President Obama got it right about Ebola. Will Australia?

In Sierra Leone, six million people are confined to their homes – the country is in”lockdown” as 30, 000 health workers and volunteers visit homes to explain the situation about the Ebola epidemic. No up to date figures are available on the number of infected people, and recent deaths. In Guinea, on September 18 2014 villagers using machetes and clubs killed 8 healthworkers, dumping bodies in a septic tank. The killers in Guinea apparently blamed the health workers for spreading disease.Sierra Leone has imposed a three day curfew, to try and stop the spread of disease.

With military crises in Iraq and Ukraine, this Ebola crisis doesn’t make the news, or even the Twittersphere, especially in Australia. Australia is sending troops to Iraq, and investigators to Ukraine. Not a word about sending people to West Africa.

The World Health Organisation has declared the Ebola epidemic to be an international emergency. USA is sending 3000 troops to West Africa, to set up infrastructure for the medical battle against Ebola.. Both WHO and Obama are calling for other countries to join this effort. Is Australia listening?

Ebola is not like other infectious diseases. It is like the medieval Black Plague, in both its often fatal course, and in its frightening social effects. From 1347 to 1351 the Black Plague killed about 25 million people – about half of the population of Europe. The causes of these two diseases may be different, but the rest of the story is uncannily similar.

The Black Death was predominantly a European epidemic, though it did spread beyond Europe. Ebola is predominantly a West African epidemic Ebola is affecting Sierra Leone, Liberia, Guinea, Nigeria and Senegal. Right now, this disease is affecting West Africa in just the same way as the Black Death affected Europe. Without real help, this is heading for a national disaster with global security implications just as dangerous as the ISIS movement.

Obama’s approach goes against the tide of prevailing system of dealing with epidemics. The developed world is used to health campaigns driven by market forces, with pharmaceutical fixes. The Ebola battle demands collective action, driven by the public interest.

The comparison of Ebola with the Black Plague is a sobering exercise.
It is hard to exaggerate the long term consequences of Europe’s Black Plague. So many workers dead meant that agriculture, industry. education – all stalled. “The result of the plague was not just a massive decline in population. It irrevocably changed Europe’s social and economic structure and was a disastrous blow to Europe’s predominant organized religion, the Roman Catholic Church. It caused widespread persecutions of minorities like Jews and lepers, and created a general morbid mood, which influenced people to live for the moment, unsure of their daily survival. ”
Starvation, poverty, malnutrition conflict and massacres, resulted in the following years, and this was reflected in morbid themes in the arts.” (see engraving of the “Danse Macabre) The Political and Social Consequences of the Black Death, 1348 – 1351 It took another 400 years for Europe’s population to its pre-plague numbers . (The very long term effects were complicated, and not all negative.)

The Ebola disease starts with symptoms like those of other tropical diseases, flu like, and with a rash. Then in about 50% of cases progresses to bleeding from nose, gums, the gastro-intestinal tract. There may be coughing up and vomiting of blood, and blood in diarrhoea The effect on internal organs is to cause excruciating pain. Blood vessels burst underneath the skin, bringing out welts, that become black, gangrenous.

These symptoms are the same as the symptoms of the medieval Black Death. Some investigators claim that the cause of the Black Death was not bubonic plague, a bacterium transmitted by flea-bites, but in fact one of the five Ebola viruses, transmitted by contact with human secretions.

The surrounding conditions, of crowding, poverty, poor hygiene, lack of clean water in many areas in West Africa are also uncannily similar. People are living in proximity to animals, their food markets are crowded, not sanitary: people are exposed to the entrails of animals.

The social and cultural environments also have similarities, that in both cases, have added to the horror of the disease, and to extreme and odd reactions of the affected communities. People shunned the plague victims. The same thing is happening with Ebola. Carers are terrified. People with symptoms hide away, rather than be treated as outcasts. Cultural customs can spread infection – traditional burial practices in West Africa led to more infection. However, now relatives stay away – while strangers in protective gear carry the dead to unmarked graves. It’s not unlike the carts that patrolled the medieval streets, with the cry – “Bring out your dead”.

“Many ended their lives in the streets both at night and during the day; and many others who died in their houses were only known to be dead because the neighbours smelled their decaying bodies. Dead bodies filled every corner.
Such was the multitude of corpses brought to the churches every day and almost every hour that there was not enough consecrated ground to give them burial, especially since they wanted to bury each person in the family grave, according to the old custom. Although the cemeteries were full they were forced to dig huge trenches, where they buried the bodies by hundreds. Here they stowed them away like bales in the hold of a ship and covered them with a little earth, until the whole trench was full.” Eyewitness to History

Isolation and stigma was the fate of the medieval plague sufferers . “…Such fear and fanciful notions took possession of the living that almost all of them adopted the same cruel policy, which was entirely to avoid the sick and everything belonging to them”

A common feature of Ebola epidemics is stigma. Sufferers and survivors are often stigmatised by the community, and so too are hospital workers. In past outbreaks, some survivors were not welcomed back into their community, some were unable to find work, and some were abandoned by their partners. In the Ugandan outbreak of 2000/2001, the possessions and homes of some survivors were burned

Religious beliefs played a role in the Black Plague. The disease was seen as a punishment from God. Some people went around whipping themselves – in the hopes that this would prevent the plague punishment. “Others took the lead in persecuting strangers and minorities as well as those unfortunates who were perceived as witches. As though there was not enough death ready at hand, innocent people were slaughtered because somebody had to be blamed. Medieval medicine was not equal to the challenge of preventing or curing the plague, so there was a ready market for magic and superstition.”

