West Africa’s Ebola epidemic has its roots in poverty

Much of my time as chief medical officer of health has recently been spent preparing Yukon for the remote chance that the Ebola virus could sneak into the territory. What if a person somehow escapes border screenings and returns infected

COMMENTARY

by Brendan Hanley

Much of my time as chief medical officer of health has recently been spent preparing Yukon for the remote chance that the Ebola virus could sneak into the territory.

What if a person somehow escapes border screenings and returns infected from West Africa to Yukon? What if an international aircraft with a sick patient – possible Ebola – is diverted to Whitehorse? What if a returned nurse or emergency aid worker – perhaps in a rural community—becomes ill?

We have conferred with our counterparts around the continent, rehearsed scenarios, and produced guidelines and communication pathways, all with the aim of preparing and protecting our health care work force – and the public – while providing the best possible care. Ebola planning has taken on a life of its own, shoving aside other important initiatives and ever greedy for more time and more details.

Don’t get me wrong. This is important planning, for even if we don’t see Ebola, we are all the better prepared for any health emergency. Emergency planning is part of public health, and if all goes as planned, a potential catastrophe becomes a mere ripple.

But while we prepare, it is on the front line that West Africans and a growing cadre of international helpers are struggling to help the thousands of ill people – to advise, to treat, or to console as best as they can those who are beyond hope.

While in Ottawa two weeks ago, I walked by the National War Memorial and recalled the tense play-by-play of the tragic one-man attack on Corporal Cirillo, followed by the near-deadly infiltration into the inner sanctum of the House of Parliament. A big, sad, day for Canada. Immersed in Ebola planning, I couldn’t help compare that terrifying moment to the frightening spectre of Ebola appearing on our own soil.

The Ottawa eruption of violence – one furious, perhaps deranged man with a gun – was fueled by events half the world away in Syria and Iraq.

Hundreds of thousands of deaths, tortures, and disappearances have occurred in the spiral of collapse and cataclysm that has intensified since the first U.S. invasion of Iraq. What was one black day for Canada is a daily trauma for people residing in much of the Middle East.

Similarly, while we carefully plan for that first Ebola case that might come to Canada, thousands are suffering and dying from the actual disease a continent away in West Africa. Both of these isolated events – the possible case of Ebola in Yukon and the shooting in Ottawa – are both connected to massive epidemics, either of disease or of chaotic violence, far away.

Beyond the immediate task of taking down a lone gunman or of controlling Ebola’s threat, more durable answers to both these epidemics surely lie in examining these connections. I can’t speak with much authority on the Middle East, but it does behoove us to realize that there are as many layers as an onion to this Ebola outbreak.

Looking past the immediate distress wrought by Ebola, we see a fragile health-care system overwhelmed so that even basic health care has all but disappeared. Immunizations, maternity care, primary care clinics, even hospitals, have either shut down or severely curtailed their services. Children, mothers, and working adults are dying as a result.

Beyond health care, transportation, schools, markets, agriculture, indeed all the essentials of societal structure have collapsed so that people are not getting education, enough food to eat, or the ability to make a living.

Peeling behind the societal collapse we see lack of infrastructure, corruption, and a people traumatized and impoverished by wars that ended only years ago. Health without peace is not possible. The wars in Sierra Leone and Liberia witnessed the use of child soldiers, systematic rape, and mutilation that tore the countries apart.

And why? Here is another layer in our Ebola onion. The story is so common, not only in resource rich Africa but in so many areas around the world. Instead of prosperity, we see pillaging by rapacious foreign-led markets, and corrupt leaders that have run away with the riches.

Look at the legacy of diamond mining in Sierra Leone; what benefits filtered down from those gems? At the same time in Liberia, Charles Taylor co-opted the lucrative Liberian timber industry for his own gain while financing the terrible war in Liberia.

Ironically, Ebola has hit these countries just when recovery was in the offing: they were growing their economies and seeing the hope of stability and some hint of material well-being return. But this recovery was so fragile that Ebola has just mowed it down.

We do have to stop this disease. That’s the emergency before us.

Then as we catch our breath we can review how failing states are fertile ground for epidemics. We should long ago have learned that economic growth in and of itself is not enough. Riches do not trickle down of their own accord.

Canada needs to support not just the economic growth that comes with mineral exportation, but balanced, fair trade, and generous aid that allows investment in infrastructure, health, and education. Peace may be fundamental to health, but peace cannot last without social justice.

Donating to the fight against Ebola as a government or as individuals must be done. But in the spirit of “thinking globally and acting locally,” we would also do well to pay attention to the global costs of letting mineral-rich countries languish in poverty.

When Sierra Leone and Liberia can benefit, with international help, from infrastructure development and investment in education and health as well as economic growth, then Ebola should be a distant threat for all.

Brendan is Yukon’s chief medical officer of health.

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