The Words are Maps
At a Glance
Section titled “At a Glance”| Metadata | Details |
|---|---|
| Publication Date | 2017-01-01 |
| Journal | World Policy Journal |
| Authors | Adia Benton |
| Citations | 1 |
Abstract
Section titled “Abstract”“I think an Ebola survivor’s house collapsed this morning,” said Katie, a friend who works for an international NGO in Sierra Leone. She looked tired as she approached me, phone in hand. At the edge of the hotel lobby, a colleague waited for her at a café table. It was mid-August, and I was two days into my first visit to Freetown, the country’s capital, in almost 10 years. Outside the hotel lobby’s doors, the circular driveway was flooded, as it had been for days. One expects rain during the rainy season in one of the wettest places in the world, but this much was unusual. The Western Area, where Freetown is located, had received more than four inches of rain that week, and triple the region’s seasonal average in the previous six weeks.I waited in the restaurant off the lobby in the hopes that the storm would die down before I headed off to find a rumored Ebola museum some 140 miles outside Freetown. I first learned of the museum from a vaguely worded Sierra Leonean newspaper article back in 2015. Then I forgot about it until two years later, when I had an intriguing email exchange with another anthropologist who had worked in Sierra Leone during the West African Ebola outbreak. I told her about my plan to visit Ebola exhibits in London and Atlanta, and she asked me why I hadn’t also planned to visit the museum in Sierra Leone. During one of her post-outbreak field visits, she added, the museum had been the subject of bitter debate between planners, government officials, and foreign sponsors. But that was all she seemed to know about it. Though Katie had been working with Ebola survivors for a couple of years, she hadn’t heard of the museum, and neither had many of her local co-workers. Scant information about the museum could be found online, and I had failed to reach any of its founders or planners by phone or email. All I knew was that it was somewhere on Njala University’s main campus, which is in the southeast, a few miles outside of Bo Town, Sierra Leone’s second city. I hired a car and a driver, Idrissa, and set out to find it.It wasn’t a stretch to suppose that a national museum was in the works but hadn’t yet made enough progress to warrant local attention. That seemed to be the case for a lot of ambitious projects proposed here. Sierra Leone is a beautiful and resource-rich country, but even for the elite, it is not an easy place to live. It has the dubious distinction of being near or at the bottom of most global development rankings and of having some of the highest infant and maternal mortality rates in the world. The civil war, which left a million people displaced and between 20,000 and 50,000 dead, contributed to the decline of health systems, but longtime Sierra Leone observers know that the root of the country’s woes took hold well before the Revolutionary United Front marched into Sierra Leone from Liberia in 1991. Extractive industries like diamond mining and cash-crop agriculture—and even the trans-Atlantic slave trade—have, to varying degrees, done their share of environmental, economic, political, and psychic damage to generations of Sierra Leoneans. Fiscal policies like structural adjustment, which capped wages for health workers, reduced civil-service jobs in the health sector, and led to steady declines in health financing, also took their toll.Then, in May 2014, Sierra Leone was struck by Ebola, a viral hemorrhagic fever with the potential to kill its host within a matter of days. It led to the largest recorded outbreak since the disease was identified in 1976. When it hit, there were just 136 doctors and 1,000 nurses serving 6 million people. By March 2016, when public health officials declared the country’s outbreak over, nearly 4,000 people had died and more than 14,000 had been infected with the virus. Many thousands more were affected by the byzantine rules and regulations that governed the response and restricted movements between and within cities. The disproportionate burden of Ebola on the nation’s few clinicians, along with the fear of contracting Ebola from public-health facilities led to shuttered clinics and a decline in health-care services.I had lived on-and-off in Sierra Leone as a researcher and academic for about three years prior to the outbreak, and the sobering reality of its recent history made it bittersweet to return. But I was happy to be in Freetown, if only to reunite and break bread with old friends, to see how the city had fared after Ebola, and to find this elusive museum.Idrissa and I left Freetown around noon. He wanted to avoid the traffic clogging central Freetown and the East End, so we took Mountain Road, which overlooks the city. As we drove up and around the hills, I was reminded of how I was once terrified to drive my car around the tight bends and curves that characterized Freetown’s hilly landscape. The road to Fourah Bay College, which we would pass on our way back into town, was too narrow for my comfort. I would often hold my breath as we drove on the edge of the steep drop into the city below.Fourah Bay College, founded in Freetown under British colonial rule, was modeled on the British system and was affiliated with Durham University in the United Kingdom until the late 1960s. It is the oldest institution in the country. Njala University, in contrast, was founded after decolonization with the assistance of the University of Illinois, on land donated by Mokonde residents. Its curriculum was modeled on those common in American institutions of higher education.The decision to locate the museum on