In the midst of all of this carnage, somehow all of us still carve out time for the FIFA world cup, another celebrity picture leak, sexy Halloween-costumes, and social media memes involving ice buckets. There seems to be an entitlement that despite the collective suffering of billions, we somehow owe it to ourselves to go on having a jolly good time. To do anything less would be giving in to evil. Unfortunately, I think that this has bred a culture of superficial activism actually hiding apathy and leading to a collective inaction. ‘The problems are so big, that what else can I do but donate $50 to my friend running the NYC marathon?’ Despite having worked in Haiti and rural Nepal the last two years, I find myself equally as guilty of forgetting other peoples’ problems the moment I land on American soil. My biggest concerns in the middle of a stretch of night shifts in the hospital are me, my food, and I.
Currently #Ebola is trending like wildfire (ie. like Ebola itself) on the internet. The American public is being fed a very different message from the reality facing Africans; that everything is going to be fine. This is despite thelatest figures that reveal 9000 cases and the death toll surpassing 4500. The response from American officials is essentially ‘keep calm and carry on’ — that polar icecaps melting, or another aviation disaster will kill you before that rare and remember-it’s-not-airborne virus (after all it’s only one dead patient and 2 American nurses that were infected from direct bodily fluid contact). A perfect example of this was a recent article on Bellevue Hospitalin NYC (where I happened to train in Internal Medicine) that revealed it ‘could treat up to four patients with confirmed cases of Ebola in isolation units.’ Prepared! With four isolation rooms? The WHO has calculated that by December in West Africa there could be 10 000 new cases per WEEK. If… and I am not saying when, there were to be more cases in America — it would be magnitudes more than four.
Potential American apocalypse aside, what we really need is the world coordinating its help around African nations to contain the chaos, and to ensure this does not happen again. The media has been abuzz with reports that a certain billionaire had given $25 million to the CDC foundation to stem the fallout, but no one bothered to question — for what purpose? In reality when the on-the-ground forces taking care of patients in West Africa are actually MSF (Doctors Without Borders), Partners in Health, Last Mile Health, and major needs are to get an adequate number of local health professionals working, what good is it giving more money to an organization that already has a $6.9 billion budget (and is US-based)? In any case, money by itself clearly doesn’t solve problems. However, before seeingdisorganization first hand in post-Earthquake Haiti, I never realized that getting money into the right hands in a timely manner is more complex than quantum mechanics. All the Ebola Czars, committees, subcommittees and specialty groups aren’t going to solve that. We already know where to send the money, and yet we consistently fail to deliver.
It’s becoming apparent with every major disaster that those in charge of protecting the most vulnerable in society have little clue of how to actually coordinate care. ‘Experts’ are a dime a dozen, and few with actual real world training in matters of mass mayhem. What is also apparent (in the words of PIH co-founder Dr. Paul Farmer) is that some lives matter less than others. Look at what we as a society value in 2014. A computer company churns out a new cellphone and 20 million people make a purchase within 1 month. A disease kills 9000 Africans, and ten months later agencies are still debating what is the best course of action. Investors are more rattled by bad video-on-demand sales figures, wearable fitness trackers (useless), and a Chinese company IPO than they are interested in investing in R&D efforts for things that actually could save lives. There has been an outpouring of volunteers (PIH reported thousands of applications for field staff immediately on request), but there have been little promises of better capital investment (build better infrastructure). Gloves and masks are easy to scrounge together from donors and funds- but it’s always an issue when governments in peril ask for assistance to build stable hospitals (not tents), or train more workers and actually pay them (and not rely on expat volunteers). Clearly there are many groups that realize the tremendous importance of this-but they are vastly outgunned by the problem at large. Larger groups in a position to help instead keep holding meetings.
I am not suggesting that everyone drop everything and start working on Ebola, but the slow response to the epidemic is a symptom of a malignant disease in our society. It’s interesting to look back at history and see that the world canceled the Olympics twice during World War II. Yes, war is different from infection, but in the end it’s devastation all around. We actually don’t even respond to war in the same way anymore (how many multi-year conflicts are still burning bright?) Instead now we talk in awe about how Twitter helped the Arab Spring (what exactly happened with that again?), click thumbs-up on links, and re-post videos of harrowing experiences of those in the middle of the action. We observe, applaud, and do little. No matter where or from what the end comes for any of us — warming, wars, or wildfire (Ebola) — the fundamental lack of concern for ‘other’ people across imaginary geopolitical borders has always been the problem. The good intentions of a select few are not enough. We all need to start not only being thankful for what we have (as the ubiquitous self-help gurus teach us), but figure out how we can also get others some relief from their misery.
We should be terrified of Ebola. It requires no vector except infected bodily fluids (unlike Malaria and mosquitos which kill 600 000 people per year), there is no specific treatment so far (only ‘supportive care’ which amounts to fluids, rest and monitoring), and even when we get a vaccine — the work of Edward Jenner 200 years ago, and more-recently the Gates Foundation pouring billions of dollars into health has shown that even when you make prevention free — you still fall short. The so-called experts are correct though; since American medicine is littered with doctors, nurses, PAs, NPs, naturopaths, chiropractors, reiki healers and billion dollar healthcare facilities — we lucky few in the United States — are probably going to be fine. Though we should be terrified for our fellow humans facing endless suffering in environments where they have nothing close to the resources that they need. Lets put aside our $700 cell phones for a second and figure out what concrete steps we can take. Doing nothing is certainly not an option — clearly that has not worked out very well for anyone in the past.
Varun Verma, M.D. is a board-certified Internal Medicine physician who splits his time as a Hospitalist at Brigham and Women’s Hospital (Boston) and as a Senior Clinical Advisor to Possible (Nepal)