The politics of fear : Médecins sans frontières and the West African ebola epidemic

305 Pages·2017·2.45 MB·English

by  Sokhieng Au

The Politics of Fear

The Politics of Fear
Médecins Sans Frontières and
the West African Ebola Epidemic
EDITED BY MICHIEL HOFMAN
and
SOKHIENG AU
1
1
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Library of Congress Cataloging- in- Publication Data
Names: Hofman, Michiel, editor. | Au, Sokhieng, editor.
Title: The politics of fear : Médecins Sans Frontières and the West African
Ebola epidemic / edited by Michiel Hofman and Sokhieng Au. Description: Oxford : Oxford University
Press, [2016] | Includes bibliographical references and index.
Identifiers: LCCN 2016027983 (print) | LCCN 2016042202 (ebook) |
ISBN 9780190624477 (hardcover : alk. paper) | ISBN 9780190624484 (ebook) |
ISBN 9780190624491 (ebook) Subjects: LCSH: Ebola virus disease—Africa, West. | Ebola virus
disease—Social aspects—Africa, West. | Ebola virus disease—Political aspects—Africa, West. |
Epidemics—Social aspects—Africa, West. | Epidemics—Political aspects—Africa, West. |
Médecins Sans frontières (Association) | Africa, West—Social conditions.
Classification: LCC RC140.5 .P65 2016 (print) | LCC RC140.5 (ebook) |
DDC 362.196/92—dc23
LC record available at https://lccn.loc.gov/2016027983
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CONTENTS
Preface vii
Christopher Stokes
Contributors xi
Introduction xv
Michiel Hofman and Sokhieng Au
THE RESPONSE
1. Doctors Against Borders: Médecins Sans Frontières
and Global Health Security 3
João Nunes
2. Whose Security? Militarization and Securitization During
West Africa’s Ebola Outbreak 25
Adia Benton
Vignette 1. A Few Days in July
Lindis Hurum
THE SYSTEM
3. The “Humanitarian” Response to the Ebola Epidemic
in Guinea: Between Routines and Exceptions 63
Jean- Francois Caremel, Sylvain Landry B. Faye,
and Ramatou Ouedraogo
v
vi Contents
4. The Initial International Aid Response
in Sierra Leone: A Viewpoint from the Field 85
Thomas Kratz
5. Dying of the Mundane in the Time of Ebola: The Effect of
the Epidemic on Health and Disease in West Africa 101
Mit Philips
Vignette 2. Treating, Suffering, and Surviving Ebola: The Story
of Prince as told to Patricia Carrick
Prince Lahai and Patricia Carrick
PATIENTS
6. How Did Médecins Sans Frontières Negotiate Clinical Trials
of Unproven Treatments During the 2014– 2015 Ebola
Epidemic? 133
Annette Rid and Annick Antierens
7. Failing Dr. Khan 175
Tim O’Dempsey
8. Finding an Answer to Ebola’s Greatest Challenge 187
Armand Sprecher
Vignette 3. Children in the Ebola Treatment Centers
Allie Tua Lappia and Patricia Carrick
CONTAINMENT
9. Fear and Containment: Contact Follow- up Perceptions and Social
Effects in Senegal and Guinea 209
Alice Desclaux, Moustapha Diop, and Stéphane Doyon
10. Challenges of Instituting Effective Medevac Policies 235
Duncan McLean
Vignette 4. Returning to the “Ebola World”
Maud Santantonio
Index 259
PREFACE
With the clarity of hindsight, the word “unprecedented” is now firmly associated
with the West African Ebola epidemic of 2014 and 2015. The figures speak for
themselves: 25,213 cases were confirmed in the first year of the outbreak and
10,460 patients died. Health professionals deployed by MSF were not immune
to the disease either: in the same period, 28 MSF staff were diagnosed with
Ebola and 14 of them died. However, these cold figures do not show the tremen-
dous impact this epidemic had, not only on those directly infected by the virus,
but also on the societies through which the disease spread and on those who
responded to the crisis. The world, including MSF, was slow to respond. All of
us, without exception, underestimated how rapidly and how far the virus would
spread. We also underestimated the scale of the efforts that would be needed to
assist those affected and to control the epidemic.
Prior to the West African outbreak, Ebola was a relatively rare disease that had
limited local impact and that burned out fairly quickly. MSF, as one of the few
agencies with direct experience responding to Ebola outbreaks in the past, had
built up a level of expertise. As a result, from the first days of the epidemic, MSF
found itself at the center of the response in West Africa. Nothing, however, had
prepared MSF for what happened next in Guinea, Sierra Leone, and Liberia. The
disease not only spread over a wide geographic region, but also, for the first time
ever recorded, reached densely populated areas such as Monrovia and Conakry.
MSF was severely challenged in recognizing the scale of this epidemic, and
subsequently in scaling up the medical and human resources necessary to
respond. The impact was profound. Not only did this epidemic push the medi-
cal and logistical infrastructure of MSF to the limit, driving personnel at all levels
