The 2014 Ebola Outbreak: How Many Deaths Will it Take?

October 20th, 2014, by § Leave a Comment

Ebola

The Ebola Virus
Photo: CDC Global

When I began writing this brief statement in mid-September, 2,630 deaths had been attributed to probable, suspected, or confirmed cases of Ebola. The World Health Organization projected as many as 20,000 cases in the West African region before the outbreak could be brought under control. The epidemic had received little news coverage and felt, to many in the U.S., as yet another disaster taking place in countries reputed for their many dangers. By mid-October, 4,033 Ebola deaths had been reported by the World Health Organization and projections on number of cases had risen to 10,000 per week in West Africa. Concerns are heightening that the epidemic may be a greater threat than originally perceived. The number of news reports providing coverage on the epidemic has increased exponentially, reaching over 30 million by the beginning of October. This dramatic increase appears to be spurred by the death of Thomas Eric Ducan, the first reported death occurring outside the epidemic hotspot of West Africa, which made headline news around the world and sparked fears that the epidemic could spread out-of-control around the globe.

This tragedy highlights the current state of global health inequities and the role of discourse (in this case media initiated) in directing the actions of global health institutions. The virus has raged across the West African region since March, with the initial case linked to a child, known only by the epidemiological term – patient zero – who died in December. It took until August of the following year for the United Nations health agency to declare an international public health emergency, and admit the need for a coordinated regional response. In September, David Nabarro, UN Coordinator for the Ebola Response, announced that that United Nations system was working on a 12-step global response plan. Prior to this, local governments have been left to manage their outbreaks with limited resources and staffing, relying on international NGOs and missionary workers to assist with the ever increasing burden on already inadequate systems. Why has it taken so long to initiate these efforts? Might the outbreak have been contained, and many lives saved, if a coordinated regional response was initiated earlier? And what about the infected U.S. nurses, was it ignorance that an epidemic was taking place somewhere else in the world that resulted in inappropriate actions and poor preparation? This Ebola outbreak is yet another example of the continued global inequities that exist, not only in resource distribution, but also in whose voices are heard and how life is valued.

Ebola, like other rapidly transmitted viruses including SARS and H1N1, have provided the story line for many medical thriller movies including Outbreak (1995), The Ebola Syndrome (1996, Hong Kong), Contagion (2011), 12 Monkeys (1995), 28 Weeks Later (2007), the opening scenes of And the Band Played On (1993) and the mini-series Pandemic (2007). These fictional accounts portray the devastation of lost loved ones, the fear of the unknown, the threat of the potential (or actual) annihilation of whole societies, and the scrambling by government health institutions, as health workers, research scientists and policy makers rush to find an answer, a cure or vaccine. In these accounts the biomedical agenda takes whatever means necessary, including quarantines, trial drugs, blood transfusions, even time travel, to save the fate of entire populations.

While this is the stuff of fiction, these stories are on not unlike the current events taking in West Africa. And, as unlikely as these events seem to those of us who have experienced a disease outbreak only from the comforts of living rooms and movie theaters, they are the current reality to people in Guinea, Liberia, and Sierra Leon. Boarders have been closed. Flights from affected countries have been diverted. Certain nationals are not given entrance to other countries. A mandatory three-day lockdown has taken place in Sierra-Leon to give 30,000 health workers the opportunity to locate potentially infected individuals and distribute soap to households.

ebola3

Sierra Leone — Protesting the Ebola shut down of Sierra Leone
Photo: David Holt
Attribution-NoDerivs 2.0 Generic (CC BY-ND 2.0)

Living in such fear, it is not surprising then that public reactions to disease prevention interventions have not been positive. A team of eight medical workers were attacked and killed by villagers in Guinea earlier this month. Critics of the Sierra Leon lockdown have argued that it will destroy public trust in doctors. People are resisting going to the hospitals for fear that that is where disease transmission takes place (and in the U.S. it is). Every major Ebola outbreak has been met with local resistance, hostility and rumor. In 2002, an international team of experts fled a village in Gabon when threatened with violence. In the 1995 outbreak in the Democratic Republic of Congo, the link between the hospital and those dying of Ebola stimulated the popular rumor that doctors were murdering workers who had smuggled diamonds out from the nearby mine. In the Ugandan outbreaks in 2011 and 2012, locals believed that white people sold the body parts of the victims for profit. Consequently, western medical staff were viewed with suspicion and suspected of bringing the disease to the country.

