When Michael Brown became a Symbol

FergusonEven as Michael Brown lay in a Ferguson street, a transformation was happening. Certainly he was changing from life to death, but something changed in those moments, not in him, but in us.

Michael Brown stopped being a person who was shot and transformed into a symbol. The metamorphosis was gradual, taking hours and days, but soon we were no longer looking at  a young man.

Officer Darren Wilson, the man who shot Michael, was also making the same change. He was becoming something much greater than himself. While Michael never lived to see himself become a symbol, Officer Wilson lives as a symbol to this day.

Even while the blood dried on the pavement, Michael represented another victim of hundred of years of oppression of black men; another recipient of a bullet from a system over-eager to shoot black men. He was the cry of an oppressed minority seeking justice.

To others he symbolized the failure of the family. Another stupid teenager who was out of control: another outcropping on a gang culture that breeds violence.

Officer Wilson also stopped being a person and became a symbol of the oppressor. A cowboy who just couldn’t wait to shoot a black man with the weakest of provocations. The hands of an oppressive state pressed him on and would protect him from any recriminations from those he wronged.

To others, he became a protector from an out of control gang war zone. The Officer Wilsons of the world were the last line of defence before hoodlums were breaking down doors. He represented a man’s right to defend himself with deadly force, if necessary.

The speed with which these symbols were generated was amazing. Partly to blame is the proximity to the Trayvon Martin case, which had similar symbolic overtones. The pain and anger felt by both whites and blacks were aggravated by the Trayvon Martin case and were now inflamed even more by another unarmed black teen shot to death.

What was amazing as well was how quickly the symbolism sped ahead of the facts of the case. Opinions were formed quickly and facts came out slowly. Most parties seemed invested in their understanding of what happened long before it was clear what actually happened. Wilson was a hero or a villain long before it was clear which one he really was.

But this is the nature of symbols. One of the great mistakes we make is to believe that the national debate that has proceeded has had anything to do with Michael Brown or Officer Wilson. They were names that were attached to a symbol that long preceded them. We had a narrative in mind before Michael Brown or Trayvon Martin and the narrative we planned was the narrative we would give, regardless of the facts.

The debate we are having has little, if anything, to do with Michael Brown. Whether he was completely innocent with his hands in the air or aggressively attacking Officer Wilson does not change that we have some serious racial tensions.

That, of course, is the real problem.

We don’t get to feel too special for having racial problems. They are ubiquitous to human culture. Britain has tensions with the Irish. Rwanda with the Tutsi. South African’s with the indigenous Africans. China with the Tibetans. Russia with, well, anyone who’s not Russian. Australia with the Aborigines.

Because the exact nature of the encounter between Michael Brown and Officer Wilson only symbolizes the existing racial tensions, we would be foolish to get hung up on the details of that encounter. Whoever is in the wrong, it does not fix the broader racial tension that exists.

So when we speak of the Michael Brown, we must be careful to realize that we are really talking about the sense oppression by African-Americans. When we speak of Officer Wilson, we must know that to most whites, he represents another victim of angry black teenagers.

So, when Officer Wilson was not charged with wrongdoing, the ensuing riots had little to do with him. He represented another one of those officers that beat Rodney King, another George Zimmerman, another case of the system protecting a racial predator. The wound in the nation is symbolized by him, but it is not him.

The riots themselves have taken on symbolism. To the minority communities, they show how deeply they feel oppressed and abused. To the white majority, it is yet another example of lawlessness and anger among minorities.

The point is that when we talk to each other about these cases, let’s not get too hung up on the facts. Let’s have the more important discussion about why we want to believe one set of facts or the other. Why is Officer Wilson’s guilt or innocence important to you? Why is it important to me?

Most of us had a narrative that we quickly placed these events inside. That narrative drives the anger and resentment. Any discussion that ignores that narrative, that symbolism, misses the point entirely.

Finally, listen, really listen to the other’s narrative. It is important for the majority whites to recognize that we simply don’t understand what it feels like to be part of a minority. We need to listen to their narrative. Really listen. There is a deep and painful story to be heard that goes back centuries.

