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Fevers, Feuds, and Diamonds: Ebola and the Ravages of History
In 2014, Sierra Leone, Liberia, and Guinea suffered the worst epidemic of Ebola in history. The brutal virus spread rapidly through a clinical desert, where basic health-care facilities were few and far between. Causing severe loss of life and economic disruption, the Ebola crisis was a major tragedy of modern medicine. But why did it happen, and what can we learn from it?Paul Farmer, the internationally renowned doctor and anthropologist, experienced the Ebola outbreak firsthand?Partners in Health, the organization he founded, was among the international responders. In Fevers, Feuds, and Diamonds, he offers the first substantive account of this frightening, fast-moving episode and its implications. In vibrant prose, he tells the harrowing stories of Ebola victims while showing why the medical response was slow and insufficient. Rebutting misleading claims about the origins of Ebola and why it spread so rapidly, he traces West Africa’s chronic health failures back to centuries of exploitation and injustice. Under formal colonial rule, disease containment was a priority but care was not―and the region’s health-care woes worsened, with devastating consequences that Farmer traces up to the present.
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First published November 17, 2020
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About the author
Paul Farmer
59 books665 followersPaul Farmer was an American medical anthropologist and physician. He was Professor of Medical Anthropology at Harvard Medical School and Founding Director of Partners In Health. Among his books are Infections and Inequalities: The Modern Plagues (1999), The Uses of Haiti (1994), and AIDS and Accusation: Haiti and the Geography of Blame (1992). Farmer was the recipient of numerous awards, including a MacArthur Foundation "genius" award and the Margaret Mead Award for his contributions to public anthropology.
Farmer was born in the U.S.A. in 1959. He married Didi Bertrand Farmer in 1996 and they had three children. He died in Rwanda in 2022, at the age of 62.
Farmer was born in the U.S.A. in 1959. He married Didi Bertrand Farmer in 1996 and they had three children. He died in Rwanda in 2022, at the age of 62.
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Displaying 1 - 30 of 224 reviews
March 11, 2021
I have mixed feelings about this book.
Importantly, for those of us who remember Paul Farmer as the protagonist of Mountains beyond Mountains - we need to remember that Tracy Kidder wrote that wonderful inspiring book. This book is written by Paul Farmer.
1. The first chapters are terrific, on the ground Ebola, a situation with grave misunderstandings all around. With huge takeaways for the global Sars-CoV pandemic.
2. The middle of the book is generally violent and sad history of the region. First, Farmer is not a historian, which he readily admits, and he does a shaky, not very professional review of the endless conflicts in the region. It's the same old heartrending taking advantage of people with a post-colonial, post- slavery angle - people being all people - and the poorest and least privileged bearing the awfulness of it all. What makes this conflict different from conflict anywhere? Farmer's rendition just ground and ground, and was ineffective. And although he is correct that one has to understand history to understand how the Ebola epic played out in 2014-15 in Sierra Leone - it just seemed misplaced here. And it was boring (and I like history).
3. The latter end of the book is just Farmer yelling at the reader. Repetitively yelling. Yelling some more. Also patting himself on the back, and his organization, while spewing vitriol at other NGOs, mostly Medecins sans Frontieres (Doctors without Borders). They don't get a chance to refute him. Maybe much of what Farmer says is true, but it doesn't seem helpful.
4. The Epilogue material was added in 2020 as Sars-CoV had hit the US. The author makes some obvious comments - but while he was railing for most of the book about spending too much time trying to confine Ebola (and not treat it), he is all of a sudden all about contact tracing in Boston. Sure, I know he can explain whatever, but he doesn't do it here, and it's irritating.
Finally - overuse of "oubliette" and "medical desert" just got irritating. Also, should be said that I listened to this book, and someone could have told the narrator how to pronounce a few things that are clinically relevant (like sequelae - which is not seQWEElie!), i mean, c'mon.
Importantly, for those of us who remember Paul Farmer as the protagonist of Mountains beyond Mountains - we need to remember that Tracy Kidder wrote that wonderful inspiring book. This book is written by Paul Farmer.
1. The first chapters are terrific, on the ground Ebola, a situation with grave misunderstandings all around. With huge takeaways for the global Sars-CoV pandemic.
