Mass hysteria breaks out in a "treeless, glamour-less, and soulless" city when thousands of rats stream in bearing a plague. At first, the citizens who "work hard, but solely with the object of getting rich" treat this pestilence as "a bad dream that will pass away." When this doesn't happen, people desperately call for the government to act, which the government is slow to do.
Given the state of the world these days, and especially the situation in West Africa, I reread The Plague by Albert Camus. Like Shakespeare's King Lear, it's something we read in high school so that later in life, when we've learned enough to understand what it's about, we look to its lessons.
The 1947 novel is set in the Algerian port city of Oran. As the carnage mounts, the characters in the novel begin to fall into one of three categories: pestilence (people who enable the plague by denying it or distancing themselves from it), victims (along with those who take a passive role in the crisis by merely lamenting the victims) and healers (who courageously take action against the plague).
We see these three categories in today's Ebola crisis: those who enable this pestilence by distancing themselves from it, the victims and those who merely lament them and the healers who take action. The suffering of Ebola victims illustrates the meaning of plague, which derives from a Latin verb meaning, "to strike." Originally it didn't describe a disease striking people, but rather people striking themselves on their breasts in distress, lamenting their fate.
The best clinical description of Ebola symptoms I've seen appears in a recent article in the London Review of Books by Dr. Paul Farmer, the founder of Partners in Health in Haiti and one of the world's leading infectious disease specialists, who recently returned from Liberia. I will spare you Farmer's details, but suffice it to say that the suffering of those struck down by Ebola is truly lamentable. The question for us, in my view, is whether lamenting the Ebola plague initiates our response or concludes it.
The poster child for denial and distancing is probably the guy who recently stood in front of the White House for several days, dressed in a white biohazard suit complete with gloves, goggles, and mask. He held aloft a simple white poster, on which he had scrawled in defiant letters: "STOP THE FLIGHTS!" His solution to the Ebola crisis is profoundly narcissistic: Americans should distance themselves from it.
Many Americans apparently agree. Ban travel to and from the region, and let the horror play itself out over there. At least we will be safe over here. We will gather without worry, travel without fear, and watch football without interruption.
Except that we can't. Ebola has lots of ways to get from West Africa to here without flying direct. Nine Ebola victims have made it to the U.S.
When it comes to Ebola, the job that should be done is quite clear. As Farmer says, "You can't stop Ebola without staff, stuff, space and systems." Nigeria has demonstrated what can be done. When Ebola broke out in Lagos, Africa's most populous city with 19 million residents, government and public health officials swung into action. They isolated and treated 19 eventual victims, traced 19,000 individuals who had come in contact with them, and enforced quarantines of those at highest risk. As a result, only eight of the 19 victims died, and Nigeria, at least for now, is Ebola-free.
West Africa, in contrast, has little in the way of staff, stuff, space or systems. The lack of medical staff and stuff has been widely reported, as has the shortage of isolation space to treat the victims. As to systems, Farmer reports, "Many airlines have halted services. Schools have been shut down, including medical and nursing schools. Food and fuel, much of it imported, are becoming scarce. Supply chains have been cut off. Hospitals and clinics have been closed."
But with resources, Farmer says,
An Ebola diagnosis need not be a death sentence... If patients are promptly diagnosed and receive aggressive supportive care -- including fluid resuscitation, electrolyte replacement and blood products -- the great majority, as many as 90 percent, should survive.
Indeed, the outcome for the nine Ebola victims who have thus far been treated in the U.S. support his claim. All have recovered except for the initial victim. We have the staff, the stuff, the space and the systems to confront this pestilence here and we should do everything we can to ensure that the people of West Africa have them there -- as quickly as possible.
U.S. leadership and foreign aid funding are desperately needed. America has a long history of being the world's most effective force in global health, leading the charge to eradicate small pox, nearly eradicating polio and Guinea worm, and bringing HIV/AIDS under better control. Our ongoing foreign aid -- which clocks in at less than one percent of the entire federal budget -- provides nutrition and vaccines, increases access to lifesaving safe water and sanitation, keeps girls in school, teaches everything from prenatal care to agriculture, and so much more. One result: 6.3 million fewer children under age five will die this year than in 1990, according to UNICEF.
Near the end of Camus's book, Dr. Bernard Rieux, one of the town's leading doctors, acknowledges that the story of the plague could not be one of final victory. Rather, he says, it would be
the record of what had had to be done, and what assuredly would have to be done again in the never ending fight against terror and its relentless onslaughts, despite their personal afflictions, by all who, while unable to be saints but refusing to bow down to pestilences, strive their utmost to be healers.
When bad things happen, good people cannot stand by and do nothing. If we can help, then we should. Because we personally take what we need from the people and world around us, we need to take personally what the people and world around us need.
Congressional hearings begin this week on Ebola funding. Call your senator and representative and implore them to ramp up the U.S. response to Ebola, but insist that they do so in a way that doesn't take resources from other vital global health initiatives. We need to continue building health infrastructures, not just for the nearest, but for the neediest, so that disease is never given the opportunity to rage out of control. Then make a donation to an organization like Doctors Without Borders -- heroic healers in this current tragedy. If you are religious, find out what your denomination is doing on this front and support it.
When healers make their way in the world, the plagues that afflict humanity begin to lose their ultimate power. As Camus puts it, "Indeed it could be said that once the faintest stirring of hope became possible, the dominion of plague was ended."