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Who Loses When Institutions Fail?

On the first business day of the new year, I received an automated telephone message telling me that a preauthorization for medical care had been denied and I would receive paperwork later to explain.

This is the first message I’ve had from a new insurance policy that we were required to purchase after the General Council on Finance and Administration (GCFA), the treasury arm of The United Methodist Church, for which I worked, dropped our retiree insurance policy.

Without explaining why, but promising we would have more choices and perhaps lower costs, we were thrown into the health insurance marketplace. In order to get coverage we were required to deal with a health care marketing firm whose function is to sell policies for select insurance companies.

Descent into Hell

After four days and at least 10 1/2 hours on the telephone and online doing research for a policy, Sharon and I stopped counting the time we were investing.

We gave up the search and enrolled in a policy that isn’t as good as the one we’ve had for the past several years. It’s less flexible, we had to give up one physician who has helped me through two surgeries for an on-going condition, and it’s not clear whether we will pay more or less money.

But, unlike 4 million other U.S. citizens, we’re insured.

In lieu of contributing the employer’s share of a premium, the GCFA is contributing to a health reimbursement account amounting to $4,100 per year for a couple.

As insurance and drug costs rise, no doubt the reimbursement will stay the same, so retirees on fixed incomes will absorb the increase.

I won’t list everything that went wrong. I don’t have enough space and I don’t want to try your patience because the list would be long.

The description one of my friends gave as he went through the process should suffice. “It was a descent into Hell,” he said.

Instead, I want to discuss a larger issue that looms over this decision.

Institutional Failure

The decision made by my employer was an institutional shift away from an understanding of deep ties of mutual obligation rooted in community to far weaker ties based on market choices by individuals engaged in a transaction.

There is a growing body of analysis that traditional institutions in Western liberal democracies are failing. They are being replaced by market-based capitalism.

Health Care as a Commodity

In virtually every country in the developed world, health care is a basic right, and a service. However, in the U.S. we buy access to health care through insurance as if health care is a commodity.

We have turned it into a retail transaction. Thus, insurers, health providers, device makers, and big pharma all are given a piece of the action, all of which is funded from the pocketbooks of everyday workers, retirees, employers (if they offer it), and the uninsured.

This is a system that gives competing forces of predatory capitalism the ability to profit from the potential and actual suffering of people, otherwise known as consumers.

I contend my relationship with my doctors is more than a retail transaction and I am more than a consumer.

Together, we make decisions about my life that affect me and my loved ones. These decisions are about how I live a meaningful, purposeful life. I’m not buying a product, I’m seeking well-being.

The consequence of my employer’s decision to place one of its most vulnerable, powerless and voiceless constituencies into this transactional marketplace illustrates the problem. It’s a direct rejection of this religious community’s theological claim to a preferential option for the poor and the vulnerable as an expression of social holiness.

Where the Power Resides

As we listened to the insurance brokers read scripts written to protect the corporation and remind us “this conversation is being recorded,” it was clear where the power resides in this transaction. Not with us.

As we surveyed which policies included or excluded our physicians, hospital and certain drugs, it was also clear our choices were determined not by our needs but by the commercial relationships large corporate interests have made for their own benefit.

We had to make judgments from a range of choices dictated by corporate bottom lines that would confound the most astute mind.

We are subjected to the vagaries of the market without voice, vote or right to appeal.

This is hardly an authentic expression of our theological teaching about caring for one another as Jesus taught in Matthew 25.

The Church as Community

In the past, as the CEO of one of the global church agencies, I encouraged staff to view themselves as an extension of our larger community of believers, and their work as a form of ministry on behalf of the community as well as service to the community.

We were not individuals pursuing our self-interests, we were part of a collective, multi-layered, interwoven community that ultimately extended from our workplace to congregations to global connections.

It is true that we were in a workplace, but it was a workplace within a context of shared values, common identity, mutual interactions, obligations and shared purpose.

We were deeply rooted, connected and responsible for a common good.

These are the qualities that mark a traditional institution. And this is what is being lost as the marketplace and predatory capitalism subsume the place of these institutions.

If the church does not preserve this understanding of community and commitment in a market-driven, consumerist society, we will continue to leave those without leverage in this predatory system unprotected and vulnerable to principalities and powers far stronger than any one of us can influence alone.

Our Evaluative Outlook on the World

Matthew B. Crawford, writing in The World Beyond Your Head: On Becoming an Individual in an Age of Distraction says, “commercial forces step into the void of cultural authority and assume a growing role in shaping our evaluative outlook on the world.”

