We took a pretty bad hiding over Ebola here when Dallas became the first city in the United States to harbor the disease. How much of that we deserved and how much we did not will be fodder for somebody’s doctoral dissertation someday. Right now it’s worth noting that a full year before Thomas Eric Duncan showed up here as Patient Zero people in Dallas were warning that a looming public health disaster in West Africa would come here soon, and they were working to do something about it.
Their efforts, stalled by the crisis of Duncan’s arrival, is resuming — an emphatic illustration of the great good we can achieve for ourselves and others by staying connected to and involved in Africa, the great harm we would wreak by slamming the door and trying to hide in our own fortress.
Foday Fofanah is a 46-year-old Teamster and small businessman who grew up in a wretched slum in Freetown, Sierra Leone. He left Sierra Leone early to escape civil war, came to Texas, went to school and made it as an art dealer. Fofanah brought his mother and 12 relatives over later, but his mother eventually wanted to return.
Soon after he sent her back, she took a fall and died. Last year when he went back to bury her, he discovered that the slum he had grown up in had metastasized to become all of Freetown. On the plane home, Fofanah sat next to another West African who, after decades in America, was as shocked as he at what had become of Freetown, of Sierra Leone, of West Africa. Both agreed that a wholesale rebuilding of public infrastructure was the only hope for staving off horrific human catastrophe there and that the catastrophe, if not forestalled, would come to the United States someday on an airplane.
Their assessment of what has happened to their place of birth is widely shared. I talked last week with Dr. Walter F. Young in Atlanta, the former Liberian honorary consul general to Georgia for 25 years and a brother to former U.S. Ambassador to the United Nations Andrew Young. He painted a bleak picture for me: “Wars in West Africa have ruined the infrastructure,” he said. “There is no power, no source of clean water, no food.”
Fofanah is connected to Dr. Young through longtime Dallas civil rights advocate Peter Johnson and the Southern Christian Leadership Conference. A year before Duncan showed up in Dallas, Fofanah and Johnson were telling anyone who would listen that if nothing were done to stop the public health catastrophe in West Africa, some terrible tentacle of it would find its way here. Someday. Soon.
Through his own extensive contacts in Dallas, Johnson was able to introduce Fofanah to an array of local leaders, always with the same message. Fofanah told me, “Peter Johnson said somebody is going to go get on a plane with something from West Africa, if we do not try to help West Africa with what is going on.” He and Johnson both told me that in their meetings with local officials a year ago they never mentioned Ebola, because it wasn’t on their radar. Their immediate concerns, they said, were malaria and typhoid.
But the larger point was that something terrible was brewing and that it would not stay there. They showed me a portfolio of grim photographs they say they took to local leaders — rivers of garbage, refuse and sewage in open ditches winding through shantytown slums. It’s not possible to look at these pictures and fail to comprehend that human beings cannot long survive in such wretched misery without succumbing to disease, starvation and violence.
Nadine King-Mays, a Dallas lawyer working with Fofanah and Johnson, says the destruction of medical infrastructure in West Africa, especially through the deaths of so many doctors and nurses, has made infant mortality there an even more terrible scourge than in other parts of the Third World. “Poor children in India [age] 5 and under have permanent damage with regard to cranial development,” she said. “But the same children in West Africa just die.”
According to the CIA World Factbook, Sierra Leone has the world’s 11th highest rate of infant deaths per 1,000 live births, at 73. India ranks 50th with 43. The United States is 169th with 6. Japan is 223rd with two.
Fofanah and Johnson went to elected leaders here and leadership in the healthcare community with a two-point plan. The first element was the gathering and shipping to West Africa of surplus medical supplies — equipment and medications destined for the landfill here that would be of high value in West Africa.
The second element of the plan was a system of public toilets designed to deal with rainforest conditions. Working with a Dallas company in a roughly comparable line of work, Johnson and Fofanah have designed a system of composting toilets that can be built into shipping containers. The containers would be installed on raised foundations to be used as public bathrooms.
Dr. Young told me that the efforts here by Fofanah and Johnson are compatible with similar efforts in Atlanta and elsewhere, all directed to the same goal: To combat disease, cheap efficient substitutes for basic infrastructure must be devised and put into operation. Young said even if then there will still be a crying need for trained people to go to West Africa to encourage cultural changes needed to make the new infrastructure effective.
All of that will take money. Fofanah is working with the man he came home with on the plane from Sierra Leone last year, a successful businessman in Philadelphia, to raise needed funding.
Obviously the efforts here are still just developing, and it’s too soon to see precisely what shape they will take. Just as clearly, there are other efforts underway and have been for some time — people working to help West Africa overcome its terrible challenges and not incidentally to protect the rest of the world from terrible ramifications.
I realized something in talking to Fofanah, Johnson, Mays and Dr. Young. First of all, Ebola and the disastrous conditions that produced it in West Africa were only new and shocking to me because I hadn’t been paying attention. Other people with more direct personal connections have been paying attention and trying to do something for a while.
The second point would be that the devastating social entropy we see in West Africa is only shocking, not insoluble. Fofanah remembers Sierra Leone before the collapse. He knows, therefore, what must be repaired in order to resolve the public health crisis there.
Wise experienced heads are at work. Dr. Young knows that merely providing equipment will change little. Human beings, brave souls, missionaries for health must go with the equipment to help foster underlying cultural changes if the equipment is to be of any use. Johnson, a longtime veteran of the civil rights movement, understands the kind of mobilization needed to achieve change on this scale. He knows how to get to people and bring them the word.
And the physical mechanical challenges are way within our technological reach. The toilets designed for West Africa are composting, for example, because the empty-and-haul-away outhouse technology common to construction sites in this country won’t work, nor will septic tanks. Massive flooding during rainy seasons turns those systems inside out. A composting toilet, on the other hand, can be protected from flooding.
The program put together by Fofanah, Johnson and others is calling itself Sankofa Infrastructural, from the Ashanti word for “looking back.” Their website is sankofainfrastructural.org.
Dallas County Judge Clay Jenkins is familiar with the Sankofa Infrastructural model and says he thinks the containerized composting toilets are “a really great idea.” But more than that, Jenkins told me he thinks reaching out to Africa is the only way to effectively protect Dallas in the long run.
“It’s a really great humane and compassionate thing to do,” he said. “But the best way to protect us here is to attack the disease at the point of outbreak.”
Jenkins says he thinks Ebola is only one of several serious health threats posed to the world by the collapse of infrastructure in West Africa, and he believes the Ebola incident here may serve to open American eyes to the immediacy of the threat.
“Before, a little bit of the reaction I got from people was, ‘Oh, now Jenkins and his church friends want to do missionary work in Africa.’” Now, post-Duncan, he hopes projects like Sankofa will hit home.
The other point — the thing we should all know by now — is that we can’t hide from a virus, whether it’s Ebola, Marburg or a host of other threats. “You can’t solve the problem by closing the door,” Dr. Young said to me. “This is a global problem.”