Miles Davis: “Kind of Blue”
Miles Davis’ 1959 record release describes my passport perfectly. It’s “Kind of Blue.” It’s a bit faded from passing between fingers, under plastic windows, held in teeth as I’ve adjusted backpack straps, or tipped ungracefully into the Nile. It is so well traveled that it has begun to pale but definitely distinctly navy enough to be considered “blue.” To be specific, this blue passport is not Mercosur. It is not Brazilian, Argentinian, Paraguayan or Uruguayan. Nor is it Libyan, Botswanan, or Yemeni. I wasn’t born in Canada or Australia, nor Kenya, or Belarus. It’s that impervious kind of blue of “vigilance and justice” that comes with the red and white stripes connoting U.S. citizenship. I would argue, that along with a few of its Western European counterparts, this is possibly one of the most benefit bearing items in the world.
With a going rate of anywhere from 300 to 10,000 USD, this blue passport allows me to enter 174 countries unannounced, to jump on a plane and go…no interviews, no green card lotteries, police clearance certificates, medical examinations, long queues, impossible evidence of financial support, a friend in the Embassy, or exorbitant fees. As symbolic of U.S. citizenship, freedom of movement, opportunity, stability, and most of all, privilege, it is in many ways invaluable. A recent observation of the beneficial nature of having this little biometric tracking device in my back pocket is that it also serves as a “get out of jail free” card, more precisely, a “get out of Ebola Land” card. In other words, in case of emergency, this blue passport affords you the opportunity to get evacuated, while everyone else stays behind. Take this history for example:
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As of November 19, 2014 seven individuals had been evacuated from West Africa, specifically Sierra Leone and Liberia, and taken to the United States for treatment. Dr. Kent Brantly and Nancy Writebol, U.S. health workers for missionary groups SIM USA and Samaritan’s Purse, respectively, were evacuated from Liberia to Atlanta early August, treated with ZMAPP at Emory Hospital and survived. Rick Sacra, another doctor with the missionary group SIM USA, was evacuated from Liberia to Omaha, Nebraska on October 5th. There he was treated with TKM-Ebola and survived. An unidentified U.S. citizen was evacuated to Atlanta, Georgia from Sierra Leone on September 9th, and lived. An unidentified doctor was flown from Sierra Leone to Bethesda, MD on September 28th. He too survived. Freelance cameraman Ashoka Mukpo was evacuated to Omaha Nebraska, October 6th, treated and survived. U.S. permanent resident and Sierra Leonean national Dr. Martin Salia was evacuated from Sierra Leone to Omaha, Nebraska on November 15th and died after being treated with ZMAPP. The U.S. State Department did assist in evacuating to Germany two unidentified doctors from Uganda and Senegal, however, comparatively, between July and October, over 400 West African health care workers have been infected with the disease and over 200 have died. Over two months ago, President Ernest Bai Koroma’s office in Sierra Leone requested that the World Health Organization (WHO) pay for the evacuation of Dr. Olivet Buck. This request was denied by WHO, as it was against their organizational policy to pay for the evacuation of non-staff. Understandably WHO was not financially equipped to begin paying for the very costly evacuation of all health care workers in West Africa infected with Ebola . Yet this still looks eerily to observers, like hegemonic favoritism. While this initial discussion is colored by states’ rights, organizational policy, domestic law and evacuation costs, it also serves as a basis for a more meaningful discussion entailing a deeper examination into the intersection of humanitarian priorities, the political economy of Ebola, militarized response, irresponsible journalistic coverage, and eugenics.
The Humanitarian Imperative
Far from a critique of the care and compassion of those who worked tirelessly at the risk of their own lives to assist those infected with Ebola in Sierra Leone, Guinea and Liberia, the “Western Evacuation” phenomenon has reawakened the napping giant of the U.S. role in sub-Saharan Africa’s emergencies. With the colossal scope and breadth of the Syrian Crisis, and ISIS ever-looming, African crises have been put on the media back burner. With much of the initial discussion about Ebola being a “humanitarian disaster,” it would seem that naturally the appropriate sequential discussion would be that of “humanitarian intervention.” On the one hand, the evacuation of infected United States Citizens represents a “humanitarian act” for the affected families; and provides, for some individuals, irrevocable proof of the U.S. government as a benevolent government which demonstrates its concern and care for its citizens and residents. On the other hand, one can only imagine that, for those left behind, especially those working side by side with U.S. citizens, another message is left to reverberate in empty villages, destroyed holding facilities, overcrowded hospitals, and presidential boardrooms in Monrovia, Freetown, and Conakry. The message wrapped in a lack of pharmaceutical response is a clear one. “We Don’t Value Your Lives.” While this may not be the intended message, it certainly may feel like this to a population on a continent in which the feeling of being “left hanging” by the West is quite common; and for good reason. It also is not a message that hasn’t been heard before.
This speaks to the accepted Western-centric double standard built into our definitions of “humanitarian action.” It also informs our understanding of the evacuation of foreign nationals. Case in point, during the Rwandan genocide, “the term ‘humanitarian operation’ was first introduced by the French representative in the informal consultations on April 9th 1994 only when France informed other Council members that a French unit of 190 troops … would serve to evacuate only the French expatriate community and other foreigners. It had nothing to do with…the protection of Rwandan civilians…. In fact, the terms ‘humanitarian operation’ and ‘humanitarian aim’ became synonymous with the evacuation of foreign nationals…” . So it should have been of little surprise that on April 9-10th the United States evacuated 50 of its nationals also at the height of the Genocide. It is arguable as to how precisely we could have predicted the degree to which this singular action was key in sealing the fate of numerous Rwandese who were left to die unprotected under the noses of the international community. As a lesson in humanitarian evacuation, for Liberia, Guinea, and Sierra Leone, what better illustration and confirmation of the U.S.’s indifference towards the lives of West African citizens and naturally the lives of African people?
