Our Perspectives

Hands-free diplomacy on Ebola


 A guard checks the temperature with a thermometer that doesn’t touch the skin. Photo: UNDP

While there seems to be some global hysteria about the Ebola virus spreading like a science fiction plague across the planet, I’m here in Ebola epicenter: West Africa. I’m on a delegation of UNDP senior managers to help the UN ramp up the battle against the health crisis in Guinea, Sierra Leone, and Liberia.

Being UNDP and not a medical organization, our focus is mainly not on the direct treatment for Ebola patients. Instead, to complement the work of the many excellent organizations that are building and staffing Ebola hospitals, we’re working to prevent the further spread of the disease in poor communities, and helping to keep the countries’ economies and societies from collapsing in terror and paralysis.

Am I scared for myself being here, in the countries where people are suffering an outbreak of a nightmare? Honestly, not much. I’m not a foolhardy person, but statistically and epidemiologically and rationally, I know that right now I have about as much chance of catching Ebola as of dying in a plane crash on the way home.

Yes, I know Ebola is serious, but I know how it’s transmitted. The disease is very dangerous for those who are touching the very sick, like at home or in hospitals. Not so much for visiting UN staff. I am sorrowful about the death and devastation here, and worried for everyone who could be at risk here in the future, and enraged, as always, by the suffering and indignity bred by poverty and inequality. I feel like we all need to do more, faster, better, different. I worry every minute that we’re not doing enough.

But I don’t worry about getting Ebola.

Here’s why. Let me describe some of the experience on a high-level UN delegation on Ebola: you are met at the airport in Guinea, the capital of Conakry, by UNDP colleagues—who live here, after all. You go to hotels full of international humanitarian aid workers, government officials, and Guinean staff and French managers. At the entrance to the hotel, there is a barrel of bleach-laced water for disinfectant, and you wash your hands in it. A guard checks your temperature with a thermometer that doesn’t touch the skin. You are not feverish, so you go in. You eat at the bar. The food is ok.

You go to meetings in UN offices and government offices. At every entrance, you wash your hands in decontaminant again and get your temperature checked again. There are bottles of hand sanitizer on every table and they are regularly passed around like gum, and everyone takes a squirt. You get briefed on the situation. You plan how you can improve UNDP’s work to prevent further contagion and support everyone who is even poorer and worse off because Ebola has derailed trade and jobs and food and schools. When you visit programmes and meet staff and volunteers working in the communities, they are on the frontlines of pushing the prevention message and living it too. You wash your hands in bleach again. You get your temperature checked again.

This is pretty low risk stuff from a personal health point of view, I must say. Everyone smells like chlorine and bleach and hand sanitizer. No one has a fever, that’s for sure.

And no one shakes hands.

This no-hand-shaking is destabilizing to an American me, for whom extending one’s hand in introductory greeting is a deeply ingrained instinct. I know from working in West Africa that it is equally ingrained here—a handshake and a friendly pat on the shoulder is a common way to start even the slightest encounter. Was. Was a common way. Now, no.

The mix of foreigners and Guineans, Sierra Leoneans, and Liberians I’ve met on this trip take a variety of different approaches to the no-touching problem. One is the Ebola elbow bump. This is what it sounds like: two people face each other and extend their opposite cocked elbows up to each other. A variation is the Ebola fist bump, which does the same thing at waist level with the outside of a closed fist. The Cuban epidemiologist we met in Sierra Leone eschewed the bumps, saying all contact could be risky: instead, he put his hand over his heart and bobbed his head forward in a courtly bow. In one government office, I watched the Foreign Minister walk down the hall and bump elbows with the rest of the Cabinet as he passed.

When the disease is so devastating, it may seem like a silly diversion to be troubled that I can’t shake a guy’s hand. But I can’t really tame my body from the habit of doing it. My right hand thrusts itself out involuntarily in meeting after meeting. My hosts glance down at the offending paw with bemusement or dismissal. Finally, as the days go on, the inadvertent hand thrust is reduced to a repressed spasm, and then to a mere twitch. My hand remembers the instinct, my brain smothers it.

It reminds me in a tiny way that it’s hard to change things. But we have to overcome the wrongs of poverty and inequality that make Ebola worse than it should have been here: lousy health systems, crowded filthy living conditions, not enough food, not enough education. We can change our handshakes. Now we have to change the world.

Crisis response Africa Sierra Leone Liberia Guinea Health

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