Gillian Tett Contagion chapter

(OR WHY CAN’'T MEDICINE STOP PANDEMICS?) “Human diversity makes tolerance more than a virtue; it makes it a requirement for survival.” —René Dubos' Paul Richards, a white-bearded anthropology professot, sat in an or- nate eighteenth-century conference room inside the Admiralty Building in Whitehall, headquarters of the British government. The walls were festooned with oil paintings of British dignitaries. Facing him, across a highly polished mahogany table was Chris Whitty, a balding doctor- turned-bureaucrat who was chief scientific advisor for the British govern- ment’s overseas aid and a respected expert on issues such as infectious diseases. It was the late summer of 2014. Whitty had reason to be wortied. Some months earlier a highly in- fectious disease called Ebola had started to sweep through Britain’s for- mer colony of Sierra Leone and neighboring Liberia and Guinea. Groups such as the World Health Organization and Médecins Sans Fronti¢res had rushed to halt the contagion. So had the UK, French, and Ameri- can governments: Barack Obama’s American administration had even sent four thousand troops to Liberia. The world’s best medical experts at

ANTHR.O_-VISION places such as Harvard were huntrng for a-vaccine, and computer scien- tists were using Big Data tools to track i it. ‘ But nothing had worked Ebola kept movrng through the vast for- ests of West Africa. The governments in, Europe and the Unrted States were braced for it to arrive 1mmrnently on their shores. Theé Centers for Disease Control in Washmgton was warmng that the world was “losing - the fight” agamst the disease and nore than 1 miillion people would die unless somethlng——anythrng—could turn the tide.? So Whitty had sum- moned Richards and other anthropologrsts with a questron. Why had - computing and medical science: apparently farled in West Afrrca> Had Western scientific experts mrssed somethrng _ » - Richards hardly knew Whether to laugh-or cry A couple of de- cades carlier a British cabmet mlnrster named Norman Tebbit had an—. nounced; ‘while workmg in-a srmrlar white stucco burldmg, that it was a waste of pubhc money to fund anthropologrsts since they just did ir- relevant research, such as “studies of the prenuptral habrts of natives of the Upper Volta valley. Rlchards eprtomrzed Tebbrts target. He hailed from the Brrtrsh Pennines and had started hrs career 4s a geographer, but then spent four decades dorng patrent partrcrpant observation among .the Mende people in the forest reglons of Srerra Leorie, living among them, spealong therr language—and marryrng a local woman, Esther -Mokuwa. She Was a seasoned researcher in her own right, and also sat - at the mahogany table facing \Whltty Richards was an expert on agricul- - ' tural practices but also fascinated by Mende ritual since he espoused a. " “Durkheimian” phrlosoph)r, named after the French intellectual Brmile _ Durlkheim, that: argued that cosmology shapes behavior (and vice versa). Richards passionately- beheved that. rrtuals matter, be they marriage cer- emonies, death rites, or anythrng else 5 Tebbrt had ‘scorned this: But in; 2014 hrstory had taken a pecu— liar twist. As-Ebola spread reports had emerged about behavior and beliefs that seemed horrrfymgly strange to Western ears: patrents were CONTAGION running away from hospitals, hiding from aid workers, attacking (and killing) healthcare professionals, holding funerals where they touched the infected—and highly infectious—corpses of Ebola victims. “I heard peo- ple kiss dead bodies,” Whitty said. Western journalists had reported this detail with baffled horror; it evoked the type of exotic—racist—images from Joseph Conrad’s novella Heart of Darkness. “They don’t just kiss bodies for no reason!” Mokuwa retorted. She had arrived at the Whitehall building stricken with grief-for her dying compatriots. But she was also furiously angry. The main reason why the anti-pandemic policy was going so wrong, she told Whitty, was that Western medical “experts” were only looking at events through their own assumptions, not locals’ eyes. Without some empathy—or an attempt to make strange seem familiar—medical and data science would be useless. The meeting drew to a close. As they trooped out, Richards spotted a historical plaque at the side of the ornate room—and burst out laughing. The meeting room had once hosted the corpse of Lord Admiral Nelson, the revered British naval hero, who had died in the Battle of Trafalgar in 1805. After death, his body was apparently pickled in a cask of brandy, brought back to Britain in a ship called the HMS Pickle (yes, really).* It was then displayed in Greenwich and Admiralty House, Whitehall. Some fifteen thousand mourners came to pay respect—by touching and kissing his brandy-soaked corpse.® “If Nelson had Ebola, everyone in London would have caught it!” Richards pointed out. Whitty laughed. However, Richards was trying to highlight a serious point: no culture has a right to dismiss other cultures as “strange” without realizing that their own behavior can also look odd. Particulatly in a pandemic. *No, I am not making this up: it really happened. If you are chuckling or wincing, ask yourself this: Why? What does it reveal about your view of ° ‘normal?” Then watch the Netflix series Zhe Crown to see how the body of King George VI was embalmed and displayed as recently as 1952. Ideas of “normal” change.