Perhaps as a result of these past experiences, and the relationship between Ebola transmission and cultural practices from the region including burial rites that expose individuals to infected bodily fluid, international health agents initially expressed an unease interfering with the most recent outbreak. In many parts of the world the deployment of biomedicine has been met with incomprehension, suspicion, or outright resistance. Historians have documented local responses to the introduction of new biomedical approaches and the associated public health campaigns to which Africans were subjected. In East Africa, for example, local rumors of vampires were linked with anti-sleeping sickness campaigns (White 2000). Given that lymph fluid was extracted using large needles for analysis by European public health workers, the vivid imagery of blood-sucking Europeans was in fact literal not just metaphorical. In the Belgian Congo, people would flee into the bush to escape the mobile public health disease eradication teams, or persuade traditional physicians to remove their lymph nodes so that they would not be subjected to the dreaded needles (Lyons 1988).

In contemporary society, echoes of the legacy of biomedicine as an extension of the oppressive colonial apparatus continue. In northern Nigeria in 2004, a campaign to eradicate polio through universal vaccination was abandoned due to widespread rumors that the vaccine was a western plot aimed at sterilizing Muslim women, and infecting children with HIV (Jegede 2007). In South Africa, conspiracy theories suggest that HIV was developed by the CIA to kill Africans (Niehaus and Jonsson 2005). In Guinea, villagers distrust the government and international community, believing foreign health care workers are part of a conspiracy in which the Ebola virus has either deliberately been introduced, or invented as a means of luring Africans to clinics to harvest their blood and organs.

Sierra Leone: into the Ebola epicentre

Sierra Leone: into the Ebola epicentre
Photo: European Commission DG ECHO
Attribution-NoDerivs 2.0 Generic (CC BY-ND 2.0)

Such rumors, paranoia and defiance of international biomedical expertise, to some might seem like the response of scared or ignorant people. However, we might consider these beliefs and actions an indicator of global power differentials, and the seemingly neutral technical methods of biomedicine’s involvement in maintaining these distinctions, in-line with Gramsci’s concept of ‘cultural hegemony’ (Forgacs 1988). Westerners are evacuated and treated with life saving drugs that at present have been denied release to affected countries, deemed untested and thus unsafe by global authorities. African bodies are left to suffer without treatment, their unknown fate in the hands of god (or their own body’s immune system).

This situation, even more so than the HIV pandemic, has put in sharp relief the imbalances that exist in global health, what Hӧrbst and Wolf (2014) call the unequal “medicoscapes” of current biomedicine. Diseases can no longer be regarded within locally isolated frames of reference, expected to remain in small villages where deaths of hundreds or thousands will go unnoticed. Bob Dylan sings, how many deaths will it take before we realize that too many people have died? Indeed, we are all members of a globalized state, yet as this epidemic again reveals, the lives of Africans appear to hold lower value and the voices of Africans in their appeals for help remained largely stifled and unheard until the epidemic reached U.S. and European shores. Speaking 34 years ago, Alexandr Solzhenitsyn, the 1970s Nobel Prize winner for Literature, noted that “divergent scales of values scream in discordance …. Which is why we take for the greater, more painful and less bearable disaster not that which is in fact greater, more painful and less bearable, but that which lies closest to us. Everything which is further away, which does not threaten this very day to invade our threshold … this we consider on the whole to be perfectly bearable and of tolerable proportions.”

 

References

Forgacs, D, ed. 1988. An Antonio Gramsci Reader: Selected Writings 1916-1935. New York: Schocken Books.

Hӧrbst, V, and A Wolf. 2014. ARVs and ARTs: Medicoscapes and the unequal place making for biomedical treatments in sub-Saharan Africa. Medical Anthropology Quarterly. 28(2):182-202.

Jegede, AS. 2007. What led to the Nigerian boycott of the polio vaccination campaign? PLoS Medicine 4 (3):e73.

Lyons, M. 1988. Sleeping sickness, colonial medicine and imperialism: Some connections in the Belgian Congo. In Disease, medicine and empire, edited by R. Macleod and L. Milton. London, UK: Routledge.

Niehaus, I, and G Jonsson. 2005. Dr. Wouter Basson, Americans, and wild beasts: Men’s conspiracy theories of HIV/AIDS in South African lowveld. Medical Anthropology Quarterly 24 (2):179-208.

Solzhenitsyn, A. 1970. The Nobel Prize in Literature 1970. http://www.nobelprize.org/nobel_prizes/literature/laureates/1970/solzhenitsyn-lecture.html

White, L. 2000. Speaking with vampires. Rumor and history in colonial Africa. Berkeley, CA: University of California Press.

