Inferno: A Doctor's Ebola Story

by Steven Hatch

Dr. Steven Hatch first came to Liberia in November 2013, to work at a hospital in Monrovia. Six months later, several of the physicians Dr. Hatch had mentored and served with were dead or barely clinging to life, and Ebola had become a world health emergency. Hundreds of victims perished each week; whole families were destroyed in a matter of days; so many died so quickly that the culturally taboo practice of cremation had to be instituted to dispose of the bodies. With little help from the international community and a population ravaged by disease and fear, the war-torn African nation was simply unprepared to deal with the catastrophe.

A physician’s memoir about the ravages of a terrible disease and the small hospital that fought to contain it, Inferno is also an explanation of the science and biology of Ebola: how it is transmitted and spreads with such ferocity. And as Dr. Hatch notes, while Ebola is temporarily under control, it will inevitably re-emerge—as will other plagues, notably the Zika virus, which the World Health Organization has declared a public health emergency. Inferno is a glimpse into the white-hot center of a crisis that will come again.

Genres: Nonfiction, Science, Medical, Medicine, History, Africa, Biography

318 pages, Kindle Edition

First published March 7, 2017

Reviews

[Petra X · Rating 3 out of 5]

I have a small connection with Liberia. A customer was the US expert on Liberia and he found a book in my shop on Liberia that he had never seen before. He didn't buy it, too heavy to take home but it turned him into a friend and I was on the cruise-ship (history tours, not four-meals-a-day plus midnight buffet ones) list of 100 best Indie bookshops.

The author says that the founding of Liberia for free American Blacks wasn't quite the utopian enterprise a lot of us believe it was. For a start the only desirable part of Liberia had been annexed by the British.

Secondly, returning free Blacks to Liberia as if Liberia was all of Africa when their ancestors might have been sold from any part of the continent made no sense. Thirdly, these free Blacks were living good lives in the Northern states. They were tradesmen and craftsmen, they were middle class, they were educated, they were doing well. But much as the North cared about slavery in general, they didn't care about it as it applied to individuals, not at all. So the free Blacks lived in constant threat of being kidnapped and sold into Slavery in the South. That was why they left.

And the local Liberians didn't welcome these Americans at all. To a racist, sharing a Black skin, made them all the same, but of course their culture was completely different.

What was so ironic was that the economy, in tatters when they arrived in Liberia, had been built entirely on capturing and selling slaves.

I don't know how much more of this book I can stand. The author doesn't leave a single thing out, and describes not only what he does, such as including where he bought a usb power strip and what was wrong with it, but also how he felt about it, how he discussed it, his tone of voice and the level off difficulty.... He has the passion and the black/white view of the world I did at 17. I admire him for maintaining it and where it matters, like a potted history of Liberia and slavery it was interesting. Otherwise, it could have been cut down to 25% and might have been a good book. And a short one. I'm over 50% in and think that's it.

But outside of the over-detail, it's actually a good book, so as not to put off those with more fortitude than me, I will give it 3 stars.

[Mark Porton · Rating 4 out of 5]

Inferno, by Infectious Diseases Physician, Dr Steven Hatch, is the story of this doctor volunteering to go to Liberia to help with the Ebola outbreak of 2013.

The author worked in an Ebola Treatment Unit (ETU) in the jungle of Liberia treating and managing patients presenting with symptoms of Ebola. This haemorrhagic virus, had a morality rate of between 50-70% (depending on the literature) and is contagious enough to cause significant outbreaks with many deaths. One thing I found interesting here is that most patients presented with severe diarrhoea and vomiting (as compared to bleeding). Imagine the challenge in keeping the patients areas clean and free of virus when patients were repeatedly and violently vomiting, defecating and soiling themselves.

The challenges were overwhelming – such as trying to follow sound infectious control protocols by cleaning up mess, and wearing PPE in the stifling heat, so much PPE, the doctors were unable to use something as basic as a stethoscope. ETUs, particularly in remote regions experienced challenges such as procurement, patient transport, infrastructure, power, comms, building standards to name a few.

When we approached him, it was clear his pants were soiled with diarrhoea and his shirt stained with vomit. He was covered in his own body fluids

But perhaps the major challenge was a result of the complicated and violent history of Liberia. This country was created by the transportation of freed African-American slaves in the early to mid-1800s. This group quickly became the ‘ruling-class’ with the local tribes (of which there are many) often being subjugated by this group. Liberia’s history is complex, and the author spends time describing this as it has an impact on Liberia’s ability to manage such an outbreak.



