A great deal has happened since the first Web Roundup on Ebola. The epidemic has spread both in West Africa and globally, and material about Ebola has spread throughout the web. According to the CDC, as of October 22, a total of 9911 cases of Ebola have been reported, primarily in Liberia, Guinea, and Sierra Leone (map of new cases), and there have been an estimated 4546 deaths. WHO has declared an end to the outbreak in Nigeria and Senegal, but there are now cases in Europe and North America. In Spain and the United States, there have been local cases of viral transmission within healthcare facilities.

It is no surprise that anthropologists are actively involved in the discussion, including this ongoing Somatosphere Series Ebola Fieldnotes. The AAA hosted a Virtual Event highlighting anthropological information and intervention. Cultural Anthropology “Hot Spots” online now includes an extensive collection of posts on Ebola, linking political, social, and viral landscapes. This series includes some key pieces for the ongoing negotiation of how to understand the social and cultural dimensions that are relevant to the spread of Ebola without pathologizing West Africa and its local cultural practices: the rhetorics and realities of “bush meat”; funerary practices and the handing of bodies; suffering and the language of witchcraft.

Adia Benton, in addition to her contributions here and to the resources mentioned above, has written many relevant commentaries, including those on her website Ethnographic Emergency and in Dissent (“The Not-So-Secret Serum”). In the London Review of Books: “Diary”, Paul Farmer asserts that “An Ebola diagnosis need not be a death sentence.” He blames weak health systems for the current situation, and he argues that border closures not only prevent resources from reaching those in need, but that they also lead to stigma, increased fear, and violence. Farmer also touches upon the question of “‘cultural beliefs and behaviours’ said to propagate the outbreak,” suggesting that this line of inquiry is a distraction (and perhaps a legacy of anthropologists’ indefatigable “obsession with funerary rituals – the more lurid the better”?).

There are also notable selections within broader discussions about political economy, media coverage, inequality, and environmental linkages. Both the article “One Powerful Illustration Shows Exactly What’s Wrong With How the West Talks About Ebola” and the image to which it refers reference the stark disparities in media coverage of cases in the US and Europe versus West Africa. The New Yorker article “Ebolanomics” outlines the global economic underpinnings of pharmaceutical research and development. Biologist Rob Wallace (Farming Pathogens) discusses potential links between Ebola, the environment, Palm Oil agribusiness, and shifts in human-animal relationships (also “Neoliberal Ebola: The agroeconomics of a deadly spillover”). Similar parallels are drawn between the virus, politics, economics, and ecology in the PLOS NTDs editorial, “Outbreak of Ebola Virus Disease in Guinea: Where Ecology Meets Economy.”

The social dynamics of transmission have become the topic of multiple critiques. In West Africa, because family and community caregivers are disproportionately female, those infected are also disproportionately female. Slate describes this dynamic as “The Most Terrifying Thing About Ebola”: “This virus preys on care and love.” Health care workers are also frequently infected in multiple contexts, and gendered aspects of caregiving extend beyond Africa. In Spain and in the US, those locally infected have been nurses and female. Labor relations, power, and risk mark a related issue: a “whistleblower” nurse from Dallas described “chaos” and a pileup of infected waste in hallways. Earlier this month, LaGuardia Airport cabin cleaners walked off the job citing unsafe conditions and lack of training and equipment to safely clean bodily fluids.

Journalists have also found themselves in situations of risk, prompting comparisons to covering war. An infected NBC cameraman has recently been released from the hospital, and physician-correspondent Nancy Snyderman has apparently been told to “take some time off” after breaking voluntary quarantine to visit a soup restaurant in New Jersey. (Following the uproar, she was subsequently placed under mandatory quarantine, and she has now been cleared.)

