Deadly distrust

Gregg Mitman’s article in the September 17th New England Journal of Medicine, “Ebola in a Stew of Fear,” is unfortunately all too prescient. Dr. Mitman highlighted “the ecology of fear” in Western Africa. Fear is present on both the part of Westerners (scared of Africa’s yellow fever, malaria, Ebola, its mere “different-ness”), and by native Africans (of whites’ history of colonization and slavery, of medical exploitation dating back well over a century). Fear of each other.

This history of fear, the cultural legacy of decades of mistrust of both Western people and their medical science, played a role in the murders of 8 people working on the Ebola outbreak in Guinea–journalists, medical officers, local administrators, and a preacher who were just trying to educate locals about the virus. The hostile crowd first threw stones at the team, and ended in their brutal deaths. The steps in-between have not been reported.

This is the extreme end of the science and medical denial continuum. We can scoff in America and attribute such horrors to the “brutal, savage Africans,” who cut their daughters and rape virgins to cure AIDS, as I’ve unfortunately already seen in some Twitter comments–some of our notions of “them” not so dissimilar from American colonists of centuries past regarding the slaves they once owned.

We can accept this scape-goating and ignore the West’s own modern-day culpability, with our fake vaccination campaigns that have left others dead in the aftermath; with our movies and popular culture depicting Africans as the West’s guinea pigs, and our shady pharmaceutical dealings that make that characterization all too believable.

No, it isn’t always a battle of Africans against Westerners. In South Africa, former President Thabo Mbeki was deceived by false claims about the relationship between HIV and AIDS that he had read on the internet, suggesting that HIV was not the cause of AIDS, and that  Western science should be distrusted in favor of traditional herbal remedies recommended by his health minister, such as garlic and beetroot. Because of his suspension of Western medical treatments, an estimated 330,000 South Africans died prematurely from HIV/AIDS between 2000 and 2005 , and at least 35,000 babies were born with HIV infections that could have been prevented.

Denialism kills. Distrust kills. Fear kills.

Here in the U.S., Natural News, a site run by the self-dubbed “Health Ranger,” Mike Adams, ran a piece this past summer suggesting that journalists and scientists who defended genetically-modified organisms (GMOs) were similar to Nazis, accelerating “heinous crimes being committed against humanity” and collaborating with an “with an anti-human regime,” and that such individuals should be named as such for future crimes:

“Just as history needed to record the names and deeds of Nazi war criminals, so too must all those collaborators who are promoting the death and destruction caused by GMOs be named for the historical record. The true extent of their collaboration with an anti-human regime will all become readily apparent once the GMO delusion collapses and mass global starvation becomes an inescapable reality.

I’m hoping someone will create a website listing all the publishers, scientists and journalists who are now Monsanto propaganda collaborators. I have no doubt such a website would be wildly popular and receive a huge influx of visitors, and it would help preserve the historical record of exactly which people contributed to the mass starvation and death which will inevitably be unleashed by GMO agriculture (which is already causing mass suicides in India and crop failures worldwide).”

Adams is similarly anti-vaccine, and currently is featuring on his website “11 horrible truths about Ebola the government doesn’t want you to know.” These “truths” include suggesting that infected individuals should avoid hospitals, and that citizens everywhere should prepare for the inevitable quarantine at gunpoint.

The worst part of Adams’ misinformation of this type is that it doesn’t stay within the borders of the U.S.–misinformation on Ebola epidemiology and quack cures like those Adams promotes are also being spread in African nations via Facebook pages and other types of social media

Denialism kills. Distrust kills. Fear kills.

Because of distrust of Western medicine, a recent article noted that parts of Africa have better vaccination rates than many wealthy neighborhoods in Los Angeles–and as a result, 10 babies died in a 2010 outbreak of whooping cough in California.

The deaths of the workers in Guinea show this fear and denial writ large; the purposeful killing of those only wanting to help their local and global neighbors in the face of a terrible epidemic. Those murdered are the latest victims of the most malignant form of distrust. They will not be the last.

Silence is the enemy

“I always think someone is following me and wants to rape me. It is better to die.” –Darfuri refugee

Sometimes there comes a public health issue that’s so big, so overwhelming, so heinous, that you just don’t know where to begin discussing it. Nevertheless, the conversation should, and must, happen just the same. Silence may be easier, but speaking out is the only way to demystify the taboos and bring attention to what’s going on for those who can’t bring attention to it themselves. And maybe, just maybe, bring about some change.

It’s no secret that rape happens during wartime. Certainly documents being discussed regarding our own soldiers’ treatment of prisoners show that wartime rape–of either “the enemy” or even female colleagues–is not limited to rogue armies in far-off countries some Americans probably couldn’t even find on a map. That doesn’t make it any less inexcusable, or the crimes any less horrendous, just because we’ve done it, too.

