Ebola’s Racial Disparity

ebola-survivors-treatment-race

(Photo: European Commission DG ECHO / Flickr)

American healthcare workers Nancy Writebol,  Kent Brantly, Craig Spencer, and Rick Sacra, as well as NBC cameraman Ashoka Mupko, were all beneficiaries of the medical sophistication of the U.S. hospital system.

All of them contracted Ebola in West Africa and lived to tell the tale, emerging from the hospital Ebola-free and appearing remarkably robust. They benefited from early diagnosis, prompt evacuation to the leading U.S. special isolation centers, and in some cases, treatment with convalescent serum and the experimental drug ZMapp.

The story is quite different for some other high-profile Ebola victims.

Martin Salia, a legal and permanent Maryland resident, was the medical director of Sierra Leone’s Kissy United Methodist Hospital and its only full-time physician. As one of a shockingly small number of doctors in that country—a mere 136 for a population of 6 million—Salia was a rare breed of physician capable of treating anything from orthopedic injuries to myocardial infarction.

In Africa, physician scarcity often precludes the luxurious medical division of labor in the West. I once visited a mid-sized hospital in rural Ghana and foolishly asked the medical director how many other doctors shared his on-call schedule. “There aren’t any other doctors here,” he replied in bewilderment.

Salia, who was deeply religious, believed his calling was to serve the people of Sierra Leone, where Ebola continues to surge. Although he was not working at an Ebola treatment center, Salia could easily have been exposed to the disease through contact with surgical patients.

When Salia first fell ill in early November, his Ebola test returned negative. Three days later, a repeat test came back positive. But unlike white Americans Writebol, Brantly, Spencer, Sacra, and Mupko, Salia was not promptly transferred to the United States.

He began receiving convalescent serum in Sierra Leone, and five days elapsed before he was sent to an Ebola isolation center for treatment in the United States—around a week later into the illness than his white American counterparts. It seems clear that delays in Salia’s diagnosis and treatment resulted in his deterioration to a point beyond repair. By the time he arrived in the United States on November 15, his raging infection had already rendered him too ill to be saved.

But even worse was another Ebola case involving an African physician for whom therapy was withheld outright. Sheik Umar Khan, a Sierra Leonean specialist in viral hemorrhagic fever, was diagnosed with Ebola last July and admitted to the Ebola Treatment Center in Kailahun, Sierra Leone.

The team of physicians from Médecins Sans Frontières (MSF) and the World Health Organization who took care of Khan reportedly “agonized through the night” over whether to administer ZMapp to him.In the end, without discussing it with Khan, they decided against it. “What they really didn’t want to do was kill Dr. Khan with their attempt at therapy,” Armand Sprecher, a public health specialist at MSF, reportedly said.

But surely the converse question should also have been posed: what if they cured Khan? Sprecher, who is involved in procuring drugs for MSF, further offered what from my perspective as a physician was the flimsiest of excuses: that Khan’s virus levels were so high that it was believed the drug would “probably not work.”

So which is it? That the team thought that the ZMapp would do nothing for their patient, or that it would kill him? It cannot be both.

Khan died several days later, and the very ZMapp that had been denied him was later sent to Liberia and used instead for Writebol and Brantly, who recovered admirably (though we cannot say for certain how much ZMapp contributed to their survival). In addition, Spanish officials confirmed that they too had obtained a supply of ZMapp for a third patient—a 75-year-old Spanish priest who died after having been evacuated to Madrid from Liberia.

In the now infamous story of Liberian Thomas Eric Duncan—who died in a Texas hospital after contracting Ebola in Africa—Duncan’s nephew Josephus Weeks has raised the possibility that racial bias entered into the decision to send the febrile man home from the Texas Health Presbyterian Hospital emergency room on September 25. Similar broad ethical questions arise about whether the treatment of Ebola victims is being stratified on criteria of national origin, making some “more equal than others.”

The physicians who have cared for these patients themselves would deny that any racial bias ever consciously entered into their decisions over choice of therapy. That, however, is exactly the trouble. Most racial bias among doctors is unconscious, meaning we must carefully consider whether our medical decisions reflect a double standard in the treatment of our patients—Ebola-infected or otherwise.

Kwei Quartey M.D. is a crime novelist and physician who grew up in Ghana. He is now based in Los Angeles. His fourth novel, GOLD OF THE FATHERS, will be published in February 2016.

  • Victor A

    I do not see a racial bias in either cases.
    Duncan lied and waited too long to go hospital. He lied about having any contact with a sick woman in Liberia. Even the cab driver who took them to the clinic said he refused to touch the sick woman passenger.
    If Duncan had died in Liberia…this would be a non issue. Maybe they should send you his $50,000 a day hospital bill.
    Dr. Salia got to the U.S late in his disease process. He is permanent residence “green” card holder. Not a citizen. There is a big difference! Ask anyone trying to bring a spouse or relative here.
    Stop attributing everthing to race card.

    • Kwei Quartey

      “Not a citizen.” If that’s the criterion, then why bother to bring him here at all? Salia was a dedicated physician in an Ebola country where there are precious few physicians and every single one of them counts in the Ebola fight, and that’s where it matters the most. He could be back there now immune to EVD. He got to the U.S. late in his disease process. I think that’s the point I was making. He needn’t have.

  • topmom100

    I too thought that they waited too long to send Dr, Salia home to America. These people are heroes and should be treated so. I should be grateful for our medical care, but instead your article causes me to worry about the lack of medical care in African countries and many other countries. I too realize that as good as we have it here, there is a shortage of physicians and medical workers in the United States. Shock:136 physicians for 6 million people!

  • Victor Kuma

    If the ebola virus is a biological weapon as observed….then the objective is being carried out. The onus is on African leadership to realize this fact and conduct their governing procedures accordingly. Their mandate to serve and protect must be their focus.

    • Ken Meyercord

      Do you suppose $6.2 billion judiciously distributed might cause them to forsake their mandate?

      • Victor Kuma

        Affirmative!!!

  • Ken Meyercord

    Talk of
    weapons which could target populations based on genotype, e.g., race, has been
    common in knowledgeable circles ever since the infamous Project for the New
    American Century published their report on “Rebuilding America’s Defenses” in
    2000, in which they opined, like wild-eyed, demented Nazis in some Hollywood
    flick, “And advanced forms of biological warfare that can ‘target’ specific
    genotypes may transform biological warfare from the realm of terror to a
    politically useful tool.”

    The International Committee of the Red Cross is sufficiently
    worried about the development of such a weapon that in 2005 they warned in an
    official report “The potential to target a particular ethnic group with a
    biological agent is probably not far off. These scenarios are not the product
    of the ICRC’s imagination but have either occurred or been identified by
    countless independent and governmental experts.”

    Of those who have contracted Ebola in the latest outbreak,
    all those who are white or yellow (15) have lived, except for one elderly Spanish
    priest; all those who have died were black. (I’m not totally confident in my
    numbers; it’s hard to find counts by race. If you dispute my numbers, please do
    provide a more accurate count.)

  • neuterable

    Or maybe, eating bats, running around naked, doinking virgins to cure disease, drinking from mud puddles and being covered in flies, is not a healthy lifestyle?

    Adjusting your culture might accomplish more than tens of billions of dollars in shipping medical treatments around the world that only delay the inevitable and allow the sick to take their time spreading around the good stuff.

    Bioweapons that target blacks were created, in South Africa, but blacks do a pretty good job of infecting themselves, with everything under the sun, anyway.