Decolonizing Ebola Rhetorics Following the 2013–2016 West African Ebola Outbreak

In fascinating ways those today who talk about Ebola “fears” being as important as the epidemiological features of Ebola are only touching on one of many facets of the colonial medical knowledge productions that still influence the ways that 21st-century social agents write and talk about Ebola virus disease (EVD). Regardless of whether we are commenting on the “West African” Ebola outbreak of 2013–2016 or the more recent outbreak in the Democratic Republic of Congo (DRC) colonial legacies linger and impact perceptions and the ability to fight EVD. As I write the final drafts of this book in the DRC there are now about 500 reported cases of EVD, and as this infectious disease spreads to urban areas and borders of neighboring countries some have recently suggested that it is once again time to declare this outbreak to be a Public Health Emergency of International Concern (PHEIC).¹

Some who study either the 2013–2016 outbreak in West Africa or the DRC epidemic go so far as to wonder whether EVD is “endemic” to the region, and they use permutations of arguments that were crafted long ago to help explain the social ←1 | 2→resistance that is coming from some segments of populations that are not sure about the vaccines, the contact tracers, the isolation practices, and the quarantines that have become part of the standard operating procedures of 21st-century Ebola “emergency” containment efforts. As Luise White has argued, today’s rumors and superstitions should be not readily dismissed as the ignorant beliefs or hearsay of the uneducated, because some of these may be based on historical “narratives, explanations, and theories in which colonial bureaucracies, corporations, events and diseases are subjects” that have everything to do with prior encounters and asymmetric power relationships.²

Throughout this book I will be focusing on the various symbolic nodal points that connect imperial pasts to the “colonial present,”³ and I will be explaining some of the reasons why those today who write about a “neglected tropical disease,”⁴ or the need to manage “emerging infectious diseases” (EVD), oftentimes come up with triage systems that allow them to view EVD in ways that avoid massive spending. In the name of “rapid response” to emergencies they can follow the former colonizers and avoid spending billions on needed African public health infrastructures.

I will be explaining how colonial histories and strange postcolonial rhetorics may have circulated in diverse ways that impacted everything from the very formation of “emergency” response ways of viewing African health care to the specific treatment and management regimes that have been produced for handling EVD. At the same time, portions of this book will show why some West African populations responded in particular ways to the efforts of those who appeared with “ ‘Ebola is Real’ … banners on the rainy streets of Monrovia” that smacked “of distant authority.”⁵

This is the perfect time to be taking a retrospective look at the 2013–2016 global Ebola outbreak because in many ways the supposed failures associated with local, regional, and international efforts during that outbreak are often said to have provided the “lessons learned” that will be needed by future successful generations of “Ebola hunters” or EVD experts.⁶ For example, when Jean-Jacques Muyembe-Tamfum, the director of the National Institute for Biomedical Research in Kinshasa, was in Liberia helping put out the West African outbreak, he heard that Ebola was revisiting the DRC. He immediate dispatched many community relay teams that helped educate the Congolese about the need for dignified, yet safe burials and isolation practices.⁷

These acts were not simply based on Western-oriented, triage-centered “emergency” practices that came from outside of Africa. Jean-Jacques Muyembe-Tamfum—who had also been involved in halting the 1995 Ebola outbreak in Kikwit—was credited with leading the successful Congolese phase of the 2013–2016 Ebola outbreak in three months, and investigative reporters noted that this was done in culturally sensitive ways that resulted in less than 70 deaths.⁸

Governments [during the West African outbreak] knew that the shutdown wouldn’t curb the spread, but they wanted to shock the entire population into taking notice. They put in place temperature checks at roadblocks, isolation wards and emergency burial teams, anything to stop the dying. … Ebola now stalks a different part of Africa. … But this time—for the first time in 40 years of combating Ebola—global health experts have something akin to optimism. Armed with an experimental vaccine and empowered by a revolution in global health security, put in place after the catastrophe of the West African epidemic, they believe they have real chance to snuff out Ebola’s deadly threat.⁹

Yet some seven months later, journalists and public health officials started to change their minds about that optimism. They asked whether the DRC outbreak was really under control, and whether having the outbreak take place in a conflict zone was going to force public health administrators to finally call this a regional, if not “international,” public health emergency.

What was this “global health security” that McKenzie was referencing, and what evidence did journalists have that the populations in Sierra Leone, Guinea, and Liberia lacked this “security?” What was so problematic about the way that various communities had handled the “West African” outbreak, and what were the material conditions and rhetorical practices that needed to have been changed?

In order to help answer those types of queries I want to begin this book by advancing one key contestable, overarching claim—that many international audiences who watched the unfolding of the 2013–2016 West African Ebola outbreak forgot their colonial legacies when they treated that epidemic as simply a small, routine, and “rural” problem that required the occasional help of outside, mobile “emergency” response teams. I agree with Mark Honigsbaum’s 2018 claim that some of the mutating social constructions of EVD impacted the ways “crisis management” solutions were being used in ways that were “obscuring the social, economic and environmental dimensions of the outbreak ….”¹⁰

My contributions will come when readers get the chance to see colonial and postcolonial facets of these infectious disease revelations and obfuscations.

