Kobe Rizk

During a Morse College Tea called “A Tale of Two Outbreaks,” Dr. Eugene Richardson — a Harvard professor of global health and social medicine — emphasized the importance of examining the social and historical dynamics of epidemics.

The tea was held on Feb. 26 and attended by students and faculty. They listened intently as Richardson contrasted his experiences during the 2018 Ebola outbreak as a clinical lead in the Kono District, Sierra Leone with his time as a consultant for the World Health Organization’s mission in Beni, Democratic Republic of the Congo. Although the DRC was equipped with effective vaccines by the time Ebola reached the country, the mortality rates of the two outbreaks were similar.

“Ebola is not the deadly disease that the sensationalist media makes it out to be,” Richardson said. “It’s the poor health infrastructure that is the real pathology.”

In Sierra Leone, a country whose infrastructure was decimated in a civil war from 1991 to 2002, healthcare systems were still fragile at the onset of the Ebola epidemic. Due to a lack of resources, doctors volunteering for non-governmental organizations in the region were told not to place intravenous lines or conduct aggressive resuscitation of patients because it was too dangerous. Richardson described that the mortality rates could reach nearly 70 percent for these quarantined yet untreated patients. He compared this to better equipped intensive care units in high-income countries, where the mortality rate would be less than 5 percent.

Despite the lack of health infrastructure in Sierra Leone, Richardson alluded to one advantage: he had the trust of the local community members, largely due to his affiliation with Partners in Health. This organization had an amicable history working with villagers in the Kono District. He juxtaposed this to the situation in the DRC in 2018, where the issue of mistrust was intractable.

“The doctor that was there before me, in my position, was killed,” Richardson said.

Richardson explained that the gunman responsible for the murder was a Congolese doctor who had grown tired of seeing “cushy jobs” repeatedly go to foreigners. The web of mistrust in the region is still convoluted, Richardson said, its fibers stretching between rural healthcare professionals and more affluent doctors from the nation’s capital. Compounding these issues is the DRC’s history as a formerly abused and exploited colony under Belgian rule.

Richardson added that “it’s often hard to see how the legacies of institutionalized racism become embodied as pathology.” Yet Richardson, who spent five years studying ancient Chinese Buddhism and the interconnectedness of beings before earning his MD, urged students and faculty to look beyond surface level explanations for epidemics. Instead, he prompted them to consider the ways that we can address systemic barriers to health in the face of a disease outbreak.

According to Richardson, Harvard studies indicate that to build trust in these communities, foreign doctors and volunteers should meet with rural chiefs, attend the funerals of victims of Ebola, or conduct similar acts to show support for the locals in the nation receiving aid. However, he described the inefficacy of these sentiments in practice, pointing instead to monetary solutions. Richardson proposed that paying cash to individuals receiving an Ebola vaccine in areas like the DRC might be a more effective reparation for a legacy of colonialism.

Morse Head of College Catherine Panter-Brick, who invited Richardson to speak after reading his paper titled, ‘On the coloniality of global public health,’ elaborated on this idea. “We need to contextualize this proposal, which otherwise would be construed as a bribe to consent to vaccination.”

Richardson’s talk, though focused on the Ebola epidemic of 2018, presents valuable lessons to be applied to the current coronavirus outbreak.

“How we take care of people exposed to a virus reflects not just our health systems but the social fabric of our society,” Panter-Brick said. “How we engage with Ebola or COVID-19 pandemics reflects how [we] wield institutional power, how we structure economic transactions, how we support communities, and how we construe the ‘facts’ about the risks of infection. What matters in global health is to mount fair and effective responses.”

For people like Daniel Ma ’23, with family members who are doctors in Wuhan, China, the sentiments expressed at the College Tea were especially poignant. He recounted, “Dr. Richardson’s contrast of the outbreak in Wuhan to the Ebola outbreaks was a good reminder of how every epidemic is fundamentally so different.”

Disease outbreaks don’t happen in a vacuum, Panter-Brick said. Whether they arise in a country with an autocracy, like China, or a former colony like the DRC, Richardson described examining the sociopolitical determinants of health will be critical in ensuring favorable outcomes for patients.

Since July 2019, ebola has been considered a “public health emergency of international concern” by the World Health Organization.

Sydney Gray | sydney.gray@yale.edu