There's no reason we can't stop this...with staff, stuff and systems.—Paul Farmer
The Ebola outbreak, which is the largest in history that we know about, is merely a reflection of the public health crisis in Africa, and it’s about the lack of staff, stuff and systems that could protect populations, particularly those living in poverty, from outbreaks like this or other public health threats.
Paul Farmer is one of the world's most respected
medical anthropologists and physicians. If you missed this in-depth interview with him on
Democracy Now, and cannot view
the video, here's a link to the
transcript.
Dr. Farmer and his colleagues in the U.S. and abroad have pioneered novel, community-based treatment strategies that demonstrate the delivery of high-quality health care in resource-poor settings in the U.S. and other countries. Their work is documented in the Bulletin of the World Health Organization, The Lancet, the New England Journal of Medicine, Clinical Infectious Diseases, and Social Science and Medicine.
Dr. Farmer also has written extensively on health and human rights, about the role of social inequalities in the distribution and outcome of infectious diseases, and about global health. His most recent book, Reimagining Global Health, co-edited with three colleagues, presents a distillation of several historical and ethnographic perspectives of contemporary global health problems. Other titles include To Repair the World: Paul Farmer Speaks to the Next Generation, a collection of short speeches, Partner to the Poor: A Paul Farmer Reader, Pathologies of Power, Infections and Inequalities, The Uses of Haiti, and AIDS and Accusation. In addition, Dr. Farmer is co-editor of Women, Poverty and AIDS, The Global Impact of Drug-Resistant Tuberculosis, and Global Health in Times of Violence.
Farmer, along with other medical anthropologists and epidemiologists does not minimize the seriousness of Ebola, but he talks clearly about what needs to be done, cuts through the fearmongering around this current crisis, and discusses how we need to approach public health as a global system.
Follow me below the fold for more.
From the interview transcript:
AMY GOODMAN: Talk about what we should understand about this outbreak of Ebola, Paul.
DR. PAUL FARMER: Well, I think the most important thing to understand is that this is a reflection of long-standing and growing inequalities of access to basic systems of healthcare delivery, and that includes the staff, the stuff and, again, these systems. And that’s what—that’s how we link public health and clinical medicine, is to understand that we’re delivering care in the context of protecting the health of the population. And so, if you go down to each of these epidemics—that are, of course, one epidemic—and you ask the question, "Well, do they have the staff, stuff and systems that they need to respond?" the answer is no. And then, what will stop the epidemic, which it will be stopped, is an emergency-type response. But then again, how are we building local capacity to do that so these epidemics don’t spread—as they would never spread in the United States, by the way?
JUAN GONZÁLEZ: And the astounding fatality rates that we keep hearing about, is that more, in your sense, in your view, a result of the disease itself or the weaknesses of the healthcare systems that confront them?
DR. PAUL FARMER: Well, you know, I think the more important hypothesis is that it’s the latter, right? Because—and it would be great to talk to our colleagues at Emory, the infectious disease colleagues who treated patients. It’s not that they had an experimental medication; it’s that they had supportive care. And supportive care, in medical terms, doesn’t mean having someone hold your hand. It means, if you’re bleeding, you get blood products. If you’re hypotensive, or your blood pressure is low, you get IV solutions, right? That’s not what’s happening in these Ebola centers. You know, it’s really quarantine without a lot of the care, right, because supportive care requires sometimes an ICU.
AMY GOODMAN: That was very interesting that you just said that Ebola couldn’t be—there couldn’t be an outbreak in the United States.
DR. PAUL FARMER: Well, there could be, but it would be stopped quickly, because patients would be isolated, not in quarantine facilities without medical care, but in places like Emory or the place where I work in Boston, at the Brigham and Women’s Hospital. And even in Haiti or in Rwanda, you know, we’ve prepared, along with the authorities, isolation rooms that are not to shut people away, but to take care of them while protecting the rest of the staff, if they have an infectious illness, an airborne illness, say.
So, you know, back to Juan’s question, why would there be such massive variation in case fatality rate? And to me, that always says, because there has not been an overlap between the epidemic, Ebola epidemic, and modern medicine. We’re talking about Medieval-level health systems and a modern plague that’s going to spread. And when we can overlap modern medical systems and modern public health systems, then we can see what the case fatality really would be. I mean, just to be provocative, what if it’s 10 percent instead of 90 percent? What if it’s 5 percent, with proper medical care? And I’m saying even without a specific therapy for that disease, which we’re all waiting for and hopeful about some of the new agents.
In an October 3 address at Stanford, Farmer stated,
We should be saving majority of Ebola patients.
