Lessons of Ebola: Unequal in life, unequal in death

October 20, 2014

Health worker is reflected in a mirror as he prepares protective equipment near Rokupa Hospital

The most important and tragic speech of these times was given earlier this week, though the author was too busy to voice it herself. Dr. Margaret Chan, who leads the World Health Organization, sent her chief of staff to a WHO regional conference in Manila to spotlight something we rarely keep in our conscious mind and don’t, collectively, do much about: Inequalities can be a matter of ever-longer life, or a most miserable death.

Chan’s speech was given by proxy because she, her aide explained, had stayed in the organization’s Geneva base to refine WHO’s response to what is “unquestionably the most severe, acute public health emergency in modern times.” That’s certainly at the top of most minds, if for no other reason than Ebola is creeping into the richer parts of the globe. But Chan wasn’t about to reassure us that her organization can keep the incidence of the disease tiny. As the world’s most senior medical figure, she had decided to use the horror to make a moral point — one that had, she said, fallen on deaf ears till now.

Samples from her speech: “I have never seen a health event spread such fear and terror, well beyond the affected countries. … I have never seen a health event threaten the very survival of societies … I have never seen an infectious disease contribute so strongly to potential state failure. … [T]he outbreak spotlights the dangers of the world’s growing social and economic inequalities. The rich get the best care. The poor are left to die. … Ebola has been, historically, geographically confined to poor African nations. The R&D incentive is virtually nonexistent. A profit-driven industry does not invest in products for markets that cannot pay.”

Just what Chan’s remarks mean was revealed in an article datelined Makeni, Sierra Leone, by Adam Nossiter of the New York Times. It was a piece of reportage and photojournalism that — as Leon Wieseltier saluted it in the New Republic — took a courage “beyond belief” to get. A photograph by Michel du Cille showed men and women lying dead or dying on mattresses spread on a floor, surrounded by pools of urine and feces. Nossiter noted that “a corpse lay in the corner — a young woman, legs akimbo, who had died overnight. A small child stood on a cot watching as the team took the body away, stepping round a little boy lying immobile next to black buckets of vomit.”

This is where fear and terror dwell. It is the way a plague takes a poor country, not with a sudden destructive wind but with an agonizingly steady buildup, cauterizing all dignity in death, putting an impossible burden on terrified medical staff of bringing out the dead, as they did in the streets of London and other plague cities in the 16th century. Those who remain to do this work are humbling. In a separate article, Nossiter wrote of burial workers, their promised $100-a-week wage unpaid, who have seen their frightened families desert them and shopkeepers refuse to serve them — yet they go on working.

Ebola hasn’t taken possession of any part of the rich world yet. But in the past few days, the haves have woken with a start to the realization that it could. Precautions are tumbling out into the public sphere. Making an appointment at the BBC’s studio in Brussels on Tuesday, I was asked — with an embarrassed little laugh, in the English manner — if I could assure my hosts that I had not been in West Africa recently. Travellers from the states most affected by Ebola — Guinea, Liberia and Sierra Leone — are checked at airports. We’re far from mass death in squalid wards — though it must figure in an increasing number of waking nightmares — but there are rational grounds for disquiet. The threat comes as the public health services of Europe — the much-prized systems at the heart of their welfare states — are strained by the growing demands of aging populations even as they undergo budget cuts.

Spain, among the most stricken of European states by the financial crisis, is the site of most concern. This is because a brave auxiliary nurse, Teresa Romero Ramos, who had volunteered to help care for two Spanish priests who had returned from West Africa infected with Ebola (both died), became sick herself — the first known incidence of the disease having been transmitted outside of Africa. Both priests, and now Ramos, were treated in a reassembled infectious-diseases isolation unit in the Carlos III Hospital in Madrid – reassembled because budget cuts had forced the closure of the hospital’s infectious-diseases facility, presumably as the one least likely to be missed.

Ramos didn’t notice strong signs of her illness until a week after treating the second priest. She went to a general practitioner, who diagnosed a fever and gave her acetaminophen. By the time she was diagnosed with Ebola, she had had contact with 83 people, all now being monitored; 14, including her husband, are in isolation in Carlos III’s makeshift facility. Ramos herself is showing some signs of recovery.

The coincidence of a deadly disease, the closure of a specialist unit and the unfamiliarity of most doctors with Ebola is one that could happen anywhere in the advanced countries. The number of Ramos’ contacts, and the further multiplication of their contacts, gives a glimpse into what could happen if prevention fails. Ebola is multiplying exponentially in West Africa. There are now 1,000 new cases a week. The WHO believes it could be 10,000 per week by early December, less than two months from now. Some 4,500 people have died to date.