Njala’s campus reflected many of the differences among higher education institutions in Sierra Leone. Unlike Fourah Bay College, which would have been Njala’s primary contender to house the museum, Njala University had a rural constituency, so its courses were designed to solve rural problems: agriculture, veterinary science, and so on. While Njala is a research-intensive institution focused on knowledge production, free from the constraints of NGO projects, Fourah Bay is plugged into the consultancy culture of the NGO world. Lecturers at Fourah Bay use their training and expertise to court NGOs and obtain lucrative contracts to support their meager academic incomes.The rural lecturers at Njala are less inclined—or, perhaps, not as well positioned—to tap into the funds emanating from international NGOs, and from federal government contracts in Freetown. But when Ebola hit, they were well placed to trace viral movements, locate potential Ebola hotspots, and describe the local conditions that enabled the virus’s spread. Indeed, some of the earliest and most remarkable work came from anthropologists working in the area where Njala is located. Yet as a site for a museum, the rural location made it a curious choice for attracting international tourists.Tackling the Ebola problem in West Africa was not easy. There was little reason to suspect that it would spread through the region the way it did over a two-year period. All previous recorded outbreaks had happened thousands of miles away—often in isolation from cities and large towns. When Ebola was first identified in Guinea in March 2014, officials from the World Health Organization and the Guinean government assumed that the epidemic would be like the others that preceded it. It would be contained quickly, they imagined, as long as they kept it out of the hospitals, where poor infection-control procedures often helped the disease spread further—as occurred in the southwestern city of Kikwit in the Democratic Republic of Congo in 1995. Experts also assumed that, as with previous outbreaks in Sudan, Uganda, and the DRC, it would “burn out” once standard public-health surveillance, isolation, and containment measures were put into place.Doctors without Borders (MSF), key frontline responders when Ebola first took root, opened these assumptions to public scrutiny in June 2014, when it formally announced that the epidemic was spiraling out of control. The humanitarian group had already treated nearly 500 patients—more than had been seen in any previous outbreak—and were concerned about the geographic scale of the cases (nearly 60 sites had been identified as hot spots). In Sierra Leone, there were 239 confirmed cases and 99 deaths. MSF requested more staff to work in treatment units, disseminate information, and roll out more expansive biohazard protection in facilities located in hot-spot areas. The organization urged rich countries to send resources for building more treatment centers and diagnostic laboratories. In the meantime, local health workers in places like Kenema, a city in eastern Sierra Leone with an international reputation for its research on Lassa fever, another viral hemorrhagic disease, conducted outreach. Still, in mid-June 2014, Sierra Le-one’s government, overwhelmed by the sheer numbers of sick and dead, closed its borders to Liberia and Guinea.The situation became so dire by the end of the month that MSF, widely known for its anti-military stance, called for foreign military intervention to help move equipment, build health facilities, and deliver care in areas struck by Ebola. But, they cautioned, they wanted the military assets without all the baggage of the military: no talk of security and weapons, no threat of force, nothing that could be construed in terms of violence or combat. In part, this was an effort to humanize the response by highlighting the importance of care and de-emphasizing the military’s usual role. Perhaps as a reaction to this—but more likely because two American clinicians had been evacuated to Emory University Hospital in Atlanta after becoming infected—the WHO declared the West African Ebola outbreak a public-health emergency of international concern in early August. The decision was made in consultation with the heads of state of Guinea, Liberia, and Sierra Leone, who had reached the conclusion that they could no longer manage the epidemic without substantial international assistance.Crises mobilize resources, and whoever defines a crisis gets to dictate how these resources are distributed. In Sierra Leone, the terms of the crisis were largely framed by international NGOs and their local sub-contractors, in collaboration with the political and business elite. In mid-September, the U.N. Security Council declared the outbreak a threat to international security. Within weeks, UNMEER, the first disease-specific U.N. mission, was established in Accra, Ghana, some 930 miles from the epicenter of the outbreak. WHO developed the “road-map” for the response, while UNMEER was slated to coordinate the wide range of international agencies and organizations involved. The U.S. pledged 3,000 troops to assist in Liberia, while the U.K. sent nearly 1,000 troops, helicopters, and a naval vessel to Sierra Leone. This move inspired critiques of the militarized responses to the spread of the disease. Alex de Waal, an anthropologist who has studied humanitarian interventions in Africa since the 1980s, asked precisely why American military intervention had become the most “logical” option for addressing a public-health emergency. “This argument has a dreadful circularity,” he wrote in November 2014. “We are in this trap because we have paid for a bloated military and a threadbare global health system.”Perhaps unsurprisingly, the