HealthLawProf Blog

Editor: Katharine Van Tassel
Case Western Reserve University School of Law

Thursday, September 4, 2014

Guest Blogger Assistant Professor Jennifer A. Brobst: The Global Ebola Health Crisis – Counteracting The Western Media’s Privilege And Prejudice In The Classroom

BrobstThe current global ebola health crisis, now infecting a documented but underreported estimate of 2,615 people, killing 1,427, is unprecedented in its scope and severity since its first appearance in the 1970s. Of particular concern is the higher numbers of medical personnel infected in the current outbreak, up to 240 infected, with over 120 deaths. However, in terms of numbers affected by a pandemic in the last century, it is by no means unprecedented in scale. In 1918-1919, up to 40% of the world’s population became ill with Spanish flu, which killed approximately 50 million people. Subsequent flu epidemics killed approximately 69,800 Americans in 1957-1958, 33,800 Americans in 1968-1969, and 9,000-18,000 people worldwide in 2009. On August 8, 2014, although the number of fatalities had not yet reached 1,000, the World Health Organization (WHO), declared ebola an international health emergency, requiring a coordinated international response due to its virulence and the struggles for containment in the West African nations affected. According to Doctors without Borders, the response is prudent but a “complete disaster” due to its 6 month delay in adequately responding to the crisis.

With daily and hourly Western media coverage of ebola’s spread across West Africa, dramatic reports of the disease’s high mortality and frightening pathology have brought attention to infectious disease and global health risks and policies in social conversations, professional discourse, and in the classroom. For American health law professors, the growing interest and awareness of the ebola contagion provides an opportunity to improve student understanding of the public health, legal, and socio-political challenges which accompany an epidemic or pandemic, but also of the uneasy relationship between Africa and the Western World.

For example, according to the WHO, an important logistical reason for increased difficulty in containment of the disease is its spread to urban areas. WHO reports that “many of the most recent Ebola outbreaks have occurred in remote areas, in a part of Africa that is more familiar with this disease, and with chains of transmission that were easier to track and break.” This statement may resonate better with law students and professionals from more rural areas in the United States. Despite or because of entrenched poverty, isolation, and lack of resources, rural communities also exhibit resilience, independence, social-connectedness, and an ability to communicate public health strategies in a culturally defined manner. In the populous, diverse, and urban communities where ebola has now spread, public health warnings and treatment strategies are far more complex and difficult to manage. Classroom discussion of rural West African populations in particular should not center on an assumed ignorance or inability to work with medical providers. The past success of medical interventions in rural Africa, maintaining the status of the ebola virus as a rare and limited occurrence, attest to this.

At the same time, breaking through American student assumptions regarding living conditions in other parts of the world is better addressed by sharing direct moments of misunderstanding. For example, public comments on online news articles now more frequently attract posts from across the globe. In an August 22, 2014 FrontPageAfrica article on the challenges of distributing food to the impoverished quarantined community of West Point in Monrovia, Liberia, a “top commentator” from Americorp at Minnesota Alliance with Youth wrote: “The method of distribution of the food and water will cause the spread of the deadly [ebola] virus [more] than ever. Why is it that this government just can't even get the simplest things right? Why don't they distribute the food by households, instead of asking people to form long lines, thereby exposing them to touch bodies?” A response came quickly: “Household???? Have you seen West Point? Do you think they have house numbers like Minnesota? Liberians really need to take responsibility and buckle up I at times blame the government but West Point has lawless people who want government to do everything for them.” Another “top commentator”, a Liberian Consultant on Policy, Research and Strategic Planning, also responded to Americorp at Minnesota: “Where are you writing from? About two weeks before the looting, I was talking to a colleague who have family in West Point. She told me stories of how people pass through other people's hallways to access their own homes, and in some cases people reach their homes via the bedroom/living room/dining room/kitchen of others.” Students should understand that culture is rarely the primary determinant of behavior when stark economic realities are at play.