Check out the blue filamentous Ebola virus, mobbing this cell

I was particularly interested in the capacity of pathology laboratories to provide rapid turnaround times for Ebola PCR testing – as these results determine, not only the most appropriate treatment of the patient, but the most appropriate location (e.g. isolation) for them. Until these results were obtained, many sick non-Ebola (keeping in mind many Liberians were sick anyway) patients would be mixing with Ebola patients – thus putting further strain on resources and importantly, increasing transmission rates. Initially the turnaround time for testing was 5-days, but this was eventually improved to 1-day. This impressive TAT was achieved by a US Navy mobile laboratory.

The country’s institutions were poor, government and other bureaucracies were mostly corrupt, there was significant and savage internecine conflict – the most significant being the Civil War from 1989 to 1997 more than 200,000 Liberians were killed, and around a million displaced as refugees (the population was only just a bit more than 2 million). Some of the accounts I have read of the violence during this war are nothing short of horrific, truly horrible. So, there is little wonder the country was in a total mess well before Ebola reared its ugly head.

The turbulent history of Liberia, is a cause of much civil mistrust towards Government and foreign actors when trying to implement an outbreak containment strategy – e.g. many Liberians believed the whole thing was a Government plot and they were spreading the disease via the ETUs.

Here is a documentary I watched today about the first Liberian Civil War – the American tyre company Firestone was up to its ears in the politics of this war, as they were managing the worlds biggest rubber plantation at the time. I don’t think I like look at a tyre the same way again - seriously.

Here’s the link https://youtu.be/Pe-K0kpyDM8 it’s not for the fainthearted, but it is fascinating.

I’ve only scratched the surface here – for those interested it’s worth reading.

4 stars

[Marialyce · Rating 2 out of 5]

2.5 stars

While I give Dr Hatch full credit for his dedication to helping those who have both come in contact and also had this disease, I have a number of objections to his philosophy. First of all, he in his Introduction, wrote that he was going to share in the human stories of the patients he met and treated in Liberia, a promise which he did little to fulfill. Secondly, this book was all about Dr Hatch. There was so much usage of the word "I" that again seemed to come up against his promise that this book was not really about him. Again I do say that it took a whole lot of courage to place oneself in the midst and treat patients of an Ebola outbreak, but I, as the reader, wanted to know of the people who were affected and it is not till the end of the book, that things are mentioned that are being done to support the survivors and the families of those who did not survive.

Another issue I had with Dr Hatch's analysis was that he looked with scorn on the effects that the US officials and politicians wished to convey in order that the people in this country remained safe from an Ebola outbreak. In my book, it is always better to be safe than sorry. Since Ebola has an extremely large percentage of killing people, I felt any effort even if it was over the top to see that Americans were kept safe was more than warranted. Dr Hatch seemed to think that we or at least those in charge of such things over reacted.

Another point that bothered me was the fact that Dr Hatch drew a correspondence between measles and Ebola pointing out that it was harder to catch Ebola than the measles. The idea I kept in my mind was that more people have survived measles than have survived Ebola. Of course if at any time, scientists come up with a vaccine to prevent Ebola, then perhaps Dr Hatch's ideas has merit.

So, to say I was disappointed in this novel was an understatement and as I write this review I read this morning that there is new Ebola breakout in the Congo.

[Liralen · Rating 4 out of 5]

Emile Ouamouno fell ill in late December 2013. Nobody knows what his precise symptoms were because hardly anyone who cared for him is left alive. (20)

It seems strange that the Ebola crisis, which dominated the news for so long, is but a memory for most people in the Western world now. I followed it pretty closely and was eager to see what books came out of this.

Hatch is an American doctor, but he found his way to Liberia to do what he could as soon as he understood the severity of the crisis. Understand: Ebola is not new, but the way it spread in Liberia (and other parts of West Africa) was new; there wasn't really a road map for this.

This isn't really Hatch's story. He says early on that he chose to keep the book focused on the disease and on the people battling it, and that he does, only occasionally talking about things like...well, like leaving his family behind to go on what he thought was effectively a suicide mission (and then the discombobulation of realising that he probably wasn't going to contract Ebola). But he has some wonderful insights into what was going on, both on a small scale and on a broader scale. Take this:

In terms of diagnostics, the ETU [Ebola Treatment Unit] practiced twenty-first-century medicine for Ebola and nineteenth-century medicine for everything else. At the time I arrived in Liberia, there was no functioning health-care system besides ETUs. Essentially all the hospitals and clinics were closed. So these people [who were brought in but tested negative for Ebola] in some sense represented all the other conditions that were being ignored in the midst of the Ebola crisis. It wasn't merely killing the people it infected; it was killing people who were dying of everything else that could be treated, since there was nowhere to turn. (83)

Elsewhere, he talks about the relationship people in the area have with the hospital:

