A Hospital From Hell, Adam Nossiter’s devastatingly intimate portrait of one Ebola treatment center in Sierra Leone, takes us inside the epidemic, where “treatment centers” turn into filthy prison warehouses for the miserable and dying, where Ebola sufferers lie untended, and those exposed but not actually ill or even confirmed infected, including young children, are incarcerated alongside them.

I’ve not written about the epidemic here because so much of what unfolds defies words. But we are at a turning point.

In today’s NY Times local public health officers are shown exiting the apartment of the identified Ebola patient in Texas, without so much as protective paper booties or masks–as if they were making a social call–while Dallas officials and the CDC remain unable to find anyone competent and willing to remove items for incineration, such as the bedsheets the patient slept on, feverishly, after being sent home the first time he came to a Dallas ER.

That the man was sent home that day is blamed on “bad communication.” His recent arrival from West Africa had been noted by a triage nurse but did not make it into the electronic version of his chart seen by caregivers inside the ER.

For health care workers involved in disaster preparedness our uneven response is not news: cutbacks in funding in this country have left many hospitals, like the one in Dallas which has become the epicenter of our first home-incubated Ebola case, alarmingly short on expertise and resources.

It doesn’t take an expert to connect the dots. Public health funding for preparedness has been cut in half over the course of the last couple of decades. It is a far lesser gap than in Sierra Leone, but Americans who believe themselves impervious because of our relative wealth and health may have a rude awakening.

WHO has estimated 1.4 million Ebola infections in Africa by the turn of the year, and warn that if the epidemic is not stemmed before that point there may be no stopping it. Already whole sectors of the three countries most affected are cordoned off, while their national economies teeter on the brink of collapse. In all three, the lack of a robust public health infrastructure, even as populations increasingly urbanize into denser contact, helped set the stage for the rampage of disease.

Global economy and interconnectedness dictate that even if we do not intervene out of simple compassion, we must do so for our own survival. Ebola is one more sign of a new mobility of emerging infectious diseases, exactly as the threat of antibiotic resistance looms, and the gutting of public funding in the sciences here has left us with paltry development of new medicines to fill the gap.

The president of Sierra Leone has promised that the Dallas patient will be prosecuted for leaving the country knowing he might be carrying Ebola. She does not add the phrase “if he survives.”

If you read the portrait of that Sierra Leone “treatment center” it might be possible to imagine how, finding yourself in the midst of that hell, knowing you too may soon succumb to infection, you might seize the opportunity to fly away to a country where Ebola patients usually survive.

You might choose life.

It is the responsibility of communities–governments, not single individuals–to be vigilant for the public health. And it is the responsibility of citizens to insist that public health resources are strong and sustained.

To be a writer is to bear witness. And to be a citizen is to be responsible for one another, and to insist on support for those critical infrastructures of our community which protect us all in times of crisis.

with love,