A recent piece in the New York Times by Nick Kristof highlighted the extent of these rapes even after the war has stopped, discussing rape in Liberia. As Kristof notes, the war in Liberia ended officially in 2003 after 14 years. However, even today–6 years into peacetime–a high percentage of the female population reports a history of rape, including girls as young as 3 years old. Of 275 sexual violence cases treated in just four months’ time in Liberia by Doctors without Borders, 28% involved children age 4 or younger, and a third involved children ages 5-12. Children are easy targets, and the most powerless of all possible victims.

Of course, rape is older than civilization itself, just like the view that women are second-class citizens (if we count as citizens at all). You may have heard about these types of rapes–of women, of children, by solo men or gangs; using only their bodies or using whatever object is handy, including guns or knives, to rape their victims–being carried out in Darfur, in the Congo, or elsewhere. Celebrities have written about it in excruciating detail, documenting some of the horrors: a child held and raped for 2 weeks, left alive but incontinent, humiliated, and shamed. 6-month-old infants raped. 80-year-old women raped and brutalized. 1,100 women raped every month in Eastern Congo according to United Nation estimates.

The situation in Darfur probably has received more international attention than other countries, yet still, little has been done–and the future of what *can* be done is uncertain, as many foreign aid groups were kicked out in March.

For those who have fled the brutality in Darfur, the situation remains bleak. A new report was just released documenting the issues Darfuri women face in refugee camps, including repeated rapes and a lack of any legal recourse either in their home country or in the camps. They are imprisoned–unable to help themselves by even getting firewood or tending to animals because of the potential for rape at the periphery of the camps–and have no one to turn to. Indeed, in many areas, the perpetrators carrying out these crimes are the very ones who are supposed to be protecting women–police, military and government officials, even teachers. In Liberia, despite having the first female president of an African country, little progress has been made in changing laws or attitudes about rape, and the country still lacks an adequate legal system able to adequately prosecute the small percentage of rapes that are reported.

What to do about this? That’s what’s kept me from writing more about this, I suppose–the sheer magnitude of what is happening, and the helplessness one feels when reading about it. With infectious diseases, though some of them are equally overwhelming, at least there is the hope of prevention via relatively simple devices (bed nets for malaria; condoms for HIV; isolation and medical treatment of TB, and of course the hope for vaccines, etc.) With systematic rape, there is no drug or vaccination to look for in the future. What is needed instead are shifts in attitude: more respect toward women; societal intolerance of such crimes by men; empowerment of women and girls; an understanding by family members of those who were raped; cessation of femicide. These are overwhelmingly difficult things to ask for, especially in countries fragmented by years of war and violence. How does one help to accomplish these things in far-off countries, when it’s hard enough to be respected as a woman right here in the U.S.?

A recent editorial by the editors of PLoS Medicine provides some places to start:

Medical professionals are powerful lobbyists whose recognition of the devastation could galvanize support for the work of humanitarian organizations and advocacy groups in documenting sexual atrocities and holding states accountable when human rights and international law are violated. Together with medical journalists and editors they have done much to try to expose the devastation of sexual violence during conflict, but we can all do more to document and disseminate the research and accounts of health workers, nongovernmental organizations, and survivors.

And they’re right. No, gang rape isn’t exactly great fodder for cocktail parties. It’s incredibly uncomfortable and depressing to speak about–and that’s probably one reason it’s gone on as long as it has, with relatively little attention. It’s taboo to discuss–not only in countries like Liberia or Sudan, but here in the US as well. It needs to stop, and we can help make that happen. Talk to someone about this. If you can’t do it in person, write a letter. Write your congressperson. Hell, write your mayor. Highlight it on your own blog. See if a local women’s group–or any other group interested in global health or women’s rights–has covered the issue recently, and if not, offer them any of the linked articles to spark the conversation. Email your local newspapers or TV stations. Send a mass email to your friends–this is certainly more important and worthy of their attention than the latest viral YouTube video, right?

Finally, keep checking back. This month frees up a bit of time for me, so I’ll highlight some of the other posts on this topic around the blogosphere as I see them crop up, in order to keep the discussion going and look for other ways to help and other perspectives on the issues. I’ll also write on some related topics. Additionally, keep an eye on Sheril and Isis’s blogs for more posts and updates. Along with them (and potentially others, which I’ll mention as I see them), I’ll be donating any wages from the blog this month to Doctors Without Borders as a token of appreciation for the work they’ve done for the victims of these brutal crimes. I’ll have a list of other charities you may want to consider in a future post.

Silence is the enemy. Speak out. Pass it on.

[Edited to add: Sheril has a list of participating blogs here, including NY Times author Nick Kristof with his post highlighting the movement. We now have a Facebook page for “Silence is the Enemy” here; and you can search Twitter using #silencehurts.]