous violence.

During this term, we will introduce you to many of these features of the human condition to prepare you for more advanced classes about stigma, human behavior, maternal and child health, hominin fossils, population genetics, human migration, ancient epidemics and so much more. This is just the start of the story.

WELCOME to Bones, Stones, and Human Evolution

Related Essays & Media Reports

Stone, A.C. (2016). Ebola Evolving. EvMedBlog

BBC News. (2017). Ebola nurse Salome Karwah died after hospital neglect, husband says.

Freyer, F.J. (2015). Ebola response shows flaws in US system. Boston Globe.

Maxmen, A. (2015). How the fight against Ebola tested a culture’s traditions. National Geographic, 30.

Seay, L., & Dionne, K. Y. (2014). The long and ugly tradition of treating Africa as a dirty, diseased place. The Washington Post, 25.

St. Fleur, N. 2014. Sierra Leone Doctor Who Led The Fight Against Ebola Dies. NPR Goats and Soda.

Von Drehle, D., Baker, A. (2014). The Ebola fighters. Time Magazine.

Washington, H. (2007). Why Africa fears western medicine. New York Times, 31.

Background Scholarly Readings

Ebola: Epidemiology, Virology, & Immunology

Bah, Elhadj Ibrahima, et al. "Clinical presentation of patients with Ebola virus disease in Conakry, Guinea." New England Journal of Medicine 372.1 (2015): 40-47.

Baize, Sylvain, et al. "Emergence of Zaire Ebola virus disease in Guinea." New England Journal of Medicine 371.15 (2014): 1418-1425.

Carroll MW, Matthews DA, Hiscox JA, Elmore MJ, Pollakis G, Rambaut A, et al. Temporal and spatial analysis of the 2014–2015 Ebola virus outbreak in West Africa. Nature. 2015;524(7563):97–101.

Evans, D. K., Goldstein, M., & Popova, A. (2015). Health-care worker mortality and the legacy of the Ebola epidemic. The Lancet Global Health, 3(8), e439-e440.

Gire SK, Goba A, Andersen KG, Sealfon RS, Park DJ, Kanneh L, et al. Genomic surveillance elucidates Ebola virus origin and transmission during the 2014 outbreak. Science. 2014;345(6202):1369–72.

Olabode, A. S., X. Jiang, D. L. Robertson, and S. C. Lovell. 2015. "Ebolavirus is evolving but not changing: No evidence for functional change in EBOV from 1976 to the 2014 outbreak."  Virology 482:202-7. doi: 10.1016/j.virol.2015.03.029.

Park DJ, Dudas G, Wohl S, Goba A, Whitmer SL, Andersen KG, et al. Ebola virus epidemiology, transmission, and evolution during seven months in Sierra Leone. Cell. 2015;161(7):1516–26.

Simon-Loriere E, Faye O, Faye O, Koivogui L, Magassouba N, Keita S. Distinct lineages of Ebola virus in Guinea during the 2014 West African epidemic. Nature. 2015;524(7563):102–4.

Tong YG, Shi WF, Di Liu, Qian J, Liang L, Bo XC, et al. Genetic diversity and evolutionary dynamics of Ebola virus in Sierra Leone. Nature 524 (7563):93-6.; doi:10.​1038/​nature14490.

Varkey, J. B., Shantha, J. G., Crozier, I., Kraft, C. S., Lyon, G. M., Mehta, A. K., ... & Ströher, U. (2015). Persistence of Ebola virus in ocular fluid during convalescence. New England Journal of Medicine, 372(25), 2423-2427.

Ebola Epidemic, Cultural Context, Colonialism & Stigma

Anoko, J. (2014). Communication with rebellious communities during an outbreak of Ebola virus disease in Guinea: an anthropological approach. Ebola Response Anthropology Platform. Accessed from http://www. ebola-anthropology. net/wp-content/uploads/2014/12/Communicationduring-anoutbreak-of-Ebola-Virus-Disease-with-rebellious-communities-in-Guinea. pdf on Jan, 25, 2017.

Davtyan, M., Brown, B., & Folayan, M. O. (2014). Addressing Ebola-related stigma: lessons learned from HIV/AIDS. Global health action, 7(1), 26058.

De Roo, A., Ado, B., Rose, B., Guimard, Y., Fonck, K., & Colebunders, R. (1998). Survey among survivors of the 1995 Ebola epidemic in Kikwit, Democratic Republic of Congo: their feelings and experiences. Tropical Medicine & International Health, 3(11), 883-885.

Fairhead, J. (2016). Understanding Social Resistance to the Ebola Response in the Forest Region of the Republic of Guinea: An Anthropological Perspective. African Studies Review, 59(3), 7-31.
Farmer, P. E., Nizeye, B., Stulac, S., & Keshavjee, S. (2006). Structural violence and clinical medicine. PLoS medicine, 3(10), e449.

Goodwin, M. & Chemerinsky, E. 2016. No Immunity: Race, Class, and Civil Liberties in Times of Health Crisis. 129 Harvard Law Review. 956.

Hewlett, B. L., & Hewlett, B. S. (2005). Providing care and facing death: nursing during Ebola outbreaks in central Africa. Journal of Transcultural Nursing, 16(4), 289-297.

Hewlett, B. S., & Amola, R. P. (2003). Cultural contexts of Ebola in northern Uganda. Emerging infectious diseases, 9(10), 1242.

Jegede, A. S. (2007). What led to the Nigerian boycott of the polio vaccination campaign?. PLoS medicine, 4(3), e73.

Monson, S. (2017). Ebola as African: American media discourses of panic and otherization. Africa Today, 63(3), 2-27.

