This past August, Sabastina Onwubgeuzie decided to take a trip to Trinidad. Summer was coming to a close, and what better a way to commemorate that than by spending three weeks in the Caribbean with his wife? The couple packed their bags and headed to London’s Gatwick Airport to catch their flight, only for Onwubgeuzie to be escorted off the plane and quarantined as a possible Ebola victim upon arriving in Trinidad. His visible symptoms? Being Nigerian.
Onwubgeuzie, who hadn’t been to West Africa in years and showed no obvious signs of having the virus, was flagged by the Joint Regional Communications Centre in Barbados based on data from the Advance Passenger Information database. After being removed from the plane, Onwubgeuzie was soon cleared by top health authorities and allowed to go. His wife, from Trinidad, was not tested at all.
Fast forward a few weeks to the United States. Ebola’s on our minds here, too. Xenophobia-tinged grunts exit the traps of numerous aspiring and elected officials, all of whom happen to target the fearful, often darker “Other” as a national security risk that must be controlled if we are to survive. Just what are we to do about this deadly virus and its carriers? If you’re Rand Paul, Scott Brown or Republican senate candidate Thom Tillis, the “cure” may be found by enacting a tougher immigration policy and simply sealing up the US-Mexico border.
Georgia Republican Rep. Phil Gingrey used his “M.D. clout” to take the argument a bit further, writing to the director of the Centers for Disease Control and Prevention that, “reports of illegal migrants carrying deadly diseases such as swine flu, dengue fever, Ebola virus and tuberculosis are particularly concerning.” He continued, noting that migrant children in particular posed a high risk given their increasing numbers and potential to “spread the disease too quickly to be controlled”.
Suffice it to say, there has yet to be a single Ebola outbreak in Latin America, and most West Africans living in Latin America can be found in Brazil and the Caribbean– not Central America– the area from which most undocumented immigrants in the United States hail. Nor does it seem likely that a sickly yet sneaky “illegal” child would find the wherewithal to make the physically demanding trek from his or her home to the United States while vomiting up his or her organs. But logic is not the point here; it seldom is in cases like this. What we’re really seeing is the way state actors use the supposedly apolitical authority (and fear) of science, disease and medicine as a political tool to shape a desired social outcome, often at the expense of the already marginalized. And it’s nothing new.
Quarantine as a social medicine has its roots in the Middle Ages, but really came into use for political ends during the mid-to-late 18th century in France. As Michel Foucault explains in The Birth of Social Medicine, it was at this point that cities and their perceived ills—namely the increased threat of a growing underclass and the mixing of socioeconomic makeups and bodies—made powerful figures during that era fearful. Surely, as philosopher Pierre Jean George Cabanis penned, when men came together and lived together in cramped quarters, health and moral deterioration would be the inevitable consequence. The solution? Isolating the often poor Other through physical expulsion, class-based zoning and regular monitoring and surveillance. This, all in the name of maintaining the physical and political “purity” of the larger whole in a rapidly changing world.
In the modern world, those fears have left the city only to become internationalized. And it’s not to say this is without warrant– infectious diseases are spreading more rapidly than ever before, as international travel, resistance to drugs and environmental degradation (among a host of other items) increases. But it is also true that, at least in the United States, much of our governing has been based more on fear than fact, and that the threat of disease has lent itself as a means of legitimizing our fear of and discrimination against the Other. We can see this in the first Immigration Act in 1875, which considered convicts, paupers and prostitutes to be “illegal aliens” whose entrance to the US should be restricted. Later, we tacked individuals with mental deficiencies onto our list of undesirable others, along with “any person unable to take care of himself or herself without becoming a public charge.” Another obvious example would be the disease-related filtering at Ellis Island, where of the millions of immigrants screened only around one percent were rejected for medical reasons. But even more recently, such thinking can be seen in the way the United States has historically treated those with HIV/AIDS.
In 1987, as HIV/AIDS engulfed much of the United States in absolute panic, US Senator Jesse Helms introduced legislation that included HIV in a list of dangerous contagious diseases, which was meant to be applied to foreign nationals seeking to immigrate to the US but spilled over into temporary travelers as well. Soon, AIDS-related Others were popularly coined as members of the 4H Club—homosexuals, heroin addicts, hemophiliacs and Haitians—in spite of the obvious fact that others diagnosed with HIV/AIDS did not fall into any of these categories.
This resulted in several social outcomes. One of the more memorable ones was when a leading Dutch AIDS educator was denied entry to speak at a national AIDS forum. Customs agents found AZT in his bags, and realized he hadn’t gone through the bureaucratic hurdles designated to individuals infected with a contagious disease providing them with legal labels indicating they are “safe” to travel. Perhaps less well known was the shipment of several HIV-positive Haitian refugees to Guantanamo Bay in 1993, where they were held in subpar conditions for over 18 months.
In spite of the many advancements in knowledge and awareness of HIV/AIDS, the 1987 travel ban—also adopted by countries like Saudi Arabia and Russia—remained until 2010. Naturally, such exclusion didn’t confine itself to travel. Social stigma and isolation presented themselves as equally debilitating consequences of HIV/AIDS.
Today, we see traces of that with the family of Thomas Eric Duncan, the Liberian man who recently became the first person to die in the United States from Ebola. While his surviving family members have since been cleared of contracting the virus, stigma continues to shape their daily lives. Members of Duncan’s family report that the Liberian community in Dallas has been fractured, that they have been forced to remove their children from day care, and that they are still referred to as “the Ebola family.” Such treatment, they say, breaks their heart, but they understand they have little recourse, “because [they] know everybody is afraid”. And as one of Duncan’s nurses has just been confirmed as an Ebola carrier, we can only anticipate that this isolation will increase.
As with HIV/AIDS in the ’80s, one has to wonder if it is really only disease that so many are afraid of. If that were the case, why don’t we see people like Rand Paul and Scott Brown up in arms over the flu, which kills more people a year in the United States than Ebola has killed in the history of the world? Why not assess the reasons why these West African countries might lack the public health infrastructure needed to successfully contain the virus on their own, and how our own history may have helped shape such dependency? Why not ask what sorts of systems might lead to the production of numerous, sophisticated erectile dysfunction pills while allowing hundreds of thousands of the world’s poor to die each year from easily curable tropical diseases? So no, fear of Ebola is not just about disease; it’s about fear of the Other. It’s about keeping the latest scene from the modern African “nightmare” off of our doorsteps. It’s an opportunity to control another unknown whose entrance into the United States, to borrow again from Cabanis, we perceive to be a “grave hazard” to the purity of our political and cultural health.
In Birth of Social Medicine, Foucault argues that the English introduced socialized medicine as a control mechanism to guarantee the health of the needy, which by effect also protected what he calls the “privileged population.” And in a way, the same can be said for the medical advances made in HIV/AIDS research. As a Brown University Professor of Medicine and Community Health said of AIDS, “We are now a global gene pool because of international travel, so the need is to deal with these problems on a global level. One cannot think of them as geographically isolated, or hermetically sealed.” It remains to be seen how we go about solving the problem of Ebola. But right now, our medicine seems to be through the promise—or threat—of a fence.