Saturday, October 18, 2014

Unimaginable

I've been wanting to blog about Ebola for the past week, but it's taken me some time to collect my thoughts and figure out what I want to say about it.

Earlier in the week, I spotted a tweet that essentially wondered why over 4000 people can die of Ebola in Africa and no one notices.  But when less than a handful of people are diagnosed with Ebola in the US, it's a national crisis--this was the gist of the wonder.

I responded: "We can't imagine a global pandemic when we hear 'Ebola in Africa.'  But when we hear, 'Ebola in Dallas,' we suddenly can."

I want to reflect on why that is.  I've been thinking all week about what a disease--or an epidemic, or a pandemic--requires of us imaginatively.

I've been thinking all week about how imagination can shape political action (or apathy) and influence our success in coping (or our failure to cope) with a virulent strain of hemorraghic fever like Ebola.

In his novel, The Plague, French writer Albert Camus comments on how difficult it is for us to understand massive destruction on a global scale.  We simply can't imagine the numbers, because it's outside of our frame of reference.  We don't know 4000 people, so we can't imagine death on such a scale. 

Of course, in this age of Facebook "friends" and Twitter "followers," we can imagine a sense of connection with numbers of this kind, but I think that we often don't.  Imagine if you went to bed tonight, knowing that Ebola was "out there" and by this time next week, over half--if not all-- of your Facebook friends were gone.

That's Ebola.  Right there.  The entity pictured in the image to the right does that.

In The Plague, Camus argues that, to make wide-scale destruction imaginatively possible for people who are currently living quiet, comfortable lives, you have to contextualize it in a way that they can imagine.

Camus suggests that people imagine a movie theater in their hometown--one that they go to themselves regularly--and then imagine it filled with people at a Friday night showing. 

Then, he says, imagine all of those people are killed, suddenly, inexplicably.  The theater reopens the next day, fills for a Saturday afternoon showing, and again, everyone in the theater is killed.  Imagine this happening on Saturday night, Sunday afternoon, Sunday night.  And on into the week.  Imagine it simultaneously happening at other theaters.  Suddenly.  Randomly.  Restaurants.  Malls.  Unpredictably, and seemingly unstoppably, the numbers begin to add up. 

To imagine this happening day after day, for no apparent reason and with no discernible end in sight, can help us imagine the devastation of a plague as something that might affect us.   Camus argues that, in this instance, because we can imagine the place (a theater we often go to with people we know and love), we can imagine the people who might be found there on any one of these disastrous occasions.

We can imagine loved ones who might be inadvertently caught in the trap, and friends who might be suffering as a result.  The numbers "mean" something to us.

As Antjie Krog argues in Country of My Skull, it forces us to confront an unimaginably painful reality, one that we hesitate to even articulate:
"How is it possible that the person I loved so much lit no spark of humanity in you?" 
If we can't force ourselves to imagine this in this way, Camus argues, the numbers will always remain somewhat meaningless.  We can't see the people in the numbers, and so our imaginations fail us.

We know it's bad, but we don't know how bad and because we can't see what that means, we will fail to act accordingly.

I first found out specifics about Ebola--and Marburg viruses in general--when I read Richard Preston's The Hot Zone (1994) several years ago.

Preston looks at the origin of the virus itself and its sporadic impact on various African communities during the 1970s and early 1980's.  Because yes, as the tweet that I initially responded to clearly pointed out, Ebola has been cropping up sporadically in Africa for several decades now.  And Marburg--an equally virulent but somewhat less lethal strain of the same virus (Marburg is often identified as a "cousin" of Ebola)--has been previously diagnosed in Europe and it too traveled to the US on an airplane.

Preston's descriptions of what the Ebola virus does to the human body are horrific and seemingly unimaginable.  Ebola begins with a headache that appears a week or so after exposure to the virus, and then quickly escalates to nausea and vomiting.  Describing the first known case of Ebola, Preston writes,
    ...on the third day after his headache started, he became nauseated, spiked a fever, and began to vomit.  His vomiting grew intense and turned into dry heaves.  At the same time, he became strangely passive.  His face lost all appearance of life and set itself into an expressionless mask, with the eyeballs fixed, paralytic, and staring.  They eyelids were slightly droopy, which gave him a peculiar appearance, as if his eyes were popping out of his head and half-closed at the same time (11-12).
The eyes become bright red and the skin becomes yellowish and speckled with red.  Over time, the skin will begin to appear to be a massive reddish-purple bruise as the spots and speckles merge and expand.

And the vomiting will become far, far worse.  Unimaginably worse.