Two nurses in the United States have contracted Ebola after coming into contact with Thomas Eric Duncan, who was treated at their Dallas, Texas, hospital. Duncan later died of the disease. One of the nurses, Amber Vinson, took flights after she was infected, and is estimated to have had contact with up to 800 other people. Another healthcare worker, who is not ill, is now quarantined aboard a cruise ship.

The core of Chan’s proxy speech will not disappear. “The rich get the best care. The poor are left to die.” Ebola has brought the desperation of the poor closer to us.

Globalization has made our lives richer in many ways; now it presents us with the horrors of the poor, and prods us, for our own safety as much as for our conscience, to respond with all our expertise and courage.


PHOTO: A health worker is reflected in a mirror as he prepares protective equipment near Rokupa Hospital, Freetown October 6, 2014. REUTERS/Christopher Black/WHO/Handout via Reuters


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If we should feel compelled to provide medical assistance to these poverty-stricken people, then we must also feel compelled to improve their living situation. If we don’t, then we are just making sure that the number of people in that awful situation is not reduced by disease and we are ensuring that they can continue to live long enough to further increase their numbers.

Alleviating those miserable conditions requires either a tremendous transfer of the wealth accumulated by those of us who do not live our lives in squalor or a concerted effort to help the world’s poorest people to reduce their population to a level that is economically sustainable in their locale… perhaps a combination of those two concepts.

It is unconscionable to provide medical and economic assistance in the absence of a concerted effort of assisting them with population control.

Posted by breezinthru | Report as abusive

I think the issue is that the governments of these poverty-stricken nations are corrupt. The United States has sent billions of dollars in aid to these countries over the years, and yet the people are still living hand-to-mouth.

While in some instances, that’s a tribal lifestyle, in others, it’s not. Where are the governments of these nations? Why aren’t they using the aid monies received to build infrastructure? Ebola is not uncommon in these nations. It has happened before. Why do they not have better infectious disease centers? The answer is: corruption.

It’s easy to blame the “haves” of the Western world- but you also need to take a good look at the “haves” of the so-called Third World as well. There is a LOT of aid going to Africa in the form of volunteers & money. We’ve been supporting the people of Africa since the creation of Liberia in the 19th century. So why isn’t that aid actually *aiding* people? It’s because of corruption.

The corrupt governments of these countries (including on the local level) do not allow for the creation of a strong infrasture. But I bet you that the rulers all have Swiss bank accounts or something in the Cayman Islands.

What good is aid, or lambasting Western societies for not doing enough, when what we do is flushed away and never actually gets into the hands of those who need it?

There’s a generational issue in Africa- a real lack of education & lack of desire for education (generally speaking). There’s still a very strong tradition of tribalism & medical magic which doesn’t help when you’re trying to explain germ theory.

There needs to be a real culture shift within the countries of Africa- a real desire to take on their own futures and turn them into something better than subsistence living.

Posted by jm22 | Report as abusive

Since early stage Ebola has no unique symptoms, laws should be directed to eliminating body contact between non family members if and when Ebola becomes significant here. Without markers isolating people will very haphazard. Also since various kinds of fruit bats have been identified as carriers, agricultural products from the affected areas should be kept out.

Posted by SamuelReich | Report as abusive

The unlearned lesson has to do with what is real.

Posted by LaPortaMA | Report as abusive

[…]   […]

Posted by Lessons of Ebola: Unequal in life, unequal in d… | Report as abusive

You know we have these elite WAll Street people who have access to stuff we don’t even know exists, they get rich before 30 and we have to work for our money- that’s not fair either but what choice do we have?

Posted by Factoidz | Report as abusive

I notice many commenters here seem very generousness with other people’s tax money. I am all for charities who want to help, but please, not with my taxed dime. I will help via contributions to a charity if I wish to get involved.

Posted by evilhippo | Report as abusive

The Teabaggers/GOP/CEO’s will never give up a penny. They would say “why bother” the’re dead anyway. Bill Gates wants to help. Will he give up his 81 billion? NOT!

Posted by Doc62 | Report as abusive

We only have to go back to 1918-19, when the Spanish Flu (not from Spain; it’s considered to have originated in either Kansas or China) killed 50 to 100 million people, over half a million in the U.S., this while WW1 was decimating a generation. The flu struck mainly young, healthy people, often killing them within hours of first symptoms; their lungs would fill with fluids, they would turn blue and drown on land. Cities and towns ran out of coffins and morticians; bodies were laid to rest in mass graves. The dead lay in the streets. 28% of the US caught it, and 2.5% of them died. People did things to avoid it such as carrying potatoes in their pockets and wore useless face masks. Though medicine was advancing, viruses were not yet understood. The flu went around the world, killing 20 million in India alone. Let’s not forget it, or act as if this scenario is in the distant past; there are still people alive who remember it.

Posted by tt2 | Report as abusive