I am a medical anthropologist. As such, I spend much of my time reading about and studying medicine as a sociocultural practice, particularly the ways that culture influences biomedical and public health practices. One of the reasons I went into medical anthropology was that I took a fantastic undergraduate Medical Anthropology course. Specifically, there was a particular ethnographic work we read in the class that resonated with me: Ebola, Culture and Politics: The Anthropology of an Emerging Disease by Barry and Bonnie Hewlett. The text opened my eyes to the ways that culture can invisibly influence even the most well intentioned medical interventions in ways that turn out to be harmful. It got me thinking about how culture might be influencing the practice of medicine in the United States in ways that contribute to, rather than help reduce, queer health disparities.
As I’m sure most readers are aware, a few areas of West Africa, specifically Guinea, Liberia, and Sierra Leone, have recently been the site of the worst Ebola outbreaks in recorded history. So far, somewhere between 800 and 1200 people have been infected and 450 to 700 have died (depends on whether one is counting lab-verified cases or probable/suspected cases). This is no doubt a serious and scary situation for those people who are being directly affected by the disease, local residents and health workers alike. But the likelihood of Ebola becoming a global pandemic are quite low, despite the sensationalized panic in the media, which has seen a recent uptick with the arrival of some people with Ebola in the US. Greg Laden has addressed these specific issues here.
Yessenia, the author of a highly problematic post on Queereka, recently shared a link on her Facebook page to a story on BBC in which a virologist referred to some of the beliefs attributed to locals as crazy. I took issue with that particular story because, from all of my studying of this topic and my own work with biomedical health care providers, these sorts of judgmental attitudes about locals (or, in the case of my research, queer people) have tended to increase tensions on the ground and in patient-provider interactions rather than help medical workers do their jobs effectively. Yessenia took issue with my stance, and her post on Queereka is an expression her distaste of my perspective.
Unfortunately, Yessenia has chosen to paint her position as the most rational and skeptical of positions, and she sets up a situation in which anyone who wishes to view this topic with nuance is to be stigmatized as being just as irrational as scientologists, anti-vaxxers, Edgar Cayce, and anti-choice/anti-abortion extremists.
This is a disturbing position to take considering it comes from someone who refused to look at evidence showing how her ideas about what is going on in West Africa are problematic due to her ignorance of the complexities of the on-the-ground situation. That she has decided to lecture others about their skeptical chops on this topic would be laughable were it not so offensive. Her post is full of claims and narrative imaginings but devoid of any evidence. I would like to address some of the specific claims she makes in that post and point out why they are terribly misguided.
The first thing I notice about her post is that it trades in typical paternalist and colonialist tropes that are often found in narratives of people from developed countries with regard to people in undeveloped countries. For example:
The bravery [sic] sacrifice of the doctors working with such patients, with the medical resources of a developing nation, cannot be overstated. They are in effect a thin blue line keeping this outbreak – already the most deadly since medical science discovered the virus in 1976 – off a plane to the rest of the world.
Note how she completely ignores the bravery and sacrifice of people who aren’t doctors in helping curb these outbreaks. In Yessenia’s narrative, it is biomedical doctors—and only biomedical doctors—who have an important role to play. Those who do not possess the knowledge produced through biomedical education are rendered invisible in Yessenia’s account. There is an erasure of local residents who are working alone and with health workers to curb these outbreaks, not to mention people who aren’t doctors, such as epidemiologists and other public health workers, who arguably play a larger role in stopping epidemics than doctors.
There is also the implication that the only important events concerning this virus have happened since the interventions of medical science beginning in the mid-1970s, and that such interventions are the only thing preventing total world annihilation. Yessenia’s assertion that Ebola is just a plane ride away from a worldwide pandemic is misinformed, as the European Center for Disease Prevention and Control notes that there is “very low or no recognized risk” of Ebola transmission from sharing public transportation. Ebola is, in reality, not highly contagious because it requires contact of infected body fluids with mucous membranes or open wounds.
Reports out of Sierra Leone describe an opposition that is reminiscent of forced-birth movement tactics in the United States.
Which reports? Who is making such reports? How are they reminiscent of anti-choice extremists? How are we to judge whether or not this is a fair comparison without any links for us to read? This is an appeal to emotion, with knowledge of the audience of this site. This is not a fair and transparent assessment of what’s actually going on.
There have been protests outside of the emergency Ebola clinic, including threats to burn it to the ground. Some patients have relatives attempting to “liberate” Ebola-sick relatives from the isolation units they are quarantined in to receive care. Individuals have been witnessed cleaning still highly-contagious corpses.