In the advanced stages of Ebola, the body begins bleeding from every orifice, because the blood's clotting factors no longer function.   Ebola attacks the connective tissue in the human body, which explains why the victim's face begins to take on an odd appearance.  The brain and internal organs bleed and slowly liquify.  The lining of the intestine or the surface of the tongue may actually be expelled from the body during a bout of defecation or vomiting.

I think Preston's description encapsulates the paradox of imagination that surrounds Ebola.  These symptoms are so horrifying that we can't even imagine suffering of this magnitude.  We can't imagine that this--this--could possibly happen to the (reasonably) hale and hearty American bodies we see all around us. 

And yet, we can, in a way.  We can demonize the disease and respond with fear, and that fear can be fueled by descriptions like the one that Preston offers--even though that was not necessarily his purpose in writing it.

Fear is both an understandable and appropriate reaction to Ebola.  The disease is contagious and it is officially categorized as "extremely lethal"--it is more lethal yellow fever, which has a mortality rate of approximately 5-10%.  It is more lethal than smallpox, which has a mortality rate of approximately 30%.

Ebola has a mortality rate of approximately 50% or higher, depending upon the strain.

But in a way, this is also a vulnerability in Ebola.  As Preston points out, Ebola viruses are efficiently lethal when it comes to humans--they often kill their human host quickly and horrifically--but this means that, in order to survive, the Ebola virus must constantly be infecting a new host.

Unlike HIV or tuberculosis, which infect a host and then linger over time, doing slow but sustained (and initially, invisible) damage, Ebola consumes quickly and then jumps, from person to person or across species.

In its ability to jump species, Ebola is not uncommon.  The flu can do it.  And HIV.  And rabies.  What Ebola does seems unimaginable, but in fact it is not.  It's unfortunately somewhat common among virulent viruses.  It's what makes them virulent.

So I think that, as we imagine Ebola and what it means for the world at large, we need to shift the focus of our thoughts and our imaginings.

We focus on symptoms that come straight out of a horror film, instead of imagining the causes that brought us to this point.

Scientists speculate that Ebola may haunt us today because, in the 1960's, it became profitable to capture, sell and ship monkeys from Africa around the world--often to pharmaceutical labs where they were the subjects of animal testing.  A monkey--like a human--can be infected with Ebola and remain symptomless (at least initially).  You wouldn't know they had the virus simply by looking at them.

So in a sense, Western economic demands may (indirectly) be what brought the virus out into the open and  put it on a plane.  Monkeys of a variety of species, in close contact with their human hunters, captured and enclosed in cages with others who may or may not have been infected.

Blood, feces, saliva, sweat, semen, vomit.  A virus-jumping paradise.

It seems to me that, if you inadvertently helped create the problem, you need to deliberately help devise a solution.  Particularly if you earned a profit from something that has now become a massive problem for thousands of impoverished people in multiple countries. 

The solution to "Ebola in Dallas," whether we like it or not, is "better health care in Africa."  If American corporations can imagine cornering capitalist markets and turning a tidy profit from Africa's resources, we can--and should-- imagine better healthcare systems in Africa as well. 

I think this is what we need to begin to focus on in our imaginings of Ebola.  Not hordes of dead Americans bleeding from every orifice, but scores of clean, efficient hospitals in Africa.  

You can't ban travel to or from countries infected with Ebola.  And even if you could, it would make little or no difference.  Imagine this: on any given flight on any given day, you are potentially exposed to all kinds of airborne pathogens that could do all kinds of nasty things that you and your body wouldn't like one bit.  It doesn't have to be Ebola.  Ebola is just what is happening right now.

This was the reality before the Ebola outbreak.  It will continue to be the reality after the Ebola outbreak.  If we can imagine testing people for fevers at airports, why can't we imagine sending some of the latest medical equipment and supplies to Africa on a regular basis, to help stop the disease before it gains a significant foothold like the one it currently has in West Africa? 

Put Ebola in the same category as rabies and HIV and the flu, and suddenly you can imagine this disease--and our response to it--a bit differently, I think.   

We don't have cures for rabies or HIV or the flu.  But we do have treatment plans that minimize the risk and alleviate the effects of these contagious diseases.  These diseases lit the spark of humanity in us, and as a result, people stand a better chance of surviving them today.

We can--and have--imagined all kinds of ways to help prevent other viruses from spreading quickly and exponentially.  We imagined scenes in which they could no longer do untold damage to the human population at large, and we worked collectively to try to make them real.  We eradicated smallpox.

I think we can do the same for Ebola.  Imagine that.  

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