global health

why we need to change the ebola paradigm

A doctor has just been diagnosed with Ebola in New York City. Last night, a man ranted for 30 minutes to everyone on the subway car about how we’re all going to die from Ebola, right then and there, but luckily I had my big headphones on so I’m not really sure what he said. Anyway, now what?

According to NPR, 75% of Americans believe that banning travel from and to West Africa is the appropriate next step. This policy, however, is misguided. A travel ban would likely exacerbate the effects of the Ebola outbreak on various levels. It may not only worsen the spread of Ebola, but also engender xenophobic, racist, and prejudiced attitudes toward African immigrants. Sharpening the physical and philosophical divisions between the U.S. and West Africa will only broaden the chasm between “us” and “them,” when in reality there is only “us.”

We need to fight prejudice, not perpetuate it

The mainstream media, especially at the outset of the outbreak, told this story in a way that characterized Africans as primitive, dirty, sick–ideas that stem from a deep legacy of colonialism and racism. Africa was historically viewed as the “Heart of Darkness,” a place of savagery and backwardness. For some, it still is. The expression of these ideas is now more subtle, but nevertheless present. The narrative that the West has created still paints the African, the black person, as Other. Someone to be feared, a life of lesser value. This idea is extremely problematic. Now that Ebola has arrived in the U.S., people’s blame on Africans may only increase. Yet placing the blame on Africans ignores the fact that the broken health systems in which this all began exist as remnants of colonialism.

The association between poor Africans and disease becomes apparent in the way that people speak. Many are saying, “keep Ebola out” when they mean “keep people with Ebola out,” as if they are the same thing. But if we think about the difference between those two statements, the question of human rights quickly comes into our field of vision.

“Twenty-two years ago, in a decision rooted in fear rather than fact, the United States instituted a travel ban on entry into the country for people living with HIV/AIDS. Now, we talk about reducing the stigma of this disease—yet we’ve treated a visitor living with it as a threat.” President Obama said this in 2010 when he lifted the travel ban on people with HIV. While his administration’s response to the Ebola outbreak has been less than ideal, his point demonstrates that a comparison to the AIDS crisis is absolutely relevant. Stigma was and still is a tremendous problem in response to the AIDS epidemic–now, we face a serious need to prevent stigma in regards to Ebola. Stigma and discrimination jeopardize human rights and put people’s lives at risk.

Exclusion is not a sound strategy

Those in favor of excluding people from West Africa claim that this would work to protect “national security.” As Vox has clearly outlined, there is no evidence that travel bans are effective public health measures. Laurie Garrett writes that “many nations have banned flights from other countries in recent years in hopes of blocking the entry of viruses, including SARS and H1N1 ‘swine flu.’ None of the bans were effective, and the viruses gained entry to populations regardless of what radical measures governments took to keep them out.”

Leaders like Paul Farmer of PIH, Thomas Frienden of the CDC, and other experts have explained that a ban would likely make the problem worse. If people are barred from the U.S., they will seek other ways to get here and their movement will be harder to track. Further, the work of NGOs and other aid groups, who are doing a lot on the ground, will be much more difficult. While some propose a selective travel ban in which only certain health professionals could get in and out, this would be complicated and counterproductive.

At the end of the day, the calls for a ban are entrenched in politics rather than sound public health policy. The majority of politicians, both Democrat and Republican, who are making the loudest calls for a travel ban are those on the campaign trail. Everyone wants to “keep Americans safe.” But if we are going to talk about “saving American lives,” perhaps we should discuss gun policies, the tobacco industry, or the structure of our food system. The language around public health always reflects political motives and social norms, and Ebola is no different.

There is a better way

Instead of focusing on how to keep the “problem” out, we should focus our efforts on the immediate containment of Ebola at its source. The U.S. and the international community must support the long-term improvement of the health systems in these affected countries. This requires things like strengthening government health facilities, building the capacity of local health workers, and improving access to care. These tasks are most effective when done through years of partnership with local people in country. This is nothing new.

While containing Ebola represents a major challenge, it is also an opportunity in which to act. This is the chance to collaborate for the sake of fundamental rights, social justice, and human dignity. Rather than revert to stereotypes grounded in racist phobias and a disregard for the Other, it’s time to lean toward a new attitude of pragmatic solidarity.

That seems intangible for those of us at home, but we can help mobilize resources by donating to worthy organizations like PIH, Wellbody Alliance, and Last Mile Health. We can be more conscious media consumers, call out dehumanization when we see it, and change the broader conversations that we are a part of.

Instead of choosing exclusion, we need to choose inclusion. We cannot afford to think of collective responsibility as a choice–if anything, the spread of Ebola illustrates that this is the world we live in. Global health is our health.

global health, Uganda 2012

advice for students working in poor places

“In order to contribute to Africa, I would have to know myself better and be clearer about my goals. I would have to be ready to take Africa on its own terms, not mine, and to learn my limits and present myself not as a do-gooder with a big heart, but as someone with something to give and gain by being there. Compassion wasn’t enough.” – Jaqueline Novogratz, The Blue Sweater

I’m traveling to Gulu, Uganda in a few weeks for a GlobeMed internship with GWED-G, a women’s rights and community health organization for one month. Too much is happening to even process what is going on, but I’m trying to carve out time to really think about why I’m doing this.

Many young do-gooders will be traveling abroad this summer. Here are a few thoughts on how to make the best of it. These are things I’m reminding myself of (aka tips on how to avoid the duffle bag complex):

1. Be a fierce listener

Taking bold action ≠ imposing solutions. Real leaders know how to listen, empathize, and then make things happen. Approach every situation with humility and flexibility — this is how you can prove your worth.

2. Let go of what you think you know

You don’t know anything. Just accept it. Okay, you know a tiny bit, but that class you took in global health does not make you a global health expert. Instead of assuming that you are a master, realize that you can master critical, thoughtful thinking.

3. Ask big and small questions

“What are the biggest barriers to accessing healthy food?” is just as important as “What is your favorite food to eat with your family?” Zoom in, zoom out. Understanding the big picture complexities of poverty also requires a deep understanding of the simplicities of daily life. As Eleanor Roosevelt said, “human rights begin close to home.”

4. Leave small footprints

Someone said that Americans take up a disproportionate amount of space with their voice and presence. Try not to destroy the land you find yourself on, but do not be afraid to leave baby footprints. You are not weightless. Do your best to leave a positive memory of your time there.

5. Don’t expect to change the world

Think about what you can give, and what it means to maximize your impact. Have concrete, realistic goals. Recognize that you will end up taking a lot, so reciprocate to the best of your ability. You might struggle with the need to have a “productive” trip given the costs, but realize the limits of your time and ability. You won’t eradicate poverty in a month. Ask the people you’re working with, “how can I be most helpful for you? What does change look like to you?”

6. Immerse yourself

Know the songs on the radio, go to a religious ceremony, learn how to cook, visit the “tourist” destinations, dance, embrace the bucket bath, drink the local beer, learn the local language, etc. I think this stuff is important, but it’s a little weird to think about how much of these experiences abroad for young people are about “understanding the local culture.” Don’t do this for the sake of “studying” the Other, do it get to know people and to broaden your perspective of what it means to wake up somewhere else.

7. Remember: everyone is human

Always. This includes the people you are living with, the staff you are working with, the people you meet on the street and in the village, and the peers you are traveling with. Every human being deserves respect. If you wish to fight inequality, you must do your best to embody equity in your everyday life. Make an effort to form bonds to others, because that’s all that really matters in the end.

Stay humble, stay happy, stay hungry.

– L