The Invisible War: Emmanuel Urey on Ebola in Liberia

Environmental historians love to debate questions about the agency of nature. But such questions take on a quite different gravity and tone when contemporary disasters, at once both natural and social, come to affect both our professional and personal lives. The Ebola crisis unfolding in West Africa is a case in point. Emmanuel Urey, a Center for Culture, History, and Environment (CHE) Graduate Associate, and I were in Liberia this June, when the first Ebola cases appeared in the capital city of Monrovia, well before the outbreak became the focus of international attention and concern.

The current Ebola epidemic has claimed close to 4000 lives in West Africa. But such a number fails to adequately convey the toll that this disease is taking on the health, well-being, and economies of the West African nations of Guinea, Liberia, and Sierra Leone. Emmanuel describes the Ebola outbreak as an invisible war. In doing so, he helps draw our attention to the collateral damage the disease is having within Liberia: food insecurity, people dying of treatable diseases like malaria, and the fears that arise when the enemy is unknown. Ebola will live in the landscape, culture, and memory of Liberia long after the virus is contained.

For more on how the history of fear and mistrust in both Liberia and the U.S. is shaping the unfolding crisis, see “Ebola in a Stew of Fear”, “On Our Minds: Responding to the Ebola Crisis,” and “Interview with Ebola Discoverer Peter Piot”.

—Gregg Mitman, Vilas Research and William Coleman Professor of History of Science, Medical History, and Environmental Studies 

Edge Effects: When were you last in Liberia and how did the Ebola outbreak affect your travels? What precautions did you take?

Emmanuel Urey: I left on May 25^th and went to Liberia. Going in I knew there was Ebola, but it was in the northwestern part of the country and there was not a lot of information in the Western media. I returned [to Madison] on July 29^th. During the course of that time—the time that I was there—the disease hit Monrovia, I think some time around June, going in to July. The situation just went really out of hand. At that point, my activity was so much more difficult because in Monrovia we don’t have an effective transport system. There are little taxis and their back seats are only designed for three persons, but four persons will sit cramming themselves in order to get from point to point. At the time, the information was, do not allow someone else’s body fluids to touch you. In most instances I preferred to walk or maybe to try and find [a taxi] with a front passenger seat, but this costs more money. So it was a tough thing, the last week I left, the situation just went really bad.

EE: How is Ebola disrupting everyday life in Monrovia and in the countryside?

EU: Liberia—we have suffered for 14 years from a civil war. The war ended in 2003 and everything was pretty much destroyed. Actually, in 2003 we were considered a failed state. So since that time, the country has been rebuilding itself slowly and moving in the right direction. In 2013, we celebrated 10 years of peace. So, then came Ebola.

Before Ebola, we have had sicknesses in Liberia just like many parts of the world. Malaria is a leading disease, cholera, and diarrheal diseases—just a variety of illnesses. The thing that Ebola did was, when Ebola broke out, the information then was if someone’s head is hurting, fever, vomiting, vomiting with blood that may be a sign of Ebola. What that communication did was cover up the rest of the illness. The fear became so much that if someone was even sick from malaria, they thought they were getting Ebola. That instilled a lot of fear.

In addition to that, the health workers started dying at a faster rate because the hospitals do not have the kind of equipment to deal with this sort of outbreak. Not knowing this disease and how contagious it is, a lot of medical doctors and health workers started to die. What then happened was the population became afraid to go to the hospital. If I am sick and the area I am supposed to go to get treatment the doctors and nurses are dying, what I am supposed to do then? The hospital was seen to be a place that was even giving out the sickness, a place where you were seen as likely to contract the disease. People began to stay home. Children, and loved ones, and parents began to give Ebola to one another. That is how this whole thing sparked up, because of the confusion that started at the beginning.

Another aspect of it is the food issue. Gbapolu County is one of Liberia’s breadbasket counties, producing a lot of rice. When I was there, there was this caterpillar outbreak, where you have groups of insects moving in great numbers, destroying every crop along the way. At a certain point, villagers could not even sleep in their villages because the armyworm caterpillars were literally coming into their villages and crawling on people. This was ongoing when Ebola took over. So Ebola had the entire attention. So people affected by the caterpillar outbreaks were overshadowed. It is a serious crisis, because Ebola is the headline news and everything else is underneath.