to exhaustion, but it also severely strained MSF’s own ethical values, forcing staff
into making daily decisions between poor, bad, and even worse options while
lives were at stake.
vii
viii Preface
Under these circumstances the usual cost/ benefit evaluations are worse than
inadequate. This epidemic tested the political resolve and operational choices
both inside and outside of MSF. It has left a legacy of lessons to be learned in
terms of much- needed technical improvements but also forces us all to recon-
sider how the world at large deals with transnational health emergencies. A per-
vasive factor influencing the decisions made during this crisis was fear. To
examine this theme, MSF has sponsored this book and made the unprecedented
step of allowing the authors full access to the internal archives of MSF’s Ebola
response in 2014 and 2015. The majority of the authors are external to MSF,
providing a unique insight into the processes of fear that informed many of the
decisions made by the politicians and the responders such as MSF.
Not all aspects of the outbreak are covered in the 10 chapters. The authors
made their own choices regarding which aspects they wanted to highlight, and
most of the chapters will elaborate on the wider response, going beyond the spe-
cific role played by MSF. This can give the impression that fear affected only
others, while the fearless MSF “heroes” ventured into the epidemic with iron
resolve. Nothing could be further from the truth; fear “infected” and partially
paralyzed MSF as well. Not only did MSF fail to realize that the epidemic was
unprecedented even as it was spreading across multiple, frequently heavily pop-
ulated locations, but MSF had difficulty scaling up its response once the disease
was recognized as being out of control. As described powerfully in the eyewit-
ness account by Lindis Hurum, the moment the first health staffer from a part-
ner organization in Monrovia was infected with the Ebola virus, MSF itself was
on the verge of deciding the risk was too great and pulling out.
On a more institutional level, some of the MSF resources were also paralyzed
by fear. MSF is organized as an international conglomeration of five semiauton-
omous “operational centers,” each with its own medical, logistical, and human
resource capacity to respond to emergencies. As the majority of the Ebola
experts were located in the Brussels operational center, the coordination for the
response was allocated there. It quickly became apparent, however, that the scale
of the epidemic required resources from the other centers as well, but this was
slow in coming. Fear was a clear internal factor in this delayed response: fear of
staff contamination, fear of lack of expertise, and fear of lack of resources. Finally,
the fear of being literally as well as figuratively overwhelmed by the epidemic
when it was at its peak in the summer of 2014 pushed MSF to take yet another
unprecedented step: to make the first call in the history of MSF for a military
intervention in an epidemic response.
Yet these unimaginable numbers of deaths, the rapid spread of the virus over
three countries, the vast number of people working to respond, and MSF’s first-
ever appeal for the deployment of militarily trained biological warfare experts
are not what constitute the lasting memory of this crisis. What remains is the
Preface ix
perpetual doubt about the impossible choices everyone involved, patients and
responders alike, had to make throughout this epidemic:
•  Do I report to a hospital when I feel sick, and risk death in quarantine? Or do
I stay home and risk infecting my family?
•  Do I allow everyone in need access to the Ebola center, even though it means
the lack of resources will force me to compromise on the levels of care? Or, do
I shut the gates and give the very best available treatment to a privileged few?
•  Do I use experimental drugs never tested on human patients and risk making
their condition worse? Do I offer the patient this choice?
•  Do I evacuate all infected foreign health staff to enjoy higher- quality care
abroad, but leave my locally based infected colleagues to be treated with the
lower standard of care available in country?
These are all profound questions putting the ethics of MSF and other respond-
ers under immense pressure. They are very real questions that have all occurred
during this crisis. Impossible environments make for impossible choices. Very
few would envy those who made the choices, or would want to pass judgement.
The main accountability is surely to be found in the future, and in helping those
who will confront similar hard ethical choices to learn from the past. We hope
this book will help inform future health responders who will have to ask them-
selves these same questions in the years to come.
Christopher Stokes
General Director
MSF Operational Center Brussels