post-conflict units that foreign governments provided to “professionalize” police and military in Sierra Leone, Liberia, and Guinea were not adequately equipped to carry out the tasks they were expected to perform during a humanitarian emergency. They did not know how to transport samples, facilitate the rapid movement of supplies, or staff and build Ebola Treatment Units (ETUs), centers set up to house suspected and confirmed Ebola cases. They learned many of these tasks on the job. According to official documents, it also appears that foreign militaries had no intention of providing the level of support for clinical care that MSF requested. Once on the scene, they were largely preoccupied with protecting themselves. In an interview, MSF International President Joanne Liu remarked, “Countries are approaching this with the mindset of going to war. Zero risk. Zero casualties.” She equated early military responses to Ebola to “airstrikes without boots on the ground,” and argued that these efforts needed to be balanced with building ETUs and getting supplies to clinicians.The height of the epidemic—that is, when it appeared to be growing exponentially—coincided with the peak of the rainy season and the scaling back of international flights in and out of the three most affected countries. It also coincided with the departure of personnel from development-oriented NGOs and private-sector actors. Employees of European NGOs usually take their leave during the summer months and that year were advised to not return; others were evacuated out of fear or due to agency mandates. When West African leaders announced that Ebola was a matter of national security, the U.N. Security Council passed a resolution paving the way for additional militarization of the response. By October 2014, Sierra Leonean President Ernest Bai Koroma, dissatisfied with the Ministry of Health and Sanitation’s handling of the Ebola outbreak, transferred leadership to the Ministry of Defense.On the ground, Sierra Leonean officials struggled with how to balance containment with the need to distribute goods and services and deliver life-saving care. Unfortunately, comprehensive, supportive care took a backseat to punitive measures. Paul Farmer, a physician and anthropologist known for his work in Haiti and Rwanda, often says that when he arrived in Sierra Leone in late June 2014, he found little “T” in the ETU—referring to the lack of treatment available in the Ebola Treatment Units. Three months after the outbreak began, Sierra Leone’s parliament amended a 50-year-old public-health ordinance and included Ebola as one of five “notifiable” diseases. The ordinance allowed government officials to mark houses, quarantine communities, and even evacuate populations to curb disease transmission. Perhaps more importantly, the law made “harboring” anyone suspected of having Ebola punishable by two years in jail. On social media outlets like Facebook and WhatsApp, some Freetown residents complained about being expected to obey curfews enforced by police, while elites continued to socialize in beachside hotel bars after dark.To some political commentators in Sierra Leone, Koroma’s decision to shift Ebola oversight to the Ministry of Defense signaled that the president was conferring greater legitimacy for handling national crises—public health or otherwise—to the military. It also led to speculation over whether the newly minted Ebola czar, Major Palo Conteh, was being groomed to assume the presidency upon Koroma’s departure. Not long after taking up his new responsibility, Conteh explained what he felt would be the best approach to dealing with a seemingly indifferent and recalcitrant public. People who refused to obey the official Ebola mandates laid out by the government, he said, were criminals:I am now using the “carrot and stick approach,” I have been giving out the carrot since I took over but our people still do the wrong things. When I start using the stick, I will see all kinds of headlines in papers and radio programs but will not be deterred by them.This punitive strategy unevenly affected the country’s citizens. On Oct. 21, 2014, two residents were left and the mining of was placed under after Ebola with up on anyone who have into with an Ebola to take the of a the of her The that she had been at for some while from a and had not been to Ebola. They assistance from to the officials from the and a between security and who were in international as to public-health month after taking Conteh set up Ebola with military at their MSF appeared by this shift and the potential security it staff wrote in a are taking a military approach and that the Sierra Leone government more police and military to the quarantine measures at the level we have the to with to have in these to help the effort without getting anyone in a and or we to and people will die if we this late March and during a set off another of between security and in Freetown. months of the response to the Ebola had During a that he down on his that the People still and the sick still visit of going to treatment they still quarantine and The government also with a of that the and reach of organizations and international They conducted and education helped that care would be provided in Ebola Treatment and in to the spread of the a Sierra like Paul that early on in the in the of outside assistance or and information, some on a do with and They put care that would to to the sick with some They made when they suspected that people were after In they did what they often did in a of They back on local of was not an epidemic in the public-health is, it wasn’t only an disease in which the of new cases an established of or cases. The West African Ebola outbreak of was an epidemic of as would an epidemic in