Caring as existential insecurity: quarantine, care, and human insecurity in the Ebola crisis

In August of this year, when the Ebola outbreak escalated in Liberia and a state of emergency had been declared for the country, Fatu Kekula, a young Liberian nursing student, improvised personal protective equipment (PPE) to care for her father, mother, sister, and cousin. After three of the relatives survived, her method was featured prominently in the international news media as the “trash bag method” (CNN, 2014). The reports were meant to ignite a spark of hope in the Ebola epidemic in Guinea, Sierra Leone, and Liberia. International organizations, like UNICEF, even started to promote this ‘better-than-nothing’ method. In most other Ebola reports, by contrast, health workers in white or yellow PPEs, collecting dead bodies or admitting sick patients to isolation units, have come to symbolize the grim and desperate situation in the region. What strikes us most in the story of Kekula’s improvised PPE is how notions of security and safety are reinscribed into gloves, trash bags, and rubber boots to enable a form of care in the context of a broken health system. When we recall that during the first months of the epidemic many people were caring for their sick relatives without any protection measures, then Kekula’s trash bag method reveals quite dramatically how care itself has become a source of existential insecurity.

In this piece we pull together a set of observations on quarantine measures and care to ask how security is embodied in everyday practices of care in a public health system which is short of the beds and basic equipment needed to address Ebola. To follow this question, it is necessary to ask how global health has transformed the intricate relationship between security and care, turning care into a source of existential insecurity. Moreover, are there alternative views on security and care which may help to orient global health approaches to the Ebola epidemic?