In the coming days I made inquiries about the mortality rate at JFK [the hospital], and my mind reeled. "Oh, it's about 40 percent," Ian told me, almost with the casual air of someone who had been following the price of Apple's stock. "The problem is that people know that if you go to JFK, you've got a pretty good chance of dying, so they delay coming when we might be able to make more of a difference, and then they end up coming so far along in their illness that they don't do well, and you have this high mortality rate, which reinforces the sense that you come here to die." The mortality on the surgical service in 2013, according to the residents with whom I spoke, was an astonishing 70 percent, for much the same reasons. (41–42)

I'm reminded of Edward Hume, who talks about opening a hospital in China in the early 1900s and understanding that, to gain the trust of the people his hospital aimed to serve, the hospital would have to go two years without any patient deaths in hospital, which meant treating only minor maladies for a long time. I don't suppose that's an option that JFK had or has, but the cyclical nature of it all is so terribly sad.

I'm curious about this, too:

I thought a lot about fluids—in particular, intravenous fluids. If, as my own two eyes had shown me, Ebola was a disease closer in appearance to severe gastroenteritis than it was to a river of blood being unleashed, then giving back as much fluid as possible might take a disease with a 50 to 70 percent mortality and turn it into one with a 10 to 20 percent mortality. (241)

I wondered something along those lines, back when the Ebola crisis was hitting a fever pitch. The Westerners who contracted Ebola and were evacuated (or contracted it back home)—it's impossible for me (as a layperson, not a medical professional, not a researcher, etc.) to know how much difference the Ebola-specific treatments made and how much difference basic things like hydration made, but I'm reminded of cholera, with which patients have a vastly better chance of survival if they're properly hydrated. I'm really the wrong person to hypothesise about this (see above re: not being a doctor or researcher or whatever), but I hope the research that comes out of this outbreak can answer a lot of questions.

But back to the book... Nicely thorough and thoughtful. I learned a lot, and outside a couple of history-dense sections, it was a really engaging read. Recommended to anyone interested in the topic.

[Cav · Rating 1 out of 5]

Oh boy. Where to begin with this one?? Maybe I'll start by saying that I didn't buy a book about Ebola to hear the moronic political ramblings of an author who is clearly in the grips of ideological possession...

Author Steven Hatch is somewhat the stereotypical screeching, self-loathing, anti-white, white "progressive".


I honestly can't believe that a book about a doctor treating Ebola in Africa could have so much political rhetoric and mindless virtue-signaling woven into its pages. There is a long diatribe in the book's intro that blames all the troubles of Africa on the evil white man; a theme he keeps bringing up - too many times to count in the book.

The book opens with a nice-sounding quote from a man called "General Butt Naked”, (named after his habit of going into battle naked because he would be invisible):
"How I wish I was in a dream, and I’m waking up, and I discover, “Oh, that’s a dream.”
—Joshua Blahyi, formerly known as “General Butt Naked,” circa 2013"

...Until you realize who Blahyi was: A murderous baby-killing cannibal responsible (by self-admission) for over 20,000 deaths, and who was once considered "the most evil man in the world."

What the fuck are you thinking quoting this person?? Oh, but it's OK, because he has now become a Christian priest, and (in the author's eyes) is no doubt the poor victim of white imperialism...

The intro of the book also features a completely irrelevant and unrelated blurb about how dropping the bombs on Japan was a terrible thing to do.
It just gets worse as it goes. He mentions the bloody machete massacre of eight aid workers, but can't seem to find the blame for such a horrific killing. He mentions how a couple of hundred dollars got stolen from his cubby at the center, but then proceeds to lecture the reader about how Africans stealing things is actually the fault of white people.

He identifies who is to blame for Ebola. The virus, from Africa , spread to humans by the eating of bats and other "bush meat", by Africans , which then spread through Africa, largely by African practices of touching, washing, and coming into close contact with their dead, was quite obviously the fault of...
...(wait for it)... the evil white man.
LMAO.

This book was a complete shitshow. I honestly can't believe that it got published.
The author mentions that he is an emotional wreck in general. The book describes no fewer than half a dozen instances where he "broke down, and cried like a baby" until a New York Times journalist consoled him. What a fucking gong show.

It's a shame, too, because there is an interesting story to be told here. If the author would have focused more on that story, instead of evangelizing his leftist worldview, this would have been a much more enjoyable experience.
I'm pretty sure that people don't buy a book about the first-hand account of a Western doctor's experiences treating Ebola in Africa to be fed non-stop rhetoric about "WHITE MAN BAD", from an author who is clearly borderline mentally ill.

********************

Inferno was easily one of the worst books I have ever read. It only contains a few paragraphs of useful information about epidemiology and virology, which is pretty terrible, in and of itself.
If I could rate it less than 1 star, I would.

