Inequalities and the Ebola crisis

Nissim Mannathukkaren 

The response to Ebola, which has killed nearly 5,000 Africans but only two western citizens, cannot be colour coded anymore. For the future, we cannot but raise questions about the structural inequalities that prevent accessible health care for the global poor, and societies that eliminate these inequalities 

The principle upon which the fight against disease should be based is the creation of a robust body; but not the creation of a robust body by the artistic work of a doctor upon a weak organism; rather, the creation of a robust body with the work of the whole collectivity, upon the entire social collectivity. — Che Guevara 

The photograph in August this year, of a very weak, 10-year-old Saah Exco, suspected of having contracted Ebola, sitting naked on a bucket and fighting to stay alive while residents of a slum in Monrovia, Liberia, milled around him, terrified of helping him, might go on to win Pulitzer Prize-winning photographer John Moore another prize. But that’s irrelevant in what is unfolding as a devastating tragedy in Africa. Moore’s and others’ pictures can only show us a glimpse of that tragedy. They do not show that Exco’s mother and brother had died earlier, or that he himself would die later. 

The popular media in America and the rest of the western world, which, until recently, was busy dealing with the horrors of beheadings perpetrated by “medieval barbarians,” and other “horrors” in the form of nude photographs of celebrities being leaked online on a daily basis, was suddenly forced to confront another horror. One that was silently brewing for many months in those parts of the world which appear in the western consciousness only through Hollywood blockbusters. And this it was forced to do so only once the first Ebola death happened on American soil.

Global apathy 

Nevertheless, the response to the crisis has been on expected lines. The entire discourse surrounding Ebola in the West is about quarantining itself against “those” poor Africans entering “our” space, bringing deadly viruses with them. Look at the discussion surrounding Thomas Duncan, the Liberian man, the first person to be diagnosed with Ebola in America, in September. Social media was rife with opinion that he had deliberately come to America to infect others. The state authorities in America, before his death, were even considering filing criminal charges against him for intentionally exposing the public to the virus! Airports in North America have begun screening passengers travelling from affected areas and the governments are on high alert for any eventuality. 

“The response of developing nations such as India, China, and Brazil — all of which want Africa as a business partner — has not been any better than that of the West.”

Of course, it is only natural that people are concerned about their own safety and lives. But what is shocking is that the concern for one’s own self is also accompanied by a complete apathy towards the distant other. Otherwise, how can we explain the response to what the World Health Organization (WHO) calls the “unparalleled” health crisis in modern times? Canadian journalist Geoffrey York who has covered wars and disasters, from the Gulf War to tsunamis, reported from Liberia that “nothing is quite like Ebola,” a feeling reinforced by photographs: stricken mothers slumped on pavements with their infants on their laps, the dead lying on roads, people pleading with health workers to touch the bodies of their loved ones. 

Piecemeal solutions 

These gut-wrenching pictures resemble nothing short of a scene of a war-ravaged zone, except that the tragic difference here, unprecedentedly, is that one cannot even help the dying or grieve for the dead. Yet, the international community has only “failed miserably,” as the World Bank president would admit. The reported response of developing nations like India, China, and Brazil — all of which want Africa as a business partner — has not been any better than that of the West either (the shining exception has been that of the tiny nation of Cuba, contributing, as in all global health crises, far beyond its means). 

The overriding concern with protecting oneself, other than producing an apathetic response, has also led to the prescribing of piecemeal solutions which will only perpetuate such tragedies in the future while hiding serious questions about the root cause of the crisis — structural inequalities in global health. While solutions like a global health fund for emergencies prescribed by the World Bank president will save lives, they will not eliminate the root causes that produce periodic crises. 

Worlds apart 

Inequalities are at the heart of the Ebola crisis. Ebolas are produced in a world in which the United States spends $8,362 annually per person on health while Eritrea (Africa) spends $12. It is the same world in which the Organisation for Economic Co-operation and Development (OECD) countries which constitute a mere 18 per cent of the world’s population spend 84 per cent of the total money spent on health in the world. Thus, unsurprisingly, 95 per cent of tuberculosis deaths and 99 per cent of maternal mortality are in the developing world. 