Instead of paying attention to recurring medical issues that could be traced back to the old “tropical disease” years, American journalists did not hesitate to dwell on present and future spending on disease control. They noted that U.S. organizations like USAID/OFDA spent over half a billion dollars in “response to Ebola in Liberia alone.”¹¹

However, what these writers oftentimes failed to discuss were Liberia’s health care struggles that required more than the spending of hundreds of millions of dollars. This was a region that had experienced massive dispossession and resource exploitation during the 19th century, and the lack of adequate spending for indigenous public health care needs was a part of the “underdevelopment” noted by African scholars. Twenty-first-century commentators could congratulate those in the West for caring enough to set aside half a billion dollars for EVD control efforts, but few noticed just how much more money was being spent on U.S. domestic Ebola containment efforts.

As I defend that overarching claim I want to advance a correlative claim—that those who look back on the 2013–2016 West African outbreak and treated this as an example of a successful case of “military” EVD interventionism—conveniently leave out the fact that these belated military interventions arrived on the scene after most of the outbreak had already been contained. “By the time the U.S. began to build ETUs,” explained Drew Calcagno, other organizations and “other ETUs had borne the brunt of patient treatment services” and the elaborate American plan for “US.-led ETU in every province was no longer necessary.”¹²

U.S. help was appreciated, and it provided belated logistical help and moral support. That said, I share the views of those who believe that too little credit was given to the African doctors, public health workers, and Ebola experts who were primarily responsible for containing the spread of EVD in West Africa between 2013 and 2016. More than a few wanted to rationalize Western interventionism in Ebola crises by exaggerating the role that outsiders played in these activities.

The social dramas associated with triumphant Western storytelling—populated by the protagonist “Ebola hunters” and those who “battled” the antagonist ←4 | 5→“Ebola” disease—appealed to those who wanted to valorize the efforts of foreigners who came to the rescue of impoverished West African communities.¹³ It also reinforced the notion that triage, emergency response efforts afforded efficacious ways of battling EVD outbreaks.

In order to avoid being labeled neo-imperialists, French, British, American, Cuban, and other interventionists constantly underscored the point that West Africans—including then-Liberian President Ellen Johnson Sirleaf—requested some of aid.

Like all self-serving discourses these types of Ebola rhetorics deflected, and reflected, partial, contingent, and political realities. Granted, the humanitarian medical help of outside nation-states was needed, but not to the extent, or in the guise, that it appeared in late 2014. When this aid was given, it did not appear in material or symbolic forms that would have helped with long-term postcolonial prevention. It was not treated as reparations or redress for past colonial expropriation of resources from these regions. Instead, the medical provisions and health aid that was provided during the West African outbreak often came with strings attached, where “health security” needs were defined, and dictated, by foreign intervening powers. This was a world where donors, or the IMF, or other banking organizations could dictate the conditions that tied strings to much of the promised aid that was needed by West African nations.

Most of the promised bilateral or multilateral aid that did trickle in did not help redress infrastructural problems that had been around since the time of the mythic “Gold Coast (Ghana),”¹⁴ and when that aid was finally provided it was often wrapped in discursive garb and symbolic neoliberal frames that echoed the old colonial “tropical disease” ways of configuring health priorities.

Medals were handed out to the Western military leaders or the U.N. officials who led their “missions” during the Ebola outbreak,¹⁵ and many in the global “North” congratulated themselves for having contained an outbreak that some predicted would have impacted the lives of millions if it raged out of control.¹⁶ Often forgotten in all of these celebrations were the invisible efforts of the West African contact tracers, local community volunteers, health care workers, ministers, and other governmental employees working in Guinea, Liberia, and Sierra Leone who most likely deserved the majority of credit for eventually containing that 2013–2016 outbreak.¹⁷

The chapters in this book put on display the heuristic value of decolonizing approaches to Ebola rhetorics that allow audiences to see some of the lingering colonial or imperial influences that are often ignored by those who find other reasons that might help explain why, for months before the 2015 World Health Organization (WHO) declaration of the “end” of this outbreak, so many hesitated to intervene.¹⁸

The stories that I will be telling in these chapters do not resemble the conventional tales that appear in mainstream newspapers or “lessons learned” reports.¹⁹ ←5 | 6→I will be critiquing what I regard as the self-serving and hagiographic ways of framing Ebola “rescue” efforts that are still used to justify the continued use of Ebola rapid response efforts. Different, but related, tales will be told about the lingering colonial features of the 21st-century search for “Patient Zero,” the acumen of Doctors Without Borders observers, the beneficence of International Monetary Fund (IMF) officials, and the need to respect universal “health security,” or the innocence of “military humanitarians.”