FEVERS, FEUDS, AND DIAMONDS

This story of the 2014 West African Ebola outbreak by an expert lacks the media hysteria common at the time but manages to be even more disturbing.

Farmer, the chair of Global Health and Social Medicine at Harvard and founding director of Partners in Health, has spent his life delivering medical care to undeveloped nations—and writing engagingly about his experiences. In his latest, the author describes the epidemic that likely killed many more people than officially reported. Readers will be surprised to learn that, despite lurid accounts such as Richard Preston’s The Hot Zone, Ebola is not a death sentence. Treatment involves routine hospital care, especially the replacement of lost fluids intravenously. Deaths were rare in victims evacuated to Europe or America but more than 50% in Africa. Farmer reserves special ire for international organizations proclaiming that simply treating individuals would never defeat the epidemic. Aggressive control measures, including quarantine, contact tracing, and sanitation upgrades, were required. It’s a no-brainer, Farmer points out, that sick people want care, and he continues his careerlong, morally sound argument that access to proper health care should be a universal right. Having recounted the epidemic in the first third of the book, the author steps back to describe how the region’s history made disaster inevitable—and what the future may hold. Of the nations involved, Sierra Leone and Guinea were colonies until after World War II. Trade has always supported the economies, at first via the slave trade and then extraction—mostly lumber and mining—which benefits wealthy locals and foreign industries. Often kleptocratic governments have built little health infrastructure, and what they did create was often destroyed by vicious civil wars. A final chapter reveals that Farmer and colleagues are now dealing with the Covid-19 pandemic, which many developed nations are handling more or less efficiently. Though not yet severely affected, many countries in Africa are unprepared.

Insightful, as always, but hardly encouraging.