In some parts of West Africa, there is a belief that simply saying “Ebola” aloud makes the disease appear. Many West Africans see Ebola as a “curse” rather than a medical illness ….As many of the locals believe that Ebola is spiritual, there is widespread scepticism about Western-trained medical professionals. Some believe that doctors are killing Ebola patients once they are taken to the hospital or that Ebola is a punishment for sexual promiscuity
“West Africa has been deemed by the UN as one of the poorest areas in the world. Superstitions run rampant in this region, as the old practices of witchcraft, Voodoo, juju and marabou, brought about through old traditions and culture and the practicing native spiritual mediums of the area. Superstitious beliefs and fears run so strongly that the simplest things, such as a spot on the road that has caused an accident will send many scrambling to slaughter sheep and goats to keep the evil ghosts and spirits away……Throughout Africa, especially in the West African region, the majority of residents believe wholeheartedly in witchcraft. Witches are seen as entities that roam the area, having an amazing effect…..The superstitious beliefs of the area solely exist due to the fear that is behind the unknown. If something happens to a family member, is it because of the evil spirits, witches and Voodoo?”

The World Health Organisation and Obama have recognised that the prevailing paradigm of free market answers, and ‘technical fixes’ cannot work to beat the Ebola epidemic.
This epidemic is very different in nature from the other recent epidemics that have been in the news – SARS and influenza. The “developed” world did develop strategies to address those disease threats, and “developed” populations have become fairly comfortable about the effectiveness of those strategies.

The Ebola epidemic does make for a pretty dramatic and scary news story. That’s because Ebola is a particularly nasty disease, and because it’s spreading very fast in in Guinea, Liberia and Sierra Leone. However, the reality of the Ebola disease is that it is not really much of a threat to rich developed countries. Ebola is not transmitted by air – inhalation, and not by a vector such as the mosquito. Ebola is transmitted by contact with human body secretions. Transmission of any of the five strains of the Ebola virus happens where people live in crowded and insanitary conditions, where hospitals lack infection control, and where infection surveillance is non existent.

So – in the relatively clean and sanitary developed world, with its modern hospitals, the Western world need not fear Ebola as much as those other recent potential epidemics.

When the news of the latest Ebola outbreak came out, I feared that the Western world would approach this problem in the same way as it approaches health problems in general. The strategy is to get a pharmaceutical fix – a vaccine, and/or a cure – a free market economy strategy. This could not work in Western Africa, for two reasons:
1. With the rapid spread of Ebola, these fixes would come too late – thousands of deaths too late.
2. The pharmaceutical companies owe it to their shareholders to not invest $millions in developing drugs unless they are pretty sure of getting those $millions back, plus some – and who would pay for this development?

So – the prevailing paradigm of free market solutions and chemical fixes is not the solution, even though vaccines and drug treatments might play some role.
Since the first recognised outbreak of Ebola disease, in Zaire in 1976, there have been over 40 outbreaks – in Sudan, Gabon, Uganda, Democratic Republic of Congo. These were contained gradually, – the Western world did not worry too much about them – no need for a global strategy.

This time – with the disease spreading to great numbers of people, this time, Ebola is a global crisis that must be addressed by an international effort. What sort of international effort? It won’t work to just throw money to pharmaceutical corporations This time – what is needed is collective action – a public interest solution – with people “on the ground” setting up clean hospitals with proper infection controls, especially for staff protection, setting up efficient surveillance systems, and developing community understanding and education.

By August 24 the 2014 more than 120 health workers had died from the current Ebola outbreak. It is understandable that health workers are reluctant to join the courageous charity teams that now struggle to treat the patients.“It’s despair on all fronts,” said Plyler, an American doctor who led the Liberian disaster response efforts for the international relief organization Samaritan’s Purse.

It has to be a huge and rapid effort to improve conditions for these impoverished West African communities. That is not something that the rich world has bothered about before, in relation to so many diseases of poor communities. HIV AIDS, TB, malaria, yellow fever dengue fever, polio – these diseases continue to take their toll in Africa, South America, Asia with many thousands of deaths, and the “developed world” remains complacent.
The Ebola epidemic raises problems beyond the medical – the potential wipeout of national economies, conflict at borders, even the spectre of the Ebola virus as a weapon of terrorism.
While several non government agencies, notably Medecins Sans Frontieres are working in West Africa, government help is essential. Cuba and China are joining in the USA campaign. The Australian government is so keen to send people to Ukraine and Iraq – but what about West Africa ?

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