Transcript Teaching about the Ebola Crisis: - African Studies Center

Teaching
about
the
Ebola Crisis:
Beyond Hysteria and
Stereotypes to Understanding
and Empathy
John Metzler & Morgan Kinstner,
African Studies Center
Michigan State University
Making sense of and teaching about the
Ebola crisis: Moving beyond hysteria to
understanding and empathy
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The following presentation was developed for
and presented at a teacher workshop hosted
by the annual meeting of the African Studies
Association, Indianapolis, November 22, 2014
We decided to post our power point
presentation in response to requests from the
participants to share the entire presentation.
We trust that other educators will find the
presentation to be helpful in addressing this
important issue with their students."
Making sense of and teaching about the
Ebola crisis: Moving beyond hysteria to
understanding and empathy
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The presentation is divided into six sections:
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Stand alone introductory map exercise (one slide)
Biomedical background: slides 5-14
Student Activity: What do these images (cartoons) tell us
about the way Ebola is perceived? Slides 15-18
Why are Americans so concerned (hysteria) about
Ebola? Africa as represented in the Western Imagination.
Slides 19 – 24
Coming to an understanding: Setting the socio-historical
context in Guinea, Liberia & Sierra Leone: slides 25 – 34
Impact and Intervention: slides 35 - 43
What are these maps telling us?
Biomedical Background Information
What is Ebola?
A filovirus in the family Filoviridae.
Causes severe hemorrhagic fever.
Five species of Ebola have been identified; only one does not
cause severe disease in humans.
Each filovirus virion (complete viral particle) contains one
molecule of single-stranded, negative-sense RNA.
New particles bud from the surface of their hosts’ cells,
although replication strategies are not fully understood yet.
(Information from Prof. John B. Kaneene, University Distinguished Professor of Epidemiology and Director,
Center for Comparative Epidemiology)
How Ebola Attacks Healthy Cells
Disease Vectors
Ebola is spread by only a few species of mammals (humans, bats, monkeys,
apes).
Blood or body fluids (including but not limited to urine, saliva, sweat, feces, vomit,
breast milk, and semen) of a person who is sick with Ebola.
Objects (like needles and syringes) that have been contaminated with the virus.
Symptoms of Ebola
Fever (greater than 38.6°C or 101.5°F)
Severe headache
Muscle pain
Vomiting
Diarrhea
Stomach pain
Unexplained bleeding or bruising4
Symptoms may appear anywhere from 2 to 21 days after
exposure to Ebola but the average is 8 to 10 days.
Recovery from Ebola depends on the patient’s immune response.
People who recover from Ebola infection develop antibodies that
last for at least 10 years, possibly for life.
Who is at risk?
High Risk
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Person has been exposed to the virus in communities where the virus is
widespread.
Direct contact with a dead body without appropriate personal protective
equipment (PPE) in a country with widespread transmission.
Has lived in the immediate household and provided direct care to a person
with symptomatic Ebola
Some Risk
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Person lives in a country with widespread Ebola Transmission.
Direct contact while using appropriate PPE with a symptomatic Ebola.
Prolonged, close (within 3 feet) contact in households, healthcare facilities, or
community settings with someone with symptomatic Ebola.
Low Risk
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Has visited a country with widespread transmission within the past 21 days.
Brief direct contact (e.g. shaking hands), while not wearing PPE with a person
with early stage Ebola.
Brief proximity (e.g. the same room) with someone with symptomatic Ebola.
Has traveled on an aircraft with a person with symptomatic Ebola.
Where there is not widespread transmission, having direct contact while using
PPE with a person with symptomatic Ebola.
No Identifiable Risk
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Contact with an asymptomatic
person who had contact with
person with Ebola.
Contact with a person with
Ebola prior to developing
symptoms.
Having been in a country with
widespread transmission more
than 21 days prior.
Having been in a country with
widespread transmission but
not having any other exposures
as listed above.
How you
don’t
get Ebola
Treatment
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No FDA-approved vaccine or medicine is
available for Ebola.
Experimental vaccines and treatments for Ebola
are in development, but have not yet been fully
tested for safety or effectiveness.
Several phase 1 clinical trials for vaccines have
begun in recent months with several others being
expedited due to current events.
Need for ethical trails, even under extreme need
Symptoms are generally treated as they appear.