2. The middle of the book is generally violent and sad history of the region. First, Farmer is not a historian, which he readily admits, and he does a shaky, not very professional review of the endless conflicts in the region. It's the same old heartrending taking advantage of people with a post-colonial, post- slavery angle - people being all people - and the poorest and least privileged bearing the awfulness of it all. What makes this conflict different from conflict anywhere? Farmer's rendition just ground and ground, and was ineffective. And although he is correct that one has to understand history to understand how the Ebola epic played out in 2014-15 in Sierra Leone - it just seemed misplaced here. And it was boring (and I like history).
3. The latter end of the book is just Farmer yelling at the reader. Repetitively yelling. Yelling some more. Also patting himself on the back, and his organization, while spewing vitriol at other NGOs, mostly Medecins sans Frontieres (Doctors without Borders). They don't get a chance to refute him. Maybe much of what Farmer says is true, but it doesn't seem helpful.
4. The Epilogue material was added in 2020 as Sars-CoV had hit the US. The author makes some obvious comments - but while he was railing for most of the book about spending too much time trying to confine Ebola (and not treat it), he is all of a sudden all about contact tracing in Boston. Sure, I know he can explain whatever, but he doesn't do it here, and it's irritating.
Finally - overuse of "oubliette" and "medical desert" just got irritating. Also, should be said that I listened to this book, and someone could have told the narrator how to pronounce a few things that are clinically relevant (like sequelae - which is not seQWEElie!), i mean, c'mon.
November 17, 2020
Thank you to the publisher for a copy of
This book via netgalley!
Nothing is scarier than real life. A first hand account of the devastating human cost of the Ebola pandemic Recounted by the mentee of Dr Fauci. A plea for more to be done in the current Covid-19 pandemic. And a dire warning that Ebola isn’t completely extinct. Will our past help deal with our current, and also enable us to prevent a future one.. Medical .pandemic that is. if not, individuals will continue to struggle to breath...
This book via netgalley!
Nothing is scarier than real life. A first hand account of the devastating human cost of the Ebola pandemic Recounted by the mentee of Dr Fauci. A plea for more to be done in the current Covid-19 pandemic. And a dire warning that Ebola isn’t completely extinct. Will our past help deal with our current, and also enable us to prevent a future one.. Medical .pandemic that is. if not, individuals will continue to struggle to breath...
This entire review has been hidden because of spoilers.
July 29, 2020
Just when I thought I couldn't respect and look up to Paul Farmer any more, he floors me with this. So much more than just a first hand account of the Ebola outbreaks, he dives deep into the social, economic, and militaristic history of the region. It's rare that authors provide such a wide scope all while keeping in mind the vastly unknown, unnamed, poor , neglected, and abused at the center of conflict and contagion. His passion and compassion are every present. A must read as the world reels from COVID-19.
Thank you to Netgalley for providing me this copy for my honest review.
Thank you to Netgalley for providing me this copy for my honest review.
November 15, 2020
This is such a timely book as we are afflicted by the global COVID-19 pandemic and have the crucial post-COVID-19 recovery ahead of us. Anyone familiar with Professor Farmer’s work would appreciate his humble and profoundly holistic approach to health, with rigorous clinical guidance. This is yet another book that is much recommended for healthcare professionals and policy makers alike.
I would put two major values on this book, 1) Professor Farmer not only gives a glimpse into the challenges of clinical management of Ebola outbreaks, but goes into the underlying details about the anthropological aspects that still play a major role in mitigating such healthcare crises in many parts of the developing world; and 2) the similar challenges, issues, disparities that would be crucial to consider as we globally embark in the journey of a post-COVID-19 recovery.
This is definitely a scholarly literature and although written for a broader audience, I think it can have a larger impact for readers engaged in the healthcare sector. I highly recommend students and early career researchers to read this book as well as other great books from Professor Farmer.
Disclaimer: I was provided with an advance reader copy for review.
I would put two major values on this book, 1) Professor Farmer not only gives a glimpse into the challenges of clinical management of Ebola outbreaks, but goes into the underlying details about the anthropological aspects that still play a major role in mitigating such healthcare crises in many parts of the developing world; and 2) the similar challenges, issues, disparities that would be crucial to consider as we globally embark in the journey of a post-COVID-19 recovery.
This is definitely a scholarly literature and although written for a broader audience, I think it can have a larger impact for readers engaged in the healthcare sector. I highly recommend students and early career researchers to read this book as well as other great books from Professor Farmer.
