Blaming everything but the real causes

October 22, 2014

To confront Ebola, we need a health care system in the U.S. that puts the needs of patients and workers first--and a massive influx of financial and medical aid in Africa.

"I AM Nina Pham." "I am Amber Vinson." The signs that the National Nurses United (NNU) union is distributing online and to its members at rallies capture the urgent need for a message of solidarity, not scapegoating--both to confront the deadly threat posed by Ebola and to counter the racist blame game practiced by politicians and media commentators.

In the U.S., the right wing is using the Ebola crisis to push a reactionary agenda, including border enforcement policies that have nothing to do with public health and everything to do with racism. Meanwhile, the Obama administration oversees a federal bureaucracy that has proven to be completely incompetent in enforcing policies that would protect health care workers like the two Dallas nurses, Nina Pham and Amber Vinson.

The epidemic is far more grave in Africa, where thousands are already dead of Ebola. But the heartless response of the U.S. political establishment is hysterical calls for travel bans by conservatives--and from the "liberal" Obama administration, the deployment not of medical personnel, but U.S. soldiers, in order to shore up the U.S. presence in the region.

CNN whips up the hysteria about Ebola
CNN whips up the hysteria about Ebola

The Ebola crisis won't be solved by racist rants, idiotic border-closing schemes or ratcheting up the U.S. war machine in Africa. If we want to see real help for the countries suffering the brunt of the Ebola epidemic--and real changes that make the U.S. health care system responsive to the needs of those who need it most--it will be up to ordinary people to reject the fear and hysteria of political leaders and focus on real solutions.

THE WORST outbreak of Ebola ever recorded has ravaged large parts of western Africa, especially the nations of Sierra Leone, Liberia and Guinea.

According to official statistics, more than 9,000 people have been infected, and over 4,500 people are dead--and those estimates are low. According to the World Health Organization (WHO), the number of people infected is doubling every month. As of October 1, one-third of all Ebola cases ever documented--that's from 1976 onward--were registered in the month of September alone.

The scale of the crisis in western Africa was dramatized by one scene described by a reporter: of a small child, infected with Ebola, sitting alone in a crowded alley, with those around him afraid to touch him.

That ought to put the impact of Ebola in the U.S.--where Dallas patient Thomas Duncan is the only person to die from the recent outbreak, and two nurses who treated him are infected--into perspective. But of course, the scaremongering of political and media blowhards has overwhelmed a rational discussion.

Among right-wingers, Ebola is an all-purpose opportunity to score cheap political points. On Fox News, "psychiatrist" and conservative talking head Keith Ablow--a member of the network's "medical A-team"--claimed that Barack Obama isn't taking the necessary aggressive action against Ebola, like closing U.S. borders to all travelers from western Africa, because...well, he hates America. "It's psychologically difficult to defend and protect a country that you have it in for," Ablow said.

Fellow right-winger Laura Ingraham disagreed, claiming that Obama has too much love to implement a travel for Africa, that is. "If a few Americans have to die to make Africans' lives better, that's what has to happen," Ingraham frothed.

These pigs at least took a position and stuck to it. Senate Minority Leader Mitch McConnell first told NBC News that people should listen to "experts" who have said repeatedly that restricting travel would not stop the disease, but could actually spread it--and then told a Kentucky news station the very next day, "I'm not an expert on this, but it strikes me that it would be a good idea to discontinue flights into the United States from that part of the world."

The strident calls for a travel ban have nothing to do with "protecting America," and everything to do with whipping up a border-security hysteria to win votes in the coming elections. If their frenzy about "illegals" and even "ISIS" isn't enough, the right wing will try to exploit Ebola.

The resulting panic has created real victims. Like the two children in New Burlington, N.J., who were kept from attending Howard Yocum Elementary School because they come from Rwanda--a country that, as pointed out, is "approximately 2,600 miles away from the closest West African country with Ebola cases--a distance roughly equivalent to that between Seattle, Washington, and Philadelphia."

Meanwhile, parents in Hazelhurst, Miss., pulled their children out of school recently after learning that Hazlehurst Middle School principal Lee Wannik had travelled to Zambia for his brother's funeral--approximately 3,100 miles away from the areas where Ebola has hit. Wannik was forced to take paid vacation time off to allay parent fears.

