At Cosmologics, we’ve watched, with the rest of the world, news unfold about the outbreak of the Ebola virus in Guinea, Liberia, Sierra Leone, and Nigeria. Although there are many issues raised by the situation that we care deeply about (e.g. the bioethics of experimental treatments, the inflammatory response by the American news media, mistrust of Western science, and medicine), we couldn’t help but wish for a guide on how to react thoughtfully and responsibly to the situation.

Fortunately, we had the opportunity to speak with Betsie Frei, a project officer for the international nonprofit Management Sciences for Health, who is currently managing a public health project in Liberia. Frei talked us through the broader political, ethical, and health issues that have contributed to the outbreak and will continue to affect this region in the months and years to come.

—Myrna Perez Sheldon for Cosmologics


Cosmologics: When was the first time that the public health community was aware of an outbreak of Ebola in West Africa?

Betsie Frei: The very first cases were likely in early December 2013, and the first reported case was in February 2014. When the first cases were confirmed and recognized as Ebola, the public health community knew about this almost immediately. The initial articles about it first showed up in IRIN (a humanitarian news and analysis service provided by the UN) in March as well. This is the first time Ebola has been a problem in West Africa, so the health system—as well as populations—were not prepared to deal with it. I personally knew about it almost immediately because we have a project in Guinea which supports the Ministry of Health’s National Malaria Control Program, so our Technical Advisor there receives these updates.


I hope it’s not too judgmental to say that the “from the source” information is not meant to incite hysteria, which is what I perceive the CNN-type coverage as doing, but rather to inform the people who are working in this region.


Cosmologics: What has been the response of public health experts to the outbreak? How is this different from what the American news media is asking?

Betsie Frei: My main sources of information about the outbreak have been the weekly reports drafted by the Ministry of Health in Guinea, my organization’s own Crisis Committee and Operations Teams which have been closely monitoring the outbreak since March and are in touch with various organizations at the forefront of the epidemic’s treatment and prevention, and then international development and public health news services, such as IRIN and Devex.

These sources are different than mainstream news sources in that their bias is to inform and mobilize the various actors that are affected by the outbreak (directly and indirectly).

Most people working in international public health have some working knowledge of the virus, or at least can easily access information about it, so there’s very little fear or thought given to the unlikely scenario that Ebola could spread to the U.S.  The questions being asked are: how many new cases are there each day? Who is doing what in each country? How are the Ministries of Health in this region communicating? What are local populations in the outbreak “hot” zones saying and how are they responding (as this has big impacts on how the virus spreads)? How is this impacting health systems? How many trained nurses and health workers are there? How are they responding?

I hope it’s not too judgmental to say that the “from the source” information is not meant to incite hysteria, which is what I perceive the CNN-type coverage as doing, but rather to inform the people who are working in this region.

Cosmologics: What are the longer-term issues that your organization (and the public health community) are concerned about?

Betsie Frei: Because there are limited resources for systemic health projects in these countries, it means that money and time that were allocated for other projects have been redirected to dealing with the outbreak. And it’s a real security and health risk to have people traveling throughout the region. So, for instance, we were supporting a project for a country-wide distribution of mosquito nets in Liberia, and now that has had to be postponed. And that’s just one example of the kind of major project, or health system issue, that is going to be significantly impacted by the outbreak.

Cosmologics: Some news articles have cited “traditional practices” or “skepticism” relating to “Western” medical knowledge as contributing to the outbreak? Does this seem like a credible issue to you? Is this an aspect of the outbreak that should be discussed at all?

Betsie Frei: This is a very difficult dimension of the outbreak to talk about without offending somebody. Probably the best person to comment on this is someone from one of the affected countries, who understands Ebola and who also is sympathetic to the fear and distrust that many people in the affected areas are feeling.

The problem with mentioning the ways in which people’s fears have influenced the virus’ spread, is that you run the risk of blaming the victims, and worse than that, accusing them of being backward and stubborn-minded. This is an all too-familiar narrative for problems across the continent, and it allows us to ignore things like fragile and under-funded health and education systems, poor governance and leadership, and historical and current experiences people in these areas have with being exploited by foreign companies, governments, and organizations, in one way or another.

