Over the past few months, I have been closely monitoring international media coverage surrounding the unfolding Ebola epidemic in West Africa as part of my role as the Communications Fellow at IntraHealth International. Somewhere in-between scattered piles of newspaper clippings, blaring audio reports, and confusing proxy manipulations to get by New York Times’ free trial period, all Ebola-related articles seemed to blur into one. Every article I read seemed to preface mentions of West Africa with something analogous to “Ebola-ravaged” or “Ebola-infected” as if these were now some sort of binding descriptors for the region. On the odd occasion when “West Africa” – as if this indicates single national entity with a unified history – was described as anything other than a vast expanse of disease-ridden space, it was characterized exclusively by its desperate need for international assistance. This pervasive narrative has continued on and on in recent months; and as media consumers, we have been too foolishly passive to question what is missing in this coverage.
Perhaps the most frustrating thing about the pervasive “Ebola narrative” featured in mainstream media coverage is the failure to explain exactly why West African health systems have failed to control the spread of Ebola. The closest explanation to this puzzling question comes when news articles condemn West African states’ poor health systems for their inability to contain the rapid spread of the virus. Still, the weakness of these states’ health systems is often stated matter-of-factly, with little to no explanation as to how they became so in the first place. In this context, we are led to believe that West African health systems are poor precisely because they are West African – an obviously problematic explanation that still leaves far too many questions unanswered.
In the few cases where Ebola was diagnosed among patients in Western countries, Western media was flooded with article after article attempting to identify the gaps in American or Spanish public health systems which permitted the virus to edge a little too-close-for-comfort. Were flight passengers screened sufficiently? Did hospitals apply identify symptoms correctly? Were prevention efforts applied to their fullest extent? Every one of these questions were scrutinized by major newspapers with international readerships. However, when the virus claims thousands of lives elsewhere, we are given a half-hearted explanation: West African health systems are weak.
Why is there such an overwhelming shortage of frontline health workers in Ebola-affected countries that we need such desperate pleas for foreign doctors? Why have existing health systems failed to stop the spread of Ebola at the source – in rural communities where it first appeared? Why, under the burden of Ebola, have domestic health systems almost completely collapsed, unable now to even provide basic primary care to non-Ebola infected patients? The popular “Ebola narrative” has largely left these sorts of questions unaddressed, leaving us to assume that we should not be asking them at all.
But we should. We should question why Liberia has only approximately 0.014 physicians per 1000 people, while higher-income countries have nearly a thousand times more physicians per capita. We should question why the international community stood in ignorance as Guinea publically recognized its chronic health workforce shortages in rural communities only months before Ebola’s “patient zero” was identified in a rural district of the country.
We should acknowledge how structural adjustment policies demanded public health financing to be reduced in West African countries for years, in the name of austerity and economic discipline. We should recognize how donors’ reliance of vertical health programming are futile if health systems strengthening is not also prioritized. We should realize that neglecting investments for training, equipping and retaining health workers in developing countries can have devastating implications.
Ebola has not exposed West African states’ weak public health systems. These countries’ fragile health systems were already protested by NGOs like IntraHealth International, advocacy coalitions like the Frontline Health Workers Coalition, and major multilateral bodies like the World Health Organization far before Ebola struck. Ebola, has, however, exposed the dangerous gaps in global health funding and policy-making, and provided resounding evidence for why health systems strengthening should no longer be left as a global health policy after-thought. Encouraging mainstream media sources to ask questions and expose these gaps is the first step towards ensuring these lessons are learned now and in the future.