What's the Matter Boss, We Sick?


Centuries of colonial domination have the leaders of Liberia, Sierra Leone and Guinea more focused on not exporting Ebola than on curing it within their borders.

When Thomas Eric Duncan was suffering from the Ebola disease in a Dallas hospital, Liberian president Ellen Johnson Sirleaf apologized to America and discussed punishing him if he survived.

With the US doing so much to help us fight Ebola and to give one of our compatriots… He’s gone there and in a way put some Americans in a state of fear and put them at some risks, so I feel very saddened by that, and very angry with him, to tell you the truth…

The fact that he knew and he left the country, it’s unpardonable, quite frankly. I just hope that nobody else gets infected. Fortunately, he’s in the United States where medical care, you know, is very good. And now that a few of the health facilities there are aware of Ebola because they have been able to treat certain people that have gotten cured of it. I hope he’ll get his treating and then after that they’ll send him back and then we’ll have to deal with him.

When asked, “What will you do after he comes home?” she laughed, and said she would “have to consult with the lawyers.”

Sirleaf based her threats on “the fact that he knew,” but we can only speculate whether Duncan knew when or where he contracted Ebola. He died on October 8th. We don’t know what he knew, nor will we ever.

A week after Duncan’s death, Sierra Leone’s president Ernest Bai Koroma issued a press release entitled: “‘We Will Not Export Ebola’ President Koroma Assures.” Sierra Leone was hosting the chief administrator for USAID to discuss the Ebola response, and the message was clear. Koroma was as concerned as Sirleaf that citizens from his country did not spread Ebola to Americans.

The two leaders’ statements were upsetting. Why was Sirleaf’s concern for Americans’ health expressed with anger? Why did Koroma need to give official assurances that the contagion would not spread? What was at stake for them in identifying strongly with the Americans? Their unreciprocated identification with the plight of the Americans, to me, resonated with Malcolm X’s description of a psychological disposition that was borne of chattel slavery. Speaking on the difference between the "house negro" and the "field negro" in 1963, Malcolm X said:

When the master would be sick, the house Negro identified himself so much with his master he'd say, "What's the matter boss, we sick?" His master's pain was his pain. And it hurt him more for his master to be sick than for him to be sick himself.

Malcolm X’s insight is that identification with the master class is intimately linked to a division of labor and relationships of exploitation across spatial and racial lines. These feelings of allegiance and identification with elites, Malcolm X suggests, are forged under conditions of violence that uphold the terms of their servitude, their presumed inferiority, and their eagerness to accept what they are given, in exchange for meager personal gain. As a kind of managerial class, the "house negro" builds an uneasy intimacy with elites and, for his survival, depends on the remains of his master’s spoils; he eats the scraps from his master’s table, lives in his master’s attic, wears his master’s old clothes. Yet while the managerial class strongly identifies with the master class, its members recognize they will never be fully incorporated into it. The burdens of this relationship are deeply felt by the masses; they both witness and experience the structural, symbolic, and psychological violence this relationship engenders.

In short, we sick.

These presidential statements take for granted a pathological, even pathogenic, political and economic relationship with the West, one that actually devalues and destabilizes the infrastructure necessary to prevent and contain a disease like Ebola. After all, the three hardest hit countries are totally dependent on foreign assistance to finance their health systems. While the proportion varies from year to year, health sector spending by foreign donors has topped out at 80% of the total in at least two of the countries in the past decade. It is easy to blame civil war for the crumbling health systems in Liberia and Sierra Leone, and there is something to that. Many doctors and nurses left Liberia and Sierra Leone during the war and health facilities fell into disrepair or were destroyed, along with the infrastructure for monitoring and training clinicians and public health specialists. Yet structural adjustment programs of the 1980s had already decimated the health systems in those countries well before there was a civil war. As in many poor countries around the world, the terms of World Bank and International Monetary Fund (IMF) loans required countries like Liberia and Sierra Leone to roll back social services, devalue their currencies, and increase exports of cash crops with low tariffs. The end of African socialism in Guinea in 1984 also marked a sharp decline in the national health system there.

As Sierra Leonean political scientist Fodei Batty reminds us, the Ebola virus followed the path of the civil war, but the region where the war began has also been the site of a land grab that has been going on for nearly a century. As Rob Wallace has pointed out for Liberia:

Lisa Fouladbash traces Liberia’s modern agroecological regime as far back as 1925 and Firestone Rubber Company’s first investments, which “ignited a wave of foreign investments in Liberia that would transition Liberia from an economy based in subsistence agriculture, to a cash-crop export economy dominated by foreign businesses.

Firestone scored 1 million acres for 99 years at 6 cents an acre. The Liberian government was forced into a $5 million loan from the Finance Corporation of America, a Firestone subsidiary, to “protect” the company’s investment. The loan’s terms allowed Firestone to restrict the government’s sovereignty for the term of the lease.

The exploitative practices of Firestone persisted from the 1920s through the war in the 1990s. During the war, the company turned away Liberian employees to be slaughtered by the rebels, and paid "protection" money to Charles Taylor to ensure smooth operations. Until recently, Firestone had refused to allow its high-tech Ebola treatment facilities to be accessed by non-employees, even as government and NGO-sponsored treatment units filled to capacity outside the plantation’s borders.

We can push the clock back even farther: Predatory practices of commodity extraction began economically devastating the region with the trans-Atlantic slave trade. European slavers arrived on the Upper Guinea coast in the 16th century, looking to enslave people from the interior of present-day Guinea, Liberia and Sierra Leone. The very region where the Ebola outbreak began in the 21st century was, in the 16th, a zone of instability wracked by small-scale slave-raiding wars.