For the African-American community, it is quite painful to have a presumption of racism placed on me simply because I am a white man from the South. Much of my own reaction comes from the narrative that assumes I am a racist simply because I am a white man. Many white men feel like I do. We don’t talk about race because we always come away judged no matter how thoughtful we are. Please, we want to engage with you in these discussions. Please listen to our narrative.

When God made human being, he made them all in His image. The chorus of Heaven will not have pale skin. The ethnicity of Heaven will have every tribe, tongue, and nation. One of the great delights of Heaven will be seamless racial harmony. When we listen well to each other now, we taste a bit of what that will be like.

I can’t wait.

-Chip

The image above is courtesy of Jamelle Bouie and is used with permission

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Lessons from the Ebola Conference

quarantine

As many of you know, I recently went to the CDC’s Ebola Safety Training that was held at the Center for Domestic Preparedness in Aniston, AL. I was expecting a good experience, but it surpassed my expectations. The practice we received was excellent.

Part of our days were spent in lectures to fills us in on the most up-to-date information about Ebola in this outbreak. Some of this was humorous (we can’t have a whole conference and never laugh), some was sobering, and most was quite enlightening.

I wanted to share with you some of the better quotes from the conference.

“If you find a chimpanzee dead in the jungle, don’t eat it

I can’t say I’ve ever been tempted to eat a chimpanzee even if it were already dead. But, if I were staring in the jungle and food was lying right there, I would be tempted. Unfortunately, Ebola kills chimpanzees just as well as it kills humans. Some of the outbreaks in the past have been started with a dead chimpanzee found in the jungle.

In fact, don’t even touch it.

“Your hands can kill you”

We touch our faces a lot. Ebola and most infectious illnesses need to come into your body through your mouth, nose, or eyes. The dirtiest part of your body, your hands, need to keep away from your face when working with Ebola.

This require a surprising amount of discipline. As I am typing this, I rubbed my right eye without thinking. It is such a constant part of our lives to touch our faces. When working with Ebola, this needs to stop.

This is most important in the Ebola Treatment Unit. With every surface as a possible place for Ebola to hide, we are not to adjust our goggles or fix our respirator. If we must fix something, we need to doff out of the unit to do it safely.

“Ebola is the Anti-Compassion Disease”

Everything we do that shows compassion or care for someone is forbidden by Ebola. We can’t hug them, care for them, feed them without taking a serious risk. All human contact is cut off by this ruthless menace.

Imagine for a moment that everyone who cared for you was wearing a giant orange suit. The only skin you can see if their eyes in the goggles. When I was practicing in the ETU, I couldn’t recognize my classmates. Ebola even denies you the compassionate looks of those caring for you.

The worst case of all for this was the very real case of when a pregnant woman comes into an ETU with Ebola. The outcome for her and her baby is not good. She will almost certainly spontaneously abort the baby and then she will almost certainly die.

So the question arose, how should we handle such a case? Compassion drives us to hold her hand through labor and help deliver the baby. Caution warns us that there are a LOT of body fluids involved in delivery and we would be under a tremendous risk of being exposed to Ebola. There are no easy answers.

Ebola is the anti-compassion disease.

“Your first responsibility is to keep yourself safe.”

As health care workers, we generally think of the patient first in priority. Not so with Ebola. Our safety take preeminence. If I should get Ebola, the first casualty will be the reputation of the Ebola unit in the community. Credibility is a precious thing in these settings. Many will wonder at us if we can’t keep ourselves safe.

The second casualty will be the negative press worldwide which will discourage others from going into these places to help. Additionally, the huge resources that will be needed to send us to our home country will further burden stretched resources.

The third casualty could be me. While no American health care staff have died of Ebola, it is a dangerous illness. I could die. I could spread it to others.

So, the most important thing is that I keep myself safe. My second priority is to keep my team safe. My third priority is to care for the patients.

“Ebola can be beaten”

While Ebola is a challenging disease, it is not the scariest disease humanity has faced. With several vaccines in the works and a number of possibly effective drug, this may be the first and last great Ebola outbreak. Those drug and vaccines are months to years away, but once we have them in our arsenal, we should have the upper hand.

