Some Thoughts On Returning From West Africa

The following is not exhaustive, nor is it brimming with detail and description of direct personal experience, that may be for the future. It is however opinion distilled from personal experience and is thus a sort of truth. My truth. Yours may be different, feel free to disagree. Quietly.

Sunrise from the Laboratory window.

Time, as we are often informed, is a valuable commodity. In societies where we began slicing it up with the hands of clocks a few hundred years ago, we are told all through our lives not to waste it, to use it more efficiently and effectively, like water in a desert. Countries which live less by the clock, especially hot ones, seem to have more time. People are less punctual, the simplest things take longer, or sometimes never happen at all. This sort of thing annoys “efficient” people. Perhaps this is one of the reasons for the irresistible urge Europeans seem to have had for interfering in the affairs of others and encouraging them to “be more like us”.

Sierra Leone is a country that historically, could have done with a little less interference and now perhaps, a little more guidance. The people are energetic, the land fertile and minerals plentiful. The sun shines and its beaches are among the most beautiful places in the world. It should have everything going for it (with the possible exception of the large wildlife that would draw the safari crowds) and yet every time it gets up from the canvas, something happens to punch it back down for another count.

European involvement began in the late 18th century with the establishment by the British St. George’s Bay company (later The Sierra Leone Company) of Granville town and subsequently

Freetown, a haven for freed slaves (initially those that had been loyal to Britain in the American Revolutionary War) and an astonishing social experiment, given the flavour of the times. Less surprisingly, the British remained as a colonial power and imposed European style administration with characteristically scant regard for indigenous sensibilities and local systems of government that had grown organically, holding the tribes in a complex sort of balance. The corruption and mismanagement through the 19th century of the subsequent politics between Freetown and what became known as “The Protectorate” i.e. the taxed but ungoverned indigenous rest of the country cemented divisions and prejudices that would last through the 20th century until they exploded into the devastating orgy of violence that was the civil war of the 1990s, a time so horrific and confusing that afterward not even the people involved knew what they had been fighting about.

Guns were banned after the war ended and - buoyed by aid money and foreign mining licenses granted to European companies and the ever mineral hungry Chinese - the country remained stable and although still poor (with the largest proportion of the populace engaged in subsistence agriculture) exhibited an optimistic rate of economic growth. If your town is between a foreign mine and the ships needed to export the mineral wealth extracted therefrom, you will benefit from an excellent highway and some decent infrastructure, at least while the mine is paying out.

Then at the end of 2013, Ebola hit and hit hard. Usually confined to relatively small outbreaks in

more central regions of Africa, around the Democratic Republic of Congo and Uganda, the West African Outbreak was unexpected and quickly grew out of hand, growing to frightening proportions, especially when it reached the larger towns and cities, striking people down “like lightning”. I’m not a religious man, but if I was I’d find Ebola hard to explain. A devastating viral disease with - as it stands - no cure or vaccine, it has a mortality rate of between 50 and 90 per cent. Its symptoms are torture and it hits the innocent hardest. Healthworkers go first (few have the training or resources to deal with a disease that turns even the tears of the afflicted into a deadly weapon). Then children, those least likely to understand or adhere to the public health precautions that are their only protection. The disease reserves a particular cruelty for infants and few survive.

If you think things would be different here then think harder. A handful of Westerners (I use the term loosely, Freetown is in the same time zone as London) have been treated, in the main successfully, in specialist units with trained staff, experimental drugs and tailored blood products: the kind of resources that can be devoted when cases are in single figures. What if they were in the hundreds? The thousands? Tens of thousands? How are the resources and high risk training at your local hospital?

Hopefully we will never need to know. The threat of a bogeyman jumping from the realms of science fiction thriller into reality has been enough of a shove to give a decent momentum to the development of rapid tests, drugs and hopefully a vaccine. These were going on anyway but regrettably in the world in which we find ourselves, the profit motive driving the development of drugs and vaccines is not a strong incentive when it comes to diseases mainly affecting those who cannot afford to buy them. This is a gravely erroneous state of affairs and not just with the kind of virus where one plane ride can quickly turn “them” into “us”. (A third of the world is infected with tuberculosis, but because it wasn’t our third we put little effort into developing the drugs needed to combat it when it did come knocking, which it now is, but in more of a slow-burning kind of way).

Thus future outbreaks of Ebola will not, hopefully be on this scale, by then the weapons will be available to keep a lid on it early on (even if our root motive is only to protect ourselves rather than help others, the effect will be the same).

I recently returned from a stint working in a laboratory in an Ebola treatment centre, where the organisations and charities involved have been and are doing an outstanding job. Quite a few people people both there and here have thanked me heartily, which is always moving (I work in a National Health Service Laboratory and am more used to opening newspapers to read what a terrible job we’re all apparently doing, slaughtering our way through the populace) and yes I did my

bit, which was a lot less than others, I can tell you, (the real heroes are the red zone workers) but the people who deserve most thanks are the people of West Africa. The people of Guinea, Sierra Leone and Liberia are the ones who, on a huge scale, have changed the way they live, ceased shaking hands and touching, closed their schools and institutions for over a year and changed the way they buried their dead. Above all we should thank them for having the courage to stay put. Even when one of the terrors of the Earth was among them they stayed in their towns and communities and very few fled to start outbreaks elsewhere. Would you have courage enough not to get in your car or onto a train if people were dying in your street? I’m not sure I would.

When I hear the small minded speak in their primitive, tribal way of “wasted” overseas aid and “problems closer to home” I think not only of how much more difficult it would be to contain an outbreak such as this if the affected countries were the forgotten failed states they might have been, but also of the debt of gratitude we owe them. What the people of West Africa bought us over the last couple of years is time, and for that we should bow down in thanks forever because they may have saved most of our lives, and by Christ they’ve paid dearly for it.

AA