2013

Outbreak of Ebola (a Filovirus, like Marburg virus; hemorrhagic fever) in southeast Guinea, then by February 2014 to Liberia and Sierra Leone (=Upper West Africa), especially where the three countries intersect (the Kissi Triangle). Initially misdiagnosed as cholera, it was an epidemic spread by caregivers: almost 1,000 healthcare workers from the three countries became infected, half of whom died: “The epidemic was fueled and sustained within this three-country region by everyday acts of caregiving, the mundane yet sacred obligations people felt to nurse the sick and bury the dead – without the PPE, or personal protective equipment, that such duties often required. . . . Like COVID-19, Ebola is a zoonosis, meaning it’s caused by a pathogen that jumps from animals to humans. . . . a ‘spillover event’. . . . [Western commentators] invoked a host of exotic practices and beliefs held to be common in this part of the world. But variations of these practices (eating game, having babies, nursing the sick, respecting and transmitting traditions about last rites and burial) are encountered across the world, and Ebola’s putative natural host or hosts also have a wide distribution zone. . . . [All such cultural explanations] didn’t throw much light on the particulars of the disease’s catastrophic spread across Upper West Africa.” International relief efforts (WHO, MSF, etc.) adopted a contain-over-care paradigm that antagonized local populations (who expected hands-on supportive care from outside providers), which led to nonreports of illness, destruction of health care facilities (ETOs, etc.), and drove the infection underground (Farmer, Preface, ch 1).