[Robin · Rating 4 out of 5]

I've been itching to read a first hand account of the Ebola outbreak in Western Africa. Hearing Dr. Hatch in a CBC radio interview provided the gateway to Inferno. Some uncomfortable thoughts that I am now contending with that Hatch is insightful enough to point out: 1) Am I fascinated by diseases like Ebola and Henda because of their "otherness" and by this same token is it because of some internalized racisim and fear of the African "other"? 2) Am I merely playing disease tourist through books and news articles. And how is that serving the greater good?
Hatch, struggles with a lot of internal angst. Not surprisingly. An accounting of the state of public health from a Liberian's pov would be incredible, but of course, what major publisher would take a chance on that - more is the shame.

[Billie · Rating 3 out of 5]

This up-close and personal account of the 2014 Ebola outbreak provides intriguing new (to me) information about the pathology of the disease and the ways in which it affects even those whom it doesn't infect. Dr. Hatch's occasional injections of humor, however, weren't enough to keep the book from dragging, at times, and there were too many people introduced for this reader to feel connected to any of them.

[David Corleto-Bales · Rating 4 out of 5]

Shattering partial memoir of an American doctor's experiences after he volunteered to aid Liberia in the Ebola outbreak of 2014; good background on Liberia's history and contemporary problems of poverty and societal breakdown in the aftermath of years of civil war and disturbance and the cultural difficulties regarding funerary arrangements that led to the epidemic spreading from Guinea to Liberia and Sierra Leone. The courage of the doctors, nurses and medical workers from Liberia and many other countries is astounding, all battling the disease where it was never thought to exist, (previous outbreaks had been in the Congo.) Disturbing reading, not for the faint-hearted.

[Tyler Mower · Rating 4 out of 5]

I give this four stars because of the human element described about the lives impacted by the 2014 outbreak of Ebola in Liberia. There were a few stories where I cried. The level of stress, worry, uncertainty, and sorrow experienced by some of the families & individuals described in the book touched my heart to a depth that made me want to embrace them. I wanted to reach out across time and space to their moments of despair and give hope, comfort, kindness, and a shoulder to cry on.

I believe when we are moved to a state of empathy - whether through literature, film, song, meditation, or conversation - we gain a broader perspective, a deeper ability to be compassionate, and a reality check that individually we are not the center of the universe. The trick is being able to take that state of empathy and direct it to the people who are around us: family, friends, neighbors, strangers we come across every day. I am terrible at doing that, but hope it is a skill I can improve.

Which is why I enjoyed seeing Steven's desire to take leave from his safe work and go help in a corner of the world that most people wanted to avoid. What better way to learn to care for others than to jump and give help where help is needed, using our unique skills to do so.

As I began reading the book, my thrill of entertainment was in full swing I was hoping for the gore, action, and chaos my mind had envisioned about an outbreak of Ebola. I am thankful that instead I got a reality check. This is not some creative stunt, or click-bait article, this is real life. This is deadly. This is world shattering for millions of people. Life will never be the same. This is exhausting. This is scary. This splits families, villages, and nations apart. Sorrow, pain, suffering, anguish, hope, recovery, death, determination, futility, joy, embracing, rebuilding.

That - human experience - was for me, the most important message of the book. However, that theme, seemed to be overshadowed by political agendas, which I'm hardly ever a fan of. Even if those represent a small percentage of the total word count, it's the "negative review" that sticks in my mind despite all the positive aspects.

I did like reading the parts where Steven expounded his emotions, thoughts, and questions he faced during his ordeal in Liberia, the medical support given, the logistics & organizational aspects of providing aid, mentally preparing for and the process of protecting oneself from the virus, the schedule and procedure of caring for patients, and dealing with a constant flow of death.

However, after reading a book I ask myself, "Is this a book I keep in my library?" My answer to that question was, this book can be removed from my shelf. The reason being, the themes I thought distracted from the most important message dominated the narrative and as such makes it a book I would not revisit.

[Terri Fish · Rating 3 out of 5]

Very interesting story from the front lines of the Ebola crisis and fight in Liberia in 2013-2015.

Although I did enjoy much of the book, I did not enjoy Dr. Hatch's at-times arrogant tone nor did I enjoy his denigration of those with opposing political, and other, points of view. I do greatly admire Dr. Hatch for his service and sacrifice; I would prefer, however, that he leave the divisive commentary out.

Even though I was at times offended, I would still read another of his works because I do think that he has valuable things to say.

So, the bottom line....Would I recommend this book? Yes, absolutely. Even when someone's viewpoint is different than mine I can usually find good parts, many times many good parts, to apprehend for improving my mind and my character. This book fits the bill.