Early Treatment
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Many people are unaware that, when
caught early, treatment is proven and
effective.
Basic supportive interventions, when used
early, greatly improve chances of survival.
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Providing intravenous fluids (IV)and balancing
electrolytes (body salts).
Maintaining oxygen status and blood pressure.
Treating other infections if they occur.
Early Outbreaks
What do you most commonly
hear at school about Ebola?
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From students
From parents
From other teachers
From administrators
What do the following
images tell us?
Why are Americans so
concerned with Ebola?
Africa in the West’s Imagination
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The West typically imagines
Africa and Africans as an
“other” – in fact, the most
impenetrable of all places to
the Western psyche and
understanding is Africa.
From the earliest contact with
sub-Saharan, “black” Africa
centuries ago, Africa has been
imagined as an
incomprehensible, “dark
continent.”
Africa is viewed in the West as
exotic but fear-inducing. What
are the consequences of this
view?
Consequences
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It’s easy for us to develop
explanatory constructs with
which we interpret Africa,
Africans, and “things” like
diseases, that emanate out of
Africa, which bear little
resemblance to reality. This is
what makes it easy to wildly
exaggerate the dangers of
Ebola in the U.S. (in part
because of its African origins)
in contrast to our interpretation
and representation of diseases
that are perceived as more
“normal” (such as influenza)
but certainly the source of
more deaths in the U.S. than
Ebola.
Sources of hysteria in the U.S.
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Mainstream media
Social media
Entertainment media
Politicians seeking political advantage at election time
Why are Americans
responsive to the hype and
hysteria even when
confronted with
biomedical evidence to
the contrary?
I am a Liberian, not a virus:
http://youtu.be/UEs8xHgBq7g
Coming to an Understanding
 Let’s
take a look at the historical, political,
economic, and social context of the
current outbreak in Guinea, Sierra Leone,
and Liberia.
Colonial State
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Political
 Weak, non-democratic
states with limited
capacity to meet the
needs and legitimate
demands for citizenry
(jobs, housing,
education, adequate
health care)
Colonial Economies & Social Infrastucture
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Economic
 Underdeveloped,
extractive, “mono”
economies; Profits
exported to Colonial
power, limited
development of
economic
infrastructure & local
markets
 Distorted capitalism
Colonial Social Infrastructure
 Social
 Underdeveloped
educational and
health systems—
limited value to
colonial agenda
 Limited sanitation
infrastructure, even in
urban areas
 Limited supply of
potable, safe drinking
water
SAPs: Weakening Post-Colonial
States
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In 1980s the World Bank and International Monetary
Fund (IMF), the major lenders to developing
countries, with full support of the U.S. and European
Union, forced African Countries to adopt “Structural
Development programs (SAPs)
Focus of SAPS: radically reduce state revenues &
expenditure in all areas, but including education,
health and social infrastructure
Result? Decimation of already underdeveloped
educational and health care systems
Hence, very limited capacity to respond to major
health crises.
“Ebola is a disease of Neo-Liberalism” (Liberian
Scholar at ASA conference, 2014
The Pathologies of Civil Wars
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Liberia underwent two civil wars at the end of the
millennium: 1989-1996 and 1999-2003.
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Sierra Leone civil war from 1991-2002
Impact of Civil War on Sierra
Leone and Liberia
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Political Legacy of Civil Wars
 Weak state bureaucracy – very limited capacity to meet demands of
rebuilding social, political, and economic infrastructure.
Economic Legacy of Civil Wars
 Devastated economy: productive base in mines and agriculture
destroyed; legacy of extreme poverty
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Guinea: GDP ranked 148 out of 182 countries in the world; Per Capital income $564
(#172 in the world); 73% population live on less than $2 per day
Liberia: GDP ranked 171 out of 182; Per Capital income $473; 95% population live on less
than $2 per day
Sierra Leone: GDP ranked 83 in world; Per Capital income $805; 76% live on less than $2
per day
Social Legacy of Civil Wars
 Destruction of social fabric – traditional community and family norms
shattered – intergenerational roles /relationships drastically altered; social
obligations /responsibilities erased; anomie; increased incidences of
stigmatization
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Education: Primary school enrollment: Guinea 70%, Liberia 41%, Sierra Leone 40%
Health Care: Government clinics and hospitals destroyed; Before Ebola outbreak, life
expectancy in Liberia and Sierra Leone was under 50 years of age; infant mortality rate
per 1,000 live births: Guinea 57, Liberia 71, Sierra Leone 74
Governance, Nepotism, Corruption,
Agency & Accountability
 Scholars
and Activists from Guinea, Liberia
and Sierra Leone assert that government
leaders in effected countries have to take
partial responsibility for (i) decay in health
infrastructure and (ii) the lack of
adequate response to Ebola crisis due to
corruption, nepotism and ethnicity (case
of Sierra Leone-Guinea border, a strong
hold of the opposition party.
