Who Dies to Fight Ebola? Who Kills in Fear of It?

Ebola health workers risk death by virus plus violence by frightened villagers.

Posted Sep 23, 2014

In the milieu of "the deadliest ebola outbreak on record," health workers and others risk their lives to fight the spread of this disease. They face danger not only from the destructive virus itself but sometimes from the very people they're trying to help, people too terrified of the disease to welcome wandering strangers. 

The current outbreak has killed more than 2,800 people, out of over 5,000 infected. According to the World Health Organization, the virus shows no sign of slowing down. It is a plague.

One team distributing information about ebola found themselves attacked with stones and clubs by a hostile crowd of villagers in a remote area of Guinea. Some escaped. Eight died. Health workers, journalists, and local officials—the eight of them were found dead, dumped into the village latrine, with three of their throats slit. Angry, fearful residents killed to try to keep the killer contagion out. Since then, a burial team in Sierra Leone, a land under lockdown, also got attacked. They had to flee, leaving five diseased corpses in the street. Misguided reactions have impeded progress against the very disease that inspired those reactions. "In communities where vital work has not been able to take place, cases of ebola have risen, increasing the impact of the disease and amplifying its spread across the region," the Red Cross reports in a plea for these attacks to end.

Both belief and disbelief can create barriers to those combatting ebola. While some believe in ebola's danger so strongly that the believers turn dangerous, there are also those in Guinea and West Africa who turn health workers away because they do not believe ebola exists. Any outsiders smugly blaming "backward" villagers for their own woes would be wise to consider how many Westerners still fall for Andrew Wakefield's anti-vaccine hoax long after his thorough discrediting and thus endanger not only their own children but other people who cross their paths.

Fear from outside ebola-affected areas compounds the effects of the fear within. Excessive travel restrictions impede efforts to import much needed supplies, create inflation locally, and can lead to food shortages. Donald Trump and others assert that those who go to fight ebola "must suffer the consequences," and all that travel from affected countries must stop regardless of security or purpose. Numerous people howled in objection when two health workers, Nancy Writebol and Dr. Kent Brantly, were brought back from Liberia for medical treatment in Atlanta, Georgia, this summer, but both have survived and their survival has taught doctors much. Although they were hardly the first to survive contracting ebola, they were the first to receive the experimental drug ZMapp. 

Ignoring wildfire does not stop its spread. Erecting a fireproof wall does not keep it out as well as actively going out to fight it before it ever reaches your wall. Fighting fire together serves us better than separately burning.

Fighting fear outside and within the ebola-affected regions requires education both outside and within. Fear-based communication tends to be less persuasive and less effective overall than other techniques except when it regards topics of health. Plenty of politicians have successfully applied fear appeal to stir voters into frenzy, to be sure, but less consistently when the topics do not relate to health and survival. Behavioral medicine and its subfield of health psychology, as they apply behavioral and medical knowledge to advance public health, often focus on individuals, family units, and maybe communities because researchers can study them objectively, both qualitatively and quantitatively, but how do they study cross-cultural panic? They can develop different models to consider how health beliefs impact behaviors, models built on questionnaires administered outside the context of imminent crisis can misrepresent how people would act under crisis or even in everyday health-related activities because health beliefs may not be static, perceptions of disease severity or susceptibility can be wrong, one's intentions may influence behavior more than beliefs will, and many other barriers to health behaviors may include self-efficacy, locus of control, interpersonal influences, social norms, or sheer convenience. Just because you believe you would risk your life for someone else does not mean you really would help under fire, nor does thinking you would never endanger yourself for the sake of another mean you would really run out in a crisis. 

Ebola spreads through bodily fluids, not through mere proximity as might a flu or cold. News agencies feed fears because it serves their purposes. "What if Ebola becomes airborne? Tune at 9 to find out if you might die!" While theoretically more probable than a mutant pig being born with wings, the likelihood is low. People often mistake possible for probable even while they ignore so many of life's threats that have much greater odds. There is "almost no historical precedent" for any virus changing its mode of transmission as radically as what ebola would have to undergo to take flight. Watching the news triggers persistent negative feelings, is associated with greater fear of danger all around, and exacerbates general negativity. What does this have to do with the original questions as to who dies to fight Ebola and who kills in fear of it? Everything that feeds your fear matters, whether you feed it with online news or word through the local grapevine. Just consider which of you worry about Ebola when you live nowhere near a single case, or which of you even let it linger in your thoughts whether you call that concern "fear" or not. You have, after all, read this article all the way to this point. Now imagine what your own tiny seed of fear might grow into if planted in a fertile environment where the danger looms nearby, when disease seems to be right there outside your gate! You might be more ready to die or to kill than maybe you know right now. How close do you let the infected come to you when they're there in your line of sight, and what lengths do you go to so you keep them out of that sight? How much do you risk on possibility they might or might not be carriers?

Which gamble do you take? How can you know for certain whether either gamble makes you a hero or a villain? Or does trying to stay out of it altogether make you a villain of a different kind?

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