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Blog Post - Smart Global Health
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Not such a Lone Star State

October 9, 2014

Not such a Lone Star State:

Texas Health Presbyterian Hospital in Dallas, where the first U.S. case of Ebola virus was confirmed last week, is a familiar site to me.   Presbyterian, as the hospital was known when I grew up in Dallas in the 1970s and ‘80s, opened in 1966.  It is where I had my tonsils removed when I was 4, where most of my family’s annual medical exams took place, and where my mother died of complications from cancer in 2012.  I have been to the emergency room there more times than I can count.  In my experience the hospital and surroundings have always been quiet, peaceful, and calm – even when there was bad news to be delivered.  So, to see the hospital thrust into the international spotlight with an Ebola patient in isolation and questions about how staff responded to the patient when he initially visited the ER on September 25 was startling, indeed.   

For several days, news helicopters have flown in great arcs around the East Dallas neighborhood known as Vickery Meadow, which includes the hospital complex as well as a dense, highly diverse neighborhood of Mexican and Central American immigrants, resettled refugees from Southeast Asia and West Africa, and others. The Ebola patient, identified as Liberian national, Thomas Eric Duncan, had reportedly been staying at the Ivy Apartments located there.   Just this past September, the John D. and Catherine T. MacArthur Foundation awarded one of its prestigious “genius grants” to Texas artist Rick Lowe, who has overseen high-profile projects to install art galleries and public art in Dallas’s “Own United Nations,” as Vickery Meadow has been called.  If that news hadn’t already catapulted the neighborhood to national fame, the recent coverage of Duncan’s background and activities in Dallas by CNN, The New York Times and other international media certainly has. 

My husband, daughter, and I moved from Washington, DC to Dallas two years ago, and it was immediately apparent just how much the city has changed since I left for college in 1986.  The DFW airport serves as a major international transportation hub, bringing people together in ways that might have been unimaginable three decades ago.   Since the launch of NAFTA in 1994, Interstate 35 brings ever more people and goods from the U.S.-Mexico border area to other regions of the country.  Many of these people pass through Dallas-Fort Worth on their way to other destinations, of course, but plenty stay here, as well.  In 2013, nearly a quarter of the city’s more than 1.2 million people were born outside the U.S., and more than 42% speak a language other than English at home.   The Dallas office of International Rescue Committee reports resettling at least 650 refugees in the area each year.

In fact, there are between 5,000 and 10,000 Liberians living in a metropolitan area often better-known for J.R. Ewing, cowboy boots, and ”big hair.”  Many of them travel back and forth to Liberia for family or business.  The local Liberian community has been hit hard by the Ebola outbreak in West Africa, with many having lost relatives or friends in the past few months.

Local coverage of, and interest in, the Duncan case has been intense, eclipsing even Big Tex, the corny dogs, and cotton candy at the Texas State Fair, held in Dallas almost every fall since 1905.   Last week, after the Ebola diagnosis was confirmed, The Dallas Morning News featured banner headlines announcing the virus’s arrival.  The City of Dallas announced that it was moving its emergency preparedness status to “Level 2/High Alert.”  Schools and doctors’ offices circulated email reminders of how Ebola is and is not transmitted.  Texas governor Rick Perry has now set up a statewide Task Force on Infectious Disease and Response. 

People here in Dallas have responded to news of the Ebola case at Texas Health Presbyterian in predictable ways.  Some drove by the Ivy Apartments to see where Duncan lived when he became sick, with traffic so clogged that police had to be stationed at the complex to limit entry to actual residents.  Others sought to avoid the area altogether.  Reportedly the parking lots at the Presbyterian medical buildings last week were less full than usual, and patients who had been on waiting lists to see overbooked practitioners suddenly had their choice of appointment slots.  In the line for coffee at a nearby Starbucks, people joked nervously about Ebola when they sneezed or coughed, forgetting that Ebola is not an airborne infection.

For a few days, it seemed as though the entire world’s focus shifted from Guinea, Sierra Leone, and Liberia, where nearly 3,500 people have died from locally contracted Ebola since March, to the one travel-related case of illness in Dallas, Texas.  Yesterday morning Texas Health Presbyterian announced that Duncan, who had remained in critical condition and was receiving an experimental treatment for Ebola, had died;  an investigation into how his case was handled is well underway.  Yet the news this week that a nurse working at a Madrid hospital is the first person to become infected with the virus outside West Africa, after caring for a priest who was brought to Spain for treatment, has shifted some attention to Europe and back to the sub-region.

Two weeks after Duncan’s first visit to the emergency room in Dallas, a handful of his closest contacts and initial care providers, as well as some officials who later entered the apartment where Duncan had been staying, are being closely monitored for signs of the virus.  As of now, at least, no new Ebola cases have been confirmed.

As things move forward, I hope that the sad news of Duncan’s death from Ebola in Dallas serves as a reminder to local residents, as well as those further afield, that we are all connected and that what happens in one region of the world can have direct implications for what happens at home.  The Lone Star State may not be so alone, after all.

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