Via The Lancet, Mark Honigsbaum writes about 19th-century cholera and yellow fever outbreaks, and how little has changed since then: Ebola: epidemic echoes and the chronicle of a tragedy foretold. Excerpt:
For all that cholera and yellow fever tested values of tolerance and decency, however, there were also remarkable displays of compassion and heroism. Moved by the plight of Memphis, people from the northern states wired money to the city while train companies sent supplies of food.
And just as present-day medics have been willing to risk their lives in west Africa, so in 1878 Dr Mitchell Howard's Medical Corps sent 111 doctors and nurses to the aid of Memphians—all but one contracted yellow fever and 33 died.
The most telling responses came from those who were too poor to flee the epidemic or who had no choice but to stay. Despite the southern states' history of slavery and the recent experience of the Civil War, historian Jeanette Keith recounts how African-American grave diggers worked into the night to bury prominent white victims, despite being told by their white bosses that they would not be paid overtime. Sex workers also died rather than abandon care of the sick.
“The epidemic turned all common categories of trust and honour upside down”, Keith writes, “and reduced good and evil to the most basic question: do you leave your people to die, or do you help?”
And so it is today. To date, many health workers have died fighting Ebola in west Africa. Meanwhile, in Nigeria an Ebola outbreak was only narrowly averted by the bravery of a Lagos-based doctor, Stella Ameyo Adadevoh, and her colleagues when they refused to accede to the demands of a Liberian national infected with the virus to be discharged from her clinic. Adadevoh's stance cost her her life when in August she too contracted the virus and died.
With reports that Ebola infections in Sierra Leone are continuing to increase at an alarming rate, it will take many more acts of sacrifice, alongside epidemic control and treatment measures, before the outbreak is finally brought under control.
Meanwhile, in the USA, in scenes reminiscent of the 19th-century tensions over cholera, many states continue to insist on restrictions on returning health workers over and above the guidelines set down by the US Centers for Disease Control and Prevention. In other words, we are still in the crisis and recrimination phase. It remains to be seen whether there will be a fourth act and if it will be cathartic.