America's Ebola blind spot: Why this country isn't equipped to save patients

We're fine at sending troops and money. But this isn't a war -- it's a public health crisis. And that's the problem

Published October 6, 2014 5:47PM (EDT)

Healthcare workers load a man suspected of suffering from the Ebola virus onto an ambulance in Kenema, Sierra Leone, Sept. 24, 2014.                 (AP/Tanya Bindra)
Healthcare workers load a man suspected of suffering from the Ebola virus onto an ambulance in Kenema, Sierra Leone, Sept. 24, 2014. (AP/Tanya Bindra)

The rapid spread of the Ebola virus across western Africa and the first diagnosis of a case within the United States has caused a spike in fear here in the United States even though few Americans face any risk of contracting the deadly disease. And when Americans are afraid, our country's response is often to declare “war” on our opponent, to send police, guns, bombs, or troops to fight it, lock it up, destroy it.

Except you can't do that to a disease.

This latest Ebola epidemic happened to come to Americans' attention at about the same time as ISIS, the militant group in Iraq and Syria that is the latest target of American military strikes. This has led to many unfortunate comparisons between the two, including a chyron at CNN asking if Ebola was “the ISIS of biological agents?” Apparently we can only understand a virus if we can compare it to armed fighters.

National security reporter Ali Gharib joked on Twitter last month, “Obama announces $500 million-dollar fund to train and equip 5000 anti-Ebola fighters.” Two days later, on September 15, he found that he'd actually been more correct than he thought, when the announcement came that President Obama would indeed commit $500 million and 3000 U.S. military forces (the number has since grown to a possible 4000). The president called the fight a “national security priority.” The Center for Disease Control and Prevention has deployed over 100 to the ground.

We are to be reassured, it seems, that the U.S. troops “will not be directly treating infected patients.” Instead, they will be doing “command and control,” setting up facilities, and delivering medical supplies. Meanwhile, tiny Cuba has sent the largest medical team from any single nation, 165 health professionals with 296 more on the way.

Obviously, the U.S. military isn't going to actually try to eradicate a disease with military force. But the national security response, the all-too-accurate jokes should tell us something about our priorities.

What it takes to save Ebola patients, according to a man who survived the disease, is care, not security. And care is something that is not particularly valued in the United States. Foday Galla, a medical student and ambulance driver who was infected with the disease while bringing an infected four-year-old boy to receive treatment, told Time it was the compassion and care of the doctors and nurses with medical NGO Médecins Sans Frontières (MSF) that brought him through. He now says he will apply this lesson from his Ebola experience to his work as a doctor: “You have to care, you have to give encouraging words, you have to tell them they will survive. Because if you don’t have that [as a patient] you are going to want to die.”

Ebola is particularly treacherous because the people who care are the ones who are most likely to be infected. Medical workers like Galla put themselves at risk trying to help. Even Thomas Eric Duncan, the Liberian man diagnosed with Ebola in Dallas, Texas, contracted the disease helping a friend and neighbor get to the hospital in a taxi because no ambulance was available.

According to Liberian officials, women make up about 75 percent of the cases they are seeing because women tend to be primary caregivers and nurses. Health officials consider educating and training women to be crucial to fighting the spread of the disease. “By reaching the women, they are reaching those who can best protect their families, and their own health,” said Maricel Seeger, a WHO spokeswoman in Monrovia, Liberia.

Women tend to be the care workers here in the U.S. as well, where over 90 percent of nurses are women, as well as 90 percent of home health care workers. Caring professions have long had lower pay and less respect in this country precisely because they are seen as jobs for women; though men make up less than ten percent of registered nurses, they make more money. Economists like Nancy Folbre have found that the pay penalty for care work applies even after controlling for other characteristics like work experience and education, and that patriarchal beliefs about women's natural role have pushed women to “overspecialize in care provision,” both for paid work and in the home, like the women of Liberia, caring for their sick family members before becoming sick themselves. We think that care work is women's natural role, not a serious job that requires skills and training, and women too often suffer for that, whether through low wages or their own health.

I would suggest that if we don't value the work done by care workers, we are unlikely to see them as the solutions to our problems. And that has echoes here at home, as well as in overseas epidemics.

Our own healthcare infrastructure, despite the best efforts of the Affordable Care Act, is fragmented, privatized, and all too often simply not up to the challenge. It crumbles under our own disasters: in New York after Hurricane Sandy, nurses famously had to carry newborns on respirators down nine flights of stairs to evacuate when NYU Langone hospital flooded, and other nurses went door-to-door to find sick patients in neighborhoods without power or transportation. Hospitals are closing, governors refusing to expand Medicaid, doctors loaded with student debt going into lucrative specialties instead of primary care. If we don't value healthcare at home, how are we supposed to help provide it abroad?

In her new book This Changes Everything, Naomi Klein argues that we have to revalue care work in order to make the kinds of changes in our society that are necessary to deal with the realities—and the disasters--of climate change. I tend to agree with her, and to suggest that our priorities need a radical readjustment when it comes to “national security threats” as well.

What is needed to fight Ebola is trained doctors and nurses, ambulance drivers, hospital staff to properly clean and dispose of contaminated materials. It is an understanding that this work cannot be left on the shoulders of overburdened (mostly female) family members, who are likely then to succumb to the disease themselves. It is an understanding that proper care, not “national security,” will save those who have already contracted the virus.

By Sarah Jaffe

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