[Beth · Rating 2 out of 5]

I really wanted to like this book. The topic is fascinating and timely. Sadly, I couldn't get past page eighty. The author was totally dry. I get he's a physician by trade, and not an author, but what an experience he had. He owes it to the reader to be more engaging. Lengthy background on Liberia and its civil war, along with detailed geographical descriptions isn't working. By the time I gave up, he had just gotten to Africa and was explaining the process of gowning up in the ETU. That was the other problem, constant use of acronyms that the average person wouldn't know, with the exception of "CDC."

[Jeff Wong · Rating 4 out of 5]

This was a very sobering book about the 2013-2014 Ebola outbreak in West Africa. Most of the stories and the horror of the treatment centers and the death in those Africa nations were documented in other medical journal articles published in the medical literature. The author is quite successful in adding the human dimension that is often lacking in more of the "scientific prose". He also outlined the incredible challenge for him and others who have completed their "tour of duty" and are trying to become re-integrated into the life they were once in before embarking upon this mission.

[Satchmo · Rating 4 out of 5]

I won this book off Goodread's First Reads Giveaways. I don't even like nonfiction, and I really liked this book. I learned quite a bit about the 2014 Ebola outbreak in Liberia. Very fascinating to get a first hand account from this brave doctor.

[Kathleen · Rating 4 out of 5]

Not gonna lie - I struggled with this book. It brought up a lot of feelings from my evacuation from Guinea. Especially the descriptions of how he felt when he was back in the states after his first stint in the ETU. Overall - It isn't the most well written book that I've ever read but that almost made it more relatable. It reads more like your friend telling you about their experiences in Liberia. I thought it was a great balance between describing the medical and scientific realities of being in the hot zone with the talking about the people and culture of Liberia. Seeing as those are two things I'm passionate about - I clearly enjoyed the book.

[sierra plowman 123 · Rating 3 out of 5]

mother says I am not allowed to go to Liberia and work in a level 4 hot zone

:'(

[Nic · Rating 4 out of 5]

Steven Hatch points out a few similarities between his book (mostly, chapter names) and Dante's Inferno. I have not read Dante's Inferno but it's high time.

But doctors' stories are our special means by which we can say to the world that the lives of our patients matter and the practice of medicine is essential to humanity. 3

Hatch has refreshingly written about Ebola without resorting to sensationalizing facts and presents well his work among patients in the African country of Liberia in Bong County, Monrovia, in as matter of fact way as possible. He was simply treating patients with a virus, as he's trained to do, as an infectious disease specialist, albeit, with extra, tightly regulated precautions in place to treat this particular virus. I cannot imagine working through the conditions presented here, under layers of PPE (personal protective equipment), basking under the heat of the Liberian sun. I appreciate his realistic descriptions of the nitty gritty of the daily grind in the work of an ETU (Ebola Treatment Unit) and the routine risks the staff willingly take. This is the sort of information I find fascinating. And this:

Bleeding may be the manifestation that has earned Ebola its fearsome reputation, but after working in the ETU for weeks, we noticed two different signs that were more likely to occur in patients and held great predictive power. Just to see a patient with either of these symptoms was enough to know their chances for survival were slim. The first was hiccups. We had long conversations about what this meant and why it was happening, but most patients who showed up hiccupping were not going to walk out the ETU front door.
The second sign was delirium. This happened usually right before the end. I saw maybe ten patients with delirium, and they all died. 191

For most of Hatch's time spent at the ETU he worked the day shift. However, towards the end of his tour he spent a little more than a week working the night shift. I enjoyed this section mostly because is was a reprieve for Hatch from the heat and intensity of the day to the coolness and calmer atmosphere (patients sleeping) of the evenings. Here, Hatch shows that no task is beneath him and I love this view of the humanity of his work. ...I think one of my proudest accomplishments in my career thus far was the night I held a child who needed an IV line, cleaned up the shit of a confused man at the end of his life, handed out medications, and just tried to comfort my patients as best I could. One of my finest moments as a doctor was the night I was Kelly Suter's nurse's aide. 188

The book did leave me with a few unanswered questions. It is most certainly the case that Hatch did not have many of the answers, if any, to these questions at the time of the writing.

It took some time for the Ebola outbreak to happen. It appeared here and there in fits and starts before becoming the large outbreak. Was it the burning of the tree, which released the bats into the environment, which caused the larger outbreak? According to Michelle Roberts, a reporter working for the BBC, the villagers said that a "rain of bats" then issued from the tree. And the screaming flew back across the sky. But by then, the epidemic was raging on the ground. 26

What made the mortality rate fall from 70% when the ETUs first opened to 50%? Was it simply the serving of bananas to counter the devastating effects of massive loss of body fluids or the daily routine care? Is there any work on a vaccine? Do those who survive have some sort of partial immunity to other filoviruses? Would survivors be more resilient to another strain if exposed?