This is the crux of my concern about the decision my institution made—it transfers responsibility for a common good to a transactional, market-based culture. It further diminishes the role of the church in the culture. It fundamentally changes our evaluative outlook on how we view this piece of our world.

Death by a Thousand Cuts

Economic sociologist Wolfgang Streeck says that the great contribution of traditional institutions is that they provide us the means to resist forces of predation: commercialism, secularization of values, economic exploitation and the depletion of the natural world.

Traditional institutions won’t suddenly disappear, Streeck says. They die by a thousand cuts, conceding responsibility, or being shut out of power, in small, almost imperceptible ways.

Imperceptible that is, until they realize they have no power to resist. They become subordinated to the dominant values of a secular, commercialized, market-dominated dynamic, that is by definition predatory.

That’s why a decision like this has larger implications than recognized on the surface.

The Most Perfect Christianity–to Seek the Common Good

An early church father, John Chrysostom (c. 347–407), once wrote: “This is the rule of most perfect Christianity, its most exact definition, its highest point, namely, the seeking of the common good . . . for nothing can so make a person an imitator of Christ as caring for his neighbors.”

When it functions as it should, the church provides us moral instruction, and functions as a moral compass, to blunt, if not challenge, the destructive effects of rampant and unrestrained materialism promoted by predatory capitalism.

It offers us an evaluative outlook on our world.

But today that challenge requires adjustment to a new world of technology, information, and economics unlike humans have known in the past.

New Forms for a New Day

It requires new forms of institutions, constituted to address the powers and principalities of the 21st Century.

It requires imagination and creativity.

Thus, the institutional church should be seeking new ways of being in community in a diverse and complicated world. It must resist the pressure to move toward a society governed by materialistic transactions and offer creative, innovative alternatives.

I believe this involves leaders in the global church giving deep thought and action to conceive new policies—pubic and private—that support a moral economy.

Re-imagining a Place in the World

To be specific, it means imagining how to provide health care to everyone as a basic human right.

In frontier America, the church did this by creating hospitals that became the backbone of the health care system that exists today.

At this writing, in Africa religious organizations provide 40% of health care in the same spirit of public concern.

Nothing less than bold, creative effort is needed in the U.S., and the church should be leading in this effort, not merely reacting to (admittedly) powerful market forces.

It is not enough for our church’s administrative arm to hand-off its retirees’ health care to a transactional marketplace as if they are little more than an economic liability to be written off.

As we hurtle toward an over-heated world whose resources are being depleted beyond the capacity to sustain us, market-based transactions will not save us, they will only hasten the downward spiral.

If the institutions that inform and protect our highest values and ideals abrogate their responsibility for the common good and don’t help us prevent that downward spiral, we all lose.

Bonds of Mutual Affection

Institutions that worked in the 20th century and earlier are faltering and in some instances failing to fulfill the functions for which they were created.

Banks and financial institutions crashed the economy. Our federal government is dysfunctional–and in actions like family separation, it is demonic.

Wherever you look institutions are under duress. Education, government, religious organizations and health care are among them.

I was reminded of this as I sat through a recent meeting in which church officials and third party vendors explained a change in health insurance for retirees from church agencies.

Before you turn away for lack of interest in retiree health insurance, hang with me for a moment because the issue is about much more than that.

In various ways our failing institutions are grasping for alternatives. Some, like banks, seek even more power and freedom to move without regulation. Others, such as churches, are struggling with divisions that threaten their survival.

The move by my national church to put retiree health care into the private market through a third party broker represents how changes in the larger society are eating away at the institution.

In the church, as in civil society, we have viewed ourselves as interconnected. In religious language, we call this “community.” We care for each other and for the larger world.

Community is not only immediate, it includes “the great cloud of witnesses” who have gone before over the centuries.

We are connected. Our humanity binds us in ways that are profound and enduring.

In civil society, Lincoln put it poetically and realistically in his first inaugural address in 1861. “We are not enemies, but friends,” he said. “We must not be enemies. Though passion may have strained it must not break our bonds of affection.”

These bonds of affection, however, are strained today, and in some cases they are breaking.

We’ve moved from these communitarian values to transactional values. We are less connected by bonds of mutual concern and more connected by the exchange of money.

The market economy has replaced the blessed community.

In the case of the church and retiree insurance, the church agency responsible for managing insurance is turning it over to a third party broker who will put the retirees into the private insurance market.

At the meeting where this was announced, everyone who spoke stated how much they care for retirees. I believe them.

However, this affection yields to the necessity of changing the connection between the retired employee and the institution.

Our speakers promised concrete advantages by including more choices in insurance packages. For some in the room that is vitally important.

