7. What’s the Matter Boss, We Sick? A Meditation on Ebola’s Origin Stories

In late October 2014, US President Barack Obama held a press briefing at the White House to describe the US strategy for bringing the 2013–2016 West African Ebola outbreak under control. He said:

We know that the best way to protect Americans ultimately is going to stop this outbreak at the source. …

And it’s critical that we maintain that leadership. The truth is that we’re going to have to stay vigilant here at home until we stop the epidemic at its source. …

But what’s also critically important is making sure that all the talent, skill, compassion, professionalism, dedication, and experience of our folks here can be deployed to help those countries deal with this outbreak at the source.1

Obama’s emphasis on “the source” reveals a preoccupation with searching for the origin of the outbreak. Such a search is a deeply human one, in which we “attempt to capture the exact essence of things, their purest possibilities.”2 Anthropologists have written extensively about how people explain misfortune by seeking its source.3 They go to great lengths to discover the answers to these questions: Who is responsible? Why us? Why now?

Obama, at least officially, located the West African Ebola outbreak’s origins in the most affected regions themselves, in order to make a straightforward case for containment “over there” to prevent sickness “over here.” This rhetoric operates through a form of projection, where the worst part of ourselves—our most pressing fears—can be displaced and recognized in others. If “health” is perceived to be the normal state of affairs in “the West,” then, as anthropologists Jean and John Comaroff have argued, “affliction was taken to be endemic to the life of Africans; it was an unfortunate corollary of their social arrangements, their moral condition, their ‘animal ecology.’”4

Issues of race cannot be disentangled from projection. Fanon, drawing a connection between projection and anti-blackness, noted that foreignness and evil are attributed to the unknown (black person); when such attributes are identified in oneself, its origins are ascribed to someone else and slated for elimination.5 Or, to reframe Obama’s talking points on Ebola more ominously: It is stopped at its source.

As the outbreak unfolded, origin stories proliferated. Journalists, building on accounts from epidemiologists; residents of Meliandou, Guinea; and survivors, reconstructed a possible scenario of a child playing in a hollowed-out tree where bats lived. From there, they speculated that a single child, the putative “patient zero,” became sick. Images of the hollowed-out tree—the alleged “ground zero”—were widely circulated and displayed in popular science press, scientific presentations that I attended, and mainstream media outlets.

Another origin story centered Ebola at the intersections of race, militarization, and the political economy of scientific research. Many West Africans and people of African descent questioned whether the American military–funded laboratory in Kenema, Sierra Leone, and its partners at Tulane University were to blame. They believed scientists working in the lab conducted experiments that put local populations at risk. Like libertarian and right-wing American media sources, they also drew a connection among the region’s natural resources, the hemorrhagic viral fever laboratory, and the sketchy presence of the US military’s Africa command.6

The first lab-confirmed case of Ebola in the United States forced many of us to broaden our vision of what lay at the root of inequitable distribution of quality health care and of Ebola virus disease itself. In early October 2014, while Liberian national Thomas Eric Duncan was being treated for Ebola in a Dallas, Texas, hospital, Liberian president Ellen Johnson Sirleaf apologized to the United States and denigrated Duncan in an interview:

With the US doing so much to help us fight Ebola … He’s gone there and in a way put some Americans in a state of fear and put them at some risks, so I feel very saddened by that, and very angry with him…

The fact that he knew and he left the country, it’s unpardonable, quite frankly. I just hope that nobody else gets infected … I hope he’ll get his treating and then after that they’ll send him back and then we’ll have to deal with him.

When the reporter asked, “What will you do after he comes home?” Sirleaf laughed and said she would “have to consult with the lawyers.”7

Sirleaf based her threats on “the fact that he knew,” but we can only speculate whether Duncan knew when or where he contracted Ebola. He died on October 8, 2014. We don’t know what he knew.