And if you think the bigotry is confined to rural or suburban backwaters, there's the recent cover of Newsweek magazine--featuring a picture of a chimpanzee and the headline "A Back Door for Ebola: Smuggled Bushmeat Could Spark a U.S. Epidemic." This racist filth was published by a national "news" magazine despite the fact that health officials say the risk of transmission of Ebola from eating bushmeat is next to nil, that eating chimpanzee meat isn't common in Ebola-affected regions, and the outbreak had nothing to do with bushmeat.

Don't think the racist hysteria is confined to Republicans, either. They are the worst offenders, but a number of Democrats have joined the call for a ban on travel to and from western Africa, including Sen. Kay Hagan of North Carolina, Rep. Tulsi Gabbard of Hawaii and Michelle Nunn of Georgia--every last one of them candidates in races this November.

THREE WEEKS after Thomas Duncan was diagnosed with Ebola, it's clear that the real cause for alarm in the U.S. has nothing to do with African travelers. The real threat is America's for-profit health care system.

According to public health experts, banning travel and closing borders is likely to make the Ebola epidemic worse by negatively impacting the economies of the hardest-hit countries; complicating the ability of health care workers to travel and track the spread of the disease; and compelling people who might be infected to travel clandestinely in order to seek work or other opportunities.

As Lawrence Gostin, director of the World Health Organization's Collaborating Center on Public Health Law and Human Rights, told the Washington Post:

It's an 18th-century view that you can somehow place a cellophane wrapper around a whole region of the world and expect to keep germs out. It doesn't work that way because it's never worked. Germs don't respect borders. They will cross borders, they will go by other means, it will give them greater incentive to get out, and it will get more people infected. It will impede medical supplies, food, humanitarian assistance. It would exacerbate a health and humanitarian crisis. We couldn't do anything worse.

Even the public screenings at U.S. airports, which the Centers for Disease Control recently instituted for passengers coming from western African nations, will do little except cost millions of dollars. For example, Thomas Duncan wouldn't have been identified as infected with Ebola--since by all accounts, he was not showing any symptoms when he travelled to the U.S.

It would be far better to deliver the money instead to Ebola-stricken countries in Africa, in the form of medical aid and supplies. Like, for example, what Cuba did--it sent 90 doctors to West Africa to fight Ebola. By contrast, the Obama administration sent not doctors, but soldiers to Africa--where they aren't trusted, needed or wanted.

BUT WHAT about the U.S. health care system. One question lost in the media's racist frenzy is a stark one: Did Thomas Duncan have to die?

Blame has been heaped on Duncan for traveling while he was infected with Ebola, but it's not clear that he knew he had been exposed to the disease when he first sought medical treatment at Texas Health Presbyterian Hospital in Dallas on September 25--six days after coming to the U.S.

What is clear is that Duncan was sent away on his first visit to the hospital with a useless prescription for antibiotics and a recommendation to take Tylenol. Hospital officials still haven't fully explained why--but it may have had something to do with the fact that he was an uninsured Liberian national seeking treatment in a for-profit health care system.

Pointing out that his uncle "was a man of color with no health insurance and no means to pay for treatment," Duncan's nephew Josephus Weeks wrote in an article sent to the Dallas Morning News:

Thomas Eric Duncan was a victim of a broken system. The biggest unanswered question about my uncle's death is why the hospital would send home a patient with a 103-degree fever and stomach pains who had recently been in Liberia--and he told them he had just returned from Liberia explicitly due to the Ebola threat.

Some speculate that this was a failure of the internal communications systems. Others have speculated that antibiotics and Tylenol are the standard protocol for a patient without insurance. The hospital is not talking.

As a Galveston, Texas, medical student explained recently in the Texas Observer, the idea that the uninsured--who make up 25 percent of people living in Texas--can seek treatment at emergency rooms if they get really sick is plain wrong. ERs are only are required to "stabilize" patients, the medical student said: "They just have to patch you up to the point where you're not actively dying. Also, hospitals charge for ER care, and usually send patients to collections when they cannot pay."

As for nurses Nina Pham and Amber Vinson, various reports have actually blamed them for contracting Ebola--because of their supposed failure to follow decontamination protocols after treating Duncan. But the NNU and others are raising disturbing questions--about whether the hospital had the proper protective equipment for nurses, and whether they were given any training in how to use it.

Abby Norman, a health care worker in Maine who has received training in hospital hazmat procedures, wrote for the Huffington Post that the process is not only rigorous, but physically exhausting. As Norman wrote:

The truth is, in terms of virology, Ebola should not be a threat to American citizens. We have clean water. We have information. We have the means to educate ourselves, practice proper hand-washing procedures, protect ourselves with hazmat suits. The CDC Disease Detectives were dispatched to Dallas almost immediately to work on the front lines to identify those who might be at risk, who could have been exposed. We have the technology, and we certainly have the money to keep Ebola at bay.

