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Ebola Containment?

The American value system embodies an individualist, self-indulgent, for-profit (above all else) mindset and corresponding institutionalized practice that makes the national response to the Ebola virus not only problematic but inherently inadequate if not also destructive. Societal mobilization for any worthy end cuts across the structural-ideological grain. Witness the feckless “battle” against climate change or efforts to secure adequate, effective gun control—just two obvious problems that COULD be managed if the will was there and the democratization of the power system, absolutely essential to any far-reaching progressive social change, followed.

Not likely, not at all. America is mired down in its own hegemonic cesspool, making any constructive solution to social problems, much less, a transformative awakening which might break the dependence on war, intervention, corporate aggrandizement, hierarchical class and racial arrangements, out of the question. The reason: whether problem-solving to address fundamentals, like a vital social safety net and conquering poverty, or internal transformation, to seek peace and social justice, works against the raison d’etre of American society–keeping profits up and protest (should it finally break surface, given the evident provocation) down. Which is harder to tolerate, democracy or Ebola, is difficult to answer; I’m betting on democracy as the fate worse than death.

The two are interrelated, the absence of democracy promoting the flourishing of Ebola, because in the structure and practice of American medicine (itself a microcosm of the US corporate order, capitalism in white gown and surgical gloves, to convey the idea of service to the community), profit trumps care and all else besides, from hospital operation/administration to pharmaceutical manufacture/marketing to the ancillary health industry preying on people’s needs and insecurities. Think Ibsen’s “Enemy of the People,” and the poisoned public baths, and you have America 2014 in a nutshell. Silence, deniability, whatever it takes to keep the wheels turning, and at this moment, no doubt, some of our compatriots are thinking ahead about how to make a fast buck on the disease. Others, and this does not require speculation, are already seizing the opportunity to drastically cut or eliminate CDC as an entering wedge for the wholesale repudiation of the PUBLIC realm as such.

Ironically, Ebola could be the Trojan horse for stripping capitalism bare of any protective mechanisms and measures put in place since the New Deal. As a start, blame the messenger for the disease—in this case, Dr. Thomas Frieden, who, from his record as Health Commissioner of New York City, on smoking and obesity, before ascending to director of CDC, appears on the level and hard-working—as a way of directing attention from the grossness of the overall system, which I would maintain, must include its military and foreign policy dimensions. Too many balls being juggled in the air, most of which are judged more important than the health and well-being of the American public.

***

Kevin Sack’s New York Times article, “Downfall for Hospital Where the Virus Spread,” (Oct. 16), makes several points about the failure of Texas Health Presbyterian Hospital to incorporate safe procedures in its treatment of the disease. That such procedures weren’t followed shows already deeper structural and systemic flaws. Even if the CDC were not a patsy for American business (let the jury be out on that question, for now), as is every other agency in the regulatory firmament, it nonetheless has been rendered largely powerless in relation to the comparable state bodies, needing their permission to intervene and do its work. Here, though, it has obviously done too little, too late. Sack points out, “it was two days after the Ebola victim [Thomas Duncan] was admitted before personnel began wearing biohazard suits.”

Presby, as the hospital is known in Dallas, cannot be wholly blamed, because infectious-disease control has been notoriously lax nationwide (one of the three top causes of death among in-patients), which puts the ball back in CDC’s court for not drawing up better protocols and, under penalty of prosecution, demanding their enforcement. Presby was a no-man’s land, hospital and federal agency each blaming the other, rather than admit both were complicit in accepting a sweetheart arrangement that satisfied minimum standards while not rocking the boat of private profit. Sack, in masterful understatement: “If the hospital has served as a canary in a coal mine for the country’s Ebola response, the results have not inspired confidence.”

The poor nurses, in the absence of rigorous CDC guidelines, “donned three or four layers of protective equipment and closed openings with tape in the belief that it would afford greater safety,” in those first days of Duncan’s hospitalization, when in reality, as Frieden notes, “’by putting on more layers of gloves or other protective clothing, it becomes much harder to put them on, it becomes much harder to take them off, and the risk of contamination during the process of taking these gloves off is much higher.’” Fat consolation to nurses Vinson and Pham, who may yet not recover. CDC-Presby now playing catch-up obfuscates the wider pattern of not making seemingly undue demands by government on the client to be regulated, as though regulation in the public interest is itself ideologically a nonstarter as well as the direct encroachment on the profit-margin. One surmises that public hospitals enjoy the same shield of protection, lest the example set there might spill over to the private sector. Better, hands-off until it is crucial—which indeed is now the case, but regulation as an adversarial process still remains a distant vision and one can expect safety protocols to be half-heartedly implemented if the cost is too high.

In emergency situations, events move fast. Successful capitalism is often a function of winning the public-relations battle. Sack writes: “Hospital officials have generally kept their remarks to a minimum [why not, given the conflicting testimony across the board, about Duncan’s release from emergency and being sent home, despite having symptoms?], issuing brief statements and appearing at only a few of the nearly daily news conferences here [Dallas].” Much disinformation, was Duncan asked about his travel history, did a nurse fail to provide the examining physician with the electronic medical records she prepared, etc., had to be covered over, and thus, “the hospital hired Burson-Marsteller, the global public relations firm, to help tell its side.” Quintessential capitalism on the mark.