which are in their sheer and often to political While for Sierra Leone’s government, Ebola an to its legitimacy and to as a much of the it as of the to to the of its people. Many so as to that Ebola the in international efforts to and local people. They also it as an for local and national elites to from to in the region and their local the early days of the epidemic were with and The even with often public-health were by as of and to the and of the the resources to the among Sierra Leone’s the national government, and international actors. Many about Ebola spread in Sierra Leone and among its that the Ebola crisis was by the government to from rich in and that the crisis was to the government free range to growing to its that the disease had the through a viral hemorrhagic fever by the U.S. of Defense and that clinicians and in were and from people who with that agriculture, and were using the disease to more land for that were people to their and that international humanitarian organizations had the disease with to that Ebola was an of the to the are political and They concern the of Ebola and the resources from the country’s health-care and They are also in had Ebola struck in this country, where there had been no previous had it done so at this the of agriculture, and mining the the who from outbreak to outbreak the with had all the hemorrhagic fever research in this local been if not to and for people in the with the to these in part, an to yet another of the residents of this Yet if these which were widely among Sierra were in media of the Ebola outbreak at they were often as than being as critiques of and in the they were as to be through through addressing The crisis of Ebola, in became a crisis of In years to over what Ebola to Sierra how it is and by how these will be and will the national about health and The of will also how Sierra see going and the they will in to we were on the of Freetown, the came another I had seen in Sierra Leone a The three on the way to Bo were not yet but the were on the of the staff in their to anyone who to that they would start the reached Bo within three drove me over the road to Njala’s campus, where I at the main about my one a veterinary who had reached out to me in the main me to was still on and was from his so I asked his for his phone The we drove to in a government When I explained why I had to Sierra find the Ebola looked up the as if by his and asked if we were available to a back into the of we drove around Bo and back to campus, he explained his The museum had been in the works for some two years, and had received from he told the World and the Sierra of it did not yet have in it. It was not how much was for the but as it seemed that the potential for was what had than support for the The to days before my with he had been that more was in to for the clinical museum, he was the of Paul a British anthropologist who has culture and in Sierra Leone, and is a of Njala’s When the outbreak was on the a on how disease was to start a museum and build an Ebola in to Sierra Leone’s in knowledge about the epidemic—that is, to the that outside of the international and around the that of At a in early the for up and the of Ebola when so many local and workers had studied Ebola during the the that so many people the outbreak as clinicians, and of that they were as on the disease. During this another official of his for and people who had with Ebola. The became a for to their with a of expertise that they as their developed Leone’s Ebola museum was to people who had Ebola the to the knowledge and legitimacy with The museum also planned to use its to and distribute information about the disease. This would the of and that had characterized Western The of made that who to know about this what and how we could visit the museum located on Njala’s Bo the government to support the museum, it seemed that building the and a system for researcher about clinical would But, as one told me, take longer than and still the with an by the president with we drove to the main which large near the of the but Njala led from that building to a and a of At that a was had months without their and lecturers a of and that were a of their in newly donated by the government, Njala on Lassa fever, and drove a few to the museum It of two once by the for The of a wide range of international were on an already in of the the I could see It was we were one there seemed to know when the would to like a museum, as it not many to how the of Ebola will be told in Sierra Leone. for exhibits are are from Njala and the They have made progress on up a for clinical of have already requested to those and the for it has been from the U.K. working with two anthropologists to help build exhibits and a about health during the outbreak. Yet there are still many more that need to be There are the of the who education before the government did the who from Sierra among the in and the United and the who with the outside WhatsApp, and to about under a Sierra Leone and the global health to with we are still from the outbreak. Many survivors the of and as well as the and social that with and isolation from The survivors that my friend Katie had been working with at her NGO were among the her they received and clinical care. of the that had been put in place to to Ebola had When I to Freetown, I that the collapsed house she had was only one of many that were by a that 1,000 people and displaced The emergency response that had helped Ebola under had been to this They enabled officials to transport to the and There still few resources for or or for dealing with of than years after Ebola, the the of the outbreak to the development of and health be developed to the reach of until any of this will the in place be to the of