“Almost no [care] delivery has occurred around Ebola,” said Farmer, MD, PhD, who recently returned from Liberia, where his Partners in Health organization is working to combat the epidemic. “There is not a lot of T [treatment] and not a lot of C [care] in Ebola care units. If you don’t have the resources, you’re not going to have the staff, the space, the stuff you need. I think the least we could do is have a safety net for everybody,” he told the 400 people who gathered to hear him speak. His presentation was moved to the Graduate School of Business to accommodate the crowd.
He said patients are not receiving even the most basic of care, such as fluids and electrolyte replacement for shock, a common symptom of the disease.“A lot of the problem is related to treatable issues. We should be saving the majority of patients,” he said.
His conclusions:
“Stopping it is going to require a lot of staff and materials. Just the sheer amount of personal protective equipment is enormous, not to speak of diagnostics, equipment and so on. And there will need to be massive renovation and creation of new spaces, because this is a difficult disease to manage. So it’s a big problem. I think it’s going to be around for a long time.”
He said those most at risk for the disease are caregivers because they are most likely to be exposed to patients’ blood and body fluids.
“Most care-giving takes place at home. Who gives care? Your mom. The others at risk are nurses, nurses’ aides, ambulance drivers, even Good Samaritans, like the Liberian man [the first infected person in the United States] who was trying to help a neighbor who was pregnant. So it is a caregiver’s disease,” Farmer said.
Medical anthropologist
Theresa MacPhail cited Farmer when she was interviewed by John Horgan for
Scientific American in
Ebola “Fear Mongering” Critiqued by Medical Anthropologist, and discussed the current climate of fear in the U.S.:
Horgan: Some Americans were very worried when Ebola victims were brought to the US for treatment. Were their fears unfounded?
MacPhail: Absolutely. Ebola is a filovirus and it’s only spread through close contact – from coming into direct contact with an infected person’s blood, mucus, or other excretions. So unless you come into direct contact with one of those things, you’re not going to get this virus. And the people being brought in were under strict isolation, so there was never any danger to the public.
Horgan: Is there a downside to exaggerated reports about infectious diseases?
MacPhail: I think so, yes. I think that when you hype up fears around a single disease agent like Ebola, or MERS or SARS for that matter, you run the risk of masking the true threats to health – which have more to do with how prepared we are to handle ANY outbreak of infectious disease than with any single infectious disease agent. Take bird flu, as just one example. For years, we’ve been preparing for an outbreak of a deadly strain of influenza. All this money has poured into surveillance systems (which is probably good) and planning. But in our myopia about flu, what did we miss? In preparing for a deadly outbreak of a highly infectious disease agent, did we adequately prepare to deal with something like the spread of dengue fever or Chikungunya – both of which are nasty viruses spread by mosquitoes and are making slow but sure advances here in the U.S.? I’m a fan of making people aware of the dangers, but I’m not sure I see how exaggerating the dangers of someone in the U.S. contracting Ebola is going to help us.
Not to be too crass, but there’s always money to be made in fear mongering. I’m sure the click-thru rates go up for a story with a bold title about Ebola.
We have sanity coming from Dr. Farmer and other public heath experts, but we have the reverse being shouted and touted, not just from the usual suspects.
One of the worst stories hyping up fear, riddled with inaccuracies, was an August cover story in Newsweek, rebutted by the Washington Post in The long and ugly tradition of treating Africa as a dirty, diseased place:
This week’s Newsweek magazine cover features an image of a chimpanzee behind the words, “A Back Door for Ebola: Smuggled Bushmeat Could Spark a U.S. Epidemic.” This cover story is problematic for a number of reasons, starting with the fact that there is virtually no chance that “bushmeat” smuggling could bring Ebola to America. (The term is a catchall for non-domesticated animals consumed as a protein source; anyone who hunts deer and then consumes their catch as venison in the United States is eating bushmeat without calling it that.) While eating bushmeat is fairly common in the Ebola zone, the vast majority of those who do consume it are not eating chimpanzees. Moreover, the current Ebola outbreak likely had nothing to do with bushmeat consumption.
Other news outlets followed suit with condemnations, such as this article,
Newsweek’s racist and misinformed Ebola cover story, say some:
Polls show that 40% of Americans (a Fox News poll cites 60%) believe an Ebola outbreak is likely in a US city. Since Ebola is transmitted through bodily fluids, the odds of an outbreak in the US is extremely unlikely. That fact does not allay concerns for roughly two out of every five Americans.
Another:
Newsweek accused of 'racism' and 'fear mongering':
Newsweek's cover story on potential Ebola transfer into the US has readers crying racism for both image choice and content. Published August 21 under the title "A back door for Ebola-Smuggled bushmeat could spark a US epidemic", the magazine promotes the story with a chimp on its cover.
