From the November-December issue of News & Letters

by Htun Lin

In the wake of the Ebola outbreak in West Africa, only one person, Thomas Eric Duncan, has died on U.S. soil from the virus. But millions have been led to panic.

Irresponsible politicians like Gov. Christie of New Jersey created a climate of fear. Ebola spreads only by intimate contact with biological fluids, but Christie called for mandatory quarantines on healthy healthcare workers like Kaci Hickox returning from West Africa.

Back home in Maine, Hickox was detained like a prisoner without due process, officials refusing to answer her queries, and violating her civil rights in the name of national security. Gov. LePage kept her quarantined in her home as a re-election issue.

Christie demonstrated how the contagion of fear is spread. This is an “us vs. them” xenophobic mentality, global capitalism existing alongside narrow nationalism. The President, on the other hand, hugged nurses returning from working with Ebola patients.

WE ARE ALL WEST AFRICANS

National quarantines do not work. West Africans’ battles are our battles. Dr. Anthony Fauci, Director of Infectious Diseases at the National Institutes of Health, stressed that the best way to protect Americans from Ebola is to help West Africans fight it in West Africa.

The mistreatment of Thomas Eric Duncan, an immigrant from Liberia, is painfully symbolic. In spite of capital’s huge infrastructure and cutting-edge technology, Mr. Duncan was misdiagnosed and then sent home. It is ironic that Duncan was sent home infected, while nurse Hickox was detained lacking evidence of any illness.

Assuming that Mr. Duncan did not have health insurance, Dallas Presbyterian hospital would have had every financial motive to dismiss a non-paying patient with an illness which could appear as the flu.

Some blamed the doctor who misdiagnosed him, or the RN who failed to tell the doctor Duncan had just traveled from Liberia, or even Duncan for “falsifying” the form at a Liberian airport. But as CNA/CNN asserts in their press release: “There were no certain protocols to follow.” One can keep saying the system is fine, it’s individuals at fault. Or one can think: there’s something else.

HOSPITAL ‘PROTOCOL’ IS THE BOTTOM LINE

Dallas Presbyterian had a main “protocol” firmly in place. It is institutionalized under the current corporate HMO interpretation of the Affordable Care Act’s (ACA) cost-control mandate—“affordable” means to them cost-cutting in the interests of the bottom line.

We frontline workers—from MDs and RNs to housekeepers, lab techs and receptionists—are keenly aware of this. We have to be to stay employed. Protocols were not breached. Doctor and nurses were following the bottom-line protocol by which they were fully disciplined.

How can we expect one nurse, one doctor, to go against this tide, when the most powerful official on earth could not resist the pull? The President, during the height of the health insurance debate, stressed two main ingredients of the ACA to get support from his opponents in Congress and the industry. The first one was the individual mandate, to make every individual purchase private health insurance. The second was that no non-citizen, no foreigner, no immigrant, would benefit from the ACA.

If any protocol was breached, it is this: Mr. Duncan, an African from Liberia, an uninsured foreigner, dared to seek healthcare at a U.S. healthcare facility, a subsidiary of an HMO chain that was looking to cut costs wherever possible. He dared to get ill by helping another West African who fell ill, and he died after repeated attempts to get care, killed by a virus which did not respect national borders, institutional jurisdiction and fiduciary boundaries.

The Ebola crisis has brought front and center a question for our times: Should medicine have borders?