Even without them, we can take on Ebola now. If the success of the ETUs in Liberia has taught us anything, it is that with a concerted effort, Ebola can be pushed back. We need to keep up those efforts.

-Chip

 

Life in Fort McClellan

1280px-CDP_7-28-07_Smaller[1]Today is the first day of my training for Ebola care in a tropical setting. I arrived last night at the Center for Domestic Preparedness in Anniston, AL. I was surprised to learn that this is the site of the now close Fort McClellan. It closed in 1999 and changed into a training facility for various disasters. Among the cooler things that are kept here is active ricin and Anthrax. They actually work with the real stuff. Fortunately, the Ebola students don’t have to work with anything so deadly.

The accommodations here are very nice. Every meal is all you can eat and delicious. The old mess hall has been converted into a regular restaurant. As pleasant as the food is, the company is even better. I’ve spoken with the heads of disaster preparedness for hospitals, overseas doctors and nurses, and everyone in between.

We are staying in the equivalent of a private hotel room. I share a bathroom with the room next to mine, but otherwise you wouldn’t know it was different from a hotel, complete with an ice machine at the bottom of the stairs.

The only caveat to all this is that they do believe in a military schedule. Classes get going at 7:30 AM and the place really gets going at 5:30 AM. Classes run until 5:30 PM, so lots to learn in these next few days.

One of the funniest things for me has been watching the local news this morning. They are lamenting the ‘Cold Front’ and ‘Cold Conditions’ this morning. It was 39 degrees. I hesitate to mention that where I came from, 10 plus inches of snow are supposed to fall today.

Well, time to head off to my first classes. I expect to bake quite nicely in the full Ebola attire.

-Chip

Would an Ebola Quarantine Work?

quarantineThere has been a lot of buzz about the possibility of quarantines of health care staff. It is time that someone explained how a quarantine works and discussed whether it makes sense in this setting.

What is a Quarantine?

An important distinction needs to be made between quarantine and isolation. Isolation is to take people who are infectious and isolate them to prevent them from spreading the disease. Isolation can be mandatory or voluntary. Historically, Ebola has had mandatory isolation but for the most part, patients and families were willingly isolated to prevent the spread of the disease to others. Isolation is very good practice for a disease like Ebola.

A quarantine is more aggressive. Quarantines are where a population of healthy people are isolated because they might become infectious. They are usually involuntary because no one wants to be locked in with infectious people. It is usually accompanied by aggressive state actions to enfoce the quarantine.

When would a Quarantine make sense?

The justification for a quarantine requires two elements. First, the illness must be infectious. It would make no sense to quarantine cancer patients because they can’t transmit their disease. In the epidemiology community, the measure of infectivity is the Basic Reproduction Number or R-Naught (written as R0). It is the number of people you would expect, on average, to get an illness from an infectious person. Influenza has an R0 of 2-3, smallpox 5-7, measles is 12-18. The 2014 Ebola outbreak has an R0 of about 1.7 in West Africa. In the US, it is much lower with only two transmissions from the seven patients who have been treated.

The second factor is the severity of the illness.  Ebola, of course, is one of the deadlier illnesses out there, so its severity is certainly enough that isolation and quarantine are worth considering.

Both factors are important. Rabies and Mad Cow disease, which are nearly %100 fatal, do not require a quarantine because they are relatively difficult to transmit. Chicken Pox may be very infectious, but it is not so severe that we should consider isolation and quarantine. We would live in quite an oppressive society is the common cold was justification for isolation just because it was infectious despite the fact it is fairly benign as an illness.

What are the Advantages of a Quarantine?

At least in theory, quarantining an illness should isolate it to a small group of people where it can be safely treated or allowed to fizzle out on its own. To separate the potentially sick from the healthy does protect the healthy and may minimize the spread of the illness.

Another major advantage of quarantines is that they are a simple solution that makes the healthy feel safer. Quarantines are usually done by the healthy to the potentially sick. It allows the local leaders to say they did something which pacifies a frightened public.