Some of us might even get insurance at no cost, they said.

To check this out, I used the Henry Kaiser Family Foundation insurance calculator to explore scenarios for no-cost insurance.

I can’t find a no-cost insurance scenario for my state, a state that chose not to expand Medicaid, and therefore, chose to deny some of the benefit of the Affordable Care Act to its low income citizens.

But I did find that an individual with $15,000 annual income and no spouse who is eligible for insurance through an employer could qualify for a subsidized policy at a cost of $20.00 per month.

I truly fear for you if you’re living at a level that qualifies you for no-cost insurance. You’re on the edge of survival.

And more than 40,600,000 U.S. citizens subsist below the poverty line.

The market economy erodes the bonds of affection. It puts relationship on a fee for service basis.

The Affordable Care Act is based on the principle that those of us in better health would support the health and well-being of those less fortunate through mutually affordable insurance.

This is civic interconnectedness. It is based on the idea that we are a better society when we reinforce our mutual bonds of affection and care for one another.

But both our political institutions and corporate health care have broken these bonds. They have imposed a survival of the fittest system upon us in which wealth correlates to access to health care.

Nearly 40% of U.S. citizens say they have gone in debt to pay medical expenses and 31 million have no insurance.

The projections for the future of the health insurance maketplaces are not good. The actions of Republican legislators to destroy the ACA have charted a course that looks like it will further undermine the principle of mutual benefit through cost sharing.

The church is caught up in the transactional model that is strangling us through the market-based economy led by politicians bought and paid for by large corporations and by the insurance industry that profits from this system.

I do not fault my church officials who made the decision to move us to the private market. They see no viable option.

If we are to recover meaningful civic and spiritual engagement–to be the kind of society that cares for all its people–we must create alternative models and new structures that connect us and restore our mutual bonds of affection.

It is left to grassroots people to organize around the issues that affect us and to seek solutions. We now understand that the political, health care and health insurance institutions are too entrenched and controlled by principalities and powers to create change.

Christian communities and their humanitarian organizations must partner with community organizations addressing poverty and health care to envision new ways of interconnecting.

It is up to those at the ground level to restore the mutual bonds of affection, and to construct new, more humane policies that foster community, equity and justice.

We must do nothing less than envision new ways to connect in order to create new institutions for the future. Difficult as it will be, health care is as good a starting place as any.

My Virginia Creeper Escapade

I recently got into Virginia Creeper, a vine that for me is as toxic as poison ivy.

I took all the necessary precautions, long sleeve shirt, work gloves, even coveralls.

I scrubbed in the shower within thirty minutes of completing my garden work.

And still I got the oils on my arms.

When the outbreak started a couple of days later I applied over-the-counter salves.

When it continued, I followed a pharmacist’s suggestion for a soaking powder and calamine lotion.

When it got worse, I went to a drugstore clinic and got a prescription salve.

As it worsened, I went back and got prednisone.

After a miserable night, I went to a hospital-run clinic and got a shot.

But it’s the prednisone that drives this escapade. I kept my wife awake all night, she claims.

She had been pretty sympathetic until this. Now, she’s suggesting a different sleeping arrangement for the duration.

I was warned the prednisone might affect my sleep. Wow. That wasn’t the half of it.

It affected my appetite, my activity level, and my sleep.

That’s what got me in trouble with Sharon.

I made repeated trips to the kitchen throughout the night, which she says she heard between her naps.

I started the evening after supper with a bowl of watermelon. But that didn’t hold me.

I followed that with a granola bar. Then a banana. Then mixed nuts. Then an apple. Then vanilla wafers.

It was the vanilla wafers at 3:30 am that were the straw that broke the camel’s back, to mix my metaphors.

Well, that and the noise of the shower, which I took to try and stem the itching.

It was the crinkling tin foil and scratching sounds that I made pulling the wafers from the box that woke her for the last time.

I thought I was being stealthy. She says it sounded like a turtle scratching inside a cardboard box.

I guess tonight I’ll sleep upstairs.

But first I have to go to the grocery store.

We Must Be As Persistent as the Parasite

Screen Shot 2015-02-20 at 5.11.41 AMA few years ago I heard a Navy physician speak about a particularly difficult drug resistant strain of malaria in Cambodia. He was a specialist in malaria research. He speculated that the strain had developed during the U.S. war with Vietnam.

Malaria was rampant in the region. People affected by it took medication haphazardly to relieve the symptoms. But if the full course of treatment is not followed, the parasite can develop resistance.

He theorized this had contributed to a more virulent parasite. It’s resistant to artemisinin, currently the most effective drug to treat malaria. His concern was that the parasite could spread.

