Disease is profoundly geographical. In its most general sense, it reveals varied social-cultural, economic, political and emotional geographies. Its diffusion patterns, for example, alert us to who and where is infected, and who and where might be at risk of infection in the future. The treatment of disease is often uneven, geographically and socially speaking, with some bodies enjoying greater access to care and attention than others.
Disease can draw our attention to how we frame people and places as ‘diseased’. How does the use of quarantine, exclusion and immunisation reveal our views and approaches towards particular areas and communities? Does the mapping of disease and its spread in regions like West Africa contribute, unwittingly, to a view of a place that is characterized by chaos, weakness, turmoil and dissolution? Is there an underlying geopolitics of fear attached to disease, as some bodies and countries are then labelled as undesirable, threatening and unwelcome? While precautionary behaviour regarding infection is understandable, there is a fine line between being careful and being prejudicial or xenophobic.
The Ebola outbreak of 2014 raises some troubling issues for all of us, but perhaps not equally troubling to all of us. The geographical epicentre is Guinea, Liberia and Sierra Leone, although other cases have been reported in Nigeria, Senegal and Democratic Republic of Congo. There have, according to the World Health Organization, been over 7,000 reported cases and around 4,000 deaths from Ebola. Treating victims is essentially a case of supportive care, replenishing the loss of fluids and monitoring blood pressure and temperature. What varies from place to place, however, is the protective clothing available to those who are nursing victims. In Spain recently, nursing staff went on strike complaining that they had been given insufficient protective clothing compared to US colleagues. Others have noted that those working in West Africa have managed to cope so long as all remain vigilant and attentive to the rules of treatment.
While remaining alert to patient care and infection pathways is one aspect, another aspect of vigilance involves border management. As the SARS outbreak demonstrated in 2002–2004, the mobility of disease via transport networks became a topic of considerable concern as governments worried about how passengers from ‘infected regions’ might be screened on arrival at airports, railway stations and seaports.
Introducing an element of ‘security theatre’, political leaders in countries such as the UK quickly promise to introduce screening and encourage their citizens to be vigilant if they suspect others of exhibiting Ebola-like symptoms. While we may wonder about the efficacy of such screening in some airports, training exercises in hospitals are not only carried out, but are also shown to be carried out to the media. Generating reassurance is crucial to managing the population – indeed we might see screening as a ‘calming measure’.
Disease can also provoke a whole series of consequences and ramifications, some of then intended and some of them not. For those who survived Ebola, they may well have to deal with the devastating consequences of bereavement and survivor guilt. For younger people, they might find themselves effectively orphaned and reduced to an immediate life of begging or even prostitution in order to simply survive if there are no family and/or social networks to intervene.
For countries such as Liberia and Sierra Leone, the impact of Ebola can be immense in terms of financial costs, political instability and societal tension as rumour and suspicion envelopes those who survive and those who die. It was reported that the World Bank intervened to stop the Liberian government offering to increase the pay of local nursing staff because it would have breached a pre-agreed health budget.
But where there are gaps of provision, there are also opportunities. One of the most notable is the role of Cuba. During the Cold War, Fidel Castro’s nation was deeply involved in military and humanitarian activity, inspired by a tri-continental fraternity with African, Asian and Latin America. Now, around 500 Cuban doctors and health care workers have been sent to Sierra Leone and Liberia. While the rapidity of the Cuban relief effort might morally shame others into action, it’s also a reminder that some use humanitarian intervention to cement political and cultural relationships (and not just the US, the UK and other western allies).
This story was published in the December 2014 edition of Geographical Magazine