C1 · Advanced
12 min
public healthgeopoliticsafricaepidemic responsecommunity trust
Set the Clinic on Fire
El enemigo que vino a curar
In the Ituri Province of eastern Congo, residents burned down an Ebola treatment center as the epidemic continues to spread. Fletcher and Octavio dig into why communities destroy the very structures meant to save them, and what that reveals about decades of accumulated distrust.
En la provincia de Ituri, en el este de la República Democrática del Congo, los residentes quemaron un centro de tratamiento del ébola mientras la epidemia sigue expandiéndose. Fletcher y Octavio exploran por qué las comunidades destruyen las mismas estructuras que podrían salvarlas, y qué dice eso sobre décadas de desconfianza acumulada.
7 essential C1-level terms from this episode, with translations and example sentences in Spanish.
| Spanish | English | Example |
|---|---|---|
| brote | outbreak | El brote de ébola en la provincia de Ituri se ha extendido a pesar de los esfuerzos internacionales. |
| confianza | trust / confidence | La confianza entre las comunidades locales y los organismos sanitarios tardó años en construirse y se perdió en semanas. |
| dicho sea de paso | incidentally / it should be said in passing | Dicho sea de paso, los protocolos internacionales de respuesta a epidemias han mejorado técnicamente, pero los problemas estructurales persisten. |
| subfinanciado | underfunded | Un sistema de salud crónicamente subfinanciado no puede construir la confianza que requiere una respuesta eficaz a una epidemia. |
| actores externos | external actors | Las comunidades de Ituri desconfían de los actores externos, sean militares, humanitarios o sanitarios. |
| protocolo | protocol | Los protocolos de aislamiento del ébola son médicamente necesarios, pero a menudo chocan con las prácticas culturales locales. |
| marcador discursivo | discourse marker | Los marcadores discursivos como 'dicho sea de paso' o 'a ver' estructuran el flujo natural de una conversación en español. |
People burned down an Ebola clinic this week.
Not militia, not soldiers.
Residents.
People who live near the outbreak.
Sí, y para quien no haya seguido esto de cerca, puede parecer un acto de locura colectiva.
Yes, and for anyone who hasn't been following this closely, it might seem like collective madness.
Pero si conoces la historia de Ituri, de esa región, entiendes que no es locura.
But if you know the history of Ituri, of that region, you understand it's not madness.
Es rabia acumulada durante décadas.
It's rage that has been building for decades.
Walk me through what actually happened.
Because the wire reports are thin on context.
Bueno, el brote lleva semanas activo en la provincia de Ituri.
Well, the outbreak has been active for weeks in Ituri Province.
La policía congoleña llegó al centro de tratamiento, disparó al aire y usó gas lacrimógeno para controlar a la multitud que se había congregado allí.
Congolese police arrived at the treatment center, fired warning shots and used tear gas to control the crowd that had gathered there.
Y la multitud respondió prendiendo fuego al edificio.
And the crowd responded by setting the building on fire.
A treatment center.
Where people with Ebola are being kept alive.
Exactamente.
Exactly.
Y ahí está la tragedia dentro de la tragedia.
And that's the tragedy within the tragedy.
Pero fíjate en lo que implica ese gesto: para esa gente, el centro no era un lugar de curación.
But notice what that gesture implies: for those people, the center wasn't a place of healing.
Era un lugar adonde se llevaban a los suyos y nunca volvían.
It was a place where their loved ones were taken and never came back.
That framing matters.
Because Ebola treatment centers do have a brutal reality attached to them.
The survival rates have improved, but historically, you go in, your family can't touch you, can't hold your hand, and a lot of people don't come out.
Y en culturas donde el acompañamiento en la muerte, el contacto físico, el ritual funerario, son parte central de la dignidad humana, ese protocolo médico suena a abandono.
And in cultures where accompanying the dying, physical contact, funeral rituals, are central to human dignity, that medical protocol sounds like abandonment.