One of the most justifiable and terrible quarantines in history is Typhoid Mary, who was an symptom free carrier of Typhoid. She was quarantined for 26 years of her life to protect the public from the outbreaks of typhoid that followed her. She was essentially imprisoned for life because of a disease she had.

What are the Disadvantages of a Quarantine?

Quarantines are not particularly effective. The only moderately effective quarantine I can find is management of Mad Cow Disease. It involved slaughtering 4.5 million head of cattle, which was the only effective solution because Mad Cow is universally fatal and untreatable.

Of course, this is not an option for humans. Quarantines have been rare in modern times. In 2007, a man named James Speaker was quarantined with extensively drug resistant tuberculosis. The last American quarantine before him was in 1963.

Quarantines can pacify a large segment of the population, but they often enrage the quarantined. During a smallpox outbreak in 1983, Local authorities attempted to quarantine the municipality of Muncie, Indiana. The population did not believe they had smallpox and several local officials were shot. Not only was the quarantine unenforceable, it created more problems than it solved.

Another difficulty of quarantines has been how often they are thinly veiled racial oppression. When a majority views a minority as dirty or disease ridden, it lowers the threshold necessary to quarantine them as a group. In 1900, California quarantined a section of San Francisco which was almost exclusively made of Chinese immigrants and their businesses. The effects were devastating to the local businesses and the quarantine was later thrown out by a federal court.

Does a Quarantine make sense for Ebola in America?

Ebola is certainly a dangerous illness with a 70% fatality rate in West Africa. A quarantine was tried in Liberia and Sierra Leone and both seem to have had no benefit and generally only aggravated an already tense public.

Ebola also is quite contagious to those performing funerals and direct caregivers of the sick. So the basic criteria for a quarantine are met in West Africa. Despite this, the quarantines that have been tried were failures. The energy and resources placed in the quarantine would have been much better spent on caring for the sick.

So would and Ebola quarantine in America make sense? The severity of Ebola in a modern health care setting has been much better than in Africa. There has been one death of Ebola in the US with this outbreak of the seven who have been treated. The death of Thomas Duncan was not surprising because even when he came for treatment in Dallas, he was sent home for several days. Despite this, Duncan only gave Ebola to the people you would expect him to transmit to, direct caregivers.

In fact, despite a botched handling of that outbreak, no one in the community developed Ebola. This is consistent with European treatment of Ebola patients where only direct caregivers of the sick have gotten Ebola.

So Ebola is not as severe nor as transmittable in a Western setting. This is not surprising as the toilet may be a greater safeguard than anything else. To take those infected body fluids away and have then adequately treated is probably more important than all of the personal protective equipment on the planet.

Taking all of this into consideration, I think a quarantine of health care workers or civilians who are not sick (which is to say, not contagious) would be neither effective nor beneficial. It is a political band-aid for a non-existent problem. In the history of this outbreak, no one has caught Ebola from a Western health care worker and no one has caught Ebola on a plane. There is simply no evidence to justify a quarantine.

But if even one person would get Ebola, wouldn’t a quarantine be justified?

This is an objection I have found is pretty common. As long as the life of a West African carries as much weight as an American, then this makes no sense. The small risk of an American getting Ebola much be weighted against the hundreds and thousands of lives that traveling health care staff going to West Africa can save. It only makes sense to say this if their lives don’t count. And their lives count!

Isn’t it selfish of those health care workers to risk the public by not quarantining themselves?

No more risk than when you get behind the wheel of your car. 34,000 Americans die in car accidents every year, so far one has died of Ebola ever. When you stop driving for public health reasons, get back to me.

As I have argued before, the burden on the health care workers who go overseas is heavy and to make it heavier only discourages us from going, which is a loss for everyone.

In conclusion

Let me end by asking that we, who want to go to West Africa, not be hindered. Care enough for the dying in West Africa to allow us to go and do what we are good at. It is no risk to you and a very great risk for them. Love them enough to overcome your fear.

And even if you are afraid, know that quarantines don’t really work that well. Find a better solution before you shackle us with a quarantine.

-Chip