When Hatch returns Stateside the writing felt a little rambly possibly reflecting his own readjustment to life back in the States. The closing chapters raise sobering points on the value of routine vaccinations and viral lethality.
And because the entire medical infrastructure had been shut down for the better part of a year in Guinea, Sierra Leone, and Liberia, with hospitals shuttered and clinics closed, the practice of routine vaccination had vanished....the upper range of their estimates was that as many as sixteen thousand children could die from measles as a direct consequence of Ebola's effect on health infrastructure. At that point in time, the official tally of people dead from Ebola infections was just over ten thousand...the fact that the estimated measles mortality was even in the same range served as an object lesson in what constitutes a virus's lethality. 256

[Thelma Fountain · Rating 3 out of 5]

I was given this book in a goodreads giveaway. This was a very informative read. I learned so much about infectious disease, West Africa, the current political situation in the region and most importantly the human experience during a devastating outbreak of deadly virus. This book put a human story to the numbers. Readers learned of families affected, patients with names their lives became part of the story as it always should have been, Doctors and nurses who were nothing less than hero's That is a very important contribution to all the news reports that came out of Africa during this time. This is an important book.

[Katie · Rating 4 out of 5]

Y'all. This was good. I learned a lot about infections and infectious diseases, but also, I have some idea what happened politically in Liberia in the last decade. So it was a good read for me.
-k

[Nancy · Rating 3 out of 5]

This is a book about the Ebola crisis in Liberia that occurred around 2014, causing a lot of panic and worry the world over. It is written by a physician, an Infectious Diseases specialist who stunned his bosses by volunteering to go over to Liberia to care for the sick and dying in an Ebola treatment center. Most of the book is about his experiences in getting involved with the group of volunteer medical professionals, undergoing training, and then going to Liberia and working with the sick. This part was the reason why I read this book and I found it to be very interesting. It is something that I have thought of doing but don't think that I actually could go overseas and do it myself. The other parts of the book I found to be less interesting and even somewhat boring and preachy. He writes at some length about the evolution of Liberia as a country, their civil wars and development. This would have been more interesting had it been shorter or more condensed or even left out altogether. Another issue I had with this book is that the author writes about talking to his boss about joining the volunteer program, and writes about his colleagues, but doesn't write about having a wife or children. I was over 200 pages into the book before I realized that the author had never once mentioned having a family, and so I just supposed he was a single man without children. So you can probably imagine my surprise when... finally (?)... his wife and children surface almost more as an afterthought. I feel like perhaps someone could have proofed this book a teensy bit better to maybe add in the family before the good doctor left to go to another continent for six weeks, and during his stay there as well. For these reasons, the almost-omission of the family and the preaching about the history of Liberia, I have to give this book three stars. There is some colorful language, death, some violence, and one or two references to sex in this book.

[Nan · Rating 5 out of 5]

I am not even halfway through listening to Inferno and am so enthralled I was late to work this AM. Hatch has written a book not just about Ebola but about the politics of outbreaks, how the media contributes to the fear, the courage of nurses and doctors and anyone working in a hot zone. I highly recommend! (And he reads it---a plus as far as I am concerned)

UPDATE: Just finished listening this morning and all I can say is...listen to this book! I am so glad I chose to listen rather than read as hearing Hatch read what he lived adds to the depth of the story. It may sound odd to say I enjoyed listening to a book about a deadly outbreak, but it was (as I said above) enthralling. I highly recommend this for anyone who is a closet disaster junkie, a lover of medical memoirs, or just interested in the experiences of someone working in a hot zone.

My only issue with the book is Hatch's absolute refusal to admit that he may possibly have had PTSD upon his initial return from Liberia. His assertion is that to diagnose him with that particular cluster of mental health symptoms is wrong because it minimizes the experience of actual OIF/OEF veterans. To me, speaking as a psychotherapist, that particular stance serves to minimize the experiences of civilians and others who has been diagnosed with PTSD: survivors of intimate partner violence, sexual abuse, traumatic accidents, people who work in disaster zones such as Haiti, New Orleans or tornado/hurricane aftermath. While he may well have been correct in saying he did not have PTSD (he seems to be naturally pessimistic and a bit dark) that particular passage rankled me a bit.

Bottom line: If you can, listen to this book. If you prefer reading, read this book. I cannot recommend it enough. (And then review it so I can see if others are as enthralled as I was!)

