As the world holds its breath on how the latest Ebola outbreak in West Africa might evolve, a clash of statist and globalist approaches has been evident all through; from media analysts, to International NGO’s to governments. Statist approaches have their reference point as the state/country and tend to view health risks as security concerns while globalist approaches have the individual as the reference point and tend to consider health risks as human rights issues that know no borders.
In classical statist responses, the government of Zambia has banned entry from or travel to any of the four most affected countries; Nigeria, Liberia, Sierra Leone and Guinea. Neighboring Ghana and Ivory Coast have suspended flights within the region while Guinea, itself the epicenter of the outbreak, has closed borders with her neighbors Sierra Leone and Liberia and even declared a state of emergency! The latter three countries have deployed troops at their borders to help enforce movement restrictions. Similarly, many Americans, in the wake of Dr Kent Brantly’s airlifting, voiced reservations at their government’s decision to import the virus onto US soil. In fact, retired famous Neurosurgeon Dr Ben Carson is on record recommending that the two infected Americans should have been at best treated abroad. Back home, many Kenyans are apprehensive and concerned that the virus might make its way into the country aboard the national carrier Kenya Airways, a major carrier connecting West African countries to Kenya. A suspected case late last week (Aug 9th) threw panic across the city. Thankfully, he tested negative. These measures are reminiscent of the early days of HIV/AIDS when fear and panic rather than sound medical principles informed most reactions.
The common theme through statist approaches is the definition of disease as a security threat to the nation akin to an invasion. As a result, nations tend to go onto the defense and shut borders, ban flights, expel victims, declare states of emergency and at the bottom of the list, even deploy propaganda. Granted, the socio-economic disruption across West Africa as a result of this outbreak is indeed a threat to the stability of the most affected nations. While in certain instances some or all of these interventions might be helpful, they are seldom successful of their own. Purely statist approaches, beyond securitizing the health threat and evoking a pervasive sense of fear, often overlook the actual necessary interventions.
“The bottom line with Ebola is we know how to stop it: traditional public health,” US CDC Director, Dr Tom Frieden.
In the case of Ebola, a viral infectious hemorrhagic fever of which there is fair medical knowledge, proper hygiene and isolation of symptomatic victims seem to help forestall further spread even as a cure remains elusive. At best, only about a third of infected patients may be nursed back to health. That said, Ebola outbreaks remain either an indictment or appraisal of a health system’s infection prevention and control mechanisms, sensu lato. This outbreak has therefore merely put to the fore an underlying and long prevalent rot: health systems that are weak from the foundation up.
In as many Sub-Saharan hospitals as homes, clean running water remains a luxury rather than the basic commodity it ought to be. Further, basic and cheap protective gear like gloves and facemasks are frequently out of supply. It is no guess whether these institutions would have enough of costly supplies like intravenous fluids and colloids for the medical support of potential Ebola survivors or management of other conditions. The last nail on the coffin that such a health system represents is surprisingly not the prevalent biting shortage of qualified personnel nor the mismanagement of the few available skilled hands, it’s the population!
“Ignorance and poverty, as well as entrenched religious and cultural practices, continue to exacerbate the spread of the disease,” President Ellen Sirleaf, Liberia.
Many Africans are yet to adopt the germ theory of infectious disease. Developed in the mid 1800’s, this theory remains the most plausible explanation for infections: that tiny living matter (bacteria, viruses, fungi, etc) must physically enter a susceptible host through a particular mode (air, food, blood, etc) in sufficient numbers to cause a disease. With this knowledge, people are forewarned and therefore forearmed on ways to avoid known infections. For Ebola, this means limiting if not avoiding all unprotected contact with infected individuals and bodies of victims and washing up adequately when such contact occurs. Sadly, many individuals still believe diseases like Ebola are curses that need exorcism or just prayers. The sick and bodies of the dead are handled casually every day; Ebola or other disease.
As more of Africa opens up to itself and the world, future outbreaks might be more complex and widespread in the absence of significant systemic changes on the public health platform. However, this threat also presents hope. The growth that is opening up and connecting Africa might come with more medical workers in the unreached areas, greater economic strength for adequate stocking of facilities with essential supplies and greater population knowledge and practise of basic hygiene and sanitation. Additionally, improved communication networks mean future outbreaks maybe detected earlier and aid to stricken populations availed sooner.
Globalist approaches to public health crises know no borders. They view health risks anywhere as a health risk everywhere in cognition of the inherent value of human life, right to a dignified pain-free existence and the interconnectedness of humans. These approaches therefore focus on open borders for collaborations, funds, skills and supplies to affected areas, advocacy for action and open reporting of events. An Africa seeking greater ties within itself and with the rest of the world will have to adopt more globalist approaches to our numerous public health perils.
“African states must do more to promote conditions for a dignified human existence within their borders.”
Finally, even though investment in proper health systems is one sure way to healthy populations, these efforts must not stop at the hospital level. The bulk of health dividends will be reaped from investment in other sectors. It is ignominious that 50 years post-independence, many African countries have yet to supply their people with adequate clean water, clean energy, safe public transport, adequate food and enough relevant knowledge. Globalists and other non-state actors will continue to play a role in this respect but the long end of the buck lies in the hands of our respective states to do that they were set up to do: promote conditions for a dignified human existence within their borders.