Disclaimer: I was provided with an advance reader copy for review.
November 1, 2020
There is a story in my family about my sister asking Mom a question while she was fixing dinner. Mom told her to go ask our Dad. “I don’t want to know that much,” responded my sister.
I fear many readers will have this reaction to Fevers, Feuds and Diamonds by Paul Farmer. Only the nerdiest of global health geeks (like me) will stick with it to the end. The fact is, global health is complicated, and it is complex. What happens when the focus of an epidemic is containment? What if care were given priority over containment? How does history impact health, both in the short term and the long term? What is the impact of disease on an individual? A family? A rural village? An urban center? This is one of the few books that tries to look at an epidemic from so many different perspectives. It can feel a mile wide and an inch deep.
Today the world is focused on Covid-19, and there is a closing section in this book on it. I would have liked to hear more from Dr. Farmer about lessons from Ebola that we should be applying to managing the novel corona virus, even though that advice would likely fall on deaf ears in the current administration.
I fear many readers will have this reaction to Fevers, Feuds and Diamonds by Paul Farmer. Only the nerdiest of global health geeks (like me) will stick with it to the end. The fact is, global health is complicated, and it is complex. What happens when the focus of an epidemic is containment? What if care were given priority over containment? How does history impact health, both in the short term and the long term? What is the impact of disease on an individual? A family? A rural village? An urban center? This is one of the few books that tries to look at an epidemic from so many different perspectives. It can feel a mile wide and an inch deep.
Today the world is focused on Covid-19, and there is a closing section in this book on it. I would have liked to hear more from Dr. Farmer about lessons from Ebola that we should be applying to managing the novel corona virus, even though that advice would likely fall on deaf ears in the current administration.
May 31, 2021
After a big gap while I read for the BookTube Prize, I finally finished this one. First, I learned a ton. Second, this should probably have been two or more different books, as Farmer went in several directions that each deserved to be a separate work. As a result, this was far too long. And third, it seems that he wrote this at several different times, which means he repeats the same ideas and stories ad nauseum. If I had a dollar off the list price for every time he used the "medical desert" metaphor, or said "staff, stuff, space, and systems," he would owe me money.
Had this book been 300 pages instead of 500+, it would have been fascinating, but the repetition spilled over into tedium in its present form.
Had this book been 300 pages instead of 500+, it would have been fascinating, but the repetition spilled over into tedium in its present form.
November 10, 2020
Critical reading for 2020
This book about global health injustice is enlightening at this moment in time: the historical reckoning with slavery since 1619, the global movement for Black lives, and the unequal life-and-death impacts of this global coronavirus pandemic.
Reading this made me rethink my own complicity and benefits in our long-term global economic system, and what I owe as a result.
I think Bryan Stevenson just said it best: "Paul Farmer's devastating account of catastrophic disease and death created by unjust systems, structures, and abusive history is timely, urgent and terrifying. This moving and compelling book is a tragic but necessary journey guided by an extraordinary anthropologist, historian, teacher, writer, and doctor who has served the poor and disfavored for decades. He has much to teach us in these perilous times."
This book about global health injustice is enlightening at this moment in time: the historical reckoning with slavery since 1619, the global movement for Black lives, and the unequal life-and-death impacts of this global coronavirus pandemic.
Reading this made me rethink my own complicity and benefits in our long-term global economic system, and what I owe as a result.
I think Bryan Stevenson just said it best: "Paul Farmer's devastating account of catastrophic disease and death created by unjust systems, structures, and abusive history is timely, urgent and terrifying. This moving and compelling book is a tragic but necessary journey guided by an extraordinary anthropologist, historian, teacher, writer, and doctor who has served the poor and disfavored for decades. He has much to teach us in these perilous times."
December 17, 2020
5 stars for the writing on disease and healthcare in West Africa. 2 stars for the tedious and meandering micro-history. This book could have been more effective with tighter pacing and concise editing around the three major themes (disease, war and resource extraction).
September 21, 2024
I FINISHED THIS AFTER TWO YEARS!!! (I’ll do an actual reflection soon).
June 13, 2021
As so often, I wish I could give this book both a 5 (for the critical nature of some of its points) and a 1 (for the appallingly bad way it was edited (or failed to be edited) and was a difficult-to-follow, repetitive mess.
