The Myth of Racial Progress in America: The curious case of Thomas Eric Duncan

In one breath, this study addresses one of the central problems in the United States, an area in which there is a concrete nexus between theory and behavior - racism. In the U.S., due to an excess of theorizing as well as Affirmative Action, this subject is increasingly appearing vague, somewhat muddled, and retreating from public discuss. That is until something shocking or outlandish happens to provoke the public's race imagination. The key research question is answered by bringing together strands of thinking about racism in contemporary U.S., which suggests that racism is not in retreat, but its discourse is. I use David Theo Goldberg's “race-blindness” (2002) and Eduardo Bonilla-Silva's "color-blind racism" (2003) to describe the new racism in the U.S. that has retreated into the "closet” but is nevertheless as the overt racism of "bigotted white men" that is erroneously thought to be in decline. By juxtaposing competing ideas about racism in this country, I aim to deconstruct the ideology of color-blindness or what Goldberg calls "racelessness," which projects a "simulacrum of inclusiveness" (Koshy, 2001) and "racial amnesia" (Puar, 2007) while all the time advancing or asserting white privilege.

The referent for this study is the Ebola Virus Disease victim, Thomas Eric Duncan and his experience within the complex U.S. race complex. Mr. Duncan left Liberia on 19 September to visit family in Dallas, Texas, and apparently became symptomatic a few days after his arrival. Few days before he left Liberia, Duncan had offered assistance to a symptomatic pregnant woman and may have contracted the disease in the process. Although Duncan did not mention this contact on his screening form before he left Liberia, he passed airport screening and showed no signs of the EVD until his arrival in the US. Four days after his arrival in Dallas, Duncan began to feel sick and sought medical treatment at the Dallas Presbyterian Hospital. Having just arrived from Liberia, which is one of the epicenters of the current EVD outbreak, Duncan spoke with a heavy African accent and volunteered to hospital staff that he had only just arrived from Liberia. The hospital did not take that information seriously; instead, Duncan was given antibiotics and released to go home. Four days later, his condition became worse and he was transported by ambulance to the same Presbyterian hospital. Duncan was immediately quarantined and the hospital made a definitive Ebola diagnosis two days later on 30 September 2014. Thomas Eric Duncan died from the EVD on 8 October 2014, ten days after he was admitted to the Dallas Presbyterian Hospital for EVD and fourteen days after he first presented at the hospital with EVD symptoms.

Duncan is the first person to die of EVD in the United States. Before he contracted EVD, two other persons – Kent Brantly and Nancy Writebol – both white Americans who were involved in humanitarian work in Liberia, had contracted the disease. Both were airlifted back to the United States in chattered aircraft and treated at the highbrow Emory University hospital with the experimental drug cocktail, ZMapp. They both survived the “almost-always-fatal” disease (Caplan 2014). Two other white Americans, Dr. Rick Sacra, of Worcester, Massachusetts, and Rick Mocha, an NBC reporter, both of who contracted the disease in Liberia were flown back to the US and received treatment at the Nebraska Medical Center in Omaha. Upon their arrival in the hospital, they were placed on an experimental drug – TKM-Ebola – and received blood from the EVD survivor Kent Brantly. Blood from EVD survivors is believed to contain anti-bodies for fighting the disease. In addition to these four survivors, two nurses who contracted the EVD after caring for Duncan at the Dallas Presbyterian Hospital also survived the disease. They were both treated at hospitals equipped to deal with EVD and not at the hospital where they contracted the EVD, which is where Duncan died.

The six EVD survivors in the U.S. have certain things in common: they are white (except one African American nurse); they are all middle-class Americans with gainful employment and health insurance; and they were all promptly hospitalized and received the highest standard of care from hospital authorities, including prompt treatment with experimental drugs and Ebola-survivor blood transfusions. In contrast, Duncan was black, had no job and no health insurance, was misdiagnosed despite showing all symptoms for Ebola, was treated in a hospital that was unequipped to deal with the disease, endured delay in his treatment, received an experimental drug 6 days after hospitalization and only after strong protests by human rights activists, and did not receive blood transfusion from Ebola survivors. The complexity of the Duncan case, especially the serial medical misstep raises concern that Duncan’s death is attributable to the continuing significance of race (and class) in the US.

