While governments and doctors around the world prepare themselves for Ebola to leap across oceans, we have yet to come to terms with the most difficult enabler of the deadly virus: human nature. While the disease could be contained if it was purely a medical issue, the behavior of people makes it virtually inevitable that it will spread beyond West Africa -- unless we deal with the psychological reality of how people react in the face of their own death.
Three examples illustrate the problems and provide some insight for what governments, WHO, CDC, and the UN might do to combat our worst enemy:
Escape artist spreads the disease to Port Harcourt.
A Nigerian diplomat who caught the disease in Lagos escaped quarantine and fled by plane to Port Harcourt, where a doctor secretly treated him in a hotel room. The man recovered, but his doctor caught the disease. While infectious, this doctor continued to see patients at his clinic, performed two operations, and when he became too ill to work, received dozens of visitors in his home before he died. At least two people are known to be infected by him, and over 200 more are under surveillance.
It's human nature to do what you can to survive -- even if you know you are putting others at risk. The diplomat is not a bad man. When he heard of the doctor's death, he came forward and confessed, and that's how the story came out (He's now being held in Nigeria, probably for manslaughter).
The lesson is we have to approach this disease in such a way that every person with symptoms sees that their best chance of individual survival is reporting themselves and staying inside the system. If the diplomat felt he was getting the best possible treatment while under quarantine in Lagos, he would not have felt the need to bolt. Getting experimental medicines available through official clinics only could also provide the right incentives.
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Faith healing and funeral rituals spread the disease.
The "laying on of hands" for healing, and rituals involving washing the bodies of the dead (which remain infectious) are two ways that culture spreads the virus. Medical professionals think that it is enough to explain how contaminations works, and that people will then make the rational choices. But in times of danger and high stress, people's ability to reason is compromised, and they are more likely to fall back on their deeper emotional responses -- their faith, and their beliefs in the spirit world.
The lesson we have to learn is that healers, those who conduct funeral rites, and traditional spiritual leaders are the ones who must be specifically targeted for training and empowered to educate their people about the disease and how to treat it. Criminalizing the spread of misinformation might help.
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The Guinean who fled to Senegal, carrying Ebola.
Senegal's first case was a young Guinean man whose brother had died of Ebola and who has since lost two other family members. He crossed through a closed border before arriving in the capital and collapsing. It's human nature to want to get away as fast as you can from something so life threatening. By blockading heavily infected communities, by sealing borders and cutting flights out of infected countries, governments are sending a message: "You are trapped in a sinking ship that is on fire!" They are exacerbating the urge to get the hell out. Wouldn't you run if your neighbor fell ill and you feared there might be a blockade around your neighborhood? In addition, reports from blockaded communities in Liberia seem dire - no food deliveries, inadequate drinking water.
The lesson here is not easy, because blockades and closures are necessary to keep the disease contained. But they are not enough. People must also be given a reason to hope if they find themselves inside an infectious area. Setting up safe zones inside the blockades, or informing inhabitants how to keep their homes free from infection is vital -- together with support systems that allow people to do just that. For example: safe door-to door food and water deliveries, medical check ups. Also, within blockaded zones allowing those with the disease to immediately check themselves into facilities where they know they will receive the best professional care possible. This will be expensive -- but lest costly than the current system that provides every incentive for infected people to cross blockages and borders and spread the disease.
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In sum, to combat Ebola, we have to outsmart human nature. This means giving people hope -- hope that if they fall sick, treatment in a facility is the best chance that they've got, faith that what the authorities they trust tell them to do will keep them healthy, and courage that if they are in a high risk or blockaded community or country, staying home will give them their best shot at survival.
Tim Ward is he author of the non-fiction travel narrative, Zombies on Kilimanjaro
He lives in Bethesda, Maryland.