And these inequalities are not only between the developed and the developing worlds, but also exist within the developed world as the health indicators of African Americans and indigenous people in North America show. In the city of London, it is estimated that while travelling on the tube eastwards from Westminster, each tube station signifies the loss of approximately one year of life expectancy. 

It is not an accident that Ebola’s epicentre is in Liberia, Guinea and Sierra Leone. They are some of the poorest countries in the world with a history of wars and conflicts, and of collapsing or dysfunctional health systems. Liberia has only 51 doctors to serve 4.2 million people and Sierra Leone, 136 for six million. 

Inequalities mark every step of the current outbreak. Questions are being asked about the initial tardy hospital treatment given to Duncan and whether his race and class had anything to do with it — here was an African man without medical insurance seeking emergency medical help in the most privatised and corporatised medical system in the West. That his nine-day treatment cost $5,00,000 (Rs.3 crore) should tell us something about the state of global health care. 

When American missionaries Kent Brantly and Nancy Writebol were infected with Ebola in Liberia, the American government had them airlifted — isolated in an “aeromedical biological containment system” — and had them successfully treated in the U.S. Contrast this with the 22-year-old Liberian woman and nurse-in-training, Fatu Kekula, who was forced to look after four of her Ebola-stricken family members at home using trash bags as protective gear after hospitals turned her away. 

While a patient brought from Africa to a state-of-the-art facility in Germany was treated in an isolation ward equipped with three different air locks (even when Ebola is not believed to be transmitted by air) and by doctors and nurses wearing hazmat suits with their own oxygen supplies, the efforts to quarantine the West Point slum in Monrovia failed completely, after it erupted in riots. 

Order and planning mark the western intervention, but chaos reigns in the centre of the outbreak. If an entire building near Paris was cordoned off and quarantined on the mere suspicion of a person having Ebola-like symptoms, in Liberia, the police had to fire at a mob which had closed down an isolation ward and even looted contaminated material as they believed Ebola to be a hoax. 

Focus on priorities 

Such conditions of absolute deprivation and desperation are fawned by socio-economic inequalities. Is it not astonishing that a deadly virus like Ebola does not have a cure despite the fact that it has been around for 40 years? The answer lies, as the WHO Director-General emphasises, in the fact that diseases that afflict only some poorer and darker nations of the world are not a priority for the global pharmaceutical industry. The latter’s market is a $300-billion behemoth of which a third is controlled by 10 drug companies only — six in the U.S. and four in Europe. 

Ebola also raises serious questions about the priorities of the global super powers. America has until now seen Ebola only as a potential weapon of bioterror. It has already spent $1.1 billion in the military campaign against IS (a monster produced by American imperialism), while the Ebola outbreak which requires at least $1 billion has got a third of it in actual paid donations from all the nations. Again, this is unsurprising, considering that the annual world military expenditure is $1.75 trillion while its health expenditure is only $6.5 trillion. 

Under globalisation, the empire also unwittingly strikes back. Thus the epicentre of the latest Ebola outbreak lies in the former French colonies, posing new threats to its former colonial master, France, by people travelling to it from them. Similarly, Duncan grew up next to a colony of leprosy patients, fled Liberia during the civil war, lived in refugee camps across Africa and finally brought Ebola to America. Such are the ironies of our deeply divided but interconnected world. 

In the immediate, the response to Ebola, which has killed 4,922 Africans but only two western citizens, cannot be colour coded anymore. For the future, we cannot but raise questions about the structural inequalities that prevent accessible health care for the global poor, and societies that eliminate these inequalities. Do questions such as why does it cost $1 billion to develop a drug in America, while Cuba achieves the same health indicators as America by spending 40 times less on health, and what makes all celebrities and others across the globe, who only a month ago were dumping ice buckets on their heads, raising $100 million for the ALS Ice Bucket Challenge, turn silent as Ebola continues to surge ahead have answers? 

(Nissim Mannathukkaren is with Dalhousie University, Canada. E-mail: nmannathukkaren@dal.ca)

http://www.thehindu.com/opinion/lead/lead-article-another-round-of-elections/article6535468.ece