Our ethical bankruptcy is going to kill us, not a virus.

Johann_Melchior_Füssli_(1677–1736),_Sketch_of_a_Cordovan-leather-clad_doctor_of_Marseilles

The United States has the most capable health infrastructure and the most capable doctors in the world, bar none,” Lisa Monaco, President Obama’s senior counter-terrorism adviser, said at a White House briefing. (“US Ebola outbreak ‘extraordinarily unlikely’, White House officials insist.” The Guardian)

You might wonder what a ‘counter-terrorism’ adviser is doing vouching for the quality of the US health system. It is an indication of just how badly this issue has been framed since the first report of the latest Ebola outbreak, which began in March of this year. Nor is it helpful that the current head of the CDC keeps insisting that an Ebola outbreak couldn’t happen in the US. And even more laughably, there’s a DA in Texas who looking into pressing charges against Thomas Eric Duncan, the Liberian who fell sick in Dallas.  Let’s hope he lives long enough for that to be a worry to him.

All these absurd statements and assurances have one thing in common: they are aimed at pleasing the public, not at informing them of realities or doing anything constructive to stop what might turn into a global pandemic. The level of magical thinking, parochial smugness, ass-covering and spin-doctoring has been staggering.

Peter, Piot, the scientist who identified the Ebola virus, recently interviewed in the Guardian had something interesting to say about why, for instance, the WHO did not alert the world to the seriousness of the outbreak earlier: “their African regional office isn’t staffed with the most capable people but with political appointees. And the headquarters in Geneva suffered large budget cuts […] The department for haemorrhagic fever and the one responsible for the management of epidemic emergencies were hit hard.”  (“‘In 1976 I discovered Ebola, now I fear an unimaginable tragedy‘,” The Guardian)

We appoint incompetents, we cut budgets in the wrong places (and I’m not defending the WHO at all – they’ve been worse than useless. One intelligent person in an office with a telephone would have been more effective.) But Medecins Sans Frontieres told everyone who would listen, including news networks and the US that there was a disaster looming, and that it had reached its limit to cope in June. (“Ebola in West Africa: ‘The epidemic is out of control‘” MSF.org, June 24, 2014).

Once this disease hit urban slums, places with high concentrations of people, this was always going to be our problem.  And if you think culture or ignorance had anything to do with it, let me remind you that a hospital in the most medically sophisticated nation in the world turned Mr. Duncan back out onto the street, sick, knowing he had been to Liberia. I suspect they didn’t want the cost of treating him for anything – he had no insurance and no social security number.  After all the bullshit from the hospital about computer system flaws, it appears they ‘just fucked up.” Call me a cynic: I think it’s a problem with for-profit medicine. No medical care facility that is run for profit can be expected to put the welfare of a community before its profits unless it has to – legally. And even then, it will do only what will satisfy the law, not what is best for the community.

Then we discover that the family Mr. Duncan was staying with, who have been exposed, have been told not to leave the apartment. They have to live in the space with infected sheets and towels for a week. There is no one to counsel them. No one comes to help them with the clean-up. There is no provision made to bring them food, or diapers (there’s a baby) or anything. The best this vastly superior system can do for them is to send someone along to take their temperatures. And when the Dallas authorities are taken to task for this, they blame the federal government.

Yeah — really. Never mind all this ‘African cultural behavior risk’ crap. We’re just as capable of at putting ourselves at risk by just being callous and stupid.

It’s greed, self-interest, and bureaucratically hidden incompetence that will kill us, not a virus.

I would like you to indulge in a little imaginative exercise: you are living in a city where people around you are dropping dead on the sidewalks of an awful disease with a 50%+ mortality rate.  The hospitals, clinics and treatment centers are so overwhelmed, they are turning people away. You know this because you’ve just tried to take a friend to the hospital and had to take her home, and carry her back into her house, probably to die eventually, in your own arms.

(There were about 1000 doctors in the whole of Liberia at the beginning of the year, and many have now died of the disease while attempting to treat others. The Chief Medical Officer of Liberia has just quarantined herself and her entire staff after one of her assistants died of it.)

You, unlike most of the population, have the money to fly out. Are you going to hang around? When you know you can gain entry into a first world country with first world medical facilities (after all, you don’t KNOW you’ve been infected, but you know you might be)?

Right now, everyone who has the money and the connections to get out of Liberia, Guinea or Sierra Leone, has either done so, or is considering doing so. This is what happened during the outbreaks of the Plague in the Middle Ages. This is what happened during the Spanish Flu epidemic. People flee to places they think are safer.

What I’m trying to make clear is that these people are just like you. They don’t think they should hang around in a hot zone and get sick anymore than you would. And no, I am not advocating the grounding of all flights to the affected countries,  because it does impede people coming in to help and fight the pandemic.  And it’s blatantly unethical to strand people in a place we have allowed, by our stupidity, our selfishness, and, frankly, our racism, to go to shit.

So all those talking heads saying that we couldn’t know this would happen? That all the previous Ebola outbreaks have been small and burned themselves out? Either they are lying to cover their reputations and their asses, or their history education has been for shit. I suspect a little of both.

We have a very deadly disease that has been allowed to spread because we didn’t care enough about those people ‘over there.’

It will come here, wherever here is — I’ll lay odds on it. There will be cases in most major cities in the world.  Our ability to cope with it and stop it will depend on the competence, the integrity, and the ethics of people at all levels – and that’s the scary part.

We live in a culture that encourages the appearance of process, diligence, expertise, and concern for the community, but beneath the layers of filled out forms, checklists and the apparent following of procedure, is increasingly less effective, less diligent, less expert and less caring. This, more than anything else, is what I think puts us at risk.

The ‘missteps’ at the Dallas Health Presbyterian Hospital in treating the Ebola patient in the US reveal exactly how wide the gaps is between having ‘processes in place’ and actual, effective responses. At some point, it becomes clear that all the ‘Ebola checklists’ and ‘red flag travel statuses’ in the world will do us no good unless we, as individuals, as organizations, as institutions stop burning energy on spin, on administration, on the appearance of competence and JUST DO OUR JOBS well. Not because there is a procedure, but because we have a duty. Not because it will be financially better for us in the long run, but because we genuinely CARE about our communities.

That’s the bottom line. It’s our ethical bankruptcy that is going to kill us. Not a virus.

P.S. Did I leave you feeling helpless? There’s something you can do. Go along to the MSF site in your country and give them some money. They’re almost wholly run on private donations and they’ve been working at the mine face of this tragedy, risking their lives to do it, since the beginning.

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