 

Being Watched Now: Notes Towards a Structure of Feeling

September 23rd, 2014, by § 2 Comments

I.

Something is changing. We know it, but we can’t say what’s happening. Not yet. But there is something uneasy in the air. It’s playing out both in grand narratives and the tiny shifts of attention that stitch together a sense of the real.

There are social feelings here, emergent in a time of rapidly changing modes of connection and circulation, and the ineffable shifts in embodiment and encounter that go along with changing technological habits. Performance here is always for an unseen and unpredictable audience. What would an ethnography of this emergent feeling be like?

I want a rash of little stories here to mimic rapid fluctuations of attention, which to many of us are becoming as natural as blinking. But all these little stories link outward, to something harder to pin down. Or maybe they link back in, to something that’s always been there. Tensions between the naturalized and the strange come to the surface.

You don’t need to be a conspiracy theorist to believe in ubiquitous surveillance anymore. Paranoia sounds like a 20th century word.

II.

You told me that something came over you while driving and you decided to trail the Google Street View car as it cruised your city’s streets. The Google brand was painted brightly on the doors like a pizza delivery car, and its world management device seemed gamely stuck on the car roof like an oldtime TV antenna. When you pulled up beside it at a red light, the young guy driving waved to you. You waved back and took his picture with your iPhone. His face performed a series of quick changes: first the bashful pleasure of mini-celebrity, shifting into a small frown as your act of recording him re-charged the air between your cars. You turned off that street, and went your separate ways.

III.

There was a deer problem in the neighborhood. They were more abundant than squirrels; on an evening stroll in the neighborhood you would always encounter several groups of deer. This particular doe must have run a while before collapsing in front of my house. She was lying half on the sidewalk, half on my lawn. Her hind legs were crossed at the delicate white knees, and the front legs were bent in two symmetrical Vs, freezing the last moment of running. A raw sliver of her chin, sticking out like a beard, must have been where a car made contact. She appeared there on Saturday morning, but Animal Control could not come to remove her until Monday. By that afternoon bugs had collected on her white underside in a frantic darkening. By Sunday morning areas of the white fur had been replaced by black holes. It was odd, for the neighborhood, to watch the natural process begin. All weekend the alien deer eyes remained open and it was impossible not to try to read in their inscrutability some kind of animal knowledge about death.

Finally on Monday morning, a man from Animal Control came out in an old unmarked pickup, dragged her by the hoofs into a lowered truckbed and drove her away. There were a lot of fawns around our neighborhood, and usually if you saw fawns you would see a doe too, watching them from across a short distance. Then one day the fawns were wearing collars. Scientists from a university in another city were tracking them. Occasionally one saw the small white science truck, with its tracking device stuck on its roof like an oldtime TV antenna. We didn’t know what kind of data they were collecting exactly, but the exploding deer population was controversial and obviously it was necessary to track them. Quickly, for the residents, the animals changed from seeming wild to not-wild. The collars were a dull pink shade, with a large buckle at the throat, making the fawns look uncomfortable but dapper. A single wire stuck up from the back of the collar. The collars with their wires didn’t surprise people anymore. This is what fawns looked like, now.

I thought it must be the dead doe’s orphan I saw a few times, ambling alone in yards with little branches and twigs stuck in its collar; it looked at first glance as if the tracking wire had begun to multiply, but really this orphan fawn was just getting tangled and stuck in the suburban bush.

IV.

For a long time, I listened with an ethnographic ear to people talk uncanny conspiracy theory. They told of surveillance by the powers that be. I heard disenfranchised social feelings and a mourning for nature entangled with overarching plots and underlying structures, all centered on a covert panopticon. In people’s intellectual beliefs and gut instincts, they – the nameless, faceless they — were always watching us. They tracked the moves of the little man, while they shifted powerful global agencies and destroyed nature, negotiating with space alien agendas to follow and abduct people. As they gathered medical and intimate information, discourses of intertwining knowledge and power tumbled out of a Foucaultian dream, grew legs and wings and nested in roofs. The huge black animal eyes of the alien evoked endless hidden watching. They sometimes emerged from the all seeing Illuminati but morphed into new coalitions behind the surface, as things sped up towards an end. I wanted to get a vernacular theory of power. It emerged in small communities of UFO experiencers and uncanny theorists, describing a power that was too big to see in its entirety but whose effects made patterns you could follow. People kept saying in many ways: something’s coming. Something’s changing. Something’s been lost.

