Leonard DeLorenzo, Ph.D.
Director, Notre Dame Vision
The short, sharp cries slowly disturbed the peaceful silence of our living room. “Isaac’s calling you,” I said to my wife, presuming that the child stirring in bed and troubling the sacred tranquility of the post-bedtime downtime was our 11 month old, for whom only his mother can provide comfort. I’m usually spot-on with my audio diagnoses, but this time I was wrong. It wasn’t Isaac, it was Josiah: our nearly three-year-old whose nighttime rumblings generally fall within my zone of nocturnal responsibility.
So up the stairs I went, quickly ticking off in my head the possibilities of what might await me in his room. The best-case scenario would be that he just woke himself up, was disoriented and groggy, and would simply need me to lie down next to him for a couple minutes as he drifted back to sleep. A much less desirable scenario would be that the stomach bug had visited him and he either already had or soon would undo the cleanliness of his bed and the surrounding area, with many similar acts of expulsion to follow in the coming hours. I’ve quickly flipped through such scenarios so many times before as I made the quick ascent to one of our kids’ bedrooms that it happens without effort now. And yet, regardless of how daunting the possibilities I think about might be, I don’t remember ever hesitating on the way. The reflex is natural to a parent: child crying, child sick, child in need… go to him, hold him, make him well.
On this occasion, there actually was something bothering Josiah. Uncertain of what exactly the problem was, I just held him in my lap as he cried—and the more he cried, the more I held him. After several minutes, the cries softened then dissipated and he drifted off to sleep. When he awoke the next morning, all was well. I think it was his stomach that was bothering him, but I’m not really sure. There are many nights like this in raising children—most of these occasions end up being about nothing at all while others have to do with some sort of sickness. In any event, the first and most trusted remedy of all is unfailingly applied, one that is never a placebo: human contact. We hold our kids when they are not well. It is less something we are taught and more something we just know. Maladies make apparent what is always the case but all too often neglected in adult life: we want to be held and we want to hold.
I wouldn’t have thought twice about that otherwise commonplace calming of Josiah had I not read a startling article in the New York Times the very next morning. The headline speaks of a cruel paradox: “For a Liberian Family, Ebola Turns Loving Care Into Deadly Risk.” What would have otherwise seemed to me a sad predicament as I quickly read this article before moving to the next one, struck me deeply as a cruel and hidden tragedy within the already well-publicized tragedy of Ebola in West Africa. Just the night before I had done the most typical thing in the world: held my child in his discomfort. But as the article describes, when five-year-old Esther fell ill, her “father faced the anguish of going to see his ailing daughter […] but too afraid to get close enough to comfort her. ‘She tried to get to me, but I stood at a distance.’”
The only way to understand that kind of tragedy and misery is through our humanity. Science can’t tell you how bad that is, nor can medicine or protocols or politics or statistics. A father stopping himself from holding his sick child is a confounding sorrow that can’t be explained. You can only empathize with that kind of sorrow. And you can’t imagine the unimaginable suffering of a child whose parent won’t go to her except by remembering yourself as a child, or else remembering the children you yourself have held.
This is a hidden side of Ebola, where perhaps the most beautiful thing about the most afflicted societies is the very source of contagion. No institution is trusted more in Africa than the extended family, and nothing is more natural than to be with and care for one’s loved ones. It is a very human thing that is culturally engrained there in a way that it is not in most Euro-American cultures. This is why, “For most West Africans infected during the outbreak, the virus was transmitted quietly, through tender acts of love and kindness, at home where the sick were taken care of, or at a funeral where the dead were tended to.” Ebola makes compassion the most dangerous thing.
