Why West Africa? There were quite a few Ebola outbreaks in the past, for instance in Uganda, but never before such a huge epidemic developed. It seems to be a fact that the extreme poverty in large areas of West Africa was a decisive factor in the spread of the EVD. But how exactly is poverty contributing to an epidemic?
To shed light on this question a bit, I want to start by distinguishing two different kinds of poverty: On the one hand the poverty of the people, on the other hand the poverty of the state. There are several reasons why Sierra Leone is not a rich country, most prominently corruption. The diamond mines, fishing grounds and beautiful white beaches, perfect for paradise-longing European tourists, should bring money into the state’s cashboxes. But like in many African states with rich resources, sadly, the opposite is the case. Criminality and corruption in the trade with exactly those resources keep countries like Sierra Leone trapped in poverty. The result is an almost non-existent social system, hospitals without any medicine or medical equipment, schools without books, streets without tar. It is these three factors that contribute considerably to the spread of Ebola: health, education and transport.
It is clear that few and poorly equipped hospitals contribute to an Ebola epidemic. The strict isolation measures which are necessary are too much to take for the health stations. To carry all this know-how and equipment into the country from abroad, via foreign aid organisations and governments, takes time. But during this time Ebola is already spreading. The low level of education of a big proportion of the Sierra Leonean people is also contributing to the spread of the disease. Many people are illiterate and cannot read all the information sign boards and news articles, unless they display also pictures. Many people have difficulties understanding the concept of a “virus” as such. And I have to admit it is not easy to grasp that a tiny particle, not visible for the human eye, causes such a terrible sickness. On top of this Sierra Leone has a really poor road network. Sick people have to be carried quickly to the next hospital, but that is far from possible. Many villages can only be reached by jeeps, some even only by boat. Transport is adventurous.
These unlucky preconditions are met by the poverty of the people. A study of the Njala University (http://www.ebola-anthropology.net/case_studies/village-responses-to-ebola-virus-disease-in-rural-central-sierra-leone/) showed that many people avoid seeing a doctor due to economic constrains. In case a family member falls sick, the first strategy is to just wait. Maybe spending money on transport to the next health facility can be avoided? Also the expenses for the treatment. In case it is NOT Ebola, the treatment is not for free in Sierra Leone. Most families wait apparently for 2-3 days before coming to a decision if seeing the doctor is necessary. In case it’s unavoidable money has to be borrowed from friends and extended family. Again a few days pass. Until the patient is ready to go, the phase of highest infectiousness is reached already. During the transport it’s hard to avoid now to infect others, the driver or other passengers. And that’s how the epidemic is spreading.
The outbreak of Ebola might happen more or less by chance. But the spread depends very much from the specific location. And Sierra Leone was clearly the wrong place.