For this Humanosphere podcast, Editor Tom Paulson talks with nurse Kaci Hickox who gained international fame not for her courageous work in the middle of the deadly Ebola outbreak in Sierra Leone but for refusing to comply with the irrational attempt by politicians to put her into quarantine – even though she wasn’t sick. Hickox won her legal battle, but she is worried that the same kind of ignorance and fear that caused her so much trouble remains epidemic in this country. We learn a bit more about what motivated Hickox to join Doctors Without Borders in its fight against Ebola in the first place and then, upon returning home, to fight with New Jersey Gov. Chris Christie and others against what she viewed as a misuse of quarantine law that, if not challenged, could endanger all of us.
As usual, Tom and I start with reviewing some of the week’s news in the Humanosphere, including a new initiative to beef up aid and development in Latin America, the defeat of some bad food aid legislation and the changing mortality landscape.
And, below, we have an added bonus! An exclusive op-ed for Humanosphere from Hickox – one of TIME magazine’s persons of the year – urging a better, bigger and rational response to Ebola.
Ebola: Will we put more boots on the ground or more heads in the sand?
By Kaci Hickox
When was the last time you were so deeply concerned about something that it spurred you to action?
This is what took me to Sierra Leone to fight against Ebola in September. I had been following news of the outbreak since March. As I read of the extreme suffering and public health need, my heart began to ache for the people of West Africa. That ache quickly turned into action as I sat near a lake in Northern Maine and said to my partner, Ted, “I have to go fight Ebola, how do you feel about that?” I was on a plane to Africa a week and a half later.
That same deep concern also spurred me to react and fight against the unnecessary quarantine of asymptomatic aid workers returning to the U.S. from Ebola-infected countries.
Although I believe quarantine is necessary in some circumstances to protect the health of the public, the misuse of quarantine directly undermines public health efforts. We cannot afford such mistakes when fighting the Ebola outbreak in West Africa, where there have been almost 18,000 cases of Ebola and 7,000 deaths.
Here’s the thing – I have read scores of news reports, comments, blogs and even letters addressed to me personally from people who believe I have been selfish and arrogant. I see that there remains much fear and misunderstanding regarding my legal battle as well as the disease of Ebola itself. Many of you are probably still wondering, why does this nurse from Maine believe that quarantining persons coming from Ebola-affected countries is bad public health?
There are few aspects to these policies that I believe must be carefully considered.
- First, to quarantine a group of people who have a very low likelihood of developing disease is not only a waste of resources, but it can have extreme psychosocial implications on the individuals themselves.
- Second, for a disease that is not transmitted from an asymptomatic individual as well as is not easily transmitted (for example, it is not airborne), to force people into quarantine is not abiding by the principle of applying the least means necessary to protect both the individual and public health. From our experiences with past Ebola outbreaks, we know that it is good contact tracing (or monitoring) of individuals with possible exposure that ensures rapid identification and isolation if symptoms occur to prevent further spread.
- Finally, and maybe most importantly, the cornerstone of truly protecting Americans from Ebola is to stop the outbreak that is ongoing in West Africa. In order to do this, we need human aid workers to go and fight Ebola at its source. So while asking workers to needlessly stay home for three weeks upon returning may seem simple enough, if it creates a climate that further burdens workers and even makes them fearful to respond, we are giving Ebola a running start and putting ourselves at further risk.
I keep wondering, how did we get here – to a place where fear and ignorance so easily overwhelms science and compassion? As I look around, I see a disturbing level of manipulation from many so-called leaders. I see a misuse of leadership. Throughout history, we have grappled with the fear that the unknown brings. In the early 1980s, fear and the unknown caused some to suggest mandatory quarantine of anyone infected with the HIV virus. With time, we learned how HIV is spread and strong, compassionate leaders helped ensure that persons living with HIV/AIDS were accepted and supported. The same knowledge gain and leadership is necessary for the U.S. to begin to build the resources to stop Ebola and keep Americans safe.
If we bury our heads in the sand and hope that Ebola will go away and we will be safe, we will lose the battle against Ebola. Actions that have undermined our ability to recruit and send experts in medicine, infection control, and water and sanitation to West Africa are counterproductive to our Ebola response as well as harmful to the individuals affected. Unfortunately, the Ebola outbreak is nowhere near over.
A recent report by Doctors Without Borders highlighted that much of the aid to West Africa for the Ebola response has “focused primarily on financing and/or building Ebola case management facilities, leaving staffing them up to NGOs and local health-care staff who do not have the expertise to do so.” Another plea for the necessary human resources in order to halt this outbreak.
I’m afraid that many people did not consider how poor policies, politics and ignoring science would adversely affect our ability to enhance our response and stop this outbreak.
In the U.S., we now have greater stigmatization against Ebola and health-care workers who are stigmatized upon return.
We have conflicting, inconsistent policies for returning aid workers depending on where they fly into or where they live. Many aid workers have written to me in concern. Some are lucky enough to live in states where they are being appropriately monitored and supported without being shunned.
Others, living in states where in-home quarantines are being applied, have decided to stay home because they fear the discrimination their spouses and children might face if they fight. I can feel the sadness, disappointment and hurt in their words as they describe feeling alone and abandoned by their country.
And these individual stories translate into larger problems. Many organizations have begun to see the negative effects of these U.S. policies. USAID reported a 17 percent decrease in volunteer applications the two weeks after New York and New Jersey governors announced quarantine policies in their states. Last week, the head of IFRC warned that travel bans were preventing his organization’s medical workers from dealing with the outbreak and urged governments to avoid acting out of fear and misinformation.
We must support and embolden those who are willing to directly fight this disease, rather than support and embolden Ebola through fear and ignorance.