Because the family is the strongest institution in Liberia and other West African countries, this virus tears at the fabric of society there in a way it wouldn’t in a country like the United States. Ebola forces Liberian families to become the opposite of what they are if contagion is to be avoided. Even as Ebola has dawned on the consciousness of Americans in the past couple months (a recent poll showed that Ebola is one of the three most serious health concerns for Americans, along with access to and cost of health care and well above concerns about cancer and obesity), this horrifying dimension doesn’t seem to register, at least not strongly. While the crucial concerns about containing the virus are common to both Africa and the United States, the African focus on the family and human connection gives way to an American focus on civil liberties.
In response to the state imposed quarantines of returning health workers in New York and New Jersey, one commentator opined that, “What’s going on is the systematic governmental destruction of the presumption of liberty in the name of public safety.” Certainly, a concern for public safety has become as much an issue in West Africa as it clearly is in the United States, but the “presumption of liberty” is a peculiarly American thing. The question in the United States isn’t exactly about the tragedy of separating loved ones from each other and obstructing human contact; rather, it is about the perceived injustice of forcing individuals to be somewhere they don’t want to be, do something they don’t want to do, or, more precisely, not be where they would want to be and do what they want to do from moment to moment. As another American commentator put it, the “other Ebola fear” for Americans is our “civil liberties.” The argument about what to do is waged on those grounds and the added drama pertains to what individuals can and cannot do, where they can and cannot be (see this Washington Post article, for example). The free range of potential actions seems to define Americans much more than the capacity to care for one another.
I found myself on the “American side” of the ledger several weeks ago when visiting with my brother-in-law (Justin Pendarvis of USAID, Notre Dame Class of 2002) who had just returned from Western Africa for a brief visit at home before returning to the other side of the Atlantic. Justin has been in thick of the Ebola response in West Africa for the past several months, not in terms of direct care but rather as an expert coordinator from whom even U.S. army generals are taking orders due to his extensive experiential knowledge of healthcare issues in Liberia and surrounding countries. The question I asked him over a drink betrayed my predominant conception of an individual among other individuals: “How have you psychologically and emotionally coped with all the death these past few months?”
His response was secretly jarring to me not so much because it wasn’t what I expected but because I immediately recognized it was what I should have already expected. To paraphrase, he said that,
Death is really common in Liberia. People die all the time. It’s just part of life there. What is really challenging is that people can’t help each other how they normally would.
Without a doubt, the massive task for containing the outbreak is persuading people to take up precautionary measures, remove themselves from situations of direct contact with the ill, and, perhaps most difficult of all, to let go of dead bodies after their loved ones perish. That work of persuasion is really, really challenging, but it doesn’t tell the whole story of the tragedy. That story comes down to the fine line between caution and fear, such that the increasing anxiety about Ebola is leading to the abandonment of those in most need even when they are not themselves infected. This is nowhere more tragic than with the abandonment of women in labor, for whom the need for medical care and accompaniment is greatest at because of their vulnerability. “I personally know of at least seven women who have died in childbirth because nobody cared for them.”
This is a particular issue wherein the medical and human crises intersect in a most vexing fashion. Even with stringent precautionary measures, the amount of bodily fluid and human contact inherent in childbirth makes healthcare workers extremely susceptible to infection if the mother happens to be infected. In the vast majority of instances, of course, the woman in labor is not infected, but fear extrapolates singular cases into general threats. Women in labor have become a threat. Now that the counter-instinct of isolation has been introduced into a society that would otherwise bond people together in times of need, that isolating tendency spreads and becomes the new norm.
In a horrifying segment of an interview recently aired on NPR, Ester Kolleh, the lead midwife at a missionary hospital in Liberia tells of this epidemic of neglect that is sweeping her country underneath the veil of the Ebola epidemic: “Last night we received three ladies. They had been in labor one week, two weeks. Nobody to help.” The three women had gone from hospital to hospital in Monrovia. They were turned away at each one. By the time they made it to ELWA, it was too late for their babies. “All of them had stillbirth,” she says. “They couldn’t get help from anyone. The babies died before they came. Now we have three dead babies in the delivery room.”