The key points are important, and appalling. Most importantly -- and Farmer never says it this way, for reasons I cannot fathom -- the germ theory of disease is wrong. More accurately, it is incomplete. Disease is *not* caused by germs, but by germs in a context. In this case, the fact that the region has been wracked for centuries by colonization, war, and ongoing strip mining of resources, have created a medical desert where disease could flourish.
Also -- Ebola is treatable. With basic modern medicine (IV fluids, primarily, or even oral rehydration solution, as well as basic palliative care like pain relief, much less antivirals and other support), the survival rate is over fifty percent. But colonial practices and assumptions have assumed it can't/shouldn't be treated, and that it should only be controlled. Which fails every time, because without treatment available, what possible incentive do people have to come to quarantine centers or comply with health regulations? Control has been prioritized over care, and research over treatment (481).
The idiocy of much public health communication, which we've seen so clearly during COVID, played out in Ebola as well -- at a time when the epidemic was raging through the close contact of caring for the ill and burying the dead, giant billboards told people to avoid eating bush meat. That might avoid the next zoonosis, but it wasn't doing a thing for that epidemic.
Farmer repeats over and over that what's needed to treat epidemics is a robust health system, which means space, stuff, staff, and systems. We've all seen how lack of any of these quickly causes huge failures of care (26).
He points out the practical reasons behind the purported "refusal to seek treatment from modern medicine" -- there was none available. Hotlines for ambulances and care went unanswered. People realized they were on their own -- as they always had been -- and they behaved that way to care for their loved ones (114). Saying that West Africans acted superstitiously or based on illogical religious beliefs is just one more way to oppress and infantilize them: "People don't want to put a body in the burial car. The authorities disappear the body, and you don't know where to, maybe a city far away. No one can recognize them behind their masks. It _is_ like witchcraft." (500)
Farmer says, "the entry of a virus into a human host is never merely a molecular event. As with all things human, inequality plays a noxious role." (471)
The fact that West Africa lacks the systems to deliver care is absurd and offensive -- they could be built, since apparently the sophisticated supply chain systems needed to mine diamonds and lithium have been able to be installed. Human beings can do whatever they want to. It's a matter of what those in power want to do (505).
The key points are important, and appalling. Most importantly -- and Farmer never says it this way, for reasons I cannot fathom -- the germ theory of disease is wrong. More accurately, it is incomplete. Disease is *not* caused by germs, but by germs in a context. In this case, the fact that the region has been wracked for centuries by colonization, war, and ongoing strip mining of resources, have created a medical desert where disease could flourish.
Also -- Ebola is treatable. With basic modern medicine (IV fluids, primarily, or even oral rehydration solution, as well as basic palliative care like pain relief, much less antivirals and other support), the survival rate is over fifty percent. But colonial practices and assumptions have assumed it can't/shouldn't be treated, and that it should only be controlled. Which fails every time, because without treatment available, what possible incentive do people have to come to quarantine centers or comply with health regulations? Control has been prioritized over care, and research over treatment (481).
The idiocy of much public health communication, which we've seen so clearly during COVID, played out in Ebola as well -- at a time when the epidemic was raging through the close contact of caring for the ill and burying the dead, giant billboards told people to avoid eating bush meat. That might avoid the next zoonosis, but it wasn't doing a thing for that epidemic.
Farmer repeats over and over that what's needed to treat epidemics is a robust health system, which means space, stuff, staff, and systems. We've all seen how lack of any of these quickly causes huge failures of care (26).
He points out the practical reasons behind the purported "refusal to seek treatment from modern medicine" -- there was none available. Hotlines for ambulances and care went unanswered. People realized they were on their own -- as they always had been -- and they behaved that way to care for their loved ones (114). Saying that West Africans acted superstitiously or based on illogical religious beliefs is just one more way to oppress and infantilize them: "People don't want to put a body in the burial car. The authorities disappear the body, and you don't know where to, maybe a city far away. No one can recognize them behind their masks. It _is_ like witchcraft." (500)
Farmer says, "the entry of a virus into a human host is never merely a molecular event. As with all things human, inequality plays a noxious role." (471)
The fact that West Africa lacks the systems to deliver care is absurd and offensive -- they could be built, since apparently the sophisticated supply chain systems needed to mine diamonds and lithium have been able to be installed. Human beings can do whatever they want to. It's a matter of what those in power want to do (505).
January 6, 2021
Very Paul Farmer: at least two books folded into one with several excellent and important ideas smothered within.