In addition to that, particularly in Monrovia, this is the rainy season so we get a lot of flooding. When I was there my apartment got flooded, the water came halfway up my leg. When places are flooded like that, you know, how unsanitary it becomes. In addition to the outbreak, we have so many things that the government and other people should be paying attention to, but the disease—the Ebola outbreak—took center stage.

EE: You mentioned the fear of going to the hospital, the troubles the health workers were having, and the difficulties with somebody contracting a disease that may not have been Ebola but people thought it was. Could you describe people you know who have suffered from these difficulties?

EU: A week before I traveled back to the United States, A friend of mine’s daughter was sick. She was convulsing, she had this very high fever, you know. Even though he was afraid to take his daughter to the hospital, he still managed to do that. The health workers were afraid to touch this girl because it sounded like she had Ebola. So, she struggled for 2 hours and 30 minutes and finally died. Then later, they tested the body, taking some fluids to the lab. The following day, they discovered it was not Ebola—it was chronic malaria. This was very emotional for me. At that moment, I became confused. I started to think, you know, where—where are we going?

EE: On a day-to-day level, are people going to work? Schools? Stores? How is daily life as you understand it?

EU: For Monrovia, when the sickness sparked out, government shut down. The president called for, what she referred to as “non-essential staff” to stay home and only essential staff to go to work. Then, people began to be very afraid of one another. You know, in Liberia, people are used to greeting, hugging, shaking hands, and other things, and they said this is how the disease spread so, people were forced to leave these type of practices because of that. That was in the beginning. I think, though, right now, people are beginning to understand the disease a little bit more. So they are taking more precautions, but at that point, when I was there, people were just really confused and they did not know what to do. Later on, the government put in a curfew and entertainment and shops have been closed since then.

This disease, I call the invisible war. It is an invisible war because you don’t know who is carrying the disease.

EE: Can you explain what you mean by invisible war?

EU: I call this disease an invisible war because it is not a war we can see through our naked eyes. Why am I calling this an invisible war? I think about it like, we had a civil war. There were bodies lying in the street. People were being killed on a daily basis. There was no food. People were just confused during the crisis. We are experiencing similar things today. There are bodies in the street. People are dying on a daily basis. People are confused. But, the civil war was not invisible. You could see the civil war. I lived in Belefanai, which is a little town, when the rebels were crossing the St. Paul River from Lofa, we heard the news and went to Guinea for safety. But, this other war, it is not like that. It is not a war where you say okay in this location the machine guns are firing and you are afraid and you run away. Even if they say that there is an Ebola outbreak in a community, people are determined to run away from that community but some of the people who are running away are already enemies, some of the people already have the disease but no one knows.

EE: And the enemy is?

EU: The enemy of this invisible war is the Ebola virus. We cannot see the Ebola virus.

EE: How does the general perception of the government complicate people’s reception of government messages?

EU: I will begin this question by trying to paraphrase the person who discovered the Ebola virus. He posted something on a website saying that this is the opportunity we have now to test the vaccine we have, if we don’t try the vaccine now, we might not have an opportunity like this in the future. When I read that, I posted it on Facebook and posted a comment saying: Yes, if Africans or Liberian leaders, if they do not change their attitudes we are going to be continually used as guinea pigs, because this is exactly what this guy is saying. What is leading to that? Another fellow wrote a piece, saying that the Ebola virus is not just a virus it is about the circumstances leading up to the outbreak, issues about trust and confidence in your leaders. In past times we haven’t learned to build confidence in our leaders simply because our leaders have not been honest to us.

If you have this kind of structure built into a society, anytime the government says something people do not take it seriously. That is the background, because government is not trusted. When I was there, another thing I did not explain initially that may have contributed to the spread of the virus was there was information that the government was using this to solicit money. Why? Well because for a couple months prior to the outbreak of the disease, the government had been crying about budget shortfalls in the budget they projected, they might not raise that money so they have got to cut spending. That was the information prior to the disease, so when the disease started, people started to question that. The government is using this strategy to gain international attention to raise money.

EE: Has the spread of the virus increased distrust? Do you fear for the political stability after emerging from decades of civil war, do you fear it could be heading in the same direction?