Suena a que te arrebatan a tu familiar y lo tratan como si fuera peligroso, como si ya no fuera persona.
It sounds like they're taking your family member away and treating them as if they're dangerous, as if they're no longer a person.
I covered the 2014 West Africa outbreak from a distance.
And even then, writing about it from a bureau, the thing that kept surfacing was this fundamental collision between biomedical logic and community logic.
Es que no es solo un problema de comunicación, que es lo que suelen decir los organismos internacionales: 'hay que explicar mejor la ciencia'.
It's not just a communication problem, which is what international organizations usually say: 'we need to explain the science better'.
No.
No.
El problema es de confianza, y la confianza no se gana con folletos.
The problem is trust, and trust isn't earned with pamphlets.
Se gana con historia, con presencia, con respeto sostenido en el tiempo.
It's earned through history, through presence, through sustained respect over time.
And Ituri has almost no trust to draw on.
This is a province that has been through years of armed conflict, massacres, displacement.
The state, any external authority, is not an abstraction there.
It's a threat.
Y esto no es nuevo con el ébola.
And this isn't new with Ebola.
En el brote de 2018 al 2020, que fue el segundo más grande de la historia, en las provincias del Kivu y precisamente en partes de Ituri, pasó algo muy parecido.
In the 2018 to 2020 outbreak, which was the second largest in history, in the Kivu provinces and specifically in parts of Ituri, something very similar happened.
Hubo ataques a centros de tratamiento, hubo trabajadores sanitarios asesinados.
There were attacks on treatment centers, health workers were killed.
Más de trescientos en ese brote.
More than three hundred in that outbreak.
Three hundred health workers.
That number doesn't get enough attention.
No, y es fundamental entenderlo porque esos ataques no surgen de la nada.
No, and it's fundamental to understand because those attacks don't come from nowhere.
Surgen de rumores que llevan años circulando: que el ébola es un invento occidental, que los médicos extranjeros vienen a experimentar con la gente local, que los centros de tratamiento son en realidad lugares donde desaparecen los enfermos para que se los lleven.
They emerge from rumors that have been circulating for years: that Ebola is a Western invention, that foreign doctors come to experiment on local people, that treatment centers are actually places where the sick disappear so they can be taken away.
Rumors that, historically, haven't always been entirely without basis.
There's a long and ugly record of medical experimentation in central Africa under colonial rule.
Claro.
Exactly.
Y eso es lo que hace que este problema sea tan difícil de resolver.
And that's what makes this problem so hard to solve.
No puedes simplemente decirle a alguien que sus miedos son irracionales cuando esos miedos tienen raíces históricas reales.
You can't simply tell someone their fears are irrational when those fears have real historical roots.
Puede que la conclusión específica sea errónea, pero el instinto de desconfianza no lo es.
The specific conclusion may be wrong, but the instinct of distrust is not.
Meanwhile, while this is happening on the ground in Ituri, the international response is escalating.
India, South Korea, Thailand all issued travel alerts for the DRC and Uganda.
South Korea is planning a full level-four travel ban for parts of the DRC.
Y Uganda ha suspendido temporalmente los vuelos con la RDC.
And Uganda has temporarily suspended flights to and from the DRC.
Eso es significativo porque Uganda no es un actor lejano: comparte frontera, comparte grupos étnicos, comparte economía informal con el este del Congo.
That's significant because Uganda is not a distant actor: it shares a border, shares ethnic groups, shares an informal economy with eastern Congo.
Cerrar esa conexión tiene un coste real para mucha gente.
Closing that connection has a real cost for many people.
And the United States paused deportation flights to the DRC.
Which is a sentence I had to read twice.
Ja, sí.
[chuckle] Yes.
Que la misma administración que lleva meses deportando a gente a zonas de conflicto tenga que parar porque hay un brote de ébola dice mucho, aunque no necesariamente lo que uno querría que dijera.
