In Kenya today, protests erupted for a second time in as many weeks. Residents are upset about a quarantine facility that the U.S. is setting up in the town of Nanyuki in the central part of the country about 120 miles from the capital, Nairobi.
Its purpose is to quarantine and observe American citizens who have had a high-risk exposure to Ebola in the Democratic Republic of Congo, South Sudan, or Uganda. Public health officials worry that the outbreak could become the world's most devastating Ebola crisis to date. The U.S. has already committed $13.5 million to Kenya to support the country's own Ebola response efforts.
Many Kenyans complain that their government hasn't been fully transparent about the quarantine center — an initiative that they worry might bring the virus into the country. But the U.S. isn't backing down from preparing the facility for possible patients, despite the tensions that it has inflamed.
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Secretary of State Marco Rubio laid out the rationale behind the facility at a Cabinet meeting on May 27. "The number one priority of our foreign policy is to protect the American people," he said. "We cannot and will not allow any cases of Ebola to enter the United States."
A week later, Rubio called his statement a "misunderstanding," saying that Americans could return to the U.S. for treatment if they're sick. But officials remain undeterred in their plans to construct the quarantine facility on an air base in Nanyuki.
In an email to NPR, the State Department elaborated, "Kenya was selected due to proximity, airports in the region having limited capability, and to ensure Americans can be evaluated and receive assistance in a timely matter."
In response to today's demonstration, police fired tear gas on the protesters in Nanyuki. Last week, two protesters were fatally shot.
The Kenyan government has approved the facility. Kenyan President William Ruto said, "When President Trump asked the government of Kenya to support them by having a center… I gave the okay because it was an agreement and a partnership with friends who have worked with Kenya for 30, 40 years."
A high court in the country has ruled against the facility, however. The Nairobi-based Katiba Institute brought the lawsuit against the government "to determine whether the Executive can expose the public to such significant risks without complying with constitutional safeguards."
Some Ebola specialists believe that this facility isn't the wisest public health approach either, including individuals who were on the ground in West Africa during the 2014 Ebola outbreak.
"This does not make America safer," says Nahid Bhadelia. She directs Boston University's Center on Emerging Infectious Diseases and has been involved with multiple disease responses over the years, including time she spent in Sierra Leone in 2014 and 2015 during a previous Ebola outbreak. "It actually makes us less secure when the rest of the world is this pissed off at us."
Craig Spencer is an emergency medicine physician and professor of public health at Brown University who treated Ebola patients and himself contracted the virus in Guinea in 2014. He wound up being treated at Bellevue Hospital in New York City.
"People on the street in Kenya are angry because for many of them, this looks like colonial decision making all over again," he says. "That we can come into a country, decide what we want to bring in, do whatever the hell we want has led to an incredible amount of anti-American backlash."
"It's build the wall, but for viruses"
The State Department says an individual who had a high-risk exposure would volunteer to be transported to the facility in Kenya shortly afterward but before becoming contagious and starting to show symptoms. There, they would be monitored and likely repatriated if they don't develop symptoms within 21 days. According to the government, if they were to fall ill, they might be transported to Europe or the U.S. for "appropriate treatment."
The State Department says that no one who's had high-risk exposure has chosen to take advantage of the facility yet. (So far, only one American has contracted Ebola.) The Department wrote to NPR: "U.S. citizens who decline this assistance will remain subject to relevant U.S. and foreign government health, travel, and screening measures" but did not elaborate further.
Spencer says this approach is consistent with how President Trump has been discussing the best way for the United States to react to an Ebola outbreak for years. "Go back to 2014 before Trump was president and look at what he tweeted about Ebola," he says. One such tweet read, "Ebola patient will be brought to the U.S. in a few days — now I know for sure that our leaders are incompetent."
"It's this idea that you externalize the threat," says Spencer. "And if you keep it out, it can't get in. It's build the wall" — a reference to the Mexican border wall Trump is erecting — "but for viruses."
A possible alternative
"This is a bad idea," says Bhadelia succinctly. "They should just transport people back [to the United States]. It's cheaper, it's safer, it's better for Americans overall." Her rationale is that it's better for individuals to "quarantine closer to a potential biocontainment care unit that has a higher quality of medical care than what can be set up with a field hospital."
Spencer also has strong reservations about the approach. "I do worry particularly about the quality of care that may be offered in this facility for people who may be infected and may ultimately need treatment for Ebola," he says.
He's concerned because caring for a patient with Ebola can require a set of urgent interventions that may not be available in Kenya, such as mechanical ventilation or continuous kidney dialysis. The State Department didn't confirm whether such treatments, which are crucial to prevent respiratory and renal failure, would in fact be offered at the facility.
Spencer worries that this policy could jeopardize the lives of American health workers who have traveled to the outbreak to treat those who are infected. And that may complicate their decision to respond in the first place.
"We continue to think that if we protect ourselves here, that's sufficient," he says, "as opposed to the only thing that's actually going to lower risk for the average American is making sure there is no Ebola."
And that, says Spencer, means reassuring those traveling abroad to end the outbreak that they'll receive the best care they may need — which he believes is not the case with the facility in Kenya. The State Department didn't reply in time for publication when asked about the quality of care that will be available.
"This is a profound abdication of the moral responsibility we have to our own citizens," he concludes. "And it's ultimately a failure of what we owe American citizens, particularly at the time when they need us most."
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