Another challenge highlighted by the media is the political instability and lack of infrastructure in the West African nations affected. According to Margaret Chan, WHO director-general, "[i]f we do not in global solidarity come together to help these countries, they will be set back for many years." In this article through Reuters, it was stated that “[Chan] noted the three hardest-hit nations had only begun to emerge and rebuild after ‘years of conflict and difficulties.’ " Little context is provided in such articles regarding causes of historical instability in Sierra Leone, Guinea, Liberia, Nigeria, and now Congo. The social and political communities of West Africa suffered the greatest from the Western slave trade, a fact not lost on African media and informational reports, but significantly missing in Western coverage. The history of Africa is also a history of the dominance, greed and inhumanity of the West. Students would benefit from a reminder of this when reading, for example, a media report that Guineans feared Western aid or distrusted their own government for being compliant with Western aid.

Perhaps the most offensive Western media strategy is the coverage of cultural practices that have exacerbated spread of ebola, such as funeral rites and the eating of “bush meat”. The news reports identify these practices out of context, implying exotic and uncivilized cultural traits, which unfortunately opens the door to online public commentary replete with Western racism and ignorance regarding Africa generally. What difference is there between hunting “bush meat” in Sierra Leone, and hunting deer in North Carolina? If faculty look farther afield from Western media to address the ebola crisis and consider reports from the nations and people most directly affected, the needed context would emerge. As one survivor of ebola from Guinea stated in an interview with the BBC, the only Western media source to have made a consistent effort to focus on African voices, “You know about African solidarity - usually when someone dies people visit you but when we lost one and then two, three, four members of our family, nobody came to visit us and we realised we were being kept at bay because of fear.” The more elaborate funeral practices in some African communities, relative to the often sterile subdued funerary practices in the United States, provide community building and mutual support through grief when honoring departed loved ones. The fact is many Americans do not know about the cultural strength of African solidarity, because they are fed a steady diet in the media of a continent of suffering, vulnerability, and isolation.

To make matters worse, the Western coverage of the ebola epidemic today not only narrowly addresses the problems of African governments and cultural views, but also now wishes to take credit for its solutions. Having monitored Western media reports on ebola since the current outbreak in February and March 2014, it is apparent that Western news coverage has increasingly focused on Western efforts by the CDC, WHO, and now the UN, yet with no detail on the efforts of local or national African public health officials who have coped with the epidemic from the beginning. With the arrival of the “Ebola Czar”, the media’s term for David Nabarro, who is the UN’s appointed coordinator of its global efforts during the crisis, the journalistic colonial tone reached new heights. “The UN's new pointman on Ebola said Tuesday he will travel to West Africa this week to shore up health services in the four countries hit by the worst-ever outbreak of the virus.” This is the byline from an article by yahoo online news, reproduced from Agence France-Presse (AFP). Students receiving their news on ebola from these sources should be invited to discuss the fact that the byline paternalistically states “to shore up health services,” rather than “assist West Africa in their efforts.”

Certainly understanding the strategies of CDC, WHO and other leaders of the current international response is vital in the health law classroom, such as the FDA emergency use authorization of ZMapp and other ebola vaccines. But understanding the West African national policies and strategies and how international efforts should respectfully complement those efforts is also key. Students should ask what are West Africa’s neighbors doing to avert spread of the disease? The Mail and Guardian Africa provides a country survey of national responses, with an appropriately lesser focus on world health efforts. For example, Ethiopia’s response is described in the article as follows:

Since Addis Ababa Bole International Airport is frequently used for transits, the Ethiopian Public Health Institute is taking strong steps to prevent the disease from coming into the country. Detection equipment has been set up at the airport and medicines have been readied, and preventive activities would be carried out in border areas. Extensive training of health professionals is underway. The country has also created awareness among the public about the disease.

This week, the Mail and Guardian from South Africa reported on its view of Western intervention in West Africa to avert the ebola pandemic: the title reads “ ‘Almost Zero’ Response to Ebola from Western Leaders.” The August 21, 2014 article addresses the greed and self-interest of Western leaders focusing almost solely on preventing spread of ebola into their own countries through travel restrictions and domestic public health policies, rather than focusing their attention on reaching out to assist West Africa battling the epidemic first hand. Three days later, American media reported:

On Saturday the UN Secretary-General Ban Ki-Moon's special representative for Liberia, Karin Landgren, pledged the world body would take a "strong role" in coordinating the response to the emergency.

But the WHO has warned that it could take "several months" to bring the epidemic under control … .

As health law professors, which article should we discuss with law students who may shape the future of global health law and policy? I suggest both.

- Assistant Professor Jennifer A. Brobst

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