The Parasite Spreads

Now it appears this may be happening according to a study in the medical journal The Lancet Infectious Diseases. The parasite may be moving to a wider area, or reporting and documentation may be locating more cases.

In either case, the study points to the need for persistence to contain and prevent this parasite from spreading. The risk is that this strain could reach beyond Cambodia to India, Africa and other parts of southeast Asia.

If this were to happen it could reverse the enormous gains made against this disease in the past decade. This has happened before and the result was an increase in deaths and loss of productivity across whole regions of the world.

The study rings an alarm bell.

Continuing the Fight

We must continue the fight against malaria. The full range of technologies must be used:

  • continuing research to replace artimisinin where resistance occurs;
  • bednets to prevent night exposure;
  • effective education to assure people use medications properly;
  • getting counterfit drugs off the market;
  • residual indoor spraying for interior protection;
  • research to potentially alter the mosquito host and the parasite;
  • enviromental cleanup and water management to control mosquito breeding areas;
  • repairing broken, inadequate health systems.

Most importantly, donors, researchers, and health care providers must remain as persistent as the parasite.

Malaria is not a fad from which we retreat when it’s no longer the cause of the day. If the disease rebounds, the death toll will be worse than before, and that would be tragic.

Sustained, ongoing, dogged determination to contain this disease is the best approach. It’s not the easiest approach, but we know the results of doing less: needless suffering, lost productivity, countless deaths.

Campaign anticipates misuse of bed nets

Teresa Ad‹o Jo‹o (second from right) receives instructions about the proper use of her new mosquito net from Ilda Nanjembe during a 2012 distribution by The United Methodist Church's Imagine No Malaria campaign in Bom Jesus, Angola. A UMNS photo by Mike DuBose.

Teresa Ad‹o Jo‹o (second from right) learns about proper use of a bed net from Ilda Nanjembe during a 2012 distribution by The United Methodist Church’s Imagine No Malaria campaign in Bom Jesus, Angola. UMNS photo by Mike DuBose.

Bed nets intended to prevent malaria are used in fishing communities in Zambia to fish for food, which is sold in the local market, according to a report in the New York Times. The nets also trap fingerlings necessary for future stock. This decimates stocks and causes environmental harm.

The issue highlights an unintended consequence of the global effort to combat malaria, an effort that has reduced the death toll by half in the past decade.

The net distributions I have seen by the Imagine No Malaria campaign anticipated the problem of net misuse.

Before a distribution, community health workers and volunteers were identified and trained. During a pre-distribution education period, they learned how to prevent malaria, request permission to enter homes to hang nets, and explain proper use and care of nets.

Media campaigns, community meetings, fliers and word-of-mouth alerted local people to the future distribution. Communities were prepared in advance to welcome health workers and volunteers into homes. The trained volunteers hung nets and demonstrated how to use them.

As followup, health workers were assigned for six months to sectors to monitor net use and record the use rate. This identified issues for future distributions and reinforced behavior change practices that are critical for regular net usage.  For 9 to 12 months after a net distribution, there are regular check-ups to ensure proper use and care of the nets.

In the Bo District of Sierra Leone, for example, health workers determined 98 percent of the nets were in use six months after installation. In addition, Imagine No Malaria nets were not distributed around fishing communities. The use of nets for fishing is likely localized to those communities.

In the past, nets distributed without such precautions sometimes appeared in local markets and were used for many unintended purposes. But net providers learned and adapted.

Underlying problems

Secondary uses of netting, as with many other items, are common in many communities lacking resources.

While this doesn’t mitigate the environmental harm, it does emphasize that people are using nets to get food and fish for sale. The root of the problem is food self-sufficiency and a healthy local economy.

It’s compounded by lack of awareness of the harm done to fish stocks.

The story also points to the need for alternatives to nets where practical and for more education.

A greater emphasis on screens and doors in living quarters is proposed. Due to construction practices and cost, this is more practical in some areas than others.

Indoor residual spraying is practical and safe, and it is used in some regions.

Responding to the challenge

Media campaigns can encourage proper use of nets and point out the harm done by this particular secondary use. Local leaders can speak against harmful fishing and build community support for prevention.

Addressing the diseases of poverty is a complex challenge. Solving one problem can lead to others. Unintended consequences reveal themselves.

Disease, poverty, education, food sufficiency and environmental stewardship are interrelated, complex human concerns. We are challenged by them to find life-enhancing solutions.

The story points to the need for thoughtful, comprehensive development to address these interrelated issues of life and death.

