Evelyn Marsters, Monrovia, Ebola, Impolitikal

Evelyn Marsters on poverty & the Ebola crisis

The Ebola (EBV) crisis is now a public health emergency of international concern. As of August 18, 2014, the World Health Organisation (WHO) reported a total of 2,473 suspected cases and 1,350 deaths in Guinea, Sierra Leone, Liberia and Nigeria. I have been following the epidemic since April this year, and becoming increasingly unsettled. We’ve all seen the terrifying images of those affected by the virus, and know by now that, with a fatality rate of over 90%, it warrants the most rapid and rigid of medical responses.

News coverage of Ebola and its spread tells the story of how we should do everything in our power to prevent the virus permeating Western public health systems, but substantive information about the virus itself is left out. This contributes to the manifestation of disease misunderstanding and generates fear among communities – both those directly affected, and those at a distance. In this article, I provide a simple explanation of Ebola itself and contextualise the crisis within the layers of disadvantage West Africans face.

For the sake of clarity, Ebola can be best understood as passing from person to person through bodily fluids, including saliva or phlegm. The virus can ride on the back of airborne fluids and remain in the environment for some time, potentially entering another person’s body. It is not aerosolized ‘in the air’ – instead it hitches a ride on bodily fluids. Ebola has a short incubation period, which means people present with symptoms shortly after infection and, fortunately, that testing for Ebola can occur quickly.

According to the WHO“EVD…is a severe acute viral illness often characterized by the sudden onset of fever, intense weakness, muscle pain, headache, nausea and sore throat. This is followed by vomiting, diarrhoea, impaired kidney and liver function, and in some cases, both internal and external bleeding. Laboratory findings frequently include low white blood cell and platelet counts and elevated liver enzymes. The incubation period, the time interval from infection with the virus to onset of symptoms, is 2 to 21 days. People remain infectious as long as their blood and secretions contain the virus, a period that has been reported to be as long as 61 days after onset of illness. The virus is then passed from person to person through direct contact with the blood, secretions or other bodily fluids of infected persons, or from contact with contaminated needles or other equipment in the environment.”

The multiple transmission routes and high fatality rates of Ebola necessitate the strictest of quarantine procedures. In order to isolate the virus, people with known symptoms must seek medical attention, and it is at this juncture that testing can occur and contact tracing be initiated. This screening process is crucial for infectious diseases in order to surveil the possible transmission of the virus from person to person. Clinicians work outward from a source case and attempt to connect all the possible subsequent infections. Contact tracing relies heavily upon early detection, which in turn relies upon affected populations trusting the medical systems, understanding the disease and seeking medical attention as soon as possible. Fear of diagnosis and disease misunderstanding are real obstacles to disease containment. In the case of Ebola, even the most medically vigilant of us can imagine the horror of a long journey to the clinic to be told of your likely death, and the implications for your family.

As the virus continues to gain momentum, we can assume that significant difficulties exist in terms of operationalizing public health interventions. To fight back against the rapid spread of Ebola, untested and unapproved drugs – namely ZMapp – have entered the scene. The WHO’s decision to forgo the normal ethical procedures and trial the drugs on Ebola patients confirms the seriousness of the threat the virus poses to global health. This intervention also elucidates the power imbalances that shape the global health landscape. The most crude depiction is that poor people in developing countries experience the highest incidences of infectious diseases, whilst people in the West, with access to effective public health services, have transitioned into an era of being mostly affected by lifestyle diseases.

Infectious diseases are by and large diseases of poverty, and the closer to poverty you are on the spectrum, the greater your vulnerability. Dwellers of countries in the West should take comfort in this; our environment – bio-physiologically, economically and socially – will most likely protect us from Ebola epidemics. The social, political and economic vulnerability of populations in Liberia, Nigeria, Guinea and Sierra Leone, however, is exacerbating its effects and shaping public health responses. While I do believe that the speed at which Ebola is spreading warrants drastic interventions such as the use of the untested drug treatments, more discourse, particular surrounding the politics of how these decisions are made, is necessary.

In my opinion, one of the most violent attempts to contain Ebola has been the militarisation of quarantine efforts in areas with high case numbers. Boundaries have been erected to contain the virus in Liberia, the country with the highest share of fatalities in this public health crisis so far. Walls constructed out of scrap materials and barbed wire are being erected by the military in Monrovia and Dolo Town without warning. A biological border has manifested, and the populations of these slum areas have been quarantined to prevent the spread of the disease. The terrifying isolation and struggle these people are facing warrants a global shift from a reaction of fear to one of immense empathy.


Evelyn Marsters has a PhD in Development Studies from the University of Auckland (NZ) and is currently based in Berlin. Her focus is global health and migration, and she is Deputy Editor at Impolitikal. Read more by Evelyn.

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