Teaching about the Ebola Crisis:

Beyond Hysteria and Stereotypes to Understanding

and Empathy

John Metzler & Morgan Kinstner, African Studies Center

Michigan State University

Making sense of and teaching about the Ebola crisis: Moving beyond hysteria to

understanding and empathy

The following presentation was developed for and presented at a teacher workshop hosted by the annual meeting of the African Studies Association, Indianapolis, November 22, 2014

We decided to post our power point presentation in response to requests from the participants to share the entire presentation. We trust that other educators will find the presentation to be helpful in addressing this important issue with their students."

Making sense of and teaching about the Ebola crisis: Moving beyond hysteria to

understanding and empathy

The presentation is divided into six sections: Stand alone introductory map exercise (one slide) Biomedical background: slides 5-14 Student Activity: What do these images (cartoons) tell

us about the way Ebola is perceived? Slides 15-18 Why are Americans so concerned (hysteria) about

Ebola? Africa as represented in the Western Imagination. Slides 19 – 24

Coming to an understanding: Setting the socio-historical context in Guinea, Liberia & Sierra Leone: slides 25 – 34

Impact and Intervention: slides 35 - 43

What are these maps telling us?

Biomedical Background InformationWhat is Ebola?

A filovirus in the family Filoviridae.

Causes severe hemorrhagic fever.

Five species of Ebola have been identified; only one does notcause severe disease in humans.

Each filovirus virion (complete viral particle) contains onemolecule of single-stranded, negative-sense RNA.

New particles bud from the surface of their hosts’ cells,although replication strategies are not fully understood yet.

(Information from Prof. John B. Kaneene, University Distinguished Professor of Epidemiology and Director, Center for Comparative Epidemiology)

How Ebola Attacks Healthy Cells

Disease Vectors

Ebola is spread by only a few species of mammals (humans, bats, monkeys, apes).

Blood or body fluids (including but not limited to urine, saliva, sweat, feces, vomit, breast milk, and semen) of a person who is sick with Ebola.

Objects (like needles and syringes) that have been contaminated with the virus.

Symptoms of Ebola

Fever (greater than 38.6°C or 101.5°F)Severe headacheMuscle painVomitingDiarrheaStomach painUnexplained bleeding or bruising4

Symptoms may appear anywhere from 2 to 21 days after exposure to Ebola but the average is 8 to 10 days.

Recovery from Ebola depends on the patient’s immune response. People who recover from Ebola infection develop antibodies that last for at least 10 years, possibly for life.

Who is at risk?High RiskPerson has been exposed to the virus in communities where the virus is widespread.Direct contact with a dead body without appropriate personal protective equipment (PPE) in a country with widespread transmission.Has lived in the immediate household and provided direct care to a person with symptomatic Ebola

Some RiskPerson lives in a country with widespread Ebola Transmission.Direct contact while using appropriate PPE with a symptomatic Ebola.Prolonged, close (within 3 feet) contact in households, healthcare facilities, or community settings with someone with symptomatic Ebola.

Low RiskHas visited a country with widespread transmission within the past 21 days. Brief direct contact (e.g. shaking hands), while not wearing PPE with a person with early stage Ebola.Brief proximity (e.g. the same room) with someone with symptomatic Ebola.Has traveled on an aircraft with a person with symptomatic Ebola.Where there is not widespread transmission, having direct contact while using PPE with a person with symptomatic Ebola.

No Identifiable Risk Contact with an

asymptomatic person who had contact with person with Ebola.

Contact with a person with Ebola prior to developing symptoms.

Having been in a country with widespread transmission more than 21 days prior.

Having been in a country with widespread transmission but not having any other exposures as listed above.

How you don’t

get Ebola

Treatment

No FDA-approved vaccine or medicine is available for Ebola.

Experimental vaccines and treatments for Ebola are in development, but have not yet been fully tested for safety or effectiveness.

Several phase 1 clinical trials for vaccines have begun in recent months with several others being expedited due to current events.

