Majority of Ebola Victims Are Women… Why Isn’t This News?
Ebola. It’s been the top international news story for several weeks, muting the impact of the Nobel Peace Prize going to Malala Yousafzai, the youngest recipient in Nobel history and even edging out news of ISIS. Dr. Margaret Chan, Director of the World Health Organization (WHO), called the current outbreak of the disease in West Africa–now being called an epidemic–”the greatest peacetime challenge the world has ever faced.”
On Oct. 11, Dr. Thomas Frieden, Director of the U.S. Centers for Disease Control (CDC), told a meeting of the World Bank, “In the 30 years I’ve been working in public health, the only thing like this has been AIDS.”
Why the alarm from people like Chan and Frieden? Because the number of new cases of Ebola has been doubling each week. Chan predicts that by November there will be 20,000 cases. Frieden contends that cases are vastly under-reported now, due to everything from stigmatization to lack of resources in the locus of the epidemic. His prediction is that there will be 1.4 million cases by January.
And now Ebola is in the U.S. and the EU with suspected cases in Australia, Brazil and Macedonia.
On Oct. 12, Frieden confirmed that a female nurse in Dallas, Texas had contracted Ebola–the first case to be contracted in the U.S. The CDC had been informed by Texas Health Presbyterian Hospital that the nurse had treated Thomas Eric Duncan during his second visit to the hospital and had “close contact” with him.
Duncan died at the hospital Oct. 8. He contracted Ebola in Liberia after transporting an infected pregnant woman to a clinic. She and her baby later died. Duncan did not become symptomatic until days after he returned to the U.S.
Frieden said as protocol, the Dallas nurse wore protective gear, including gloves, mask, gown and face shield while treating Duncan. The hospital is not releasing the name of the nurse.
Another nurse, Teresa Romero, 44, was diagnosed with Ebola in Madrid, Spain, a week prior to the nurse in Dallas. On Oct. 11, Romero was listed in critical but stable condition.
Romero had treated two priests with Ebola who had been sent back to Spain from Africa. One of the priests died in August, the other in September. Before the nurse in Dallas was diagnosed, Romero was the first person to contract Ebola outside of Africa.
On Oct. 9, a third female nurse, Australian Sue Ellen Kovack, 57, was put into quarantine as a suspected Ebola patient. Kovack had been treating patients in Sierra Leone as a volunteer.
All three women had self-quarantined after detecting fever, which is usually the first sign of the illness. Those with whom the women have been in contact have also been quarantined, including, with Romero and the Dallas nurse, their dogs.
Ebola can only be contracted through contact with bodily fluids of an infected person, including blood, urine, vomit, sweat, saliva, feces, semen and soiled clothing or bedding.
That the only two people to contract Ebola outside of Africa have been women is not surprising. The current outbreak–mostly in Liberia, Sierra Leone and Guinea, with a handful of other cases in Nigeria and Senegal–has infected over 8,000 people and claimed the lives of more than 4,000 people as of Oct. 10. The majority of both the dead and infected, according to UNICEF and the WHO, have been women.
Ebola is a zoonotic disease, meaning it is transmitted from animals to humans. Monkeys transmit Ebola and it is thought the virus spreads through tainted bush meat. But since women are Africa’s caregivers, health workers and nurses, they are most likely to come in contact with the cause of viral transmission–bodily fluids–while caring for sick relatives and patients. In addition, as cross-border traders, women are also most likely to either acquire or transmit the infection on as they go to markets in other countries.
Women are also expected to prepare bodies for burial, so they are tasked with washing the dead and thus inevitably come in contact with those deadly fluids. In Africa, there is little access to the kind of hygienic conditions essential to preventing the spread of the disease, which has no cure.
Sia Nyama Koroma, first lady of Sierra Leone, said in an interview with the Washington Post in August, “Women constitute a large section of the health workers and are on the frontlines of this crisis.”
On Oct. 12, the CDC called nurses like the one with Ebola in Dallas “heroic.”
That heroism, however, is killing women, and not just health workers. In Africa, as in the West, women are traditionally the ones who care for sick children and sick elderly. And as, in the West, women are the primary hospital cleaners and in charge of laundry, another avenue of risk. But unlike in the West where protocols for protecting workers from the virus are intense, there is no special protection for cleaners and laundry workers in Liberia and other affected countries.
That women are the disease’s main victims is not a secret–the three most impacted countries have been reporting it to their health ministries as well as the WHO, the UN and CDC since the outbreak began at the end of July. Julia Duncan-Cassell, the Minister of Gender and Development in Liberia, told the WHO that in Liberia, 75 percent of deaths as well as infected persons have been women. Among the dead thus far? Over 150 nurses, according to the WHO.
Thomas Eric Duncan contracted Ebola from a 19-year-old pregnant woman whom he drove to a clinic–which then sent her away, because they had no room for her. According to health officials, pregnant women are at highest risk in these countries because they are most likely to come into repeated contact with health care workers and/or hospitals and clinics. According to the WHO, maternity wards and clinics were where two of the three most wide-spread Ebola outbreaks began, due to the proximity of infected patients to each other.
Pregnancy has, according to a recent WHO report, become a risk-factor for Ebola with any pregnant woman who is hemorrhaging presumed to have the disease. Yet because of this presumed prevalence, pregnant women are also most likely to be turned away from hospitals and clinics; this has a dual and deadly effect–the women die and the disease spreads further.
Maternal and infant mortality were already high in these three countries. Now they are higher, still. The NGO Life for African Mothers suspended their midwifery program in September due to fear of contracting the disease from pregnant women.
Why the 2014 Ebola outbreak has continued to spread instead of tapering off like previous outbreaks is because it began not in rural outposts in Central Africa where containment was easily achieved, but in cities in West Africa, making quarantine and containment much more difficult if not impossible.
Spain and the U.S. have quarantined those who have contracted the disease, but similar quarantining has been almost impossible in Liberia where there are thousands of cases. What’s more, women are often the only aid workers who will help during an epidemic, putting them at further risk.
Yet this is an obvious element of the problem–it could easily be argued that the slow global response has been because the majority of victims have been women caring for the sick. In the two previous Ebola epidemics in Uganda in 2000 and Sudan in 1979, three-quarters of the victims were also women.
Why hasn’t the fact that women have consistently been the majority of victims been an issue in the context of reporting on the disease?
Nor has the long-term impact of women becoming ill and dying been addressed. Farming has already virtually ceased in areas of Liberia’s prime farm country–and it is women who do this work, not men, which means food insecurity, a perennial problem throughout Africa, could increase dramatically due to Ebola. And for those who are being quarantined, how to access food is one more concern.
The kind of work women do in these nations will be impacted by the disease, either by outright killing them, as it has health care workers and other ancillary workers like cleaners and laundry personnel, or by curtailing their access to work, as with the cross-border traders, because quarantine areas are going up throughout the regions where Ebola is being spread.
One more reason women are dying is because cultural norms preclude anyone but women attending to women who are sick. So women tend to men and to women. Giving them twice the opportunity to get sick.
In the past week the governments of the U.S., UK and Cuba have all pledged to help provide both aid to set up more temporary clinics as well as send aid workers to the countries most affected. Will it be enough to control the current epidemic? No one can be sure. But what we do know, is that educating women in these countries about the disease and how it is spread might help staunch the hemorrhage of new infections and deaths. Women’s second-class status has made them the primary victims of this disease. Treating those women with respect and concern may be the only way to contain Ebola and protect all of us from its ravages.