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This post was edited to remove a sentence that said the NY Times article did not refer to new nets. The article quotes a fisherman who says new nets are better because they don’t have holes.

Relating to Cuba

Doctors attend to newborn in pediatric hospital in Havana

Doctors attend to newborn in pediatric hospital in Havana

A nurse slowly squeezed a manual respirator to keep the newborn breathing. Two physicians worked quietly and methodically on the distressed child. We were in the critical care unit of the central pediatric hospital in Havana, Cuba. It was more than 15 years ago, but as I hear criticism about the normalizing of relations with Cuba today, it makes me wonder how much has changed since then.

A Grave Situation

I was photographing medical care for children at the invitation of a pediatrics official as part of a visit with friend and colleague Joe Moran of Church World Service. We were documenting the humanitarian work of Cuban Christians and others. Cuba has long emphasized quality health care and many South American nations send patients to the island nation for care.

As I concentrated on photographing them, I was not aware of the gravity of their efforts. An X-ray negative was taped to a window. It revealed the baby had been born with a single lung.

As I looked through the viewfinder, concentrating on focus and composition, one doctor stood erect after having leaned over the child’s bed. The nurse put down the respirator. The three laid their equipment aside and looked toward me. The child had died.

I leaned against the wall, shocked and humiliated by my lack of awareness. Tears welled in my eyes. And these people who had just completed heroic efforts to save this child came over to console me!

Embargo Results

As we talked, they explained the difficulties of caring for the child. His chances of survival were dire. One of the challenges was a lack of needles small enough for the tiny veins of  newborns. As with many other medical supplies and equipment, they attributed the shortage to the U.S. embargo that had been in effect for the past 30 years.

Except for case-by-case humanitarian exemptions, medical supplies made in the U.S. were blocked from entering Cuba. And this had recently been extended to equipment under U.S. patent. This meant that materials from third party sources could not be imported if they were patented in the U.S.

This was only one of the hardships visited on the vulnerable, like this infant, that resulted from the embargo. The Cuban economy was anemic. Travel to the U.S. was  prohibited. Remittances from family in the U.S. were limited. Trade with the U.S. was restricted.

Tourism from other nations was just beginning to attract foreign exchange, but a dual economy–one for tourists and one for locals–only highlighted financial inequality.  Life was hard for most people.

Putting the Past Behind Us

I thought of this experience when I heard of the agreement to normalize relations between Cuba and the U.S. I thought of the Cuban people: the children in the pediatric hospital, the pleasant old woman in a senior residence who told me with a smile as I was leaving, “Remember, you have a grandmother in Cuba,” the teachers and children in the schools I visited, the farmers and the health care workers.

They are everyday people seeking to live meaningful, purposeful lives like you and me, under difficult circumstances made unnecessarily more difficult by political differences that have festered now for a half century.

I understand the Cold War ideology. I lived through it: the missile crisis, the political detainees, the human rights violations. But this baby had nothing to do with that. He was simply born into this world of hubris and hatefulness, without a fighting chance for survival.

Things have changed since my visit, but slowly and incrementally. And not enough to greatly improve the lot of most Cubans. The normalizing of relations will notch up the change. But it does not end the embargo. That requires an act of Congress.

It will be a political struggle. But this, too, must happen. So long as it continues, it undermines our best values, and punishes the innocent.

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The National Council of Churches in the U.S. and Cuban Council of Churches have issued a joint statement about normalization nd future steps: http://nationalcouncilofchurches.us/news/2014-12cubastepsforward.php

We must support Dr. Salia, Ebola caregivers

Dr. Martin Salia, shown at the United Methodist Church's Kissy Hospital outside Freetown, Sierra Leone, in April, has tested positive for Ebola. Photo by Mike DuBose, UMNS.

Dr. Martin Salia, shown at The United Methodist Church’s Kissy Hospital outside Freetown, Sierra Leone, in April, has tested positive for Ebola. Photo by Mike DuBose, UMNS.

In an interview with United Methodist Communications in April, Dr. Martin Salia explains why he works in Sierra Leone. He provides health care to all who come to the hospitals where he serves. “I took this job not because I want to but because it was a calling and that God wanted me to,” he said.

Like many health care workers across the African continent, Dr. Salia’s motivation is deeply religious.

Dr. Salia is a key figure at Kissy Hospital run by The United Methodist Church of Sierra Leone. Sierra Leone has three physicians for every 100,000 persons in the country. Kissy is one of the facilities that Dr. Salia has been serving.

The average income in Sierra Leone is $347 per year. According to the U.S. State Department, this translates to “over 72 percent of the population living on less than $1 a day, in extreme poverty.”