That the same administration that has spent months deporting people to conflict zones has to stop because of an Ebola outbreak says a lot, though not necessarily what one would want it to say.
It says the calculus is purely about containment, not about the welfare of the people being deported.
Exactamente.
Exactly.
Lo cual, dicho sea de paso, es también parte del problema de la respuesta internacional al ébola en general.
Which, incidentally, is also part of the problem with the international response to Ebola in general.
Las fronteras se cierran, los vuelos se suspenden, los países ricos emiten alertas de viaje, pero eso no apaga el fuego.
Borders close, flights are suspended, wealthy countries issue travel alerts, but that doesn't put out the fire.
Solo aísla más a las comunidades que ya desconfían de todos los actores externos.
It only further isolates the communities that already distrust all external actors.
There's a pattern here that goes back to 2014, to the airport screenings, the travel bans on West African countries.
And the epidemiological consensus was always that those measures didn't work and probably made things worse.
El argumento técnico es bastante claro: si los países afectados se ven estigmatizados y castigados por declarar brotes, van a tener menos incentivos para reportarlos.
The technical argument is fairly clear: if affected countries find themselves stigmatized and punished for declaring outbreaks, they'll have less incentive to report them.
Con lo cual reduces la transparencia justo cuando más la necesitas.
Which means you reduce transparency precisely when you need it most.
And yet here we are, doing it again.
Porque los gobiernos responden ante sus propias poblaciones, no ante la lógica epidemiológica.
Because governments are accountable to their own populations, not to epidemiological logic.
Cuando hay un brote de ébola, el ministro de sanidad de Seúl o de Nueva Delhi tiene que demostrar que está haciendo algo.
When there's an Ebola outbreak, the health minister in Seoul or New Delhi has to show they're doing something.
Y cerrar un aeropuerto se ve.
And closing an airport is visible.
Financiar centros de tratamiento en el Congo no se ve.
Funding treatment centers in Congo is not.
Let's go back to the clinic burning, because I think there's something deeper there about what outbreak response actually requires that we haven't fully named yet.
A ver, lo que requiere una respuesta eficaz es que la comunidad afectada sea parte activa, no objeto pasivo de las intervenciones.
Look, what an effective response requires is that the affected community be an active participant, not a passive object of interventions.
Eso significa que los trabajadores sanitarios tienen que ser locales en su mayoría, que los mensajes tienen que venir de líderes comunitarios y religiosos de confianza, que los protocolos tienen que negociarse, no imponerse.
That means health workers need to be mostly local, that messages need to come from trusted community and religious leaders, that protocols need to be negotiated, not imposed.
And that takes time and relationships built before the outbreak, not scrambled together during it.
Claro, y ahí llegamos al problema estructural de fondo: el sistema de salud del Congo está en un estado de abandono casi total.
Right, and that's where we arrive at the underlying structural problem: Congo's health system is in a state of near-total neglect.
Hay provincias enteras donde no hay un médico por cada cien mil habitantes.
There are entire provinces with no doctor for every hundred thousand inhabitants.
El personal sanitario lleva meses sin cobrar en algunas zonas.
Health workers haven't been paid for months in some areas.
¿Cómo vas a construir confianza con esa base?
How do you build trust on that foundation?
There's also a particular cruelty to the geography here.
Ituri is remote even by Congolese standards.
It's a province the size of Portugal with terrible roads, active insurgent groups, and it sits at the nexus of borders with Uganda and South Sudan.
Y eso, combinado con el movimiento de población que genera un conflicto activo, hace que contener el virus sea enormemente difícil.
And that, combined with the population movement generated by active conflict, makes containing the virus enormously difficult.
El ébola se mueve con las personas.
Ebola moves with people.
Las personas se mueven cuando tienen miedo.
People move when they're afraid.
Y en Ituri la gente tiene miedo de muchísimas cosas al mismo tiempo: del virus, de las milicias, del ejército, y ahora también de los que vienen a tratarlos.
