Since the Start of the Ebola Outbreak, Half of Liberian Doctors Have Died

Anthropologist Mary H. Moran told a Duke audience this week to look past the medical chaos and doomsday tales surrounding the current Ebola pandemic and understand the overall political and sociocultural context.

Moran, professor of anthropology and Africana and Latin American studies at Colgate University, has been studying politics and society in Liberia since the early 1980s. As part of a series of Ebola Week events, she spoke Tuesday to students and faculty on “Can Sirleaf Survive Ebola?”

Liberian President Ellen Johnson Sirleaf is the first democratically elected female president of an African nation. She currently has two years left in her second and final term as president.

Since her election in 2005, Sirleaf has significantly decreased Liberia’s foreign debt, bolstered natural resource extraction and promoted other social and economic development, Moran said. Sirleaf also shared the 2011 Nobel Peace Prize with two other women.

But her presidency has been characterized by as much corruption as success, and coupled with the government’s insufficient response to Ebola, Liberians are increasingly calling for Sirleaf’s resignation.

 “It’s clear that many of the accomplishments she was able to achieve will be tarnished because of [Ebola],” Moran said. “It will sadly enough be her legacy, and the best we can hope for is that Liberians will refuse to put up with the kind of government they have put up with for the last decade.”

 

A context of conflict

Civil conflict as much as general political corruption is an important factor in the failure to contain the epidemic, Moran said. Between 1989 and 2003, Liberia experienced two civil wars, decimating its infrastructure.

“If you have a catastrophic civil war and you are defined as a failed state and occupied by 15,000 United Nations troops to provide security, you no longer have a lot of control of your own national policy, even though you’ve gone through an election,” Moran said. “Many of the priorities of your budget and attention are being determined outside of the boundaries of the state.”

As a result, Liberia’s public healthcare system consists almost entirely of several humanitarian organizations with no centralized leadership.

 “The state health policy has become the vector for this disease,” she said. “Because there had been no systematic investment in healthcare infrastructure and there was an extensive goal to decentralize services in post-war Liberia, most of the [healthcare] provisions were still being done by private humanitarian organizations.”

Despite increased domestic and international military efforts to control the spread of Ebola, including President Barack Obama’s recent pledge of 3,000 U.S. soldiers, Moran said the situation could only improve if Liberians have access to more medical professionals.

At the start of this outbreak, Liberia had one doctor for every 100,000 people, Moran said. But since June, half the doctors in Liberia have died.

“In rural clinics in Guinea, Sierra Leone and Liberia where patients first appeared in early days of the epidemic, many found only shells of buildings and dying providers,” Moran said. “And that in many ways is the enormous tragedy of this.”

 

Inaccurate media coverage

Moran criticized Western press coverage of the outbreak, citing numerous articles that blamed traditional African practices or corrupt politics for the spread of Ebola.

“Having had a war in the last 10 years makes a huge difference in the ability of a public health system to absorb a threat like this,” Moran said. “Being an African public health system is not what makes a difference in containing a threat like this.”

She urged the audience to ignore reports that “these are irrational people who believe in juju, eat nasty animals and are suspicious of Western medicine.”

 “People are giving up their sick dying and dead family members to people wearing anonymous white space suits, in most cases never to see them again,” Moran said. “Give them the benefit of the doubt that, just like Americans, if people in your family are sick, you want to take care of them.”

Moran’s presentation is part of a week-long series regarding the West-African Ebola outbreak, hosted by the Duke Africa Initiative, Duke University Center for International Studies, Duke Global Health Institute and Program in the Arts of the Moving Image.