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Ebola crisis
Reuters/Joe Penney
Humanitarian action begins at home.
SHOULD I STAY OR SHOULD I GO

Why rushing off to fight Ebola in West Africa isn’t the right choice

In emergencies, we expect firemen and women, police officers, doctors and nurses to run to the rescue.

On 9/11, many lost their lives rushing to the site of the Twin Towers, without concern for personal safety, because it was their job to do, to put others first when calamity strikes.

This is what Nina Pham, the nurse in Texas did in caring for Thomas Eric Duncan. Though, with proper use of personal protective equipment she shouldn’t have been exposed to the virus, no one at Texas Health Presbyterian Hospital had the kind of practice in dealing with such emergencies, which the staff at the National Institutes of Health and the Nebraska Biocontainment Patient Care Unit regularly receive. She knew the risks and did her job.

The Ebola epidemic in West Africa is also an emergency, but covering thousands of square miles and unfolding over days, weeks, now months. Hundreds of medical practitioners, logistical experts, infection control specialists, and others who constitute what is called “essential personnel” are now in Liberia, Sierra Leone and Guinea. They come from all over the world, but largely from North America and Europe, with Doctors without Borders/Médecins Sans Frontierès (MSF), Partners in Health, the Centers for Disease Control (CDC), the World Health Organization (WHO) and others institutions, including foreign military units.

But, unlike with 9/11 in New York City or when tornadoes strike the Midwest, or when a little girl falls down a well in Texas, when tragedy strikes in other people’s countries, things get more complicated.

The ethics of humanitarian action go beyond our good intentions.

As the Nigerian writer Teju Cole said in his 2012 Atlantic piece “The White–Savior Industrial Complex,” “there is an internal ethical urge that demands that each of us serve justice as much as he or she can.” But beyond the emergency response, the immediate need to save lives and stop the epidemic, “there are more complex and more widespread problems,” “both intricate and intensely local” where the origins of the epidemic reside, which is where the solutions need to start. These issues get ignored and pushed aside in the rush to help from afar and in fact, any notion of local agency gets obliterated, where a narrative of African helplessness predominates. Cole’s piece was about the Kony2012 frenzy, but the commentary is much more widely relevant and worth reading in the context of what is now happening with Ebola.

The ethics of humanitarian action go beyond our good intentions.

To write about such things in the midst of the current tragedy may seem needlessly academic, even heartless. Yet the West has a history of making things worse, setting the stage for the next crisis and hurting the very people one sought to help. This details the limits of what it is possible to achieve by humanitarian action alone. For example, famine relief has propped up authoritarian regimes and wiped away political responsibility for these disasters in the haze of doing good, ensuring that these emergencies will happen again. What we do now sits in the shadow of our past. We can turn our gaze away from it or try, even in the fevered pitch of current activities, to reflect and learn how to do things differently.

But what about the rest of us, the “inessential personnel,” a vast number of people who wish they could do something to help? Is there an ethics to staying home?

This is a personal question as well. In my own household, the urge to volunteer has been a strong one, and led to asking friends working for groups like MSF, or at CDC about the need for non-medical assistance on the ground in West Africa. The answer has been to stay where we are, that we would largely get underfoot, be cost without much benefit.

However, do we heed this advice? Or take it upon ourselves to go anyway? Perhaps we should reflect first on the urge to go in the first place?

Beyond the desire to help, there is something about the spectacle of the tragedy happening in Liberia, Sierra Leone and Guinea that has a perverse attraction for a kind of liberal American like me working in health, which verges on a kind of disaster tourism; a voyeurism, like being near the scene an grisly accident from which one can’t avert one’s eyes.

Interrogating our own motives is vital in situations like this. The noted South African AIDS activist Zackie Achmat has called this “managing our own imperialism,” understanding when we are intervening to satisfy our own needs and ego, and when we are truly useful to those on the ground doing the work, willing to follow their lead and take a supportive role behind local actors.

There are other issues at stake as well. I live in New Haven, a city, which, except for one very rich university, is fairly poor and where health outcomes depend on race and income. The map of these local health disparities is replicated across all 50 states and international travel is not required to confront a health crisis among the poor and marginalized. The field of global health has revived over the last 15 years largely driven by the response to the AIDS epidemic in the global South. However, global health today almost always never means looking closer to home for those of us in the North.

If our instinct to help has no local roots what does it say about how we approach work elsewhere?

This isn’t to suggest that one should tend one’s own garden, act locally and ignore what is happening now in West Africa or elsewhere across the globe. But if our instinct to help has no local roots what does it say about how we approach work elsewhere? We become then like the “telescopic philanthropist” Mrs. Jellyby from Dickens’ Bleak House: suffering in the abstract and at a distance animate us, but are bored of the lived realities of those closest to us. It makes us missionaries, tied to our own perspectives, consumed with our own roles, likely to act precipitously from far away and without respect for what is happening on the ground in other places because we ignore the earth beneath us at home.

The idea that the response to Ebola is also just about the medical work happening now, the initial humanitarian effort, also de-politicizes what has happened. As I’ve written, the roots of the current epidemic are in both local and international politics— they involve failures of national leadership in Sierre Leone, Guinea and Liberia, but also the policies of international institutions like the IMF and World Bank and the so-called “donor nations” that have ignored and continue to ignore the needs of health systems and public health.

Inessential personnel—and there are hundreds of millions of us—can make a real difference at home, where we become an essential part of the solution, but it means taking political responsibility, and then political action.

This means putting the whole story together; understanding the genesis of policies that create epidemics in West Africa, but also put the lives of millions of people at home at risk, not of Ebola, but of HIV, diabetes, heart disease, asthma, with outcomes depending on your zip code. It means understanding that your governor’s decision not to expand Medicaid is linked to the decisions in Congress that cut health agencies spending under the guise of fiscal responsibility, which is linked to a virus now captivating your attention.

The most recent reports are that the government of Sierra Leone and the US CDC have given up on trying to contain the epidemic—they require 1148 beds but only have 304 of them for their Ebola Treatment Units.

844 beds. They need 844 beds.

844 beds. They need 844 beds.

Yet, political leaders worldwide seem incapable of mobilizing these modest resources. Jim Kim on the eve of the World Bank’s annual meeting this past weekend said the international community has failed miserably on the response to Ebola and has called on countries to create a pool of 20 billion dollars to address the epidemic and similar emergencies.

That leaves with a decision—an ethical one—to make. The burden is on us all: to do, to respond, or to watch it all unfold on CNN, until we switch the channel, click on the next link, get to a world far away from this mess.

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