And in Ituri people are afraid of an enormous number of things at once: the virus, the militias, the army, and now also the people who come to treat them.
I keep thinking about the India-Africa Forum Summit that just got postponed because of this.
Which is its own story.
India has built a lot of diplomatic capital in Africa over the past decade, and now they're pulling back, visibly.
Sí, es una señal que no pasa desapercibida en el continente.
Yes, it's a signal that doesn't go unnoticed on the continent.
Aunque hay que decir que India tiene sus razones sanitarias legítimas, también envía un mensaje sobre las prioridades reales cuando llega la primera complicación.
Although it must be said that India has its legitimate public health reasons, it also sends a message about real priorities when the first complication arrives.
The broader question I keep coming back to is whether the global architecture for responding to outbreaks, the WHO, the emergency frameworks, COVAX and all the rest of it, has actually learned anything since 2014.
Ha aprendido cosas técnicas, sí.
It has learned technical things, yes.
Los protocolos de respuesta rápida han mejorado, hay vacunas ahora que no existían antes, la vacuna rVSV-ZEBOV demostró ser eficaz en el brote del Kivu.
Rapid response protocols have improved, there are vaccines now that didn't exist before, the rVSV-ZEBOV vaccine proved effective in the Kivu outbreak.
Pero el problema de fondo, que es el de la confianza comunitaria y el de los sistemas de salud crónicamente subfinanciados, eso no se ha resuelto.
But the underlying problem, which is community trust and chronically underfunded health systems, that hasn't been solved.
Ni cerca.
Not even close.
And that gap between the technical capability and the social infrastructure, that's exactly the gap you see illustrated when a community burns down a clinic.
Es una imagen que ojalá no tuviéramos que usar, pero que resume mejor que cualquier informe técnico todo lo que ha fallado.
It's an image I wish we didn't have to use, but one that summarizes, better than any technical report, everything that has failed.
No solo el sistema de salud del Congo, sino el orden internacional que lleva décadas prometiendo que esta vez sería distinto.
Not just Congo's health system, but the international order that has been promising for decades that this time would be different.
Hey, one thing you said earlier that I want to circle back to.
You used the phrase 'dicho sea de paso' and I wrote it down because I didn't know it and I want to know what I'm missing.
Ah, sí.
Ah, yes.
'Dicho sea de paso' es una expresión fija que significa algo así como 'mencionándolo de paso' o 'ya que estamos'.
'Dicho sea de paso' is a fixed expression that means something like 'mentioning it in passing' or 'while we're at it'.
Es un marcador discursivo que usas cuando quieres introducir un comentario secundario sin interrumpir del todo el hilo principal.
It's a discourse marker you use when you want to introduce a secondary comment without completely interrupting the main thread.
Como si dijeras: 'esto no es lo central, pero merece ser dicho'.
As if you're saying: 'this isn't the main point, but it deserves to be said'.
So it's like 'incidentally' or 'for what it's worth', but a bit more pointed than either of those.
Sí, tiene ese matiz.
Yes, it has that nuance.
'Por cierto' puede ser casi neutro, una simple transición.
'Por cierto' can be almost neutral, a simple transition.
'Dicho sea de paso' lleva un pequeño peso editorial, como si lo que añades fuera una observación que el hablante considera importante aunque no sea el tema central.
'Dicho sea de paso' carries a small editorial weight, as if what you're adding is an observation the speaker considers important even if it's not the central topic.
Lo usas cuando quieres que la acotación cuente, pero sin reclamar demasiado protagonismo para ella.
You use it when you want the aside to count, but without claiming too much prominence for it.
That's actually a subtle distinction.
English doesn't have one phrase that captures all of that at once.
I'll probably use it wrong the first seventeen times.
Dicho sea de paso, Fletcher, tampoco lo habrías usado bien en inglés.
Incidentally, Fletcher, you wouldn't have used it well in English either.
Pero es un placer verte intentarlo.
But it's a pleasure to watch you try.