"We're at the cusp of a larger conversation that needs to happen," said Dr Renzo Guinto, a Filipino physician and doctoral candidate at Harvard, who has written about decolonising global health.
That conversation is considering both the direct legacy of the colonial era on health systems and the way that patterns from that era are reproduced. "But we cannot take the trajectory of a long, winding conversation," Guinto said. "These issues are right on our doorstep."
The Ebola outbreak declared in the DRC in August 2018 is spreading at a record pace. Despite the introduction of a new vaccine, at least 1,121 people have died of the disease. Yet in some areas, Congolese have met response efforts with violence — burning down clinics and even attacking and killing healthcare workers.
Communities have expressed frustration with a response that upends traditional systems of care and isolates patients from their families. And they are confused about why Ebola merits an international response, where other diseases that have plagued their communities have not.
Dr Joanne Liu, international president ofMédecins Sans Frontières (MSF), says communities in DRC have been left behind, creating failure in the Ebola response — and blames a growing security mindset where countries only choose to assist when they feel threatened.
The international organisations shoring up that response are grappling with this reaction. In a March statement, Liu acknowledged that "choices must be given back to patients and their families on how to manage the disease." That includes integrating diagnosis in traditional health facilities, rather than creating a parallel system, and providing families who ultimately decide to care for patients with the resources to do so as safely as possible.
In instances where health interventions are imposed on low-income communities, the neocolonial influence is more obvious, observers said. But advocates argue that colonialism is also bound together with a political and economic system that prioritizes unfettered access to the markets of the global south — no matter that the expansion of some industries, such as sugary drinks and processed foods, has been linked to skyrocketing rates of noncommunicable diseases in those countries.