In America, people would be justifiably outraged and this would be considered an affront to each of these women’s right to healthcare. In Africa, there is an additional sting to this horror because it is so contrary to the ethic of care that is born in the institution of the family and pervades outwards into society. In either place, it is a tragedy for which Ebola is to blame.
These are desperate times. The desperation does not come because this outbreak is uncontainable, for it seems as though the vigilant adherence to protocols—including targeted quarantines and the proper handling of dead bodies—along with better communication, organization, and early detection and care will slowly limit the exponential growth of the infection and eventually allow for its containment. What is so desperate is that, in the meantime, Africans are forced to act against the beauty of their humanity: to hold and to heal one another. There is also a sort of desperation in the general lack of recognition of this deeper tragedy on behalf of the rest of the world, especially in the United States. In failing to see the tragedy of parents unable to hold their children, of mothers left alone in their time of greatest need, we are confronted with the reality that perhaps we have lost touch with the beauty and goodness that would and should be there if not for this insidious virus. Even if the virus disappeared today, would we run to hold each other in sickness and in need, or is the urge to isolate that seems to come so much more naturally in the United States indicative of our character? It might serves us well in this instance, but is it a good in itself?
On issue in which the American tendency to isolate exacerbates the very real threat to Africans’ tendency to care is in the dis-incentivizing effect of mandatory quarantines for healthcare workers returning to the United States from West Africa. Without a doubt, this is tricky situation and one for which few would want to be responsible for making policies. At the same time, I can’t help but think that the self-protective impulse of American policy makers and of the American public at large is contributing to an international crisis of abandonment that will only prolong and further exaggerate the intra-familial abandonments that Ebola is forcing West Africans to endure. Governor Cuomo is certainly right that in a region like New York, “you go out one, two or three times, you ride the subway, you ride a bus,” as an Ebola carrier, and “you could affect hundreds and hundreds of people.” Governor Christie may also be right that, as an elected official in a position such as his, “Your first and most important job is to protect the health and safety of the people who live within your borders.” But what these positions are symptomatic of is an underlying mentality that focuses first on the individual: my health, my safety, my right to isolate. In this case, the individual has become a metropolitan area or even a nation, but the meaning is the same. There is “me” and there is “you”; there is “us” and there is “them”. The fact that the forced quarantines don’t bother Americans because of that bifurcation but rather because of the assault on civil liberties is alarming. And lest we think that these policies aren’t having an effect on West Africans, the decline in healthcare volunteers in the past month provides evidence that they do. “The word is out on the street: if you go, you’re at risk of losing your liberty,” says Lawrence Gostin, a professor of global health at Georgetown University Law School. “And people don’t volunteer because of it.”
It is hard to imagine a practical response to such dire and far-away circumstances for those of us who have neither the power to make policy nor the expertise to help with healthcare. At the risk of proposing an embarrassingly minimalist response, I can’t help but think about that peculiar Spiritual Work of Mercy: to pray for the living and the dead. What would it mean in this instance to pray for the living? It would mean reorienting our hearts to consider the pain that comes from family members pulling apart from one another in order to save one another. It would mean allowing ourselves to imagine that this is not “their problem” that we only fear because it might become “our problem”; rather this is our problem together because it is not just a healthcare issue or a public safety issue but a human issue. And what would it mean to pray for the dead now? It would mean honoring the suffering of ones who have been forced to die not just in pain but also alone. It would mean reaching out through the human contact of prayer towards those who were denied human contact at their time of greatest need. It would mean begging that what has been rent asunder in families and communities and between nations will be put back together in the love of God.
Works of Mercy always appeal to our humanity, and an appeal to our humanity is precisely what this Ebola epidemic and the attendant, hidden epidemic of isolationism require. Unless we learn to see the plight of our African neighbors through the lens of the parent hastening to his crying child in the night, we will continue to miss the real tragedy and thus lose some hold of our own humanity.