Kissy serves those who cannot afford to pay for medical care. It is one of the faith-based hospitals that provide 40 percent of the health care across Africa. In the course of my work in reporting on Africa, I’ve been in clinics and hospitals like Kissy. I’ve seen people pay for services with chickens, goats and mangoes.

The world owes a debt of gratitude, and more, to health care workers like Dr. Salia. We should do all in our power and our resources to assist them.

At great personal cost, Dr. Salia’s spouse has arranged for him to come to the U.S. for treatment for Ebola. A physician who has given so much of himself in treating others, Dr. Salia is now an Ebola patient himself. Kissy Hospital has been forced to close temporarily.

This complicates the challenge of controlling this virus. It also adds to the burden of untreated cases of malaria, diarrhea and other killer diseases of poverty.

Tragedy upon tragedy. And yet, heroic individuals like Dr. Salia put themselves in harm’s way to bring well-being to West Africa.

Dr. Salia is going to the University of Nebraska Medical Center in Omaha for treatment. I’ve had intimate experience with this medical center. It’s among the nation’s best. I think the state can take great pride in its personnel to care for Dr. Salia.

We know that with proper care, equipment and interventions, the survival rate for Ebola patients treated in the U.S. is favorable. It’s understandable that people fear Ebola, but we know that control of the virus is possible. And after missteps in Dallas, the health care community has shown it can self-correct. It has demonstrated a capacity to care for this disease responsibly.

If ever there were a time for welcoming and hospitality, it is now. And if ever there were a time for the world to contain its fears about Ebola and act responsibly toward those who are working under extraordinarily difficult conditions to contain this virus, this is it.

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The Foundation for United Methodist Communications has established an emergency communications fund. With your help, we can provide communications support in the event of a crisis or disaster. Donate here.

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The Great Plains Conference of The United Methodist Church has established a fund to receive gifts toward the cost of his transportation to Omaha and related medical costs not covered by other sources.  Contributions can be made through any United Methodist church, or sent directly to: Great Plains Conference Office, 4201 SW 15th, PO Box 4187, Topeka, KS 66604.   Please put “Dr. Salia Fund” on the memo line.

No one should live outside the web of connectivity

The national health systems of Sierra Leone and Liberia are barely functioning, and increasing pressure on them risks a complete meltdown, according to reports in popular media. Coordination of services to contain the Ebola outbreak remains fragmented and under resourced.

A woman uses a smartphone in contact tracing, a method used to trace people who have had contact with Ebola patients. Video screen shot, Centers for Disease Control and Prevention

A woman uses a smartphone in contact tracing, a method used to identify new Ebola cases quickly and isolate patients as soon as they show symptoms.  Video screen shot, Centers for Disease Control and Prevention.

In an article as tragic as it is frightening, Adam Nossiter of the New York Times details how people are dying from Ebola in Makeni, Sierra Leone. The article reads like the script from a horror movie with no happy ending in sight.

The story sent shivers down my spine, and it coincided with my return from a meeting near London of IT and communications professionals with major international agencies gearing up to meet this crisis at scale. The fact is, the response is far behind the spreading virus, and while this is belatedly being addressed, it will take long-term, sustained attention to bring the contagion under control. Time is an enemy, and the complications of scaling up are many.

International agencies are dealing with major crises from Syria to Gaza to the Central African Republic. The World Health Organization currently lists eight Grade 3 emergencies, which are situations that require substantial international response. They are: Central African Republic, Guinea, Iraq, Liberia, Nigeria, Sierra Leone, South Sudan and The Syrian Arab Republic.

This means the various agencies designed to deal with such emergencies were already being stretched before Ebola struck. Equally frustrating is the fact that this crisis graphically demonstrates how the lack of reliable communication today is a matter of life and death, but communication infrastructure lags behind human need.

The tipping point

Nearly every input imaginable is needed for this crisis from skilled personnel, to vehicles to transport the ill and the deceased, to a supply chain for materials, to communications for internal operations and external messaging, to technical personnel to support the technology, to facilities for isolating ill persons and myriad other physical and personnel needs.

What is called for now is urgent placement of skilled staff in the affected regions, facilities to support isolation and treatment, and material resources such as gloves, disinfectants, medications, body bags, protective suits and equipment.

But too many leaders, including global leaders and church leaders, have underestimated the significance of communication and the infrastructure necessary for it to work. We have reached a tipping point in our understanding of humanitarian aid. It is no longer limited to food, shelter, clothing, water and medicines. Lack of communications capacity has exacerbated this crisis.

The ability to communicate and the quality of the information delivered are matters of life and death. Pure and simple, communication is aid.