The intersection of race, class, and health, especially disparities in the treatment of whites and blacks and rich and poor by the U.S. healthcare system, continues to be an enduring issue in the U.S. Scholars contend that the U.S. is racially constituted and in every material particular articulates racial difference, which ultimately determines access to medical care. For instance, Goldberg (2002) suggests that racism and the U.S. are co-articulated since racial classifications and exclusions (including differential access to medical care) is the primary motive force of the state. By this account, the state is the main center for human categorization and classification and for accessing health benefits and opportunities. In fact, Goldberg suggests that the US has historically governed its populations in explicit racial terms in that some racial groups are identified legally and administratively as inherently inferior and expendable. Thus, the US has developed conceptually and materially through the process of racial differentiation and exploitation. Perhaps, this fact explains disparities in the treatment of Thomas Duncan compared to the care that the other mainly White American victims of Ebola received. Considered racially inferior and poor and thus underserving of standard medical care, Thomas Duncan’s case was allowed to grow worse culminating in his death at the Dallas Presbyterian Hospital. Every other victim of Ebola in the U.S. was treated in better-equipped facilities across the United States, raising substantial questions about the status of race in the U.S. in the era of President Barack Obama, the first Black person to occupy the White House.

Although the U.S. government says it adopted a “whole of government” approach to prevent the disease outbreak in the US by containing the disease at its source, which in this case was West Africa, questions are being raised about its preparedness to deal with highly contagious disease outbreaks in the U.S. because of historical disparities in the treatment of Blacks and Whites in this country. During the period the EVD raged, four West African countries reported outbreaks with the disease escalating in its scope and intensity in three of those countries: Guinea, Liberia, and Sierra Leone. The fourth country, Nigeria, managed to contain the disease after about 9 deaths and more than 1000 exposures. To help contain the spread of the disease, President Obama approved the deployment of about 4000 American troops to the region, part of a team that helped to improve logistics, build field hospitals and “Air Bridge,” and establish new training facilities to prepare local health workers to handle sick patients (Christensen and Liptak 2014). The American effort cost over $750 million (Berman 2014).

However, the World Health Organization believes that key to effective containment (including deflecting citizen apprehension) is dissemination of information about the disease: what it is, its origin, how it is contracted and transmitted, its symptoms, and how it is diagnosed and treated (WHO 2014). This last point is important because in the U.S. diagnoses of diseases and the care of sick people are often factored by race and class. Whites in many instances benefit from whiteness to the extent that they can expect better care at any and all U.S. health institutions than the average Black. Moreover, compared to Whites, Blacks have typically smaller resource assets and have only 10 cents for every dollar owned by Whites with the consequence that Blacks generally occupy lower class positions with little or no access to standard medical care. Even among Blacks in the U.S., immigrants (especially new migrants) face challenges accessing medical care because they typically have no employment or employer-provided health benefits, including health insurance. This means that they may only be treated in emergency situations when their sicknesses and diseases have reached critical levels. As the Duncan case exemplifies, unless sick Black people who have no health insurance enter the hospital as critical emergency cases, they may not be attended to by health workers or their institutions that are permanently attuned to the U.S. race complex and routinely face pressure allocating dwindling tax dollars to indigent Black populations.

This study, therefore, uses the Thomas Eric Duncan case to examine the status of race in the United States after six decades of “racial progress.” Considering American hysteria about contagious disease transmission from outside the U.S., especially from Africa, and the pervasive myth of the diminishing of the significance of race in the U.S., this is an enormously important study. In light of Thomas Lee Duncan, Black immigrants who already face challenges blending into America’s complex race and class systems may face increasing hardships due to discrimination from a society historically hostile to Blacks. Ultimately, the study helps to situate race and its tensions in the U.S. many decades after comprehensive Civil Rights reforms and in President Barrack Obama’s second term.