EU: Initially I thought, no I do not see things degenerating into civil chaos because of the virus. That was my initial thought. Right now, that thought is shifting from that belief. Why? Because, so many people are dying and so many people are hungry and the government took some harsh decisions in terms of quarantining large areas that they cannot contain. Nobody going anywhere, a curfew, and a state of emergency, which are recipes for food crisis and chaos. These are big government powers that the Liberian government thought by using them it could  contain something they cannot contain. Then, even under those circumstances the virus escalates and so if you see people as somewhat desperate then they will do anything. So, yes, if the situation was to continue like this. . . .

EE: In what ways is the Ebola crisis an environmental crisis?

EU: It is an environmental crisis because everything is the environment, if I can put it that broadly. When we have so many people dying it presents a lot of challenges. One thing that the government did was at a certain point the burial of Ebola patients was sent from the Ministry of Health to the Department of Interior. The Minister of Internal Affairs usually deals with traditional matters. I don’t know why they have been given the authority over burial of Ebola contagious patients. They know nothing about health. There were a lot of bodies and I think at a certain point 45 bodies or so were dumped in a creek. Well that is environmentally unhealthy. The issue of cremation came out. In Liberia we don’t cremate. Culturally we don’t do that. The only culture that has cremation is the Indian community that lives in Monrovia. They  use a cremation facility for completely religious purposes. They then gave that to the government to cremate Ebola patients. The place that is supposed to be for  religious people, now you have 10 or 15 bodies a day being cremated. The process was bad. Poor people, they put all kinds of things on their bodies, pouring gas and fire. How do you that? It is environmentally wrong to do that.

Of course we cannot talk about environment and leave the food crisis out. When people are hungry and they are quarantined, what happens to their livelihoods? Well so, those two things. So it is indeed also a serious environmental issue. We are talking about burial, the food crisis, burials in swamps or bodies decaying.

EE: You’re in the US getting training as a scholar and I know you are thinking a lot about how you can help in this crisis. How do you see your role? Where is your energy focused?

EU: Two different things, my energy is focused on the containment of Ebola in Liberia and my studies here at UW-Madison. The containment of Ebola is my primary concern. The second is my study here. I am trying to split my time in that line. I am the leader for the Liberian Association of Wisconsin. We are putting some energy here in Wisconsin to raise $50,000 and to donate to Liberia the cash and some equipment that are needed. We have worked to get a list of things from the Minister of Health that are lacking in Liberia. If anyone wants to help and does not want to give money, give materials. We have a comprehensive list and so we trying to see if we can solicit help from here in Madison and around the Wisconsin area. So I am putting a lot of energy into doing that. What tied me here now is my family—my two boys and my wife. If I were here alone, I would leave Madison to volunteer. I am really interested in the communication aspect of the disease. What type of information do people need to change their attitudes? We all know this is clinical but not as clinical as the public health aspect of the disease. I have a background in that area. I feel pressured to go, but because of family and the responsibility as a community leader, I can contribute from a distance, so that is what I am doing.

Emmanuel Urey was born in a small rural village in Bong County, Liberia. At the age of 13, he fled Liberia with his family for a refugee camp in Guinea. One year later he learned to read and write. He holds a BSc, MPH, MSc and is now pursuing a PhD at the University of Wisconsin-Madison, USA. His research focuses on the relationship between rural people’s health & livelihoods, land tenure and state control. Contact.

Gregg Mitman is the director of the Nelson Institute’s Center for Culture, History, and Environment and the Vilas Research and William Coleman Professor at the University of Wisconsin-Madison.  He is currently at work on a multimedia project that explores the history and legacy of a 1926 Harvard medical expedition to Liberia and the environmental and social consequences that followed in the expedition’s wake. Contact.

Mohammed Rafi Arefin and John Suval produced this interview.

Mohammed Rafi Arefin is a PhD Student in Geography at the University of Wisconsin-Madison. His research interests include urban geography, waste, psychoanalytic geography, and development. He explores these interests in projects on the relationship between garbage, culture, power, and politics. His work has taken him to Cairo to examine the politics of garbage in the January 25 Revolution. Other projects include work on representations of hoarding and hazardous waste. Contact.

John Suval is a doctoral student specializing in nineteenth-century U.S. political and environmental history. His research focuses on public lands and the nature of democracy. For his dissertation, he is exploring how frontier squatting influenced U.S. political culture, imperial expansion, and conflicts leading up to the Civil War. Prior to graduate school, John worked as a newspaper reporter and media producer in Texas, Mexico, and Washington, D.C. Contact.