And humanitarian aid, like so many other necessary daily functions, is becoming digitized. This means that globally, communication infrastructure, messaging and personal communication devices will become essential for daily affairs, much as they already are in the global North.

Text messages, such as this one from United Methodist Communications, represent the new form of digital aid being used in the international response to the Ebola virus outbreak. Photo by Kathleen Barry, United Methodist Communications.

Text messages, such as this one from United Methodist Communications, represent the new form of digital aid being used in the international response to the Ebola crisis. Photo by Kathleen Barry, United Methodist Communications.

A paradigm shift

In the short-term future, we will see a paradigm shift toward digital humanitarian aid through the use of smart cards and mobile services. And this is changing older methods of providing aid because the new model is faster, more efficient and more economical, and it will reach more people. It also makes aid customizable and personal. And this means it is measurable, and the delivery system can be made more accountable.

This may seem like a pipe dream, but we are, in fact, already seeing how digital tools are being used in refugee settlements in the Middle East, and this will only grow as the systems become perfected.

The Ebola crisis is demonstrating that in this new age of pervasive technology, no one on the planet is so isolated that they can exist outside the global web of connectivity that delivers life-enhancing, and life-saving, information. And it is demonstrating that those concerned with humanitarian assistance to people in crisis situations must be at the forefront of this new era of technology for good because to do otherwise is to allow events to spiral out of control, with tragic results.

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The Foundation for United Methodist Communications has established an emergency communications fund. With your help, we can provide communications support in the event of a crisis or disaster. Donate here.

A new front in the Ebola crisis

United Methodist Bishop John K. Yambasu, chairman of the religious leaders task force, demonstrates to participants a new way of greeting instead of the traditional handshake. New traditions are being created to help prevent the spread of the Ebola virus. Photo by Phileas Jusu, UMNS.

Bishop John K. Yambasu, chairman of the Religious Leaders Task Force in Sierra Leone, demonstrates a safe way of greeting instead of the traditional handshake. Photo by Phileas Jusu, UMNS.

With the killing of a delegation of health officials, journalists and a pastor by a mob of rural villagers in Guinea, an even more tragic page has turned in the Ebola crisis.

The mission of the group was to dispel rumors about the outbreak, but the villagers thought they had come to spread the virus. The people attacked the group with rocks. Eight bodies were later found, bearing signs of having been attacked with machetes and clubs.

The event is a severe example of the irrational fears that are rife across the region. In Sierra Leone, the government’s Emergency Operations Center issued a release to dispel a rumor that soap to be distributed during the three-day lockdown, known locally as Ose to Ose Tok (House to House Talk), had been infected to spread the virus.

Fear drives these rumors. The immediate challenge is to arm trusted local people with accurate information to correct the inaccuracies and dispel the fear. The Ose to Ose Talk during the three-day lockdown in Sierra Leone is an example.

Correcting misinformation

In addition, commentaries on television, radio and in print by trusted leaders such as Bishop John Yambasu, the United Methodist leader in Sierra Leone, are helping to correct misinformation and encourage cooperation with health programs to halt the spread of the disease.

United Methodist Communications is providing text messages to clergy in rural areas as well as cities in Sierra Leone and Liberia. These messages are consistent with those developed by the World Health Organization and the Centers for Disease Control. The church’s advantage lies in its grassroots network of clergy and leaders who live in the affected regions and are trusted.

Two messages are sent daily. The morning message is usually about health practices. For example, these messages were sent this morning:

Community health workers are trained to help us all and are essential to beating Ebola. Please cooperate with them during the lockdown. – Bishop J. Yambasu (Sierra Leone)

In the Ebola crisis, handle animals with protective clothing. Thoroughly cook animal products (blood and meat) before eating. – Ad., WHO (Bishop J. Innis) (Liberia)

Each afternoon a message based on Scripture is sent. For example: Do not worry … in everything by prayer and supplication with thanksgiving let your requests be made known to God.” (Philippians 4:6) – Bishop J. Innis or Bishop J. Yambasu

We are also distributing solar cellphone chargers to give these messengers a cost-free means of keeping their phones charged.

The long-term challenge 

This crisis underscores a truism: Poverty breeds social discontent and mistrust of unresponsive government. Liberians clearly do not trust their government. At the outset of the crisis, the rumor spread that the outbreak was false, created by the government to bring more foreign dollars into the country to pay corrupt government officials.

In the long term, the challenge is to provide education that leads to better understanding of disease and how to prevent infections. This will require effective public education. It is also necessary to build effective, accessible public health systems, and equally important to establish responsive, transparent governance.

