This morning, I woke up to two emails about the most recent NYT article about the Ebola outbreak in West Africa. Having worked in Sierra Leone on a range of health issues, I have been a recipient of these kinds of messages at least a few times a week. I’ll just comment on this article because it best articulates a number of trends that I am seeing in these articles.
From Guinea, Adam Nossiter writes:
Eight youths, some armed with slingshots and machetes, stood warily alongside a rutted dirt road at an opening in the high reeds, the path to the village of Kolo Bengou. The deadly Ebola virus is believed to have infected several people in the village, and the youths were blocking the path to prevent health workers from entering.
“We don’t want any visitors,” said their leader, Faya Iroundouno, 17, president of Kolo Bengou’s youth league. “We don’t want any contact with anyone.” The others nodded in agreement and fiddled with their slingshots.
Singling out the international aid group Doctors Without Borders, Mr. Iroundouno continued, “Wherever those people have passed, the communities have been hit by illness.”
What I find intriguing about this piece is that it’s one of the first to make explicit people’s mistrust of international health workers and their motivations. Implicit is, as Susan Shepler notes, a related mistrust of government officials and the perceived competence of government officials to manage an epidemic, have shaped local responses to this outbreak. Add to this that hospitals are widely perceived to be a place where people become sick or die — not simply in West Africa, but elsewhere, too — and we’ve got ourselves some moral panic. (It bears repeating, too, that Ebola was previously unseen in the region and looks like a lot of other endemic diseases in its early stages. Where I previously worked, Lassa Fever, a hemorrhagic fever with which many Sierra Leoneans are familiar, was also endemic, raising questions for me about whether they used those lessons to address Ebola.)
So, back to the NYT. Young men are trying to bar MSF from their village. Yet, in the paragraph following this vivid description, the analysis falls back on pathologizing the movements of West Africans:
Health officials say the epidemic is out of control, moving back and forth across the porous borders of Guinea and neighboring Sierra Leone and Liberia — often on the backs of the cheap motorcycles that ply the roads of this region of green hills and dense forest — infiltrating the lively open-air markets, overwhelming weak health facilities and decimating villages.
In short, foreigners should move and have unfettered access to ‘Africa’, but these same (literally pathological) movements of foreigners — certainly not all white and Western, but at least symbolically so — are pushed to the background, while the usual movements of West Africans are pathologized. They must stay in their rightful place.
This is not to say that epidemics aren’t traveling “on the backs of cheap motorcycles,” but these young men suspect, as many others in the region do, that (1) the disease may also be traveling with the foreign health workers who move fairly easily across international borders and who are at greatest risk for contracting the disease; (2) that there was a slow and inadequate government response upon initial rumors of the outbreak; and (3) the arrival of Ebola to West Africa is not a simple matter of chance, porous West African borders, ignorance and ‘local traditions’, but one embedded in a range of biological, political, economic and cultural arrangements that have put entire communities at risk. These at-risk communities are having a hard time building trust with people who have failed to control Ebola.