Thursday, October 30, 2014

Ebola, the timely epidemic that reveals so much about US

By Isabel Manuela Estrada Portales, Ph.D., M.S.
Ebola, in many ways, has come at a crucial time in our world. I want to believe that the dead it is leaving in its trails will become the martyrs in the altar of a reconsideration of the systems and beliefs we hold so dear, and that are failing us so obstreperously.
There are many areas in which Ebola is showcasing the worst of us;  but there is no doubt the medical personnel that have rushed into the burning building at the risk of their own lives would be the saints that may elicit pity from a judgmental, and this time, somewhat correct deity ready to burn down the globe.
In a sense, Ebola is a condensed version of all the seasons of the famed series The Wire, because it reveals the disheartening truths about various areas of society at once: the press, the U.S. health care system, the global institutions, the non-profit sector, the government, even higher education institutions.
I recently wrote a piece about my problems about Ebola. I question in particular our lack of foresight, despite our oversized self-interest. I contend that, in most cases, our self-interest suffers from a terrible shortsightedness and immediacy. We appear incapable of doing anything other than react for fear of giving something away for free. Why should we spend money and resources on really helping those countries in a truly transformational fashion? That’s their problem! Then, when things come rolling all the way to our doors we have two reactions: shut that door as tightly as possible; and, if that’s not 100% safe, spend all the money necessary to make sure the problem is contained…preferably over there.
Ebola has shown the insides of the United States non-existing health care system, and they are ugly. We are surprised and amazed at the dire conditions of the West African countries Ebola is rampaging, but we should be ashamed of our own system. It has shown a lack of coordination – next to the many a times excessive technology we can’t stop parading around – and an inability to set and mandate clear guidelines that has contributed to engender further lack of confidence and panic in the population; while encouraging unhelpful, harmful and, perhaps, politically motivated actions from governors and local authorities.
The absence of timely guidelines is particularly perplexing because it shows incredible lack of foresight. Who was not reading the news? Was it so hard to imagine that we would have a couple of cases of Ebola landing this side of the world? I will say nothing of the after the fact explanations because they really ranged from the sad to the comical.
As a result, despite having only EIGHT cases of Ebola in the country, the population witnessed a never-ending parade of excuses, missteps, back pedaling, and the like, and they can only assume that the people who were in charge and on top of things, well, weren’t. This uncomfortable feeling leads to cries for building a cocoon and placing the United States inside it. And the usual suspects waste no time in encouraging such behavior with their scaremongering.  
Unnecessary and blanket quarantines are wrong on many levels – Are we ready to treat our soldiers we so chant as heroes like pariahs? The New England Journal of Medicine had an excellent editorial, Ebola and Quarantine that reasons it better than I ever could. I would focus only on the communications aspects. The quarantines do further harm by feeding the absurd level of panic already rampant in the United States. Whatever we are saying with our mouths is rendered invalid when the public hears we are quarantining people following the Sarah Palin’s protocol: basically, you get quarantined if you saw West Africa from your window.
While a lot better than unwarranted quarantines, the system of having State Health Departments following up with people is not so much a public health measure, nor a medical one, as a public relations effort to assuage fears. While I am all for communications efforts that inform and help reduce fear and increase dully preparedness, I think this is the clearest proof that we lack a health care system with minimal interconnectedness. Instead of those supersized attempts to centralize control, we should have all doctors and facilities around the nation in sync, and up to date with the protocols. We should be assigning people to their own doctors, who would follow up properly, instead of creating an overwhelming bureaucracy in which cases can fall through the cracks. If every person who comes from West Africa were assigned to his or her own doctor – or assigned one if they didn’t have one already – all communities and health care personnel would become prepared for the exceedingly rare eventuality of a case of Ebola. The nurses would be following up with those assigned to them on daily basis – very few persons per nurse, actually, since they would be spread around the country – and in the case of a temperature change, then appropriate protocol would be followed. In an interconnected system, doctors would report back immediately any development. We would learn very much, and the system would be strengthened as a result, because, the real question is: what would happen if we actually have another very contagious disease right here in the country, with the pitiful system we now have?
We have missed an amazing communications and educational opportunity with the family of Thomas Eric Duncan, the only one who has died of Ebola in the United States and who contracted it in Liberia. His fiancée and other members of his family were in close quarters with him when he was already infected, but, clearly, not infectious. None of them contracted it. We should be putting them on billboards, actually.
The politically inspired measures – quarantine, travel ban – emphasize the self-centeredness and ignorance that plague us. People are dying today, by the thousands. They need help today. But we are running around in circles trying to prevent that epidemic that apparently is marching down Time Square. It is amazing to hear the “kill the government” faction now saying that the government should protect us by quarantining the best among us. Of course, those same people would be threatening armed revolt if a connected health care system were to be proposed, in which medical personnel were reachable, trainable, organized, directed, and made accountable.  
The worst side of the Media has also surfaced – although, its best side has shown as well in amazing thorough pieces from The New York Times, The New Yorker, The Washington Post, NPR and others. The alacrity of the cable news and others – sadly, main source of (dis)information for many Americans – makes it seem the epidemic is trolling around the states. They pay lip service to the true mantra of “Ebola can only be transmitted through direct contact with bodily fluids” on their way to showing images of people in astronaut suits, charts of potential transmission courses, and discussion about how Ebola infected terrorists are crossing the Mexican border.  
As an article in the Post says, fearbola and its very real propensity for stigmatization, discrimination and unnecessary pain is spreading really fast and furiously. That fear brings about the worst in us and shows how little we care for those who we still consider others. The only part of religion I think is right is the one that says: we are all one. There is no us and them.
Even our acclaimed – and expensive – institutions of higher learning are helping to fan the panic flames. The Syracuse University dean of the journalism school dis-invited a Pulitzer Prize-winning photographer who had already passed the 21 days mark after coming back from Liberia. Her excuse: “We did not want to create a panic.” Seriously? What do you think you were creating around the Nation with that decision? Yes, this is also a journalistic decision, because you are telling the journalism students that it is OK to cater to hysteria and panic, which is exactly what the current Media has done. I am a mix of amazed and dismayed that other departments from Syracuse University - say, the Public Health or the Public Communications ones - did not protest firmly their school's association with obscurantism.
As Michael Kinzer, a medical epidemiologist for the Centers for Disease Control and Prevention, who has been fighting the outbreak in Guinea, said “Ebola’s not transmitted by the air. Fear and ignorance are transmitted by the air.”
The big picture is that Ebola is rampant in West Africa because these are very poor countries in which people often lack access to public health care. Ebola victims suffer in unhygienic conditions, and their caregivers struggle to keep themselves clean, Kinzer said. Burial traditions include close contact with the bodies. Under such conditions, a pathogen is not under pressure to evolve in a way that enables a new mode of transmission.

They, that is, all of us, need our help.
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