January 15, 2021
The subtitle of Paul Farmer's latest book, Ebola and the Ravages of History, hints at the two different but inextricably linked topics we as readers learn about over the next 700 pages, namely the Ebola pandemic that ravaged Upper East Africa (Sierra Leone, Liberia, and Guinea) and the historical and present-day cultural and economic factors that made such a pandemic unavoidable. Social medicine, which Paul Farmer has long been a strong advocate for, makes the case that healthcare can only be administered properly when it harmonizes with the culture and mindset of the sick on the receiving end. The botched domestic and international response to Ebola in Upper East Africa, in this context, is thereby revealed in all its clarity: an inability to deliver effective treatment there is ultimately rooted in the failed worldview of nations and businesses who see these countries as sources of materials, both raw and human. To give some examples:
-- A decision among international aid organizations was made early on that containment would be prioritized above all else, while funds could not be mustered for treating anyone that catches Ebola. Without having the resources to treat the sick, any aid workers that caught the virus needed to be medevacked to Europe or the States at considerable expense, far more than would have been required to provide basic necessities to village hospitals. Similar policies had been implemented in these countries over the last two centuries with extremely similar results.
-- Media outlets in the West openly speculated as to why locals would rather hide their sick in their homes and risk infection than report the ill to authorities. Historical context reminds us that white people have a troubling past of permanently taking away African bodies, while present day economic conditions that largely result from exploitative industries run by Americans and Europeans mean that the great majority of the population barely has enough to survive, let alone isolate alone for weeks on end.
-- Containment over care is seen not only in the disregard over mortality by high-ups in international organizations, but in the failure to provide necessary basic supplies for the treatment of long-term side effects of Ebola, including blindness and renal failure. History repeats quickly, as seen when the rush of aid inflowing to these countries following civil war in the 90s/early 2000s quickly dries up before long-term solutions to the obliterated medical system can be provided.
In addition to providing us with the tragic history needed to give context as to why Upper West Africa ended up as the scene of one of this century's deadliest pandemics, Fevers, Feuds, and Diamonds delivers heartfelt stories of people who have lived through a hundred lifetimes worth of pain and still manage to keep going, doctors and nurses who gave it their all to the bitter end, and patients learning to cope after the physical and mental trauma of being on the verge of death. I think it's in these stories that Farmer's writing comes with greatest effect, but everything else he writes in this tome adds potency to these stories, and we're left not wondering, but knowing there's a better way.
Consider donating to Partners in Health today.
-- A decision among international aid organizations was made early on that containment would be prioritized above all else, while funds could not be mustered for treating anyone that catches Ebola. Without having the resources to treat the sick, any aid workers that caught the virus needed to be medevacked to Europe or the States at considerable expense, far more than would have been required to provide basic necessities to village hospitals. Similar policies had been implemented in these countries over the last two centuries with extremely similar results.
-- Media outlets in the West openly speculated as to why locals would rather hide their sick in their homes and risk infection than report the ill to authorities. Historical context reminds us that white people have a troubling past of permanently taking away African bodies, while present day economic conditions that largely result from exploitative industries run by Americans and Europeans mean that the great majority of the population barely has enough to survive, let alone isolate alone for weeks on end.
-- Containment over care is seen not only in the disregard over mortality by high-ups in international organizations, but in the failure to provide necessary basic supplies for the treatment of long-term side effects of Ebola, including blindness and renal failure. History repeats quickly, as seen when the rush of aid inflowing to these countries following civil war in the 90s/early 2000s quickly dries up before long-term solutions to the obliterated medical system can be provided.
In addition to providing us with the tragic history needed to give context as to why Upper West Africa ended up as the scene of one of this century's deadliest pandemics, Fevers, Feuds, and Diamonds delivers heartfelt stories of people who have lived through a hundred lifetimes worth of pain and still manage to keep going, doctors and nurses who gave it their all to the bitter end, and patients learning to cope after the physical and mental trauma of being on the verge of death. I think it's in these stories that Farmer's writing comes with greatest effect, but everything else he writes in this tome adds potency to these stories, and we're left not wondering, but knowing there's a better way.
Consider donating to Partners in Health today.
November 22, 2020
A very wise, well written and timely book, not only because of the current pandemic. Paul Farmer is an exceptional man, and it's worth listening to what he has to say.