A week after Duncan’s death, Sierra Leone hosted the United States Agency for International Development chief administrator, Rajiv Shah, to discuss the Ebola response. The communications unit for Sierra Leone’s president, Ernest Bai Koroma, issued a press release entitled: “‘We Will Not Export Ebola’ President Koroma Assures.” The message was clear: Koroma, like Sirleaf, was also deeply concerned with ensuring that citizens from his country did not spread Ebola to Americans.8

The two leaders’ statements were upsetting. Why had they felt the need to assert their concern for Americans’ health? Why did they identify so strongly with the Americans? Why did they couch their concern for these distant others within the context of aid? Their remarks, which registered as unreciprocated identification with Americans’ “plight,” resonated with Malcolm X’s ideas about a psychological disposition borne of chattel slavery. Speaking on the difference between the “house negro” and the “field negro,” Malcolm X said:

When the master would be sick, the house Negro identified himself so much with his master he’d say, “What’s the matter boss, we sick?” His master’s pain was his pain. And it hurt him more for his master to be sick than for him to be sick himself.9

Here, Malcolm X outlines how identification with the master class is intimately linked to a division of labor and relationships of exploitation ordered along spatial and racial lines. Feelings of allegiance and identification with elites among a managerial class, Malcolm X suggests, are forged under conditions of violence that uphold terms of their servitude, their presumed inferiority, their eagerness to accept what they are given, in exchange for meager personal gain. As a kind of managerial class, the “house negro” builds an uneasy intimacy with elites and, for his survival, depends on the remains of his master’s spoils. He eats the scraps from his master’s table, lives in his master’s attic, and wears his master’s old clothes. The managerial class strongly identifies with the master class, yet recognize they will never be fully incorporated into it. The burdens of this relationship are deeply felt by the masses; they both witness and experience the structural, symbolic, and psychological violence this relationship engenders.

In short, we sick.

The presidential statements about their concern for Americans take for granted a political and economic relationship that is pathological, even pathogenic. This relationship has long devalued and destabilized the infrastructure necessary—systems, staff, and stuff10—to prevent and contain a disease like Ebola. The three countries hardest hit by the outbreak are largely dependent on foreign assistance to finance their health systems. Some money for “public” health care never becomes part of government health budgets and is instead funneled through international NGOs who are, in turn, financed by development agencies mostly in the West.

It is easy to blame civil war for the crumbling health systems in Liberia and Sierra Leone. Indeed, many doctors, nurses, and technicians left Liberia and Sierra Leone during the war. Health facilities fell into disrepair or were destroyed, along with the infrastructure for monitoring and training clinicians and public health specialists.11 Yet structural adjustment programs of the 1980s had already had a significant impact on the health systems in these countries, well before there was a civil war.12 As in many poor countries around the world, the terms of World Bank and International Monetary Fund loans that accompanied structural adjustment reforms required countries like Liberia and Sierra Leone to roll back social services, devalue their currencies, and increase exports of cash crops with low tariffs.13 The end of African socialism in Guinea in 1984 also marked a sharp decline in the national health system, with only short-lived improvements in health indicators after the institution of the cost-recovery primary health care scheme (also known as the Bamako Initiative) in 1988.14

As Sierra Leonean political scientist Fodei Batty reminds us, the Ebola virus has followed the path of the civil war.15 The region where the war began has also been the site of an ongoing, century-long land grab. In Liberia, Firestone ushered in a new way of doing business in the 1920s;16 a pattern of exploitation persisted through the war in the 1990s, with the company turning away its Liberian employees to be slaughtered by the rebels and paying “protection” money to Charles Taylor to ensure smooth operations.17 Although it built an Ebola ward in April 2014 to respond to a single case on the plantation, Firestone refused nonemployees treatment until early August—even as government and NGO-sponsored treatment units filled to capacity outside the plantation’s borders.18 But we can push the clock back even farther: Predatory practices of commodity extraction have economically devastated the region since the trans-Atlantic slave trade.19

Today, African presidents like Koroma and Sirleaf manage the extraction and export of natural resources and distribute the revenues these exports generate. In an attempt to attract foreign investors, Sierra Leone provides tax breaks to international mining and agribusiness companies that have diminished the resources required to administer public services like health care and education.20

Ebola disrupted this system and substituted it with its own viral economy. In July and August 2014, mining and agribusiness companies and international NGOs, which offer services usually provided by the public sector, evacuated their staff. An expanded emergency aid industrial complex built up around the Ebola response filled the economic gap left by suspended bauxite, diamonds, and rutile extraction operations and long-term development initiatives. The Ebola aid coming into the three countries was under intense scrutiny, as international and local media outlets, accountability watchdog agencies, and citizens demanded more precise accounting. Some saw a persistent lack of accountability as contributing to failures to contain the epidemic, with some going as far to suggest that better accountability measures for Ebola constituted a cure.21 But as Marilyn Strathern has argued, accountancy and accountability are not the same—nor does the former remediate an enduring legacy of extraction, dependency, and exploitation.22 A true “reckoning” of Ebola response—a different origin story—must also account for failures to implement robust public health systems in light of extensive and significant health-sector expenditure by foreign donors in the aftermath of the civil conflicts in these countries.