Need for ethical trails, even under extreme need Symptoms are generally treated as they appear.

Early Treatment

Many people are unaware that, when caught early, treatment is proven and effective.

Basic supportive interventions, when used early, greatly improve chances of survival. Providing intravenous fluids (IV)and balancing

electrolytes (body salts). Maintaining oxygen status and blood

pressure. Treating other infections if they occur.

Early Outbreaks

What do you most commonly hear at school about Ebola?

From students From parents From other teachers From administrators

What do the following images tell us?

Why are Americans so concerned with Ebola?

Africa in the West’s Imagination

• The West typically imagines Africa and Africans as an “other” – in fact, the most impenetrable of all places to the Western psyche and understanding is Africa.

• From the earliest contact with sub-Saharan, “black” Africa centuries ago, Africa has been imagined as an incomprehensible, “dark continent.”

• Africa is viewed in the West as exotic but fear-inducing. What are the consequences of this view?

Consequences

It’s easy for us to develop explanatory constructs with which we interpret Africa, Africans, and “things” like diseases, that emanate out of Africa, which bear little resemblance to reality. This is what makes it easy to wildly exaggerate the dangers of Ebola in the U.S. (in part because of its African origins) in contrast to our interpretation and representation of diseases that are perceived as more “normal” (such as influenza) but certainly the source of more deaths in the U.S. than Ebola.

Sources of hysteria in the U.S. Mainstream media Social media Entertainment media Politicians seeking political advantage at election time

Why are Americans responsive to the hype and hysteria even when

confronted with biomedical evidence to

the contrary?

I am a Liberian, not a virus:

http://youtu.be/UEs8xHgBq7g

Coming to an Understanding Let’s take a look at the historical,

political, economic, and social context of the current outbreak in Guinea, Sierra Leone, and Liberia.

Colonial State Political

Weak, non-democratic states with limited capacity to meet the needs and legitimate demands for citizenry (jobs, housing, education, adequate health care)

Colonial Economies & Social Infrastucture

Economic Underdeveloped,

extractive, “mono” economies; Profits exported to Colonial power, limited development of economic infrastructure & local markets

Distorted capitalism

Colonial Social Infrastructure Social

Underdeveloped educational and health systems—limited value to colonial agenda

Limited sanitation infrastructure, even in urban areas

Limited supply of potable, safe drinking water

SAPs: Weakening Post-Colonial States

• In 1980s the World Bank and International Monetary Fund (IMF), the major lenders to developing countries, with full support of the U.S. and European Union, forced African Countries to adopt “Structural Development programs (SAPs)

• Focus of SAPS: radically reduce state revenues & expenditure in all areas, but including education, health and social infrastructure

• Result? Decimation of already underdeveloped educational and health care systems

• Hence, very limited capacity to respond to major health crises.

• “Ebola is a disease of Neo-Liberalism” (Liberian Scholar at ASA conference, 2014

The Pathologies of Civil Wars Liberia underwent two civil wars at the end of

the millennium: 1989-1996 and 1999-2003.

Sierra Leone civil war from 1991-2002

Impact of Civil War on Sierra Leone and Liberia

Political Legacy of Civil Wars Weak state bureaucracy – very limited capacity to meet demands of

rebuilding social, political, and economic infrastructure. Economic Legacy of Civil Wars

Devastated economy: productive base in mines and agriculture destroyed; legacy of extreme poverty Guinea: GDP ranked 148 out of 182 countries in the world; Per Capital income $564

(#172 in the world); 73% population live on less than $2 per day Liberia: GDP ranked 171 out of 182; Per Capital income $473; 95% population live on

less than $2 per day Sierra Leone: GDP ranked 83 in world; Per Capital income $805; 76% live on less

than $2 per day Social Legacy of Civil Wars

Destruction of social fabric – traditional community and family norms shattered – intergenerational roles /relationships drastically altered; social obligations /responsibilities erased; anomie; increased incidences of stigmatization Education: Primary school enrollment: Guinea 70%, Liberia 41%, Sierra Leone 40% Health Care: Government clinics and hospitals destroyed; Before Ebola outbreak, life

expectancy in Liberia and Sierra Leone was under 50 years of age; infant mortality rate per 1,000 live births: Guinea 57, Liberia 71, Sierra Leone 74

