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.

 

2014 Diana Forsythe Prize Winner: S. Lochlann Jain for Malignant: How Cancer Becomes Us

September 29th, 2014, by § 1 Comment

The Committee on the Anthropology of Science, Technology, and Computing (CASTAC) of the General Anthropology Division (GAD) and the Society for the Anthropology of Work (SAW) announce that S. Lochlann Jain (Stanford University) is the winner of the 2014 Diana Forsythe Prize for her book Malignant: How Cancer Becomes Us (University of California Press, 2013) and that Adriana Petryna (University of Pennsylvania) has been awarded an Honorable Mention for her book When Experiments Travel: Clinical Trials and the Global Search for Human Subjects (Princeton University Press, 2009). The Prize Committee chose these books from among a remarkable set of nominated volumes.

Fashioned as a melancholic and justice-seeking expedition to and through “the kingdom of the ill” and permeated by a raw and highly evocative imagery of the ways “cancer becomes us,” Malignant is a masterpiece. It epitomizes the spirit of Diana Forsythe’s lasting feminist contributions to science and technology studies. Critical and self-reflexive at every turn, Lochlann Jain illuminates the messy, unstable, cultural-historical-biological reality of cancer. With an authorial voice at once intimate and authoritative, she breaks open expert knowledges of all kind and delivers the disturbing news that cancer is part of the American way of life, hard-wired into the operating systems of the U.S. polity and economy. Lochlann Jain also reveals the many ways in which the suffering of cancer patients, particularly women, is sanitized through a set of survivor scripts that cause their own kind of suffering. In our “laboratory of toxic waste” in which accountability is diffuse and hard to pin down, the cancer which wreaks havoc on individual bodies and lives is folded into logics of individual survivorship, statistics, medical knowledge (or its lack), pharmaceutical reason, gendered normativity, and genetic predispositions and becomes impossible to read politically. Malignant speaks expertly to the legacy of Diana Forsythe who was, like Lochlann Jain, concerned with politics behind expert systems of knowledge production and consumption. With its realism, sophisticated analysis, alter politics, joy de vivre and human force, Malignant is anthropology at its best. It will certainly continue to reach and transform multiple audiences and, in the process, open up new fields of inquiry and action.

Adriana Petryna’s When Experiments Travel is recognized and honored for pioneering the anthropological inquiry of the global clinical trials enterprise, for its rich ethnographic contributions to our understanding of health capitalism, and for its original theoretical work on “experimentality” and “ethical variability.” The book provides a rich and compelling account of the organizational cultures and labor regimes of industry-sponsored clinical research, probing scientific, ethical, and regulatory practices and thus exemplifying Diana Forsythe’s lasting contributions to anthropological research on work, science, and technology. Moving between corporate and scientific offices in the United States and research and public health sites in Poland and Brazil, When Experiments Travel documents the complex ways that commercial medical science, with all its benefits and risks, is being integrated into local health systems and emerging drug markets. The ethics of researchers, markets, and patient-subjects are a living evolving practice in which we are all implicated. Bluntly and deftly, the book exposes the contemporary problems of the instrumental use of humans for research and teases out the logic of and gaps in regulatory structures that legitimate experimentality internationally. When Experiments Travel provides academics and the wider public with a vital compass that can help us monitor and interrogate the changing scientific infrastructures of our lives.

The 2014 Diana Forsythe Prize and Honorable Mention will be awarded at the annual American Anthropological Association meetings in Washington DC, during the General Anthropology Division Awards Ceremony and Distinguished Lecture on Friday, December 5, 2015, at 1 pm in the Palladian Ballroom of the Omni Shoreham Hotel.

The Diana Forsythe Prize was created in 1998 to celebrate the best book or series of published articles in the spirit of Diana Forsythe’s feminist anthropological research on work, science, and technology, including biomedicine. The Prize is supported by Bern Shen. João Biehl, Stefan Helmreich, and Nina E. Brown composed this year’s Forsythe Prize Committee.