Of course, all that covert government watching and listening stuff came true.

V.

Back then, surreptitious watching, listening and tracking were imagined as the sole provenance of enormous, uncanny power. But as modes of surveillance also integrate down into the techniques of the ordinary, and to saturate the fabric of things, their association with power both splinters and intensifies in ways we still can’t sum up.

John Jackson Jr. (2012) muses on the vanishing of an ethnographic “backstage,” recalled as a place to test scholarly ideas in an oral talk before the finality of publication, since any academic talk (or classroom lecture, or seminar) will now most likely be recorded on a phone and posted online to sustain a “potential afterlife” (Jackson 2012: 494). Now the context of any performance, including the performance of an anthropological talk, shifts into the unknowable, making it impossible to plan for its reception; Jackson wonders, “does [the] ethnographer talk about his project the same way in the academy as he does when he’s … representing himself and his work to his subjects?” (Ibid).

Anxieties of an unknown audience transcend the disciplinary ethics of anthropology. We’re not just anthropologists immersed in our discipline’s longstanding concern about the power implications of representing others. We are also just subjects of the same changes in technology and circulation as everyone is; we are not above any of it. Reflections on unknown audiences resonate as much with vernacular discourses about shifting power and surveillance as they do with thinking specifically about writing culture in the digital age. Ethnographic authority and its dilemmas then play on more widely unpredictable channels of circulation, the permanence of the seemingly throwaway moment, and the ubiquitous anxiety of being tracked from above or below…

A shift in the air drifted from the margins to the center of things. It went along with a habitus shifting in subtle ways, a glimmer of perceiving rapid change – about bodies in relation to devices, to information, and to each other as we speak.

VI.

My middle school nephew sits on the couch, laptop open, while adults drink tea. He looks up with a quick nostalgic smile, the kind we use for shared memories, and says, “Remember when everyone used to get all upset because the N.S.A. reads our email?”

 

 Work Cited

Jackson Jr., John. 2012. “Ethnography Is, Ethnography Ain’t.” CULTURAL ANTHROPOLOGY, Vol. 27, Issue 3, pp. 480–497.

 

Aaron’s Call

August 11th, 2014, by § Leave a Comment

On the morning of January 11th, 2013, the Internet entrepreneur and political activist Aaron Swartz was found dead in his apartment in Brooklyn, New York. Soon after the news reached the Internet, manifestos and hackathons were organized to celebrate Aaron’s political and technical work. In a matter of weeks, parallel events were organized across the United States, finding solidarity with Internet technologists and activists abroad. This collective effervescence elaborated on a narrative to evaluate the present, help to frame the past and project the future in relation to Aaron’s accomplishments and indictment for computer crime.

One year after Aaron’s passing, Brian Knappenberger‘s documentary “The Internet’s Own Boy: The Story of Aaron Swartz” was screened at the Sundance Festival and publicly released this past June. As far as the narrative goes, the spectator is offered a reconstruction of Aaron’s life with key elements for debate regarding legal overreach in his case. Knappenberger’s work was very careful in attending to the details. Despite the familiarity of most of us with the succession of events, there is much to be gained from the documentary if its depiction of Aaron’s trajectory is to be interpreted vis-à-vis broader, transnational battles on the grounds of intellectual property enforcement and expansion.
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On the Porous Boundaries of Computer Science

June 18th, 2014, by § Leave a Comment

The term “big data” [1] brings up the specter of a new positivism,  as another one in the series of many ideological tropes that have sought to supplant the qualitative and descriptive sciences with numbers and statistics.[2]

But what do scientists think of big data? Last year, in a widely circulated blog post titled “The Big Data Brain Drain: Why Science is in Trouble,” physicist Jake VanderPlas made the argument that the real reason big data is dangerous is because it moves scientists from the academy to corporations. « Read the rest of this entry »

Waiting for the Rain: Techno-Scientific Landslide Mitigation in Teziutlán, Puebla, Mexico (Part II)

June 12th, 2014, by § Leave a Comment

In my previous blog post, I wrote about the relationships between people, policy, and materiality that make catastrophic landslides possible in Teziutlán, Mexico. In this second entry, I want to explore how the development of a landslide early warning system by National Autonomous University of Mexico researchers and National Center for Disaster Prevention engineers becomes a site where humans and non-humans become increasingly interconnected in the making of disaster mitigation techno-science. While doing this, I want to pay particular attention to those arrangements among people and between people that materiality engineers and researchers envision as optimal and those that are feasible in the context of contemporary Mexico.

