On Scientific American's Molecules to Medicine blog, Dr. Judy Stone writes: Ebola – the World’s Katrina. Click through for the full post and many links. Excerpt and then a comment:
To anyone who follows infectious disease outbreaks, it is no great surprise that the most immediate, looming threat, Ebola, has received scant attention until recently. Even now, the world’s response has been incomprehensibly and seemingly irresponsibly slow. Why is this the case? Likely because of disparities in the power and wealth of people affected by the epidemic.
The Washington Post has a good backgrounder, “The long and ugly tradition of treating Africa as a dirty, diseased place,” by professors Laura Seay and Kim Yi Dionne. They note the racism of the European colonizers, and how that led to “othering” of Africans, attributing inherent flaws to the people and their societies rather than to cultural differences, without any true basis or understanding. And they cite the “persistent association of immigrants and disease in American society.”
The impact of such “othering” was first really brought home to me in a provocative lecture by Eileen Stillwaggon in 2006, at a Global Network for Neglected Tropical Diseases conference. She spoke of the perception that AIDS was more prevalent in Africa because of different sexual mores—hypersexuality and promiscuity. Then she ripped this apart with eye-opening evidence of the links between helminth (worm) infections, schistosomiasis, malaria, and AIDS, effectively demonstrating that the parasitic infections strongly increase the susceptibility to HIV, explaining the difference in HIV rates between Africa and industrialized countries.
SARS vs. Ebola
SARS, or severe acute respiratory syndrome, is a viral infection that caused a pandemic in 2003. Transmitted by droplets and respiratory secretions, SARS is more readily spread than Ebola, which requires close contact with blood or secretions, but it is less deadly. Yet there was an immediate, coordinated global response to SARS, with unparalleled cooperation between countries and organizations.
In contrast, the world’s response to Ebola has been incredibly slow. Médecins Sans Frontières (MSF, Doctors Without Borders), a well-respected medical humanitarian response agency, provides care where others haven’t dared to go. They also serve as the canary in the mine—an early warning system for disasters that haven’t yet reached the threshold to garner attention from much of the wealthier world. They have worked to control more localized outbreaks of Ebola for years, and were reporting from the field months ago (March, 2014) about the current outbreak being “unprecedented.”
With the agency now long overstretched and ignored, MSF International President Dr. Joanne Liu recently denounced the United Nations and the world’s lack of response. Dr. Liu noted that many countries have teams already trained to respond to biological threats, suggesting that these teams be rapidly deployed.
Certainly severe cuts in funding the World Health Organization (WHO) play a significant role in the tardy response. But so do apparent rivalries. Per the NYTimes, “One consultant thought it strange that the W.H.O. would not send Twitter messages with links to the C.D.C.’s Ebola prevention information, part of a policy not to promote material from other agencies. Various offices within the W.H.O.’s balkanized hierarchy also jockeyed for position.” And WHO was certainly warned by MSF, which it ignored.
I can’t agree enough with Laurie Garrett, when she begins her latest, must-read article explaining this debacle with “Public health officials knew Ebola was coming. They know how to defeat it. But they’re blowing it anyway…World, you still just don’t get it.”
And she aptly notes that MSF’s surprising and desperate call for military help is complicated by wariness of US intervention by Islamists and by the legacy of mistrust since the CIA’s vaccination ruse, which I wrote about last month.
"Othering" is a very good term. It explains not only our feckless response to Ebola but a similar response to Haiti after the earthquake and especially the later cholera outbreak.
I can understand the psychology behind it. If we evolved in groups of no more than 120 or 130 people, it was because hunting-gathering societies couldn't sustain larger numbers. So anyone outside the group was not just an outsider but probably a threat to survival. Hence most tribes called themselves "The People" as opposed to outside nonhumans.
A whole spectrum of words define virtue in tribal terms: You treat your relatives (kin) with kindness. "Gentle" is the behaviour that the gens, those born together, expect from its members. The ancient Romans defined their class-ridden society as distinguished between the upper-class honestiores and the lower-class humiliores—"dirt people." To be poor but honest is to be an upper-class person with inadequate funding; to be humiliated is to be besmirched and polluted.
Long ago, the American actor Ossie Davis argued that The English Language is My Enemy, because it has so many negative terms for "black." Racism is ingrained in our language. It is no coincidence that "fair" means both "just" and "blond." The complimentary expression "That's white of you" didn't begin to fade out of American English until about the time I was born in 1941, and as a young man I still heard "free, white, and 21" as a definition of personal freedom.
For those of us in the West who happen to be free, white and 21 in the 21st century, the black people in places like Haiti and West Africa are indeed the others. To regard them as equals would be to question the half-millennium of slavery and exploitation that made us what we are today. We don't want to go there.
Not long after Katrina, my wife visited relatives in the US South and the subject of rebuilding New Orleans came up. "Why rebuild a toilet?" asked the 20-something husband of her bright and educated niece. Hey, it was a city full of black people.
Cultures are bloody hard to change, whether they demand we wash our mother's corpse or that we despise the sorrows of people unlike us. Rome fell, but its culture of honestiores and humiliores is triumphantly immortal. The self-styled advanced countries who want to save West Africa from itself are as locked in their cultures as rural Liberians are locked in theirs.
I hope our own culture has the guts to self-amputate whatever bigotries limit the effectiveness of our response to a disaster that will assuredly hit us as well as the "others."