Building public infrastructure that is common in societies in the global North, such as sanitary sewers, clean water, and Wi-Fi and mobile phone systems, is also  a long-term solution.

Addressing inequities 

Africa’s leaders must gain the trust of their citizens by ending corruption and conducting government affairs with transparency, and citizens must have access to the information they need to make responsible decisions. Access to information is a human right in this information rich age. It’s essential to good citizenship.

The stark realities of the Ebola crisis make clear the need for these basic changes. The world must stem the immediate crisis. But that is not enough. We must address the underlying deficits that periodically surface and remind us that inequities in the world make all of us less secure and threaten global well-being when systems break down.

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The Foundation for United Methodist Communications has established an emergency communications fund. With your help, we can provide communications support in the event of a crisis or disaster. Donate here.

Their problems are our problems

As the Ebola epidemic continues to spread amid warnings by Doctors Without Borders that it is out of control, Dr. Michael T. Osterholm writes that health professionals are not talking publicly about the potential for Ebola to mutate into an even more dangerous form by developing the ability for airborne transmission. This has not happened yet in humans, but he says controlled studies have confirmed respiratory transfer of the Ebola Zaire strain from pigs to monkeys.

In addition, Osterholm says Ebola Reston, a different strain, passed through air transmission in a study group of monkeys in 1989 and the animals were euthanized to contain the virus.

If the virus reaches the megacities of Africa, he says, the opportunity for mutation could lead to more dire consequences, endangering many more people. Even without this speculative possibility, one mapping model predicts the number of victims will far exceed WHO estimates and could take a year or more to contain.

The rising rate of infections and deaths is cause for more than words of concern. It’s a call to action.

Poverty must be addressed

The Ebola virus carries the disease, but the disease is transmitted by ignorance, mistrust and resistance to proper care by ill-informed people. Ebola gains its foothold in poor communities where lack of understanding of the virus and how it is transmitted is widespread.

It gains momentum because these communities lack basic health care services and medical staff. It roars forward where people do not trust the information they are given by government officials. This escalating pyramid results in a contagion that threatens communities, nations, and potentially, the world. The underlying culprit is poverty.

Obviously, the immediate crisis must be contained. But we cannot stop there.

We must address poverty in a systematic, comprehensive way. Too many people are still dying of malaria, HIV/AIDS and other diseases of poverty. This will require a more effective, coordinated approach than we’ve mustered so far. Small one-off projects and uncoordinated development efforts will not get at the problem of poverty.

We need to provide people with access to accurate information, better education, more effective, well-staffed and well-equipped health facilities, treatment and immunization that cover the entire population, clean water, sanitation systems and economic opportunity.

This requires global resources. We know this, but we don’t approach it holistically.

What we don’t talk about

This neighborhood in Bom Jesus, Angola, is representative of many communities in sub-Saharan Africa.

This neighborhood in Bom Jesus, Angola, is representative of many communities in sub-Saharan Africa. Photo by Mike DuBose, United Methodist Communications.

The poor have no constituency. Their voices go unheard. And yet, they are not invisible. Faith organizations have been working with poor people for decades, and within faith communities, poverty is seen for what it is, a dishonoring of the sacredness of the human spirit.

But faith organizations have been focused on limited goals and have admirably addressed human needs within this limited perspective. Today, however, the need is for a broader approach and advocates who seek to change public policy in addition to performing their own good works locally.

Before they head for their destination, every mission team should make it a priority to be briefed on the conditions that contribute to the poverty that afflicts those they go to serve. And they should commit to addressing those conditions upon their return by advocating for public policies to alleviate the root causes.

We need to see the social, economic and political context in which Ebola, malaria, HIV/AIDS and other diseases of poverty thrive. This is what we in faith communities don’t talk about.

Thinking – and acting – globally

Palliative measures will ease the immediate suffering, but they do not change the conditions that are at the root of human ignorance and suffering. These roots are structural and systemic. They result from poor governance, economic inequity, lack of empowered citizens and corporate responsibility.

We must build out the digital infrastructure that carries reliable, useful information, make it accessible to everyone and train people how to use it. This infrastructure has not only shrunk the world, it contains the store of the world’s knowledge, and everyone needs access to it.

We must change our thinking that diseases like Ebola, and those affected by it, are remote from us. We must foster a global understanding. We think of Ebola as thousands of miles across the ocean, but it’s all-too-clear today that it’s really only  a six-hour flight away.

Like it or not, we are global citizens, and “their problems” are our problems.

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The Foundation for United Methodist Communications has established an emergency communications fund. With your help, we can provide communications support in the event of a crisis or disaster. Donate here.

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