Capitalism? Again Sack: “Presbyterian Hospital of Dallas opened as a faith-based non-profit in 1966 in what were then sparsely populated northern suburbs. In 1997, Texas Health Resources was formed by merging the hospital with others in Fort Worth and Arlington. The hospital’s most recent tax filings, from 2012, show that it had $613 million in revenue and $1.1 billion in net assets. The hospital’s president at the time was paid $1.1. million.” Were it not for Ebola, one might well want to vacation in Presby, given its “gleaming hallways and teak-paneled waiting rooms,” especially for the satisfaction of being among one’s own kind; for, he continues: “it is the hospital of choice for some of the region’s richest and most prominent residents. The maternity wing is named for Margot Perot, the wife of the technology magnate and former presidential candidate Ross Perot. The board chairwoman at the hospital’s parent company, Texas Health Resources, is Anne T. Bass, the wife of the billionaire investor Robert M. Bass.” (One reason Duncan may have been discharged prematurely from emergency was that he did not have health insurance. Administrators deny this.)

My favorite guide to social analysis, Willie Sutton, of go-where-the-money-is fame, may have had banks in mind, but for present purposes, hospitals (the whole health industry!) will do just as well, thank you. I have in mind, to see the dynamics of government-business relations at work, and hence, why Ebola is ensured easier spread freed from obstacles of effective regulation, one need only look at the statements of Dr. Daniel Varga, “chief medical officer at Texas Health Resources,” who is a master study in evasion. (Sack’s use of the term “Downfall,” in his article, may be a bit precipitate. With THR behind it, Presby will land on its feet—all 900 beds and 1,000 physicians.) For in response to a question about how, when Duncan had been re-interviewed by the physician 10 minutes after the nurse had noted that the patient had come from West Africa and thought instead he was a local resident, Varga “said he did not know how that had happened,” and then on the offensive: “Let’s be clear. We’re a hospital that serves this community incredibly well, and we have for nearly half a century.”

For more statements (here, congressional testimony in prepared remarks) of Varga , whom we learn is also “a senior executive vice president for the hospital operator,” I turn to John Swaine’s article in The Guardian, “Ebola crisis: Texas hospital apologises for failures in handling of first patient,” (Oct. 16). On a certain lack of veracity: “’In our effort to communicate to the public quickly and transparently, we inadvertently provided some information that was inaccurate and had to be corrected.’” Inadvertence is, I believe, the ace-in-the-hole for explaining away any failure of will in the containment of Ebola. It may also characterize, not dissembling, but simply sloppiness, because allowing public responsibility to trump profits has become inconceivable in America. How Ms. Pham was infected, “’we don’t yet know precisely how and when,’” which does not stop Varga from passing the buck to CDC: “’[she was] using full protective measures under CDC protocols.’” To which the head of The National Nurses United union said, “Were protocols breached? The nurses say there were no protocols.’” As for Varga’s explanation about Duncan, corporate apology is in order: “Unfortunately, in our initial treatment of Mr. Duncan, despite our best intentions and highly skilled medical team, we made mistakes. We did not correctly diagnose his symptoms as those of Ebola. We are deeply sorry.”

***

My New York Times Comment on the Sack article, Oct. 16, follows:

Presby is a stark example of an America floundering in its seeming abundance. It will be the fall-guy for a wider failing system, in which damage control–calling in a famous p.r. firm–substitutes for frankness and competence. Everyone is scurrying around, applying band-aids where in fact fundamental correctives affecting attitudes as well as, if not more than, procedures, is required.

If an Ebola pandemic should be realized, business-as-usual will no doubt trump an adequate response. Why? Because America is too busy asserting its POWER in the world to respond effectively at home. Expect finger-pointing of a partisan nature before we’re done here, the same twisted logic that gives us intervention, drone assassination, and deregulation (the last-named germane to the present case).

Self-indulgence, me-me-me, will make sane health protocols hard to follow, much less formulate and enforce. My heart goes out to the young nurses; their inadequate preparation was not their fault, but the institutional failure of a system which eschews the very notion of public responsibility.

It’s too late to wring hands or look for scapegoats. Can America rise to the occasion? Doubtful, so long as the prevailing mindset is world hegemonic leadership, no questions asked. Not Presby, but America, is a broken system when it comes to national and global emergencies. E.g., climate change can be viewed as a protracted Ebola–DENIABILITY conquers all.

Norman Pollack has written on Populism. His interests are social theory and the structural analysis of capitalism and fascism. He can be reached at pollackn@msu.edu.

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Norman Pollack Ph.D. Harvard, Guggenheim Fellow, early writings on American Populism as a radical movement, prof., activist.. His interests are social theory and the structural analysis of capitalism and fascism. He can be reached at pollackn@msu.edu.

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