The most important and tragic speech of these times was given earlier this week, though the author was too busy to voice it herself. Dr. Margaret Chan, who leads the World Health Organization, sent her chief of staff to a WHO regional conference in Manila to spotlight something we rarely keep in our conscious mind and don’t, collectively, do much about: Inequalities can be a matter of ever-longer life, or a most miserable death.
Chan’s speech was given by proxy because she, her aide explained, had stayed in the organization’s Geneva base to refine WHO’s response to what is “unquestionably the most severe, acute public health emergency in modern times.” That’s certainly at the top of most minds, if for no other reason than Ebola is creeping into the richer parts of the globe. But Chan wasn’t about to reassure us that her organization can keep the incidence of the disease tiny. As the world’s most senior medical figure, she had decided to use the horror to make a moral point, one that had, she said, fallen on deaf ears till now.
Samples from her speech: “I have never seen a health event spread such fear and terror, well beyond the affected countries. … I have never seen a health event threaten the very survival of societies … I have never seen an infectious disease contribute so strongly to potential state failure. … The outbreak spotlights the dangers of the world’s growing social and economic inequalities. The rich get the best care. The poor are left to die. … Ebola has been, historically, geographically confined to poor African nations. The R&D incentive is virtually nonexistent. A profit-driven industry does not invest in products for markets that cannot pay.”
Just what Chan’s remarks mean was revealed in an article datelined Makeni, Sierra Leone, by Adam Nossiter of the New York Times. It was a piece of reportage and photojournalism that — as Leon Wieseltier saluted it in the New Republic — took a courage “beyond belief” to get. A photograph by Michel du Cille showed men and women lying dead or dying on mattresses spread on a floor, surrounded by pools of urine and feces. Nossiter noted that “a corpse lay in the corner — a young woman, legs akimbo, who had died overnight. A small child stood on a cot watching as the team took the body away, stepping round a little boy lying immobile next to black buckets of vomit.”
This is where fear and terror dwell. It is the way a plague takes a poor country, not with a sudden destructive wind but with an agonizingly steady buildup, cauterizing all dignity in death, putting an impossible burden on terrified medical staff of bringing out the dead, as they did in the streets of London and other plague cities in the 16th century. Those who remain to do this work are humbling. In a separate article, Nossiter wrote of burial workers, their promised $100-a-week wage unpaid, who have seen their frightened families desert them and shopkeepers refuse to serve them — yet they go on working.
Ebola hasn’t taken possession of any part of the rich world yet. But in the past few days, the haves have woken with a start to the realization that it could. Precautions are tumbling out into the public sphere. Making an appointment at the BBC’s studio in Brussels on Tuesday, I was asked with an embarrassed little laugh, in the English manner, if I could assure my hosts that I had not been in West Africa recently. Travellers from the states most affected by Ebola — Guinea, Liberia and Sierra Leone are checked at airports. We’re far from mass death in squalid wards — though it must figure in an increasing number of waking nightmares — but there are rational grounds for disquiet. The threat comes as the public health services of Europe — the much-prized systems at the heart of their welfare states — are strained by the growing demands of aging populations even as they undergo budget cuts.
Spain, among the most stricken of European states by the financial crisis, is the site of most concern. This is because a brave auxiliary nurse, Teresa Romero Ramos, who had volunteered to help care for two Spanish priests who had returned from West Africa infected with Ebola (both died), became sick herself — the first known incidence of the disease having been transmitted outside of Africa. Both priests, and now Ramos, were treated in a reassembled infectious-diseases isolation unit in the Carlos III Hospital in Madrid – reassembled because budget cuts had forced the closure of the hospital’s infectious-diseases facility, presumably as the one least likely to be missed.
Ramos didn’t notice strong signs of her illness until a week after treating the second priest. She went to a general practitioner, who diagnosed a fever and gave her acetaminophen. By the time she was diagnosed with Ebola, she had had contact with 83 people, all now being monitored; 14, including her husband, are in isolation in Carlos III’s makeshift facility. Ramos herself is showing some signs of recovery.
The coincidence of a deadly disease, the closure of a specialist unit and the unfamiliarity of most doctors with Ebola is one that could happen anywhere in the advanced countries. The number of Ramos’ contacts, and the further multiplication of their contacts, gives a glimpse into what could happen if prevention fails. Ebola is multiplying exponentially in West Africa. There are now 1,000 new cases a week. The WHO believes it could be 10,000 per week by early December, less than two months from now. Some 4,500 people have died to date.
Two nurses in the United States have contracted Ebola after coming into contact with Thomas Eric Duncan, who was treated at their Dallas, Texas, hospital. Duncan later died of the disease. One of the nurses, Amber Wilson, took flights after she was infected, and is estimated to have had contact with up to 800 other people. Another healthcare worker, who is not ill, is now quarantined aboard a cruise ship.
The core of Chan’s proxy speech will not disappear. “The rich get the best care. The poor are left to die.” Ebola has brought the desperation of the poor closer to us.
Globalization has made our lives richer in many ways; now it presents us with the horrors of the poor, and prods us, for our own safety as much as for our conscience, to respond with all our expertise and courage.