Bottom line read it! The

[Stefanie Robinson · Rating 4 out of 5]

Doctor Steven Hatch traveled to Libera in 2013 to work in a hospital there as an infectious disease specialist. The Ebola outbreak in Libera was reported to be the largest on record. It ransacked the African continent, killing thousands, and killing others in various countries around the world. (Due to plane travel.) Unfortunately, Libera had a very poor health system at the time, which caused people to be hit especially hard by this outbreak. The author speaks in great detail about the disease and the effects, the death toll, and the difficulty of working in that situation on limited supplies and manpower. I cannot imagine doing this type of work and being in fear of contracting such a thing or dying from it. I cannot imagine seeing my friends and coworkers suffering from this infection and also still trying to work.

I have never personally needed an infectious disease specialist, but I am certainly glad that we have them in the world for those who find themselves in need of one. I would not want that job! We have all experienced this Coronavirus Pandemic, which is bad enough, but I cannot imagine a disease where I bleed from my eyeballs. I read Hot Zone about ebola and it was very educational and horrifying, and this book was the same. I think it is very important to understand that there are diseases like this out there, how they spread, and how to keep from getting them if at all possible. I enjoyed this book, which I assumed that I would, as I like all types of morbid and medical things.

[Todd G · Rating 3 out of 5]

One thing I HATE about non-fiction that is not really supposed to be about politics is when the author throws in politics. That’s such a huge turn off to me.

I was enthralled with the book. I appreciated the pain and suffering, what the people of Liberia were going through as well as what the doctors sent there to help had the deal with...all as narrated by Hatch. I saw, but was able to look past, the occasional focus on Hatch himself (a necessity for this story) and still suck it all in. And then....Hatch blew it. And REALLY blew it around page 180. Politics did have a place but really only in how the government of Liberia was truly ill-prepared, making poor or no decisions on containment. Hatch’s comments, however, on his personal political views were entirely unnecessary. I don’t feel this way only because I have different views but Hatch’s personal politics lent nothing to the story. I mean, if you want us to FEEL for the people who are suffering then by all means, do what you need to do. Don’t muddy the waters though with crap thy doesn’t mean anything.

Anyways...3 stars for what he did accomplish...but a long long way from 5 stars

[Tara Phillips · Rating 5 out of 5]

Wow, I couldn’t put this down. Much like Sheri Fink, Inferno makes a great contribution to the medical journalism genre. Dr. Hatch’s harrowing account reads like a retrospective diary on the frontlines of the Ebola crisis - as it truly was, not as it had been reported in US news media. He draws many interesting conclusions in hindsight but makes a point of balancing them with careful consideration of the emotional landscape (individual and social on both the Liberian and State-side) from fear, anxiety, and panic, to disbelief, anger, guilt, and grief. He does an excellent job of putting this recent historical trauma into context politically and culturally, all the while keeping it real. In other words, the dry facts are well woven into the horror and excitement of personal experience to inform and entertain through the lens of your classic Liberal Jewish professor. As a professional clinician turned global heath expert slash amateur anthropologist (as I aspire to be myself) he definitely makes an outstanding first impression that inspires and impels to action. If UMass allowed him to teach a course in writing for the international aid volunteer, I’d be the first to enroll!

[Sunkaru · Rating 4 out of 5]

I approached this book with the optics of an African used to reading biased depictions of Africa from western authors and I must say that this book brings to readers, a balanced description of the challenges confronting Africa in the context of one of the most deadly epidemics in recent history.

In the second chapter the author reflects on the circumstances that lead to his decision to forego a life of comfort to go to Liberia. The book while describing a tragic narrative of events, is punctuated by funny moments reflective of the author's melodramatic personality and humor.

The book left me wondering; in the aftermath of this last epidemic, whether lessons have been learned from this experience that will drive the both African governments and the international community to build long term sustainable partnerships that will strengthen the health systems outside of the "glitz" of an epidemic allowing the next epidemic to be curtailed by local staff (as was the case in Nigeria) as opposed to another influx of western humanitarian saviors?

[Patricia K Ogden · Rating 3 out of 5]

This was a good book giving a good background to the situation in Liberia that led up to the outbreak, explaining the political/social situation that made the outbreak so dire, and then giving an interesting account of treating patients in Liberia. It was well-written with some good humor in the book to relieve the day-to-day tension. Dr. Hatch does not have an exaggerated opinion of himself and gives credit to all the good people working in a difficult situation.

Dr. Hatch does have some obvious political views that creep into the narrative, but his opinions are sound and based on what he experienced and saw so I didn't have any problems with that at all. It was good to read the opinions of someone who has first-hand knowledge of infectious diseases on a variety of topics such as immunization, quarantine, etc.

I would recommend this book to be read. The only reason I didn't give it a five-star rating is that if you are looking for solely a medical journal, this is not it. There is history and politics in the book which I enjoy, but others may not.