What we don't have is communication. What we don't have is a health care system that values preventative care. What we don't have is an equal playing field between nurses and physicians and allied health professionals and patients. What we don't have is a culture of health where we work symbiotically with one another and with the technology that was created specifically to bridge communication gaps, but has in so many ways failed.

Thankfully, the rallies and national conference calls held by the NNU are injecting some rationality into the current debate about how to protect both patients and health care workers. As NNU has made clear, we don't need any more scapegoating of patients and workers, but the opposite: a transformed health care system that can protect patients and health care workers at home--and in Africa, an influx of financial and medical aid to overcome the lack of resources that has frustrated progress in halting the Ebola epidemic.

IN AFRICA, the main culprit behind the spread of Ebola is well known: poverty.

Ebola is not easy to catch. It is passed through contact with the body fluids of an infected patient who already has symptoms of the disease. But the latest outbreak of this particularly virulent strain of the Ebola virus has spread rapidly because of the close living conditions in urban slums in cities like Monrovia, Liberia.

The other reasons for a high mortality rate in these countries--as high as 70 percent, according to the WHO--are a lack of basic necessities like clean water, electricity and adequate nutrition; a lack of medical supplies like IV fluids, gloves and protective equipment; a shortage of health care workers, adequate quarantine facilities and protection for burial workers; and a distrust of health care workers and the infected among some local populations.

In a diary published after a recent trip to Liberia, Paul Farmer, cofounder of international nonprofit Partners in Health, outlined the scale of the public health crisis there:

Both nurses and doctors are scarce in the regions most heavily affected by Ebola. Even before the current crisis killed many of Liberia's health professionals, there were fewer than 50 doctors working in the public health system in a country of more than 4 million people, most of whom live far from the capital. That's one physician per 100,000 population, compared to 240 per 100,000 in the United States or 670 in Cuba.

Properly equipped hospitals are even scarcer than staff, and this is true across the regions most affected by Ebola. Also scarce is personal protective equipment (PPE): gowns, gloves, masks, face shields etc. In Liberia, there isn't the staff, the stuff or the space to stop infections transmitted through bodily fluids, including blood, urine, breast milk, sweat, semen, vomit and diarrhea...

Many of the region's recent health gains, including a sharp decline in child mortality, have already been reversed, in large part because basic medical services have been shut down as a result of the crisis. Most of Ebola's victims may well be dying from other causes: women in childbirth, children from diarrhea, people in road accidents or traumas of other sorts. There's little doubt that the current epidemic can be stopped, but no one knows when or how it will be reined in.

What makes the current crisis so appalling is that Ebola is a disease that could be eliminated--with the proper resources, health care infrastructure and aid. But the governments of the most heavily impacted countries in Africa have lacked the will or the resources, and the world's wealthiest governments have been completely unwilling to do what needs to be done to stop a humanitarian catastrophe. As Farmer wrote:

I've been asked more than once what the formula for effective action against Ebola might be. It's often those reluctant to invest in a comprehensive model of prevention and care for the poor who ask for ready-made solutions. What's the "model" or the "minimum basic package"? What are the "metrics" to evaluate "cost-effectiveness"?

The desire for simple solutions and for proof of a high "return on investment" will be encountered by anyone aiming to deliver comprehensive services (which will necessarily include both prevention and care, all too often pitted against each other) to the poor. Anyone whose metrics or proof are judged wanting is likely to receive a cool reception, even though the Ebola crisis should serve as an object lesson and rebuke to those who tolerate anemic state funding of, or even cutbacks in, public health and health care delivery. Without staff, stuff, space and systems, nothing can be done.

But as the far less severe outbreak in Texas shows, even where there is the "staff, stuff, and space," the current health care system is totally inadequate for putting a halt to Ebola.

The underlying cause of the epidemic abroad, and the negligence that led to Thomas Duncan's death and the infection of Nina Pham and Amber Vinson are connected: The real disease is capitalism. Exploitation and resource extraction for multinational corporate profits has crippled health systems in western Africa--and the for-profit health system in the U.S. is claiming victims of disease and threatening workers' health and safety.

The culprits in this deadly crisis are the upside-down priorities and structural discrimination of a system where profit is king--not a virus, however virulent, and certainly not the people who fell victim to it or the health care workers struggling to treat them.

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