Fear, Panic, Anti-Panic

Dynamics and questions of fear and mistrust permeate discussions surrounding the Ebola outbreak in West Africa. In “Ebola in a Stew of Fear” (NEJM), Gregg Mitman catalogs the “ecology of fear” surrounding the virus in Liberia, including echoes of past outbreaks, American medical research expeditions, civil war, and resource depletion at the hands of multinational corporations. In “Dispatch From Liberia: An Epidemic of Fear,” Adam C. Levine recounts his work treating patients while encased in layers of protective clothing; because Ebola so frequently infects health care workers, “the very people who calmed our fears in the past, who talked us through other epidemics and assured us that everything was going to be okay if we only kept calm and did A, B, and C, are now running scared themselves.” The remedy is the rejection of fear itself: “There is a dire need for the international community to stop treating this crisis like a horror movie, closing its eyes tightly until the scary part is over, and start treating it like a real humanitarian disaster that requires an adequate input of monetary, logistical, and yes, human resources.” Rumor and folklore are also described in epidemic terms, and Ebola perches high atop the “dread factor.”

It is therefore not a surprise that both panic and discourses of panic arrived in the United States even in advance of its first Ebola case. In August, the MIT Knight Science Journalism tracker had already noticed that “Media give mixed messages on ‘out of control’ Ebola outbreak.” The CDC has focused on the management of perceptions and panic control, with multiple reiterations, and local governments, doctors, and some media outlets have followed suit (Wired, Slate). On the “Colbert Report,” Kent Sepkowitz, head of Memorial Sloan Ketterings’s infection control program, placed Stephen Colbert’s odds of getting Ebola at “zero.” Even for the rich and famous, zero chance is a difficult level of certainty to reach; in 2008, scientists even conceded that there was some risk of the Large Hadron Collider destroying the world, though it was considered extremely unlikely.

Next, add analyses of the (dangerous) media overreaction to a mythical public overreaction (because “twice as many Americans believe in witches as are afraid of Ebola“) and more parodies of media overreaction (for example, on The Daily Show), and we have the makings of a stew of our own. More recently, the CDC has appeared to realize that too much placation can lead to under-reaction, and the big picture has been tempered: “Frieden warned Thursday that without immediate, concerted, bold action, the Ebola virus could become a global calamity on the scale of HIV.” The CDC needs resources for public health and infection control, and public sentiment (and perhaps some level of fear) is not a trivial ingredient in acquiring these resources.

Images

The imagery that accompanies discussions of Ebola calls to mind a 1996 article by Arthur and Joan Kleinman, which addressed the complexities of photojournalism, public health, and professional appropriations of the images of suffering. Recent New York Times images include a video of a young man “Dying of Ebola at the Hospital Door” and “a 4-year-old girl lay on the floor in urine, motionless, bleeding from her mouth, her eyes open.” Referring to the latter image, a featured comment from “Hannah” reads: “To see a four year old [little] girl on the floor of a what is called a “hospital”, alone, scared, bleeding and dying in the remnants of other patient’s fluids, is so [unacceptable], inhumane and shocking, that I can hardly stand to [contemplate] it.” But then the comment goes on to call for the United States to provide resources for health care in West Africa, showing the complex ties between disturbing media imagery, global attention, political will, and resource allocation. In comparison, coverage of children who have died of Enterovirus in the United States tends to include more pictures of the children taken before they became ill than of sick children in hospital settings (For example: New York Times, CNN). Of course, there may not be any truly appropriate ways to select imagery to go along with globally distributed stories telling of local death and suffering, (and it is also with ambivalence that I have linked these images here).

Additional Resources

• “Ebola and the Epidemics of the Past” (WSJ) and “Visualised: how Ebola compares to other infectious diseases” (The Guardian)
• “Ebola’s Chain of Infection” (Contagions)
• Ebolavirus topics on the Virology Blog by Vincent Racaniello and Ebloa topics at the Lancet
• Commentary from Peter Piot, the co-discoverer of the virus, on NPR and Spiegel online.
• Longer video documentaries and news reports: “Saving Dr. Brantly” (NBC News) and “Ebola Outbreak” (PBS Frontline)

Reference

Kleinman, Arthur, and Joan Kleinman. 1996. “The appeal of experience; the dismay of images: Cultural appropriations of suffering in our times.” Daedalus 125(1):1-23.