“No Ebola in West Point” was the reported cry of the local crowd that attacked a quarantine center and freed patients in a township near Liberia’s capital. Their words signaled skepticism toward the Liberian government and disbelief in the spread of the Ebola virus.
The cries of the crowd were met with cries of shock and dismay on Twitter and other social media. “Are they crazy or just stupid?” one person indignantly asked. Some called the crowd “idiots” and “fools.” Still others declared that “Liberians are savages.” One man went so far as to tweet: “Why am I not surprised that ppl who rape virgins to cure AIDS attacked an ebola treatment center.” Yet even those who do not descend into racist generalizations approached the story with a sober sense of incomprehensibility. Cecily Hilleary of the Voice of America, the U.S. government-funded media outfit charged with promoting “freedom and democracy” and enhancing “understanding” to a global audience, tweeted the story with the comment, “Controlling #Ebola in the face of ignorance.”
While the group of people who raided the quarantine center outside of Monrovia may not have fully understood the impact of their actions from a biomedical perspective, there is more than one kind of ignorance that has been revealed in the unfolding of this story. In the West, the attitudes of high-minded disbelief, of condescending bafflement, betray a dangerous form of unawareness that has a long and complex history that continues to afflict even the most hallowed institutions of global health. The attack on the West Point clinic points to a tension between indigenous populations, governmental agencies, and scientific communities that has persisted throughout history during outbreaks of infection. We should not be surprised by reactions against Western medical intervention.
Colonial narratives from the past are deeply intertwined with medical narratives of the present. During the cholera pandemic of 1817, the disease itself was exoticized as “Asiatic cholera.” The British explorer Sir Samuel Baker claimed that “infectious disorders, such as plague, cholera, small-pox, may be generally tracked … from their original nests; those nests are in the East, where the heat of the climate acting upon the filth of semi-savage communities engenders pestilence.” Geographical boundaries were viewed as measures of disease containment, an attitude that still persists as demonstrated by the fears surrounding the return of two infected American workers to Emory University Hospital. The Western projection of a country’s deficiency comes to define an “us” and a “them” — a “them” who “engenders pestilence” and who is at fault for the progression of disease.
Western suspicions about geography and the responsibility for the spread of disease are compounded by the belief that local cultural practices often serve as foolish and retrograde obstacles to sensible medical care. During the outbreak of the bubonic plague in India in the late 1890s and early 1900s, British governmental and medical agencies attempted to curtail the plague, sparking friction between those institutions and the local population. British Physician Dr. R. Bruce Low presented a report to Parliament on the Western “special methods…adopted to secure discovery of plague cases, there being a general tendency among the native races to conceal cases with the view of escaping the segregation, disinfection, and other measures which were either imperfectly understood or not comprehended at all, such measures being regarded as affronts to the native religion.”
Europeans viewed indigenous communities as culturally backward, attempting to escape treatment and preventative measures implemented by Western medical officials. This attitude echoes in the judgments made of local West African communities in the current Ebola outbreak. The discrimination against different cultural practices continues to inform the perception and treatment of populations during pandemics.
During the 1995 Ebola outbreak in Zaire, NOVA filmed a documentary called “Plague Fighters” that focused on the militant efforts of Western physicians working to contain the pandemic. Marginalizing the perspectives of members of the local communities most directly impacted by the disease, the film casts the WHO and physicians as white saviors tending to the Congolese population unable to save itself from its own ignorance. The documentary was sensationally narrated by actor Stacey Keach, who voiced “World’s Most Dangerous Animals” in the same year as “Plague Fighters.” Objectifying and marginalizing portrayals of the diverse cultures of continental Africa like this one both reflect and shape popular perceptions in the West, making it even more difficult for international institutions to serve as partners in addressing medical needs.
In the current Ebola outbreak, we can see that Western medical perception of traditional practices has not changed. While the current WHO guide does acknowledge cultural difference, it offers no advice for bridging the gap between Western health practices and local customs, rather viewing the traditions in the area as adversarial barriers to effective care that must be overcome. The specific guidelines on containing epidemics have already come into direct conflict with burial practices in West Africa. As in the bubonic plague outbreak in India, the WHO and other Western medical organizations continue to use the possibility that a disease will spread from a “developing” country to a “developed” one as a premise for medical intervention, while still simultaneously failing to provide the necessary tools to successfully work with communities and their beliefs.
So when we criticize local communities conceptions of disease and their reactions to international medical help, we shouldn’t think of their views as retrograde or primitive. Medicine remains deeply embedded within imperialism and colonialism and continues to perpetuate historical injustices towards geographical and racial “others.” There has been little self-reflection on the part of Westerners to acknowledge their own subjective relationship to medical practice. The policies that the WHO and Doctors Without Borders are implementing in West Africa are, after all, themselves culturally constructed practices; Western medicine imperialistically promotes itself as the rational means for treatment, even as its trivialization of other cultural and religious beliefs is born of the same limited views it ascribes to indigenous populations.
This lack of cultural sensitivity has created a tension between Western medical professionals and local communities, contributing to the mistrust and confusion in Liberia. Until institutions such as the WHO can provide constructive programs for reconciling the treatment of disease with cultural respect, until onlookers across the Western world can treat others with a greater sense of interpretive charity and understanding, there will continue to be “No Ebola in West Point.”
Kristin C. Prewitt is a medical student.