Road Blocks and Mental Blocks
Excerpt from Chapter 10, "The Urgency Instinct," in Factfulness by Hans Rosling
“If it’s not contagious, then why did you evacuate your children and wife?” asked the mayor of Nacala, eyeing me from a safe distance behind his desk. Out the window, a breathtaking sun was setting over Nacala district and its population of hundreds of thousands of extremely poor people, served by just one doctor—me.
Earlier that day I had arrived back in the city from a poor coastal area in the north named Memba. There I had spent two days using my hands to diagnose hundreds of patients with a terrible, unexplained disease that had completely paralyzed their legs within minutes of onset and, in severe cases, made them blind. And the mayor was right; I wasn’t 100 percent sure it was not contagious. I hadn’t slept the previous night but had stayed up, poring over my medical textbook, until I had finally concluded that the symptoms I was seeing had not been described before. I’d guessed this was some kind of poison rather than anything infectious, but I couldn’t be sure, and I had asked my wife to take our young children and leave the district.
Before I could figure out what to say, the mayor said, “If you think it could be contagious, I must do something. To avoid a catastrophe, I must stop the disease from reaching the city.”
The worst-case scenario had already unfolded in the mayor’s mind, and immediately spread to mine.
The mayor was a man of action. He stood up and said, “Should I tell the military to set up a roadblock and stop the buses from the north?”
“Yes,” I said. “I think it’s a good idea. You have to do something.”
The mayor disappeared to make some calls.
When the sun rose over Memba the next morning, some 20 women and their youngest children were already up, waiting for the morning bus to take them to the market in Nacala to sell their goods. When they learned the bus had been canceled, they walked down to the beach and asked the fishermen to take them by the sea route instead. The fishermen made room for everyone in their small boats, probably happy to be making the easiest money of their lives as they sailed south along the coast.
Nobody could swim and when the boats capsized in the waves, all the mothers and children and fishermen drowned.
That afternoon I headed north again, past the roadblock, to continue to investigate the strange disease. As I drove through Memba I came across a group of people lining up on the roadside dead bodies they had pulled out of the sea. I ran down to the beach but it was too late. I asked a man carrying the body of a young boy, “Why were all these children and mothers out in those fragile boats?”
“There was no bus this morning,” he said. Several minutes later I could still barely understand what I had done. Still today I can’t forgive myself. Why did I have to say to the mayor, “You must do something”?
I couldn’t blame these tragic deaths on the fishermen. Desperate people who need to get to market of course take the boat when the city authorities for some reason block their road.
I have no way to tell you how I carried on with the work I had to do that day and in the days afterward. And I didn’t talk about this to anyone else for 35 years.
But I did carry on with my work and eventually I discovered the cause of the paralytic disease: as I suspected, the people had been poisoned. The surprise was that they had not eaten anything new. The cassava that formed the basis for the local diet had to be processed for three days to make it edible. Everyone had always known that, so no one had ever even heard of anyone who had been poisoned or seen these symptoms. But this year, there had been a terrible harvest across the whole country and the government had been buying processed cassava at the highest price ever. The poor farmers were suddenly able to make that extra money they needed to escape poverty and were selling everything they had. After a successful day of selling, though, they were coming home hungry. So hungry that they couldn’t resist eating the unprocessed cassava roots straight from the fields. At 8 p.m. on August 21, 1981, this discovery transformed me from being a district doctor to being a researcher, and I spent the next ten years of my life investigating the interplay among economies, societies, toxins, and food.
Fourteen years later, in 1995, the ministers in Kinshasa, the capital of DR Congo, heard that there was an Ebola outbreak in the city of Kikwit. They got scared. They felt they had to do something. They set up a roadblock.
Again, there were unintended consequences. Feeding the people in the capital became a major problem because the rural area that had always supplied most of their processed cassava was on the other side of the disease-stricken area. The city was hungry and started buying all it could from its second-largest food-producing area. Prices skyrocketed, and guess what? A mysterious outbreak of paralyzed legs and blindness followed.
Nineteen years after that, in 2014, there was an outbreak of Ebola in the rural north of Liberia. Inexperienced people from rich countries got scared and they all came up with the same idea: a roadblock!
At the Ministry of Health, I encountered politicians of a higher quality. They were more experienced, and their experience made them cautious. Their main concern was that roadblocks would destroy the trust of the people abandoned behind them.
This would have been absolutely catastrophic: Ebola outbreaks are defeated by contact tracers, who depend on people honestly disclosing everybody they have touched. These heroes were sitting in poor slum dwellings carefully interviewing people who had just lost a family member about every individual their loved one might have infected before dying. Often, of course, the person being interviewed was on that list and potentially infected. Despite the constant fear and wave after wave of rumors, there was no room for drastic, panicky action. The infection path could not be traced with brute force, just patient, calm, meticulous work. One single individual delicately leaving out information about his dead brother’s multiple lovers could cost a thousand lives.
When we are afraid and under time pressure and thinking of worst-case scenarios, we tend to make really stupid decisions. Our ability to think analytically can be overwhelmed by an urge to make quick decisions and take immediate action.
Back in Nacala in 1981, I spent several days carefully investigating the disease but less than a minute thinking about the consequences of closing the road. Urgency, fear, and a single-minded focus on the risks of a pandemic shut down my ability to think things through. In the rush to do something, I did something terrible.
—Hans Rosling