[Susan Olesen · Rating 4 out of 5]

I've read quite a few of the Ebola stories, but this one takes a different angle with the Western African outbreak in Liberia and Sierra Leone. Hatch goes as a temp volunteer, fighting against all kinds of bureaucratic BS just to volunteer as an experienced doctor. Hatch covers the humanitarian angle, discussing WHY it's so hard to control Ebola outbreaks, from cultural norms (touching the dead), poverty norms (having to carry a sick person 8 hours by canoe, car, and foot just to get to medical care), political horrors (Liberia had endured a decades-long brutal civil war, cannabalism inclusive, and medical facilities and infrastructure were leveled), and the agency ones (few people received IVs, because it wasn't possible when wearing heavy PPE misted with sweat, and one pale light bulb to light an entire ward). Even so, what was once a 90%-fatal disease was at no more than a 50% fatality rate, mostly from extreme fluid loss (people could lose almost 3 gallons of body fluids a day. Yes, Gallons. Remember that next colon prep.) Hatch covers the Liberian history that made the outbreak worse, and the people who both lived and died inside. He also covers a lot of the dirty politics on the American side, which made returning to his job that much more difficult.

Hatch is very down to Earth, no high science here, though he's a brilliant doctor. The book reads well and is always interesting, though it takes more than 200 pages to finally achieve a Star Trek reference (it's amazing how many books have them). It was published just before the Covid epidemic, and I'm interested to know his thoughts on the disease and how it was handled.

Very good read.

[Melanie Krivdić · Rating 1 out of 5]

I was very disappointed in this book. I thought it would be about the outbreak in African, how it was handles, and maybe things we learned about the virus. it covered those things with politics and other pointless drivel added. this doctor states he works with infectious diseases; studies them, but claims he felt by going to Liberia he was never going to return, but would die of the virus. if he studied these viruses he would know that with proper ppe, transmission rates are very low. But he is the expert, so death it is. or wasn't since he wrote this book of tripe with some information about the virus. this was more like a diary of his private though than an informational work on a virus we are still learning about. summing it up, he thought he was going to die, Africa is in the way it is because of imperialism, Republicans as terrible, he cries a lot, people were scared of him when he returned and he was upset about his, he needed to return again and again to help this poor country. oh and we learned some new info inspite of panic by people who get news from media. and parts of Africa are very corrupt due to imperialism. and Republicans are bad. I just saved you from having to slog though it. Had he left his personal feelings about politics and his crying over leaving it would have been better. just write the facts. and leave out the commentary on things like Africans watching movies like the Lion King or American elections. if you are looking for a book about Ebola look elsewhere.

[Senator · Rating 3 out of 5]

I have to command Hatch on what he was trying to accomplish with "Inferno." I freely admit that the ebola virus and its many strains are my lifelong obsession, so reading anything about it -- especially the most recent outbreak -- has me wide eyed and enthralled. In fact, Inferno is NOT about ebola. It's about the effect it had on the countries and families during the 2015 outbreak. After a brief moment of disappointment I read on, newly invigorated and excited to read another angle of how the virus affects the lives it doesn't claim.

I can't put my finger on if it's because Hatch is a doctor and that's why the book is so dry or what, but "Inferno" turned into a decent, but not all that enthralling read. Abrupt halts in stories about the victims, then needing to repeat some of the story when he finally circles back to it... well, it got old really fast. This is a book, not a lecture. Pick it up to have in your brain pocket if you like history or medicine, but I suggest reading this with a heavy dose of patience.

[Elizabeth Hayhoe · Rating 4 out of 5]

He is a courageous man and a good writer. I learned a lot about Ebola and I appreciated his descriptions of working in a medical unit wearing the garb and perspiring so much he could empty his shoes of sweat after his shift.
The book was too long and he could have cut out all his opinions about politics in the states.
After saying the book was too long I think I would have liked him to talk about his personal life a lot more, at first I thought he was unmarried and lived with his parents, then I thought he was divorced and left his children with a nanny for months at a time? Anyway turns out he is married and I believe he has two daughters. Since none of us live in a vacuum it would have been a better book if he had described his work life and home life at the beginning, I still wonder what his wife thought when he told her he was taking his vacation time and going to Africa to treat the Ebola epidemic...
I listened to the audio version. It was good!

[Casey · Rating 4 out of 5]

A fairly interesting audiobook by an American doctor treating Ebola in Liberia for several years, starting in 2013. The book reported his efforts to treat patients while maintaining safety, a difficult task with all the layers of PPE. And we got to know the local and foreign health workers and many of the patients -- those who survived and those who did not.

The book was published in 2017 and, I believe, another outbreak has already occurred. Perhaps a smaller outbreak. But small can easily spread.

Recommended, especially since the next Ebola outbreak could turn global at any time, considering our constant world travel.