The Anthropology of Emory and Ebola: Emory Healthcare Thinks Outside of its “Concrete Box” by Laura Jones
23 Dec, 14 | by BMJ
Two days after Halloween, I met with Dr. Bill Bornstein, Chief Medical Officer and Chief Quality Officer at Emory Healthcare. I am a cultural anthropologist who has been conducting field work at Emory University Hospital (EUH) for three years, and Dr. Bornstein and I meet monthly to discuss hospital culture, specifically that of the operating room. I asked him if I could write about Emory’s experience with Ebola, and he said yes but was curious about my angle. I said I was unsure.
Before leaving, Dr. Bornstein asked about my Halloween. I told him I went as Natalie Portman’s black swan. He replied, “Have you ever heard of Nassim Taleb’s Black Swan Principle?…” He explained that people once believed all swans were white, and had never conceived of a black swan simply because no one had ever reported seeing one. The metaphor suggests that we have endless assumptions about finite evidence. Outliers are rarely predicted, but always seen in hindsight as glaringly obvious. Dr. Bornstein and I locked eyes and smiled, knowing I’d found my angle.
The Ebola virus was named the Lingala word “Ebola,” or “Black River,” for a waterway near where it first surfaced. I sought to understand how Emory predicted the black swan that had emerged from the Black River. However I soon learned that it didn’t–the isolation unit, or what its associate director Angela Hewlett calls the “Concrete Box,” was built with tuberculosis in mind, not Ebola. But it wasn’t because of luck that Emory has been able to successfully treat four Ebola patients. The M.O. of Emory Healthcare is that it’s better to be over-prepared than underprepared. This had me thinking–has paranoia been key to the survival of our species, and will it ultimately cause our demise?
When I conduct behavioral observations at hospitals, my research subjects–the clinicians, not the patients–understandably wonder if there’s a chance I’m going to ultimately get them into trouble. I am often called “the spy” and sometimes “the interloper.” During the height of the recent media frenzy over Ebola, I was once called “the Liberian.” In what seemed like every surgical procedure I observed, clinicians were agonizing over other people’s stressing about Ebola. Despite being in the same hospital as the disease, I didn’t overhear a single conversation about Ebola in the operating room. Maybe EUH wasn’t paranoid?
When Thomas Eric Duncan died in Dallas, my postdoctoral advisor, primatologist Frans de Waal, and I had a few impromptu conversations about empathy and socieoeconomic status. Never a light discussion, it definitely wasn’t so with the man who has repostulated our understanding of the evolutionary foundations of morality (they’re not in humans).
This led to a conversation with Emory Healthcare President and CEO, John Fox, about empathy in the medical community. When I asked if he’d lost any sleep in recent months, he said generally no. “I think we did the right thing by our mission and values. [We asked ourselves two] basic moral ethical questions. Can we do it better than the alternative? …Can we manage it [and keep our community safe]? He continued, “We adopted the highest standards from day one. There were ideas and discussions of adopting lower standards; we had people who said we could do this more cheaply … We just said no. If we’re going to err, we’re going to err on the side of being too cautious. I said it very clearly–this may have a bad outcome. We have to be able to accept that.” So from the operating room to the executive suite, there was a sense of responsibility and confidence at EUH that the rest of the country seemed to lack.
“The media attention was off the charts,” President Fox lamented. “We thought it would be X. turned out to be 10X. It was major sideshow [on campus].” He explained a few of the public’s divergent perspectives, “Some had a vision of the Ebola patient coming in on a concourse at Hartsfield, getting off the plane , getting on the trains, sitting there at baggage claim, and getting in a cab and then coming here.”
The public imagination is boundless. It hungers for black swan stories and even apocalyptic plagues. We have become what sociologists Anthony Giddens and Ulrich Beck call a “risk society.” I call it an “obsessive-compulsive” society. As both a social scientist and someone who has been professionally diagnosed with mild OCD since childhood, I do not apply the label lightly. One of the ways I have managed my tendency to speculate ad nauseum is to stop ingesting sensationalism. Simply by replacing toolbar links to websites that cover celebrities and shootings with those that feature healthier interests, like discoveries in archaeology and neuroscience, I have stopped visiting the damaging sites altogether.
People are always surprised that as an anthropologist, I work with hospital executives. I give major credit to these leaders, especially Director of the Emory Center for Critical Care Dr. Timothy G. Buchman, for understanding the need to explore the culture of biomedicine, and the broader culture in which we practice biomedicine. Emory may not have been able to predict the black swan from the Black River any better than anyone else, but the hospital understood that Ebola does not mean the Black Death. It was prepared but not paranoid, unlike the unprepared and paranoid public. Rather than entertaining irrational fears and compulsively consuming news that exploits those fears, we need to look to intelligent, informed leaders like those at Emory Healthcare–who prepare for the worst but expect the best.
Laura Kathryn Jones, PhD
Department of Psychology
36 Eagle Row
Atlanta, GA 30308