My first question is who has used the word “liberate”? Is it a local term, or has it been ascribed to locals by others?
More importantly, why are the protests happening? Rather than viewing the protesters as backwards, ignorant, primitives who can’t tell their elbows from their asses, maybe it would be beneficial to find out why local people are so concerned about their relatives going into hospitals, and then respond with compassion and empathy rather than scorn and judgment.
The logic behind such actions, supposedly, is that the individuals believe that the doctors are actually the people spreading Ebola, possibly to steal individuals and kill them and sell their organs, or other such paranoid nonsense.
In all my attention to media reporting on the ongoing Ebola outbreaks, one thing has been suspiciously absent: the voices of the local residents affected by the outbreaks. All of the reports of events on the ground that I have seen are from journalists, health workers, politicians, and scientists. The silence of local voices is troublesome, even when there are obviously very compassionate and caring workers on the ground.
Further, and contrary to Yessenia’s claim above, the belief that relatives who go into hospitals could have their organs harvested and sold is not “paranoid nonsense.” There has been an increasing problem of human trafficking for organ harvesting all around the world, including countries in West Africa. In this light, it is actually quite a rational response to be fearful of health workers, who are viewed as being associated with such activities (which, by the way, is not all that unreasonable of an association). Local residents do not necessarily make a distinction between Ebola workers from the US and Europe and organ traffickers from elsewhere.
But think about this situation for a moment: Imagine if people in your community, even family members, were being taken away without an understandable explanation, kept isolated and out of contact, most of the time never to return, and other times when they did return they’d had surgeries that left them weakened and ill. Do you seriously believe people wouldn’t be upset and fearful, or protesting outside of hospitals where such things were happening?
Yet, that question raises the same kind of problem posed by Yessenia’s post. Our situation in the US is nothing like the situation in Sierra Leone, Liberia, or Guinea. Or in most places in the world for that matter. Even my empathetic thought experiment cannot really evoke the same kinds of fears and mistrusts in those areas. So for Yessenia to use her own experiences being raised by scientologists as a proxy for the motives of people in West Africa stems from a misguided ethnocentrism. Her experiences, certainly traumatic and troubling, are not analogous to what’s happening in West Africa with Ebola.
A final problem I’d like to address are Yessenia’s “guesses” about the true causes of the spread of Ebola, which boil down to the specters of religion and sorcery. Unlike Yessenia, people who have actually worked in these areas have provided other explanations that don’t appeal to xenophobic boogey-ideas about people who live in Africa.
For example, medical anthropologist Adia Benton of Brown University has worked closely with the Ministry of Health in Sierra Leone. Contrary to Yessenia’s “guesses,” she explains that there are a number of factors that contribute to the spread of Ebola. Aside from the already-discussed mistrust for health workers, one of the problems is with the way Ebola symptoms present. Local people in these areas are acutely aware of diseases endemic to the area. But Ebola is not endemic to Sierra Leone, and symptoms in the early stages of Ebola infection are similar to other endemic diseases such as Lassa Fever. So, local response practices that may work for diseases like Lassa Fever could inadvertently contribute to the spread of Ebola. No appeals to sorcery required.
Another important point Dr. Benton makes is the way that Westerners believe “they should move and have unfettered access to ‘Africa’, but the 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.” There is an assumption underlying Yessenia’s post that since we know best, we should ultimately be able to dictate who has access to which places at what times anywhere in the world where we perceive a public health threat (again, despite the fact that Ebola is actually not highly contagious).
There are a number of things contributing to the rapid spread of Ebola. I would be remiss if I said that beliefs about sorcery or other religious beliefs had never played any role in the spread of Ebola anywhere. But the narrow focus on those things and the claim that they’re the principle cause of the ongoing epidemic is wrong-headed. It ignores the nuances and complexities on the ground and instead, and contrary to Yessenia’s claims, takes an un-skeptical and uncritical view that trades in stereotypes and confirmation biases.
That a post such as Yessenia’s was published on Queereka bothers me deeply. That a person involved with social justice claims to care about people in other parts of the world but shows that “care” by calling them paranoid, narcissistic idiots is appalling to me. That someone who identifies as a skeptic would write such a thing, however, is less surprising to me. Because if there’s one thing I have learned in my involvement with this community over the last few years, it’s that self-identified skeptics are some of the worst when it comes to practicing what they preach.