Liberia’s poverty, skepticism of experts makes treating Ebola harder
The media is focused on the horrors of Ebola, a disease with no known cure that is jumping across borders in West Africa, leaving more than 900 dead in its wake. Fears of the disease’s spread even traveled to the United States, where two Ebola patients are being treated at Emory University hospital in Atlanta, Georgia.
The virus first appeared in West Africa in March, but suddenly gained momentum in the past few weeks, making it the worst outbreak ever. The vast majority of cases and deaths have been in Sierra Leone, Guinea and Liberia, but Nigeria now confirms the presence of the disease.
The virus is spread through bodily fluids and has a relatively long incubation period of up to 21 days. At this point, roughly 40 percent to 90 percent who become infected eventually die.
Though the majority of victims are poor, the wealthier people who have contracted Ebola — those able to travel by plane or car during the long incubation period — may be the mechanism of Ebola’s march through so many West African countries.
Widespread poverty, inequality and unequal development have challenged efforts to stem the disease in these countries. Healthcare workers tell of resistance from the people most in danger of contacting Ebola. Some villagers are reportedly running away from medical teams.
This is perhaps understandable. Doctors and nurses are among the recently infected and dead, including the leading Ebola authority in Sierra Leone. So people, mindful that there is no cure, may be unwilling to risk exposure from healthcare workers.
In addition, Ebola has taken hold in countries where citizens have little confidence that the medical authorities have the infrastructure and resources to make things better.
Consider Liberia, with a population of roughly 4 million people. The country experienced a terrible civil war from the 1980s to 2003. Its public infrastructure was severely limited before the war and government services have only recently become available.
During the civil war, refugees from the country’s rural regions flooded the capital, Monrovia. Roughly 750,000 people now live in the capital, many in unsanitary conditions. Overall, 71 percent of the people have no access to modern sewer systems. Not surprisingly, Monrovia is one of the main centers of the Ebola outbreak.
What’s worse, there is no medical infrastructure to support the kinds of isolation and public health work required to manage an Ebola outbreak. In 2010, Liberia had 0.8 hospital beds per 1,000 people, and in 2008, it had 0.01 physicians for every 1,000 people. By comparison, the United States, in 2009, had three hospital beds for every 1,000 people, and 2.42 physicians for every 1,000 people.
Under these conditions, Liberians have good reason right to feel skeptical about their doctors’ ability to manage the contagion.
Liberia’s long history of inequality also undermines the public trust in the authorities. Americans colonized the country in the 19th century. Their descendants, known as Americo-Liberians, dominated politics and the economy into the late 1970s. To some extent, they still do.
Historically, ordinary Liberians have watched the benefits of education, the profits from the nation’s vast natural resources and opportunities to work in government flow to the elite. Resentment caused by such unequal access to power and wealth, as Liberia’s Truth and Reconciliation Commission documented, was a major fuel on the country’s civil war.
Since President Ellen Johnson Sirleaf took office in 2006, she has wrestled with how to deal with the legacies of the war and inequality. Popular in her first term, she was unable to make much progress in building a public infrastructure to deal with a crisis like Ebola — despite heroic efforts by local organizations, her government and international non-governmental organizations. Sirleaf’s second term has been plagued by charges of corruption and nepotism, which has revived the historic distrust between the people and the ruling elite.
Foreign experts have been caught up in this distrust as well. Since the end of the civil war, Liberia has seen an influx of many international experts. Their efforts have produced results — new roads, new schools and improved governmental services. But progress has come at a cost. Some Liberians feel powerless — that they are being told what to do rather than controlling their country’s future.
This sense of feeling sidelined, with deep poverty and lack of educational opportunities continuing, contributes to Liberians’ wariness of people who present themselves as experts
This does not bode well for efforts to contain Ebola. Stopping the spread of the disease vitally depends on people complying with public health policies that stress isolation of the sick and abandonment of conventional methods of burial in favour of cremation. These demands collide with Liberian society’s most basic values. To ask Liberians to comply, authorities much have the highest degree of trust. Yet this is what is lacking.
We need to think about how political and social conditions shape communities’ responses to disease and intervention. Such analyses might help people outside of West Africa be more empathetic to countries confronting this outbreak and lead to better partnerships to help combat Ebola.
PHOTO (TOP): Medical staff working with Medecins sans Frontieres (MSF) prepare to bring food to patients kept in an isolation area at the MSF Ebola treatment center in Kailahun, Sierra Leone. July 20, 2014. REUTERS/Tommy Trenchard
PHOTO (INSERT 1): Liberian President Ellen Johnson Sirleaf during an onstage newsmakers interview with Reuters journalist Axel Threlfall in Washington, May 17, 2013. REUTERS/Jonathan Ernst
PHOTO (INSERT 2): Health workers carry the body of an Ebola virus victim in Kenema, Sierra Leone, June 25, 2014. REUTERS/Umaru Fofana