Governance, Nepotism, Corruption, Agency & Accountability

Scholars and Activists from Guinea, Liberia and Sierra Leone assert that government leaders in effected countries have to take partial responsibility for (i) decay in health infrastructure and (ii) the lack of adequate response to Ebola crisis due to corruption, nepotism and ethnicity (case of Sierra Leone-Guinea border, a strong hold of the opposition party.

How does this civil war legacy help explain the ability of Ebola to spread rapidly in Guinea, Liberia, and Sierra Leone?

Dr. Paul Farmer, founding president of Global Partners in Health, said, “This [Ebola outbreak] isn’t a natural disaster. This is the terrorism of poverty.” What does this mean?

The history and epidemiology of the current outbreak

Impact of the disease Economic

Increased demand on scarce government revenues for health care, transportation, food, etc.

Lost productivity – illness, missing work caring for loved ones; quarantine areas

Some estimates that countries will lose up to 25% of their food production

Reduction in direct foreign investment due to fear Decline in exports due to “chocolate fear” Increase in price of imports Greater indebtedness GDP may decline by as much as 10% this year

Social Unequal burden on women, the primary care-givers Children – increase number of orphans School closures Over-taxation of inadequate health care system Impact on traditional family/community structures

by both loss and stigma Political

Challenge to already weak governmental apparatuses to meet the increased health, social, and economic demands brought on by the Ebola outbreak

Crisis of legitimacy

Global Intervention: Who has been responding?

Primary Responder: International NGOs

Medecins Sans Frontieres (Doctors Without Borders)

Global Partners in Health

Religious Charities

Global Intervention: Who has been responding?

International Health Agencies: World Health Organization (WHO)

Criticized for Slow Response: lack of capacity due to insufficient funds—U.S. has not fully paid dues to WHO for nearly a decade

Global Intervention: Who has been responding?

Developed countries: U.S. primarily Liberia U.K primarily Sierra

Leone France primarily Guinea Medicines, medical

supplies, field hospitals, advisors (CDC)

U.S has allocated $750 million to its field hospital initiative (approximately $2 per American)

Cuba—265 doctors!

Global Intervention: Who has been responding?

Individual volunteers and contributions

Many American nurses and Doctors volunteering in Guinea, Liberia, Sierra Leone, but,

Charities indicate that individual contributions to support Ebola efforts lower than response to “Christmas Tsunami,” and Haitian earthquake relief: WHY?

Problematizing the International Response

In addition to the inadequate response in terms of material and personal:

Lack of recognition of local context—heterogeneous even within three neighboring countries: cultural, socio-economic, religious, urban-rural etc. “universalization” treatment-intervention

Medicalization of an epidemic that is deeply social, economic and political in its manifestations: where are the African/Africanist social scientists? (movement/quarantine/funeral practices)

Unwillingness to recognize or acknowledge local knowledge & practice—example of Liberian nurse who nursed family members back to health

Local Response In spite of stories

of stigmatization of Ebola victims & their families, Guineans, Liberians, & Sierra Leoneans have responded with great courage and compassion

What can we do as educators to: (1) change the stigma and hysteria surrounding Ebola? And,(2) how can we help students critically engage and understand the context of the Ebola outbreak?

For Additional Information

In an attempt to respond to the hysteria perpetuated by much of the mainstream media in the U.S., exacerbated by posts on social media, the African Studies Center at Michigan State University has compiled a list (which will be updated weekly) of electronic articles and blogs that bring reasoned understanding to the crisis, challenging the hysteria in the U.S. with a comprehensive analysis of the human, social, economic and political impact of the outbreak in Guinea, Liberia and Sierra Leone and their neighbors.  

Visit our website: http://africa.msu.edu/news/ebola_background/