Ebola: The U.S. Crisis that Wasn’t and What It Means for You

November 19, 2014

By Julie Anne Friend

Julie FriendFirst, a disclaimer – I'm a lawyer, not a doctor, so the purpose of this blog post is not to provide medical advice, but to reference verifiable medical information and how it can be used to support your risk management strategies, as well as communication efforts, in managing a real or perceived health crisis.

Ebola hemorrhagic fever and I go way back. We first met in 1995 while I was a graduate student in Lusaka, Zambia. There was an outbreak of Ebola along our northern border with the Democratic Republic of Congo (then Zaire). Three hundred and fifteen people died in a village called Kikwit. It was big news, but I can't really recall how. There were no cell phones, no Internet, and certainly no Twitter. E-mail existed, but access was sporadic and cumbersome. I think I learned everything I needed to know from CNN. I don't remember being alarmed or afraid. I was right there - well, nearby - and I was not at all afraid.

That remained true for me even during the latest outbreak, which reached our shores but only in the most negligible way. And by negligible, I don't mean to make light of the death of Thomas Eric Duncan or the transmission of the virus to four others, all of whom remain alive (the five others treated in the United States contracted the disease abroad, for a total of 10 cases). But compared to the tragedy playing out in West Africa – 5,165 dead with a fatality rate of 53-85 percent (depending on the source) – a more compassionate and less fearful reaction would've made more sense, particularly on campus.

After all, the impact of the Ebola outbreak on U.S. college campuses was not deeply considered at the start of the outbreak. It was summertime and most schools' campuses were filled with area teens attending sports and science camps. A good chunk of our undergraduates were studying abroad, yes, but mostly in Europe. In fact, according to the Institute of International Education's (IIE) Open Doors data, only one African country –South Africa– regularly falls into the "top 25" of destinations. Of the 283,332 students that studied abroad in 2011-12, just 209 studied in Guinea, Liberia, and Sierra Leone combined. So, let's be clear about one thing – while there may be a great deal to see and learn about in all three of these countries, they are not yet a hotbed of study abroad activity.

International students weren't thought to pose much risk to our campuses either, especially since those from developing countries an ocean away seem to go home less and less frequently. The cost of airfare, the hassles of returning through customs and immigration weighed against the benefit of continuing research or coursework, makes traveling home undesirable. Furthermore, according to Open Doors data, in 2012-13, approximately 14,000 international students came to the United States from Africa; 374 from Guinea, Liberia, and Sierra Leone combined. So, in fairness, their populations are small and the options for those seeking education abroad are vast. The United States is one of many choices.

Despite the media sensation, there were rational voices speaking out during the outbreak. On October 29, Charles Blow of the New York Times wrote in his editorial about Ebola:

"We aren't battling a virus in this country as much as a mania, one whipped up by reactionary politicians and irresponsible media. We should be following the science in responding to the threat, but instead we are being led by silliness. And that comes at heavy cost."

A few days later, Samantha Powers, the United States ambassador to the United Nations, tweeted," Ebola has no greater friend than fear—it thrives on it." And yet, Maine Governor Paul LePage refused to accept the science behind the transmission of the Ebola virus, disagreeing with a District Court Chief Judge's decision to lift the quarantine on Kaci Hickox, a nurse who had recently returned from treating Ebola patients in Sierra Leone. Hickox won in law, but lost to the court of her community, who didn't want her touching their hothouse tomatoes, and she graciously obliged by not traveling into town until her 21-day incubation period ended November 10. Thankfully, she can now shop and work and bike with impunity as the day passed without any sign of illness.

What does an irrational public have to do with the real or perceived health crisis lurking in the corners of our campus? Perceived or not, it means we have to be prepared to deal with the threat, because someday it could be real, more likely in the form of measles, mumps, or whooping cough ( thanks to you, non-vaccinators ) as well as SARS, H1N1, or H7N9. (Or, more likely the seasonal flu, which in combination with pneumonia killed 53,826 in the United States in 2010). Using a situation like Ebola to practice your ability to respond to a more likely threat will aid in your ability to act effectively and efficiently.

So here's my 10-step plan for responding to real or perceived health crises involving international programs or travelers.

  1. Know where all your people are now, where the came from recently, and where they are going in the future. Use this information to calculate your potential exposure. If you don't have policies or procedures in place that provide you with such data, use your political capital now to start getting some in place.
  2. Classify your stakeholders and determine the type and frequency of messaging they require. Accept that you will have to issue a variety of messages in multiple formats (e-mail, websites, social media, etc.) to get your information out, and that chancellors, parents, and students all demand different levels of detail.
  3. Connect and re-connect with campus health professions. Unearth that dusty "pandemic plan." Disclose everything you know (and don't know) about your travelers. Discuss reliable web-based resources (to be referenced in your messages) and brainstorm for worst-case scenarios.
  4. Convene your crisis management team, at least by phone, and lay out the status of travelers; probability of exposure; response readiness for real medical need; reputational and financial risks of staying back or pressing on; etc.
  5. Make assessments based on science and probability, not hyperbole. Decisions, on the other hand, particularly to alter, suspend, or cancel travel may be made for reasons of public policy or financial protection. In doing so, say so.
  6. Write collaborative health messages. Work with key stakeholders, including risk health professionals, to determine content and coordinate delivery. Establish a single site for basic health information. Schedule regular check-ins so you all stay abreast of the changing health and travel landscape.
  7. Get and stay informed, really informed. Stay on top of the news so you are always prepared to update your messaging or dispel myths. Gather your facts from trusted medical and public health resources, such as this World Health Organization Ebola fact sheet.
  8. Do not practice medicine without a license. Set boundaries of your advice and expertise with your campus health colleagues. Establish a medical professional on campus to whom detailed, medical inquiries can be referred.
  9. Prepare simple talking points and train all faculty or staff that may be contacted by students or parents on how to respond to inquiries and the risks of transmission of Ebola.
  10. Practice non-judgment. Recognize our profession involves informational resources and experiences that don't much apply to other professions. This makes it easy for us to wonder, incredulously but also unfairly, about our less-than-worldly fellow citizens. When confronted with irrational Ebola fear or a true misplacement of facts, use it as an opportunity to educate. Graciously. And with compassion.

Responding to real or perceived crisis is part of the job of any study abroad professional. While the widespread outbreak of infectious disease is unlikely to occur as frequently as appendicitis (once a year on my watch!), it will occur again. And now we have no excuse not to be ready.

NAFSA has joined with the American Association of Collegiate Registrars and Admissions Officers, the Institute of International Education, and the National Association for College Admissions Counseling to share the following guidance for member institutions implementing policies and practices related to Ebola and other global public health concerns. In addition, NAFSA has compiled a number of valuable Ebola-related resources for education abroad and international student and scholar services professionals.


Julie Anne Friend is the director of global safety and security at Northwestern University. She is a licensed attorney in the state of Michigan and writes regularly for NAFSA's International Educator on topics of insurance and risk management.


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