As Sirleaf and Koroma intimated during their apologies and assurances to Americans, the disruption of extraction, cultivation, and export of commodities gave rise to fears that Ebola would become a primary export to the West. The local elites were no longer comfortable in their position of managing resource extraction and allocation; of distributing aid flows to other elites; and of allowing international NGOs to conduct the parallel business of making live and letting die. In the wake of Ebola, leaders of these three countries were under pressure to prove their capacity to manage the virus and control its movements.

It is bitterly ironic, then, that Koroma and Sirleaf felt the need to publicly express their concern for the health and welfare of Americans, a group that, at the time and to this day, has not experienced an Ebola epidemic. They have demonstrated, however, the lengths they are willing to go, the extent to which they will try to exercise sovereign power over the living, by establishing cordons sanitaires around entire regions and communities, instituting national lockdowns, and supporting village-based quarantines.23 None of these are innately bad interventions. But these leaders’ inability to manage the Ebola crisis at home threatened their political legitimacy on many fronts.24 They risked losing whatever credibility they had with their trading partners. Their failure to care for the multitudes of sick people threatened their political power at home.25

We sick.

By the time Duncan succumbed to his illness, Sirleaf’s popularity had declined.26 She was unpopular in Monrovia before the outbreak, but a confrontation between residents of West Point, an informal settlement in Monrovia, and national security forces signaled a turning point. This community has a history of civil conflict, dispossession and marginalization, and unsubstantiated rumors had circulated about the government wanting to clear slum housing for urban development.27 When area residents opposed the establishment of an isolation unit for outsiders in their community, the military quarantined West Point. Already tense relations between the government and area residents were stretched to the breaking point. During the quarantine, troops fired shots into crowds of protestors, killing a 15-year-old boy and injuring others.

In some ways, Koroma has been more successful than Sirleaf in asserting his authority, but he has also been criticized for those to whom he has entrusted leadership positions. In 2012, he appointed Miatta Kargbo, a pharmaceutical representative, to the post of minister of health and sanitation. Allegedly the relative of a close friend, she became the object of scorn during this outbreak when she appeared before Sierra Leone’s Parliament and mocked two health care workers who succumbed to Ebola.28 A video in which she accused the health care workers of adultery circulated as evidence of her incompetence and lack of integrity. That it took so long to replace her with someone more experienced did not help Koroma’s cause.29

When Martin Salia, a Sierra Leonean surgeon with permanent resident status in the United States, succumbed to Ebola in Nebraska, many asked: Why are Africans the only people to have died from Ebola in the United States? What was the message to be communicated to the rest of the world by these deaths? For them, a global hierarchy of value had been erected along fault lines of class, race, nationality, and region. The technologies of surveillance, monitoring, and exclusion began not at airports in New York, Newark, Atlanta, Chicago, and Washington, DC. Rather, the barriers to passage to the United States are erected at the ports of Conakry, Monrovia, and Freetown. The barriers to quality health care in the United States were racialized and located in “the clinic” itself. The problem of infection is reified and policed by West African leaders themselves, who have expressed an internalized disregard for their own afflicted as they also extended unreciprocated sympathy for the “pre-afflicted” in the United States.

We sick.

Origin stories have profound consequences for how people explain, interpret, and respond to an emergent Ebola crisis. They also impact how we begin to plan for “the next one,” an important concern as the West African epidemic dies down. Experts have rekindled security paradigms of public health, which are premised on thinking not only of diseases as global threats that transgress national borders, but of certain places (and their residents) as posing inherent danger to others.30 The accounts presented in this chapter suggest the need for multiple origin stories attentive to political economy and its intersections with race, class, and scientific knowledge production. We must imagine new origin stories. If imagination signals a present future, then memory serves, as Barbara Adam has noted,31 as a kind of “past future,” in which origin stories about the current epidemic—and efforts to end it—must also be understood within the context of enduring histories of exploitation, deception, dependency, and re/source extraction.

Acknowledgments

For their editorial assistance with earlier versions of this essay, I would like to thank Aaron Bady at The New Inquiry, where a different version was originally published, and Siddhartha Mitter.