According to the Central Intelligence Agency World Fact Book, pre-Ebola Liberia and Guinea had approximately 1.4 physicians per 100,000 people and Sierra Leone had approximately 2.2 physicians per 100,000 people. Imagine this in contrast to the United States, which has 2500 doctors per 100,000 people. Therefore even the death of a few health care workers in these countries, makes a verifiable difference. The logical question, as Rony Zachariah of Doctors Without Borders poses is, if “you have one nurse for 10,000 people and then you lose 10, 11, 12 nurses. How is the health system going to work?”  The deaths of health workers in these countries represent not only casualties of human life but movement towards the entire health care system as a casualty.
A number of doctors living in infected areas have left their respective countries to avoid becoming its victims. Many health care workers working in hospitals or clinics and seeing them overrun with the virus have correctly identified themselves as directly in the line of fire, and left. This includes President Sirleaf Johnson’s own son, James Adama’s Sirleaf, now living in Georgia, who told the Wall Street Journal that, “the symbolism of me going there and potentially getting Ebola when I have a nine- and a seven-year-old at home isn’t worth it just to appease people.” But many like the latest casualty in the United States Dr. Martin Salia, did not leave. Abdullah Kiatamba, born in Liberia, heads the “Minnesota African Task Force Against Ebola”, which is organizing a legation of 150 Liberian-born health care workers who have volunteered to work in Liberia, Sierra Leone and Guinea.
It is impossible to weigh hearts against feathers like Maat, with family and self-preservation on one scale and nation on the other. How do we dare judge anyone who puts his or her family first? The issue goes deeper than individual decisions. The greater question is, given the impending demise of the health care systems in these countries, amongst the numerous systems already fractured, and crumbling, as an inheritance of war and colonial-induced depravity, how can the future of health care be supported?
Political Economy of Ebola
While this does not serve as an argument for the State Department to neglect its citizens, it does raise very serious issues around the moral imperatives of states, specifically Western states who have played some role in the underdevelopment of their Global South neighbors. It is reminiscent again of the exploitative relationship that the West has and continues to have with Africa in which the West takes, removes, extracts, evacuates and gives back in a way that does more harm than good, creating an altruistic façade.
A laissez-faire, blame-the-victim attitude has been adopted towards these countries’ inability to manage the disease. Even WHO’s early Global Alert and Response begins by discussing “negative cultural values” and “traditional beliefs”  as the reason for the proliferation for the disease, as if to shame backwards Black Africa for their incapacity to be “civilized” enough to control the disease. The irony lies in the context. No one dares point a finger at the “negative cultural values” like Western capitalism and greed, which fueled the colonization of these countries and created the exploitative systems under which African countries must still operate.
However dire the situation of their health systems, the rapid spread of the disease and incapacity of government must be understood within the context of (1) colonial underdevelopment, and (2) the neoliberal economic policies that have played a large role in undermining and defunding the health infrastructure. The initial colonial exploitation of West Africa and resulting power struggles “post-liberation,” economic decline, and war have plunged many parts of West Africa into states of volatility and poverty which have continued until today. According to the 2014 Human Development Index out of 184 countries, Sierra Leone comes in 183rd , Guinea comes in 179th, and Liberia ranks highest at 175th . These three countries are among the 10 poorest in the world.
Ecologist and phylogeographer Rob Wallace made the very clear connection that historically in the region, “structural adjustment programs have been encouraged and enforced by Western governments and international financial institutions that require privatization and contraction of government services, removal of tariffs while Northern agribusiness remains subsidized, and an orientation toward crops for export at the expense of food self-sufficiency. All of this drives poverty and hunger…” Further, these programs in the 1980s and 1990s also moved money away from health spending. Professor of Political Economy at Oxford University, David Stuckler, who undertook research covering health care expenditures in countries under IMF programs, found that these programs grew at half of the pace of countries not under IMF agreement. According to Stuckler, “these arrangements tied the hands of governments so that when there were disease outbreaks, they didn’t have the resources in place to control them.”  This lack of basic human needs, compounded by historically destabilized governments, which are unable to manage the spread of disease, has also burgeoned the virus’s spread. While the IMF, World Bank and other international financial institutions have agreed to allow changes in how loans may be spent, provision for some emergency debt relief and grants,12 Liberia, Sierra Leone and Guinea find themselves in the same cycles, which created their initial impoverishment. Instead of mass debt forgiveness, there is a focus on loans are being redirected towards disaster management, and away from systems building and fortification. What does this mean? A culture of firefighting is being demanded and encouraged. Without working structures, governments will never fully function independently, and as the “borrowers” these countries will continue to operate at the mercy of its “leaders” and the whims of its “lenders.” Therefore, Ebola is now serving to concretize in some way, economic enslavement to and dependence on the West. While this serves as just part of the discussion, context is critical. So often, in our busyness in blaming the victim, the structural milieu is ignored. Amongst the evacuations, and fear mongering, it is easy to forget that that the injury was inflicted long ago, and in this case specifically, the rapid spread of the new infection is simply proof of the gravity of the initial wound. And I’ll bet my blue passport on that.