The story sparked criticism from activists, academics, bloggers and journalists, many using the hashtag #NewsweekFail.
This type of fearmongering and playing to hatreds isn't new for me, having worked as an
applied medical anthropologist in AIDS research and having lived though some of the worst periods of the epidemic in New York City, dating back to the days of so-called
GRID. I am reminded of the stupid homophobic and racist U.S. entry laws put into place—laws President Obama
put an end to in 2010. Stigma against gay men and Haitians was rampant. Fear was hyped up to the point that there were people advocating for removing all persons found to be HIV positive, or with AIDS, and putting them in quarantine in remote facilities.
Granted that the AIDS fear mode has receded, we certainly haven't "ended AIDS." The disease is still the likeliest killer of people in Africa, followed by malaria. Coverage of the epidemic has shifted here as well, onto the back pages of newspapers and blogs—simply because the affected populations are those who are poor, young, and primarily people of color.
Fear, racism, and xenophobia are rampant, hyped by the media—with FOX news leading the pack. But left and liberal venues are not immune either. Combine "Ebola scare tactics" with nativist and xenophobic positions and you have a toxic and volatile stew.
Tommy Christopher wrote Latest Fox News Racism Doesn't Even Make Racist Sense, for The Daily Banter:
Forget Ebola, there is no cure for this kind of stupid. In her latest bout with Acute Hemorrhagic Negrophobia, Fox News’ Outnumbered co-host Andrea Tantaros earned a Media Matters flag this afternoon when she tried to explain this Ebola thing to her fellow Outnumberers. After first telling Fox News’ audience that the man diagnosed with the deadly virus in Texas “exposed himself to children,” and that we “we can’t rely on people for human intelligence,” Tantaros proceeded to explain the danger of people from Africa lying in order to exploit our country’s superior medical care. That’s where she ran into trouble,
"Witch doctors and someone who practices Santeria"
Christopher continues:
Set aside the gratuitous shot at NOBAMA, himself the target of the “witch doctor” slur, and just evaluate Tantaros’ statement on its own logical merits. One minute, she’s afraid that these lying Africans will scam their way into the country to use our awesome hospitals, and our awesome hospitals are not equipped to handle this! Then, she’s worried that the covetous-of-medical-advancement liars will instead go to a “witch doctor,” because where would they find a Santeria practitioner in West Africa? So, now, hopefully, they will overwhelm our hospitals.
Not a lot of what conservatives are saying about Ebola makes a lot of sense, but at least blaming Obama makes sense on its own terms, because that’s what they do for everything. Maybe someone should quarantine Tantaros, because clearly, she’s picked up something from all that guano.
The story was also covered in
Racist Fox Troll Claims African Ebola Patients Will Seek Out ‘Witch Doctors’ For Treatment:
During a segment on Fox News’ Outnumbered Thursday, the network’s favorite little racist troll, Andrea Tantaros, claimed Africans traveling to the United States who may possibly be infected with the Ebola virus won’t go to hospitals, but instead seek out witch doctors for treatment. The discussion on the show first centered on news surrounding the first Ebola patient in the United States, Thomas Eric Duncan, and the fact that he was initially allowed to leave a hospital with antibiotics after being admitted for a fever and abdominal pains. Two days later, and ten days after he had first arrived from Liberia, Duncan tested positive for Ebola. It is now thought that he may have come into contact with as many as 100 people since first arriving in America.
When it was time for Tantaros to talk, she did her usual job of semi-coherent blathering combined with full-on racial stereotyping. She first complained that “we can’t look to people for human intelligence. We just can’t!” I want you to please re-read that quote and then try to make sense of it. It appears she’s saying we can’t count on humans to be as smart as humans. It seems to me that Tantaros got confused when putting together whatever word salad she had prepared and just hoped for the best when she opened her mouth.
After that little morsel of WTF, Tantaros then moved on to her favorite pastime — saying awful things about people of color. Tantaros said we can’t trust people from Africa to be truthful about their activities, and we also can’t trust that they will do the right thing if they feel symptoms. At the same time, she also claimed that they want to come to the US in order to get treatment, seemingly contradicting the point she was trying to make about African people going to witch doctors.
Um ... "Santeria" (
Lukumi) is Afro-Cuban in origin, and has no relationship to Liberia. It does have roots in Nigeria. And no, Lukumi priests and priestesses are not "witch-doctors." Some are even medical anthropologists, like me.