For more about The Diana Forsythe Prize: http://www.aaanet.org/sections/gad/awards/

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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Political Economy and the Internet of Things

August 5th, 2014, by § 2 Comments

According to Cisco, the number of things – smart phones, cars, delivery vehicles, smoke detectors, outflow sensors, electricity meters – connected to the internet surpassed the number of people connected to the internet in 2008. Projections for the coming decade vary, but corporate researchers at firms like Cisco, Intel, IBM and Siemens are betting big on the exponential growth of networked sensors and microcomputing devices. These companies are working in loose concert to shepherd this emergent swarm of networked things into a truly infrastructural data-collecting system. They see in the so-called “Internet of Things” the consummation of promise held forth to the corporate world by big data analytics; comprehensive, actionable, real-time data about production and consumption, allowing for ever more agile and sophisticated extraction of value from human activity. « Read the rest of this entry »

Life in the Laboratories of Breaking Bad

June 30th, 2014, by § 2 Comments

A Chemical Drama
I freely admit to an obsession with Breaking Bad that hasn’t quite come to an end, despite nearly a year having passed since the final episode aired. I am not the only one, apparently, as a new book written from a media studies perspective, Breaking Bad: Critical Essays on the Contexts, Politics, Style and Reception of the Television Series has just come out. While this is no doubt a productive frame to examine Breaking Bad, I am going to argue that Breaking Bad also illustrates key problematics in laboratory studies. If The Wire can become a staple within urban studies, why not Breaking Bad within STS? In what follows, I will sketch a few possible directions, which assume at least a passing familiarity with the plot and characters. WARNING: spoilers ahead! « Read the rest of this entry »

Facing the Selfie

June 24th, 2014, by § Leave a Comment

Last weekend I had the pleasure of participating in the symposium entitled Face It: Photography, Ethics, and Identity in the Age of the Selfie, which was held at the San Francisco Art Institute (SFAI). The program featured an eclectic mix of voices representing artists and scholars interested in exploring how photographic images blur or highlight the distinctions between authenticity and enactment of identity on social media sites. Of particular interest was exploring the political and ethical obligations and ramifications of a seemingly unabated proliferation of images. « Read the rest of this entry »

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 »

Greetings from Paris: A View from Ethnografilm 2014

April 21st, 2014, by § Leave a Comment

Recently I had the pleasure of attending an exciting new film festival called Ethnografilm, a showcase of ethnographic and academic films that visually depict social worlds. Helmed by the festival’s Executive Director Wesley Shrum (Professor of Sociology, Louisiana State University), the event took place April 17-20 at Ciné XIII Théâtre, a unique venue in the Montmartre district of Paris.

The variety of films was indeed impressive, and ranged from old-school anthropological investigations of “disappearing worlds” to animations that stimulated the eye and illustrated interactive tensions in visual forms. Despite fears about the disappearing anthropologist filmmaker, it was interesting to see that Jean Rouch’s classic film Tourou et Bitti (1971), which was screened on Saturday night, played to a packed house! Given that co-sponsors included the International Social Science Council and The Society for Social Studies of Science, it is perhaps not surprising that the festival included many technology-related films. Themes included both opportunities and tensions in areas such as online interaction, ethics, “primitive” technologies, and high-tech bodily enhancements. Below I profile a few of the films I was able to screen. Ethnografilm Poster ImageJ

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Associate Editor Intro: Jordan Kraemer on digital culture, tech trends, and why anthropologists can’t predict the future

February 4th, 2014, by § 1 Comment

As one of the new Associate Editors for the CASTAC Blog, I want to introduce myself and the kinds of topics I’ll be presenting here. In my work as an anthropologist of media and technology, I focus on how social and mobile media are reshaping experiences of space and place, especially in contemporary Europe. Ethnographic studies of social media have been in the public spotlight recently, when anthropologist Daniel Miller asserted that, for a group of teen users he is currently studying in the UK, Facebook has lost its coolness (“What will we learn from the fall of Facebook?” Nov. 24, 2013). Miller was sharing preliminary findings from a project still in progress, but his findings quickly got spun and distorted, in some cases by tech reporters more interested in Facebook’s stock value than its social implications. Miller and his team found that teen users (16-18 years old) in his fieldsite north of London no longer consider Facebook a cool space to hang out with peers, which isn’t shocking in light of previous research. He attributed this shift both to older family members joining Facebook and to younger users seeking to carve out their own spaces on newer sites. He also predicted that teens will continue using Facebook less and less, relegating it to communication with family. Facebook isn’t going to disappear, he argues, but its use is stabilizing as primarily a platform for adults: “it is finally finding its appropriate niche where it will remain.”

(Clip from NBC Nightly News: “Study: Teens leaving Facebook as parents flood site”)

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