My friend and colleague, Felipe Juarez, at the foot of the Aurora landslide in February 2014. The CENAPRED monitoring station is located in the house behind (photograph by Roberto Barrios)

My friend and colleague, Felipe Juarez, at the foot of the Aurora landslide in February 2014. The CENAPRED monitoring station is located in the house behind (photograph by Roberto Barrios)

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Waiting for the Rain: Techno-Scientific Landslide Mitigation in Teziutlán, Puebla, Mexico (Part I)

June 9th, 2014, by § Leave a Comment

The sun comes up over Teziutlån, Puebla, Mexico (photograph by Roberto E. Barrios).

The sun comes up over Teziutlån, Puebla, Mexico (photograph by Roberto Barrios)

On the first days of October 1999, the city of Teziutlán, Puebla, Mexico, experienced levels of precipitation that tripled its annual rainfall. Throughout the city, a number of hillsides occupied by working class family homes reached a critical point at which upper layers of soil and environmentally degraded rock began to give way under the weight of accumulated rainwater and settlements, creating major landslides. The most dramatic of these landslides occurred in the neighborhood of La Aurora, where settlement and land use practices came together with geological history and environmental factors to create a massive movement of soil, trees, rocks, and houses that killed 109 of the 200 people who died in similar events throughout municipality that week. The catastrophe was deeply traumatic at the local level, leading to a period of mourning that overtook the city, and it also gained national attention, resulting in a visit of the devastation by then president Ernesto Zedillo.
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Science Cheerleaders – Is There a Role for Hollywood Hyper-publicity in Science Communications?

June 2nd, 2014, by § Leave a Comment

Over the past two months, I’ve been watching Years of Living Dangerously (YLD), a nine-part documentary series examining the issues and politics of climate change science through the eyes of popular American celebrities, who serve both as narrators and foils for exploring global warming scientific arguments and (mis)conceptions. Employing visually compelling imagery and urgent, albeit mostly alarmist, rhetoric, YLD is actually pretty standard fare for contemporary climate science programs. What makes the program interesting to me is the role it has assumed as a sort of cheerleader for science in a contest that in the past was populated only by participants (climate scientists and non-believers) and observers (the general public). In that paradigm, you either played the game, or watched from the stands. Now, it seems, with the right credentials you can be on the field as a cheerleader, yet not really in the game. « Read the rest of this entry »

What Educates in DIYbio?

May 27th, 2014, by § 2 Comments

The Pedagogical Paradox

Two human inventions can be regarded as the most difficult, — namely, the art of government and that of education; and yet we are still contending among ourselves as to their fundamental nature.

– Immanuel Kant

Kant here is referring to the pedagogical paradox presented by education. This paradox of moral authority most often occurs in the context of schooling: How does education, in the sense of external regulation), lead to the internally regulated autonomy of thought and action? Stated more generally, the pedagogical paradox is assuming the existence of something for which education is the precondition. For example, can someone declare oneself to be a biologist and launch an independent course of inquiry without recognized credentials? The pedagogical paradox is also a question of legitimate knowledge; in this case, who may speak the truth of biology? « Read the rest of this entry »

Cosmos: A Spacetime Conversation

May 6th, 2014, by § Leave a Comment

Cosmos: A Spacetime Odyssey, premiered on Fox on March 9, 2014 and will run until June 1, 2014. Hosted by Neil deGrasse Tyson, director of the Hayden Planetarium at the Rose Center for Earth and Space, it is a ‘reboot’ of Carl Sagan’s series similarly titled Cosmos: A Personal Voyage. Ann Druyan and Steven Soter serve as lead writers for both series (Sagan also co-wrote the original, though Tyson is not involved in the writing process for this series) and there are clear aesthetic connections between the two series.* Today’s Cosmos, though, is airing on Fox, not PBS, and American science in 2014 operates in a different landscape with a different set of concerns than Sagan’s series of 1980.** There has been an active social media engagement with Cosmos (#cosmos) and many historians of science, STS scholars, and journalists have been blogging and live tweeting their reactions to how the science is portrayed. I recently had a conversation with two historians of science who have been engaged with the Cosmos conversation, Ben Gross (@bhgross144, a research fellow at the Chemical Heritage Foundation) and Audra Wolfe (@ColdWarScience, an independent scholar), to discuss how Cosmos can offer insight into the current state of science and society.

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