The issue of people misunderstanding and distrusting the Western medical establishment and foreign actors should not feel unfamiliar to us as Americans. Nor should widespread lack of understanding of how illnesses work. We ourselves have experienced broken promises and even some violence in the name of western medicine. Also, we should be humbled by how quickly misinformation and hysteria over Ebola spread here in the US. When a new illness shows up (and note once again that this is the first time Ebola has been present in West Africa), people will try to make sense of it quickly and with whatever tools are at their disposal. The same is true for people in Guinea and Liberia: rumors and misinformation have spread.

That said, some of the extreme responses to Ebola are very troubling. For those of us not on the frontlines of the outbreak response, this is a good moment to seriously reflect on how these extreme responses speak to the distrust and resentment people are feeling towards their own leaders, foreign powers, including multilateral bodies and development organizations. The looting, the violence, and other extreme responses should be reviewed within the broader context of decades of unfulfilled or broken promises made to people by politicians and aid organizations, which may have little or nothing to do with people’s experiences with the Ebola virus.


Also, we should be humbled by how quickly misinformation and hysteria over Ebola spread here in the US.


Cosmologics: Would there be a better way of talking about this aspect of the outbreak?

Betsie Frei: Well, I think that instead of saying “traditional practices,” which has such a negative connotation, it would be more straightforward to explain what is happening: people want to be able to bury and care for the dead, and this is contributing the spread of the virus.

I think that if the Western news put it into terms that weren’t immediately associated with “primitive” or “backward” images, it would be much better. I mean, people aren’t just buried in villages in West Africa. Every culture has rituals for deathand it would be deeply upsetting in any culture to be told that you couldn’t do what you felt was necessary for a loved one, once they died.

Cosmologics: Honestly, I hadn’t thought about it quite like that—although I really should have, considering that we did a whole series about death and death rituals in the magazine last week. But I agree with you, explaining the situation in a way that is more likely to emphasize commonality or empathy, I think that’s really positive. Related to this, do you think it’s a positive or negative thing that this has gripped the news cycle?

Betsie Frei: If the takeaway is that Ebola is coming to get us all, and that Africa is a scary place full of scary diseases, then I would say it’s a negative thing. I’m not of the opinion that anything that gets people to think about West Africa is a good thing.

Cosmologics: In light of this, what do you think is the most productive and ethical response of the average person who is watching this unfold, but who is outside of West Africa? Should or can there be different responses in different regions of the world?

Betsie Frei: I think it depends on what you care about. If your concern is that people here in the US will start contracting Ebola, then the only question you need to ask is “Is this a possibility?” Once you have the answer to that, you can stop asking questions, because the possibility is almost nil.

If you care about helping the people in these places who are affected by the outbreak, then the easy answer is to donate to any of the organizations that are on the ground, directly addressing it, Doctors Without Borders and the International Rescue Committee are my top picks, but I also know that Samaritan’s Purse has done a lot of important work in this area as well.

Ultimately, there should be different responses to different problems. From what I understand, the Ebola response work, in the short term, needs more money. In the long term, we need better trained health officials, more organized health systems, and of course, more money for everything that goes along with this (salaries for doctors and administrators, training, medical supplies, infrastructure, technology, electricity, etc). Ebola is obviously not the only major health concern for this region, nor is it truly the most threatening in terms of mortality rates. Other concerns, such as sanitation, nutrition, attended childbirths, and illnesses, such as malaria, will continue to be top priorities, even after the Ebola outbreak is contained.

Betsie Frei is a project officer for Management Sciences for Health. She has a Masters in International Development from The George Washington University and a degree in Sociology from Westmont College. Her decade of work in this region began in 2006, when she spent two years in the Peace Core in Benin. Her views in this interview in no way represent the opinions and views of MSH.  


Image from Flickr via CDC International


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