I should begin by saying I am not a doctor, and nothing that I say here should be construed as medical advice. What I aim to highlight here is the political dimensions of the pedestrian response to the Ebola outbreak in West Africa, which I believe is wrongly premised on panic.
Yes, when it comes to Ebola, if there’s a line between unchained panic and dangerous nonchalance we are yet to find it. Ebola is an extremely dangerous and highly contagious disease. It is definitely spreading at a rate unseen in the past. According to Centers for Disease Control and Prevention, this is the 24th outbreak of the disease that has affected humans in the last 38 years, but it has already killed more people than in any other instance. Given that many of the other countries affected in the past – the Democratic Republic of Congo, Uganda, South Sudan and Sudan – are also developing countries, it is likely that specific political, infrastructural and social issues are in play in the countries affected that are making a terrible situation much worse.
The risks of panic
It’s hard to imagine any sentiment as unproductive as the unfettered panic that commentators like Laurie Garrett for Foreign Policy are urging. To analogise, it seems to me that with Ebola we are at the same stage we were in with HIV in the 1980s and 1990s – when we all wrongly believed that HIV/AIDS was a “homosexual disease” or witchcraft. That panic led to horrific social consequences for gay communities and afflicted heterosexual individuals, but also placed millions of heterosexual people at risk. It created a stigma that made it difficult to deliver even basic preventative measures. Public misinformation ran high. Reactionary behaviour led to the diversion of resources from where they’re needed the most.
What this outbreak needs right now is clear-headed, focused and well-resourced attention. Panic doesn’t help. Panic drives out reason. The consequence of panic will only be further “otherisation” of the communities and countries being devastated by this disease. Already in Nigeria there is significant backlash against Liberians – even those who were already in Nigeria – as somehow being part of a conspiracy to bring the disease to Lagos. Panic leads to the risky decision to move a highly contagious person and introduce them to an uncontaminated environment. Panic leads to unnecessary travel restrictions that prevent health workers from getting to the places they are needed.
Panic distorts perspective. Ebola is not a death sentence. It seems close to one, particularly because it is so infectious and of the particularly horrific way in which those who are afflicted die. Nonetheless, as of August 16, 219 infected persons in Sierra Leone have been treated and discharged. Although there is no approved medical treatment for the disease, with proper intervention people have recovered from the disease.
This means that even without the “silver bullet” medications, it is still possible for people who have the disease to walk away from it. How do they do that? Early detection. Early intervention. Quarantine. These are resource intensive interventions and that the three countries worst affected by this disease are in dire need of support to deliver. All three primary sites – Liberia, Sierra Leone and Guinea are recovering from long standing conflicts that devastated their healthcare systems. But the interventions exist, and now what is needed is focus on how these interventions can be efficiently implemented in all four major sites.
Panic also drives out empathy. A specific moment note on Nigeria. Nigeria is a large country with enough political and social problems to warrant book-length opinion pieces. But Patrick Sawyer’s wife – he was the Liberian patient who carried the disease to Nigeria – wrote on Facebook that he apparently left for Nigeria because he believed that he could receive superior medical treatment there.
Indeed, Patrick Sawyer was a senior NGO official being treated at a prestigious, private hospital in Lagos, likely far better resourced than any of the institutions that have been afflicted in the other three countries. This is not to say that Nigeria does not have a legitimate crisis on its hands; only that politics and social factors aside, it is in a marginally better position to deal with the disease than Liberia, Guinea or Sierra Leone.
Yes politics and social factors are an integral part of any public health situation. Still, panic does nothing to address those factors. The largest risk factor in the spread of Ebola right now is ignorance. Behaviour and personal choices, eg the decision to get on a plane when one is almost certain they are infected; to escape a hospital when one is placed under quarantine. These are not the decisions of stupid people. They are the decisions of frightened people who don’t understand how the disease works and don’t understand how their choices endanger other people.
Furthermore, recall that mysticism was an integral part of the conflict in both Liberia and Sierra Leone’s long running wars – factors that arguably are feeding into the mistrust of medical workers, and thus contributing to the alarmingly high death rate in both countries. During the war, drug-addicted child soldiers were often made to believe in their own inviolability after receiving mystical powers from traditional healers and witchdoctors. T
The generation that grew up in war isn’t afraid of what can and what cannot be seen. Paranoia and fear of outsiders is a predictable consequence of this history. Panic doesn’t assuage these fears. Knowledge does.
Similarly, doctors who worked on the Ebola outbreak in Uganda in 2001 reported that one of the major causes of the spread of the disease was cultural norms regarding treatment of the dead. These norms required female relatives to wash dead bodies before burial. Unfortunately, bodies of people who die of Ebola are the most contagious for the disease, and this meant that women disproportionately died from that particular outbreak of Ebola.
All these fears and ignorance can be addressed through education and information, and that can contribute towards containing the disease. People can unlearn these cultural norms, but they can’t unlearn the stigma that other people direct at them when they panic.
Ebola is real, frightening and devastating. Particularly because of that, we need more sobriety in talking about it. Instead of urging panic, we should be urging people to donate generously to organisations that are helping families and communities who are being destroyed by this disease. We should hold politicians who did not take the outbreak seriously enough to account for their lethargy, not because we’re afraid of how it will affect us, but because those who are dying are people who can be helped significantly by marginal inconvenience on the part of the unafflicted.
We don’t need panic. We need a human response that recognises that each life is valuable and that a concerted effort should be made to protect it.
Nanjala Nyabola is a freelance writer and political analyst.
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