Today, African presidents like Koroma and Sirleaf manage the extraction and export of natural resources and distribute the revenues these exports generate. Sierra Leone provides tax breaks to international mining and agribusiness companies, but attracting foreign investors with tax breaks also diminishes the resources for public services like health care and education. As Claire Provost reports,

In 2012, tax incentives primarily for just six firms amounted to 59% of the entire government budget—more than eight times greater than spending on health and seven times higher than the amount spent on education.

Ebola has disrupted this system, substituting its own viral economy. International NGOs offer services usually provided by the public sector, while mining and agribusiness companies have evacuated their personnel, leaving behind the hotels, high-end restaurants, shops, and other businesses that cater to them. The gap left by suspended iron ore, bauxite, diamonds, and rutile extraction operations—and long-term development initiatives—has been filled by an expanded emergency aid industrial complex built up around an Ebola response. The massive amounts of aid coming in to the three countries are under greater scrutiny, as international and local media outlets, accountability watchdogs, and others demand more precise accounting. Some see a persistent lack of accountability as contributing to the epidemic and failures to contain it, with some going as far to suggest that better accountability measures for Ebola constitute a cure. But accountancy and accountability are not the same thing; nor does the former remediate an enduring legacy of extraction and exploitation. A true "reckoning" must also account for failures to implement robust public health systems in light of extensive and significant health sector expenditure by foreign donors.

As Sirleaf and Koroma intimated during their apologies and assurances to Americans, the disruption of extraction, cultivation and export of commodities has given rise to fears that Ebola will become a primary export to the West. Local elites are worried that their control is slipping over the management of resource extraction and allocation, the distribution of aid flows to other elites, and the overseeing of international NGOs as they conduct the business of making live and letting die. They are now under increasing pressure to prove their capacity to manage, police and control the virus and its movements. They must work hard to prove that they are up to the task, and they are doing so.

It is bitterly ironic that Koroma and Sirleaf so publicly express their concern for the health and welfare of Americans—who are largely not experiencing the epidemic at all—since they have shown far too little public sympathy for their own citizens. At the same time, they have demonstrated the lengths they are willing to go to exercise sovereign power over the living, as they establish cordons sanitaires around entire regions and communities, institute national lockdowns, and support village-based quarantines. None of these are innately bad interventions, of course. But these leaders’ inability to manage the Ebola crisis at home threatens their political legitimacy on many fronts. They risk losing whatever credibility they had with their trading partners and within a long-standing imperial system, while their failure to stop transmission and care for the multitudes of sick threatens their political power at home.

We sick.

By the time Duncan succumbed to his illness, Sirleaf’s popularity and legitimacy had seen a marked decline. She had been unpopular in Monrovia before the outbreak, but a confrontation between residents of West Point, an informal settlement in Monrovia, and the military signaled a turning point. West Point has a history of dispossession and marginalization, and unsubstantiated rumors have long circulated about the government wanting to clear slum housing for urban development, a wholly reasonable suspicion. When area residents opposed the establishment of isolation units for outsiders in their community, however, Sirleaf ordered a military quarantine to be erected at West Point’s border. Already tense relations between area residents and the government were stretched past the breaking point. During the quarantine, troops opened fire in the community, killing a 15-year-old boy and injuring others.

In some ways, Koroma has been more successful than Sirleaf in asserting his authority, but he has also been criticized for whom he has trusted in leadership positions. In 2012, he appointed Miatta Kargbo, a pharmaceutical representative, to the post of minister of health and sanitation. Allegedly the relative of a close friend, she became the object of scorn during this outbreak when she appeared before Sierra Leone’s Parliament and mocked two health facility staff who succumbed to Ebola. She claimed that they were carrying on an extramarital affair. The video circulates as evidence of her incompetence and lack of integrity. Kargbo was eventually removed from her position and placed in a less visible role working in the State House; that it took so long to replace her with a more seasoned public health professional did not help Koroma’s cause.

As these kinds of mistakes plague their presidencies, these leaders have tried to assert symbolic control of the situation and thereby preserve the system they have made and from which they profit. Koroma transitioned control of the Ebola response to the military, away from the Ministry of Health and Sanitation. Sirleaf launched an investigation into the murder of Shaki Kamara, the 15 year old killed in the West Point quarantine, and has also sacked her minister of health and social welfare. They both appeal to the United States and their other trade partners by suggesting that they are concerned about controlling the export of Ebola to those countries. Airline travel is not simply about the easy movement of aid workers into the region, however; it is about sustaining an economy buttressed by aid and extraction, even under non-emergency. It is about granting better access to mines, plantations and needy communities.

After the death of another West African from Ebola in the United States—this time, a Sierra Leonean surgeon with permanent resident status—I have heard my people ask once again: Why are Africans the only people to have died from Ebola in the US? A hierarchy had been established along the fault lines of class, race, nationality, and region. The technologies of surveillance, monitoring and exclusion begin not at airports in New York, Newark, Atlanta, Chicago, and Washington, DC. Rather, the protective boundaries drawn around the United States—the barriers to passage—are erected at the ports of Conakry, Monrovia and Freetown. As the problem of infection is reified and policed by West African leaders, they have internalized a disregard for their own afflicted, even as they express sympathy for the “pre-afflicted” in the United States.

We sick.