How does this civil war
legacy help explain the
ability of Ebola to spread
rapidly in Guinea, Liberia,
and Sierra Leone?
Dr. Paul Farmer, founding president of
Global Partners in Health, said, “This
[Ebola outbreak] isn’t a natural
disaster. This is the terrorism of
poverty.” What does this mean?
The history and epidemiology
of the current outbreak
Impact of the disease
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Economic
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Social
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Increased demand on scarce government revenues
for health care, transportation, food, etc.
Lost productivity – illness, missing work caring for loved
ones; quarantine areas
Some estimates that countries will lose up to 25% of
their food production
Reduction in direct foreign investment due to fear
Decline in exports due to “chocolate fear”
Increase in price of imports
Greater indebtedness
GDP may decline by as much as 10% this year
Unequal burden on women, the primary care-givers
Children – increase number of orphans
School closures
Over-taxation of inadequate health care system
Impact on traditional family/community structures by
both loss and stigma
Political
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Challenge to already weak governmental
apparatuses to meet the increased health, social, and
economic demands brought on by the Ebola
outbreak
Crisis of legitimacy
Global Intervention: Who has
been responding?
 Primary
Responder:
International NGOs
 Medecins Sans
Frontieres (Doctors
Without Borders)
 Global Partners in
Health
 Religious Charities
Global Intervention: Who has
been responding?
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International Health
Agencies: World
Health Organization
(WHO)
Criticized for Slow
Response: lack of
capacity due to
insufficient funds—
U.S. has not fully paid
dues to WHO for
nearly a decade
Global Intervention: Who has
been responding?
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Developed countries:
U.S. primarily Liberia
U.K primarily Sierra
Leone
France primarily Guinea
Medicines, medical
supplies, field hospitals,
advisors (CDC)
U.S has allocated $750
million to its field hospital
initiative (approximately
$2 per American)
Cuba—265 doctors!
Global Intervention: Who has
been responding?
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Individual volunteers
and contributions
Many American nurses
and Doctors
volunteering in Guinea,
Liberia, Sierra Leone,
but,
Charities indicate that
individual contributions
to support Ebola efforts
lower than response to
“Christmas Tsunami,”
and Haitian earthquake
relief: WHY?
Problematizing the International
Response
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In addition to the inadequate response in terms of
material and personal:
Lack of recognition of local context—heterogeneous
even within three neighboring countries: cultural,
socio-economic, religious, urban-rural etc.
“universalization” treatment-intervention
Medicalization of an epidemic that is deeply social,
economic and political in its manifestations: where
are the African/Africanist social scientists?
(movement/quarantine/funeral practices)
Unwillingness to recognize or acknowledge local
knowledge & practice—example of Liberian nurse
who nursed family members back to health
Local Response
 In
spite of stories of
stigmatization of
Ebola victims &
their families,
Guineans,
Liberians, & Sierra
Leoneans have
responded with
great courage and
compassion
What can we do as educators to:
(1) change the stigma and
hysteria surrounding Ebola? And,
(2) how can we help students
critically engage and understand
the context of the Ebola
outbreak?
For Additional Information
In an attempt to respond to the hysteria perpetuated
by much of the mainstream media in the U.S.,
exacerbated by posts on social media, the African
Studies Center at Michigan State University has
compiled a list (which will be updated weekly) of
electronic articles and blogs that bring reasoned
understanding to the crisis, challenging the hysteria in
the U.S. with a comprehensive analysis of the human,
social, economic and political impact of the outbreak
in Guinea, Liberia and Sierra Leone and their
neighbors.
Visit our website:
http://africa.msu.edu/news/ebola_background/