Nelson, R. H. (2003). Environmental Colonialism:" Saving" Africa from Africans. The Independent Review, 8(1), 65-86.

Team, W. E. R. (2016). After Ebola in West Africa—unpredictable risks, preventable epidemics. N Engl J Med, 2016(375), 587-596.

Tiffany, A., Vetter, P., Mattia, J., Dayer, J. A., Bartsch, M., Kasztura, M., ... & Ciglenecki, I. (2016). Ebola virus disease complications as experienced by survivors in Sierra Leone. Clinical Infectious Diseases, 62(11), 1360-1366.

Unigwe, Chika. 2017. Why I No Longer Use the Term Game for Bushmeat. Brittle Paper.

Youde, J. (2005). The development of a counter-epistemic community: AIDS, South Africa, and international regimes. International Relations, 19(4), 421-439.

Zoonotic Disease Transmission

Field, H., Young, P., Yob, J. M., Mills, J., Hall, L., & Mackenzie, J. (2001). The natural history of Hendra and Nipah viruses. Microbes and infection, 3(4), 307-314.

Max, D. T. (2006). The family that couldn't sleep: a medical mystery. Random House.

Mohd, H. A., Al-Tawfiq, J. A., & Memish, Z. A. (2016). Middle East respiratory syndrome coronavirus (MERS-CoV) origin and animal reservoir. Virology journal, 13(1), 87.

Quammen, D. (2012). Spillover: animal infections and the next human pandemic. WW Norton & Company.

Rist, C. L., Garchitorena, A., Ngonghala, C. N., Gillespie, T. R., & Bonds, M. H. (2015). The burden of livestock parasites on the poor. Trends in parasitology, 31(11), 527-530.

Saéz, A. M., Weiss, S., Nowak, K., Lapeyre, V., Zimmermann, F., Düx, A., ... & Sachse, A. (2014). Investigating the zoonotic origin of the West African Ebola epidemic. EMBO molecular medicine, e201404792.

Immune Function

Dantzer, R., & Kelley, K. W. (2007). Twenty years of research on cytokine-induced sickness behavior. Brain, behavior, and immunity, 21(2), 153-160.

Hoebe, K., Janssen, E., & Beutler, B. (2004). The interface between innate and adaptive immunity. Nature immunology, 5(10), 971-974.

Larsson, M. M., Rydell, G. E., Grahn, A., Rodríguez-Díaz, J., Åkerlind, B., Hutson, A. M., ... & Svensson, L. (2006). Antibody prevalence and titer to norovirus (genogroup II) correlate with secretor (FUT2) but not with ABO phenotype or Lewis (FUT3) genotype. The Journal of infectious diseases, 1422-1427.

Maternal & Child Health

Bhutta, Z. A., & Black, R. E. (2013). Global maternal, newborn, and child health—so near and yet so far. New England Journal of Medicine, 369(23), 2226-2235.

Hayden, E. C. (2016). Spectre of Ebola haunts Zika response. Nature, 531(7592), 19-19.

Mor, G., & Cardenas, I. (2010). The immune system in pregnancy: a unique complexity. American journal of reproductive immunology, 63(6), 425-433.

Menéndez C, Lucas A, Munguambe K, Langer A. Ebola crisis: the unequal impact on women and children's health. Lancet Glob Health. 2015 Mar;3(3):e130. doi: 10.1016/S2214-109X(15)70009-4.

Hunting, Health, & Human Evolution

Ahl, A. S., Nganwa, D., & Wilson, S. (2002). Public health considerations in human consumption of wild game. Annals of the New York Academy of Sciences, 969(1), 48-50.

Aiello, L. C., & Key, C. (2002). Energetic consequences of being a Homo erectus female. American journal of human biology, 14(5), 551-565.

Bramble, D. M., & Lieberman, D. E. (2004). Endurance running and the evolution of Homo. Nature, 432(7015), 345-352.

Hoppe, E., Pauly, M., Gillespie, T. R., Akoua-Koffi, C., Hohmann, G., Fruth, B., ... & Todd, A. (2015). Multiple cross-species transmission events of human adenoviruses (HAdV) during hominine evolution. Molecular biology and evolution, 32(8), 2072-2084.

Marean, C. W. (2016). The transition to foraging for dense and predictable resources and its impact on the evolution of modern humans. Phil. Trans. R. Soc. B, 371(1698), 20150239.

Roach, N. T., Venkadesan, M., Rainbow, M. J., & Lieberman, D. E. (2013). Elastic energy storage in the shoulder and the evolution of high-speed throwing in Homo. Nature, 498(7455), 483-486.

Wolfe, N. D., Daszak, P., Kilpatrick, A. M., & Burke, D. S. (2005). Bushmeat hunting, deforestation, and prediction of zoonotic disease. Emerging infectious diseases, 11(12), 1822.

Wrangham, R., & Carmody, R. (2010). Human adaptation to the control of fire. Evolutionary Anthropology: Issues, News, and Reviews, 19(5), 187-199.

Human Evolution: Social Learning & Cumulative Culture

Henrich, J. (2015). The secret of our success: how culture is driving human evolution, domesticating our species, and making us smarter. Princeton University Press.

Hoppitt, W., & Laland, K. N. (2013). Social learning: an introduction to mechanisms, methods, and models. Princeton University Press.

Mathew, S., & Perreault, C. (2015, July). Behavioural variation in 172 small-scale societies indicates that social learning is the main mode of human adaptation. In Proc. R. Soc. B (Vol. 282, No. 1810, p. 20150061). The Royal Society.

Caretaking in Neanderthals

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