ANTHRO-VISION The word “Ebola” comes from the name of a river deep in the Aftican Congo. In 1976, doctors reported a strange—terrifying—new “hemor- thagic fever” around that Ebola River. It started with a fever, sore throat, muscular pain, headaches, vomiting, diarrhea, and rashes, but often led to liver and kidney failure and internal bleeding. The Johns Hopkins Medical Center observed that “25 percent to 90 percent of those infected” died, with “average case fatality rate . . . around 50 percent.”” That was comparable to Europe’s thirteenth-century Black Death plague.* In the subsequent three decades, the disease sporadically flared up in different African regions, but then ebbed away because its victims ex- pired so fast. That changed in December 2013 when a two-year-old child became infected in a village in Guinea, near the town called Guéckédou, located near the wiggly—artificial—borders that nineteenth-century co- lonial rulers had used to divide the vast West African forests into coun- cries called “Guinea,” “Sierra Leone,” and “Liberia.” The Jocal population were tightly entwined with one another, constantly moving across the borders, and the disease spread quickly. A dark-haired American called Susan Erikson was one of the first Westerners to hear about Ebola. Early in her life she had spent a couple of years in Sierra Leone, as an idealistic volunteer with America’s Peace Corps. She then returned to college in the 1990s to do a doctorate in anthropol- ogy but with a twist: she combined cultural analysis with medical studies. This branch of the discipline, called “medical anthropology,” champions a core idea: the human body cannot be explained by “hard” science alone, since sickness and health need to be put in a cultural and social context. Doctors typically view the human body in terms of biology. However, in *The reason for the wide range in mortality rates is that the impact of Ebola varied enormously between communities, depending on poverty levels, healthcare, and infra- structure, as Paul Farmer, the medical anthropologist, has stressed. CONTAGION most cultures the body is also treated “as an image of society” that reflects our beliefs about issues such as pollution and purity, as Mary Douglas, the anthropologist, points out.? This affects how health, sickness, and medi- cal risk are viewed. Or, as Douglas observed in a book she coauthored on nuclear, environmental, and medical risks, since “the perception of risk is a social process,” each culture “is biased towards highlighting certain risks and downplaying others.” During a pandemic, for example, people typi- cally cling to “their own” group, however they choose to define it. That means people typically overemphasize risks that arrive from outside the group and underestimate the ones that are inside the group. Throughout history pandemics have been associated with xenophobia, even if people are complacent about domestic infection risks. Erikson initially hoped to use medical anthropology to study repro- ductive health in Sierra Leone. But in the 1990s a brutal civil war erupted in the region. So she switched her focus to Germany before eventually re- turning to Sierra Leone, from her academic base at Simon Fraser Univer- sity in Canada, to explore how digital health technology was impacting public health. On February 27, 2014, she woke up in a rented room in Freetown, Sierra Leones capital, reached for her phone, and read about a “strange hemorrhagic fever presenting like Ebola” in an online news- feed. “I just went, ‘OK,’ better note that. But I wasn’t too concerned. I see a lot of ‘dread disease’ feeds like that,”'® she recalls. Then, when the health ministry called a meeting to plan its response, with government officials and representatives from groups such as Médecins Sans Fron- tieres (MSF), UNICEE and the World Health Organization, Erikson’s research team attended to do some participant observation. “An administrator begins the meeting with an overview of Ebola and the threat of its spread,” the research team’s field notes say. “Then [the administrator] moves to the task: “We have a template [to fight Ebola], but we need to bring it home, to make it Sierra Leonean.” He explains that the template is a WHO document from [an earlier Ebola episode in] 59