Hunter covered more on Fox Spews recently in Fox News, pundits try their best to sow Ebola panic. Because Obama, concluding:
There's probably a long explanation to be written here about why certain folks are insistent upon turning themselves into quivering masses of fear over this one particular thing when there are a great many other homegrown 'Murican diseases or bullets or terrorists are much more likely to kill them and we can't get them to ever shut up about how piffling those things are, or how uncannily the tide can turn from government has no business spending money on this to government should move heaven and earth now that I have decided I am afeared of this thing, but it's probably also unnecessary. If you can get from Ebola to Benghazi to the IRS in one half-sentence, we all pretty much get the gist of what's going on here.
If a true epidemic does arrive in America anytime soon we're screwed, you know. Something like the Spanish Flu? We tsk at the foolish people in Africa who suspect the doctors of manufacturing the disease, or who refuse to take precautions because it's what the conspirators want them to do, but we'd have entire news programs devoted to the same thing. There might be a vaccine, but there'd also be pundits warning people not to take those vaccines because suspicious. Everyone would stockpile guns, because the answer to everything is to stockpile guns. We'd be told people were dying because God was punishing us, and that to stop the epidemic we had to appropriately punish gay people, or brown people, or "diversity"-peddlers, or ACORN, or that government was intentionally not stopping the epidemic because they had $1 billion of disposable coffins that they really needed to get out of the FEMA warehouses. Nope, we would be well and truly screwed.
The following is a short clip from a
longer video that I recently showed my students, who reacted with horror (they don't watch FOX, and were unaware of what FOX is brainwashing viewers with).
Conservative Xenophobic Nativism, Disinformation and White Fear in America, which links disease fearmongering to anti-immigrant hyperbolic spewing.
This mash-up of rightwingnuttia is dangerous—scabies, lice, tuberculosis, and Ebola are used as stigmatizing rhetoric to push the meme of "close the borders and kick people out." Some go as far as demanding people be shot.
Dr. Farmer discussed some of this in his interview with Amy Goodman and Juan Gonzales:
Several Republicans have suggested migrants from Central America could bring the Ebola virus with them when they cross into the United States. The trend began in July, when Republican Congressmember Phil Gingrey of Georgia wrote a letter to the Centers for Disease Control and Prevention that noted, quote, "reports of illegal immigrants carrying deadly diseases such as swine flu, dengue fever, Ebola virus and tuberculosis are particularly concerning," unquote. Then, this month, Representative Todd Rokita of Indiana expressed similar fears during a radio interview on WIBC.
REP. TODD ROKITA: We sent a letter to the president saying, "Look, first of all, you know, we have got to know—not from the press. We have got to know ahead of time, so we can plan for this." So we did that. Dr. Buschon was helpful—and I’m not sure if this made the final draft of the letter or not, I think it did—to your point about the medical aspects of this. He said, "Look, we need to know just from a public health standpoint," with Ebola circulating and everything else—that’s my addition to it, not necessarily his. But he said, "We need to know the condition of these kids."
AMY GOODMAN: That’s Congressman Todd Rokita. And the Dr. Buschon he refers to is Congressman Larry Buschon of Indiana, who’s a heart surgeon. Well, our guest is Dr. Paul Farmer, infectious disease doctor, medical anthropologist, founder of Partners in Health, professor at Harvard Medical School. Your response?
DR. PAUL FARMER: Well, I mean, you kind of know my response, because if the pathogens don’t have borders, you know, or don’t respect borders—Partners in Health was founded with the idea that every human life has equal value and, in fact, that we should pay more attention to poor people. So, I would say, if we have resources, that we should bring them in. So, I mean, I’m already not even allowed to be part of that conversation. First of all, that’s also epidemiologically absurd, right? Because we don’t have any reports of Ebola or other hemorrhagic viruses in the border he’s referring to, which is our big one to the south.
The international health community has known about the Ebola virus disease (EVD) since
1976. Even after the latest severe outbreaks, there were
major obstacles—economic, bureaucratic and political—that prevented a comprehensive response. Farmer talks about "paying more attention to poor people." Given the political climate and balance of power here in the U.S.—currently dominated by obstructionists and right-wing haters—it is hard for me to imagine that we will stem the tide anytime soon. Yes, Americans are concerned and fearful—now, now that they are aware that pathogens don't respect borders. Building walls, and fences, and blocking entry to the U.S. of anyone from affected areas is not a solution. Just like climate change and global warming science is ignored and denied by a host of our elected officials, so too will stemming this current crisis be stymied by those who frankly don't give a damn about malaria, or AIDS, or black people, or the poor. They voted for cutting funding for WHO, and the CDC, and are constantly railing against the federal government that pays their salaries. Republicans want to
block funding for the Ebola battle. Until we have more sane officials sitting in Congress, long-term solutions are not going to happen.
How can you make a difference? Support turning Congress around with your donations, and help us hold the Senate.
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