Ebola’s hard lesson: Africa’s vulnerabilities are our own
This piece was originally published on Oct. 26 on www.BizBeatBlog, the business blog of The Dallas Morning News. Michael Lindenberger is a Washington correspondent for business at the newspaper. He was in Sierra Leone last year as part of a multidisciplinary team of doctoral and master’s students from Stanford University.
WASHINGTON–A year ago last March, I stood in the remote village of Baomahun in Sierra Leone listening to the desperation in the voice of villages talk about their plight. I listened, and as I did I nervously eyed the water coming from the single well-pump a few dozen yards away.
Town chief Joseph Karimola spoke with desperation about the mining company whose brightly lit compound could be seen on the hill in the mid-distance. The company had secured a license in Freetown, the capital, and come to dig for diamonds and gold. The farmers whose family had owned the land for many centuries were being pushed off, in exchange for a small payment and yearly rents of often-rotten rice.
“We are suffering and yet they occupy our land,” he said. “We used to farm on that land. The company should provide micro-credits to our women, scholarships for our children. They are up there enjoying themselves. They sleep with electricity, and we sleep here in darkness. How is that when the land belongs to us they enjoy themselves and we do not enjoy anything?”
“If this continues,” he said through a translator, “we think our life spans will be short.”
I was eyeing the water a little nervously because upon arrival, because just weeks before, 15 people had died when the latest outbreak of cholera had swept through the village of a few hundred people. Now, everywhere the adults had come in from the fields, some dressed in finery, to meet with the small group of us who had come from Stanford to examine the distribution of natural resources in Sierra Leone. For many of them there, this was the first time someone had asked them about their lives.
In the village, children followed us around, half-naked and smiling. Some spoke to me about their hopes, and fears of a future in a country that was still struggling to escape the legacy of the brutal civil war that had ended 12 years before.
You can’t travel to Freetown, the capital, or any of the villages in Sierra Leone and not sense their terrible vulnerability. Everything in the spring of 2013 seemed fragile. Twelve years past one of the most brutal civil wars on record, bands of amputees still wandered — or scooted — the capital asking for donations. The political order had only just begun to feel like it might last. Chinese funds were building highways and even suburban housing settlements up the way from the city along the coast. Uniformed school children would walk in long lines, for what looked like miles, filing their way to school early in the morning.
What none of us knew in March of last year was how quickly death would come for swaths of people just like these villagers. Ebola has killed 5,000 people in Sierra Leona, Guinea and Liberia — and had just now begun to infect people here in the United States. Health authorities say that the chances of it spreading widely in the U.S. are slim, but fear has understandably shaded the discussion from Dallas to New York to Washington.
What lingers, some 20 months later, is just how vulnerable these villages — to say nothing of the overcrowded capital — are to a disease like Ebola. How thin their defenses are, how undeveloped their responses.
Seeing those vulnerabilities wasn’t enough to teach me the one lesson that was probably the most important to learn, however. I saw those weaknesses as problems for Africa and Africans. I saw efforts to help largely through the lens of philanthropy. Ebola in Dallas, and now in New York, is teaching me that I was a fool.
The weak public health system in Sierra Leone is a weakness that affects all of us, the world over. It is a risk to our health and to our economy. In short, its vulnerabilities are our vulnerabilities.
That’s an important lens through which to see the developments since Friday in the U.S. response to Ebola.
Late Friday, the governors of New York and New Jersey announced that anyone traveling back from western Africa who has had contact with an Ebola patient must be quarantined for 21 days. By Sunday, the governors of Florida and Illinois had made similar announcements. The rules will apply to all travelers, including healthcare workers.
That message was met by push back and outright criticism from some Obama Administration officials and public health groups.
Hours earlier, in a Washington breakfast with reporters, one of the world’s leading voices in public health, had sounded a very different alarm.
Dr. Jim Yong Kim couldn't have been more emphatic. The only way to keep American cities safe from Ebola is to stop the disease in Africa, he said. That means many, many more doctors and other healthcare workers are desperately needed to go to the three nations where the disease is still spreading and treat the people who are sick.
“We need literally thousands and thousands of trained health workers, who will need additional training around Ebola, to step up and volunteer,” he said.
Kim is the World Bank president, and insists that the threat to the global economy posed by the Ebola virus and, in the future, other deadly diseases is considerable. Under his direction, the Bank has already spent $400 million on immediate interventions in Liberia, Sierra Leone and Guinea, where nearly 5,000 have died of the disease.
He’s also a physician and former president of Dartmouth University. He personally treated patients, and helped organize an international response, when a treatment-resistant and highly contagious tuberculosis raged in slums in Lima, Peru. He was the world AIDS coordinator for the World Health Organization, a pandemic that has claimed 60,000,000 victims since 1960.
There he was on Friday saying U.S. hospitals should organize large-scale interventions, and encourage staff members to take leaves to go treat the patients.
Surely, that’s a tough call to arms to answer for doctors and nurses in relative safety in America. But he insists that’s what it means to be a doctor — to treat the sick.
What role the governors’ additional burdens — three weeks of forced isolation — will play as doctors and others weigh their willingness to heed the call by Kim and many others to travel to Africa is unknown. But clearly the Administration believes it’s an hindrance.
Wherever we stopped, villagers gathered en masse to tell us of their economic privation, such as here in this dusty classroom. Most pointed fingers at the deals struck between foreign companies and the Ministry of Mines in Freetown, the agency that held the most power in a nation still recovering from civil war and desperate for foreign capital.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said he’d have opposed it, using language almost identical to Dr. Kim’s.
“The best way to protect us is to stop the epidemic in Africa, and we need those health care workers so we do not want to put them in a position where it makes it very, very uncomfortable for them to even volunteer to go.” he said.
Gov. Chris Christie of New Jersey defended the quarantines over the weekend, and New York Gov Andrew Cuomo insisted on Sunday morning they are legally enforceable.
Also over the weekend, it was announced that the American ambassador to the U.N. will be the highest-ranking official from the U.S. to travel to the hard-hit countries since the outbreak. It doesn’t surprise me. My trip to Sierra Leone had been organized by Stanford University professor Jeremy Weinstein, formerly one of the bosses of the African portfolio on President Obama’s National Security Council. Dr. Ambassador Samantha Power had been his mentor, and he is now her chief of staff in New York.
History is full of devastating proof of the death that can by pandemic. Twenty million died from the influenza outbreak of 1918. National Geographic estimates that 100 million died in the plague of Justinian in the 6th Century.
But the horrific numbers aren’t all from the hoary past. Some 6,600 people have died in Haiti since 2011, all from the same disease that claimed the 15 lives in the village I stopped in last year. In West Africa 1,200 died of meningitis in 2009–10. And 12 years ago, nearly 800 died worldwide form the SARS pandemic.
On Friday, Kim said his staff has begun discussions with its member-nations to prepare for outbreaks in the future. There is talk of establishing financial instruments that will put at the ready billions of dollars in cash, in a fund that would only be drawn down in the event of a global emergency. But beyond that, the developed world must look at the health challenges of the undeveloped world through a new lens, he said.
“This is a wake-up call,” he added. Weaknesses in Africa are our own weaknesses. And the only way for us to get strong in our defenses against pandemic is to go to the place where we are weak.
Time will tell whether that’s a message whose potency is watered down by the governor’s messages over the weekend. But thinking back to those children with watery eyes and big smiles — not to mention the sad fate of Eric Thomas Duncan and the ordeal of Nina Pham — it’s impossible to feel the stakes are anything but very high.
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Originally published at bizbeatblog.dallasnews.com on October 26, 2014.