The book provides not only a fascinating description of the 2014 Ebola epidemic in West Africa but also answers to the question: "how the heck this happened". I think it's thanks to his anthropological background that he can describe the history of this turbulent region with such empathy and understanding. The only other medical author that I can compare him to is my favourite Atul Gawande. Highly recommended!
Thanks to the publisher, Farrar, Straus and Giroux, and NetGalley for an advanced copy of this book.
The book provides not only a fascinating description of the 2014 Ebola epidemic in West Africa but also answers to the question: "how the heck this happened". I think it's thanks to his anthropological background that he can describe the history of this turbulent region with such empathy and understanding. The only other medical author that I can compare him to is my favourite Atul Gawande. Highly recommended!
Thanks to the publisher, Farrar, Straus and Giroux, and NetGalley for an advanced copy of this book.
April 1, 2021
This book steadily progressed from stupendous to a slog. Its points about the control-over-care paradigm and the influence of slavery, racism, conflict, and greed on the progression of the Ebola epidemic in West Africa are critical. But the writing style, especially after the first section, is meandering and long-winded, and I had a hard time sustaining interest with each passing chapter. I'm still not sure what an oubliette is, despite the word being used once per page.
December 22, 2020
Fevers, Feuds, and Diamonds was my first foray into Dr. Paul Farmer since reading Mountains Beyond Mountains nine years ago. Dr. Farmer remains an absolute legend in my mind, yet this book went to show him as less superhuman than I imagined. Personally, I felt like Fevers, Feuds, and Diamonds could have benefitted from being about 20% shorter. While I especially enjoyed Dr. Farmer's descriptions of both the clinical and societal presentations of Ebola—as well as his vignettes of two victims afflicted thereby—it was evident that history is not his strength. Although I feel it important to understand the cacophony of factors that play into epidemics, I personally found it very difficult to keep track of all of the various time lines and places that were presented throughout, hence weakening the overall power of this book. Nonetheless, this was an enjoyable book that I would recommend to someone who has plenty of time on their hands to invest in topics that are too often overlooked
April 8, 2021
Important, powerful, honorable, thoughtful. Probably quite thorough, too, but it was dense in a way that could be confusing; I was very inspired and committed to read carefully and finish it but had to bolster myself each chapter.
I agree with other reviewers that editing (quite a lot?) would really honor the content and intent of this book for readers (it may be very clear to understand to Dr Farmer and colleagues) Editing such as: to address often-repeated ideas and phrases (the same thing again and again dilutes message); to add more maps and charts to make ideas more clearly understood; perhaps even adding subheadings for chapters to draw the themes being addressed, contrasts being made: and perhaps a way to better highlight the West African heroes of the story (their own chapters?).
If not made shorter in length, than an actual table of contents for each separate part would be helpful.
I agree with other reviewers that editing (quite a lot?) would really honor the content and intent of this book for readers (it may be very clear to understand to Dr Farmer and colleagues) Editing such as: to address often-repeated ideas and phrases (the same thing again and again dilutes message); to add more maps and charts to make ideas more clearly understood; perhaps even adding subheadings for chapters to draw the themes being addressed, contrasts being made: and perhaps a way to better highlight the West African heroes of the story (their own chapters?).
If not made shorter in length, than an actual table of contents for each separate part would be helpful.
February 20, 2021
Very informative book, also very long (25 audio pieces!) and dry. It’s important stuff to know: feuds and diamonds (and feuds about diamonds) caused a poor health system in Sierra Leone and Liberia, which means basic diseases are extremely difficult to impossible to treat.
It’s not different strains of Ebola that killed people, it’s lack of access to very basic health care. That’s very sad, and why I support PIH.
But, as a narrative it was long and dry and as an audiobook I often found myself drifting in and out and not paying strict attention at all times, and I don’t feel I missed much. I considered abandoning it but pushed through because I wanted the final takeaways, and on that it did at least deliver.
It’s not different strains of Ebola that killed people, it’s lack of access to very basic health care. That’s very sad, and why I support PIH.
But, as a narrative it was long and dry and as an audiobook I often found myself drifting in and out and not paying strict attention at all times, and I don’t feel I missed much. I considered abandoning it but pushed through because I wanted the final takeaways, and on that it did at least deliver.
March 31, 2024
This book isn't really about Ebola and I didn't read it for any information on the disease. Paul Farmer used the disease, its 2014 epidemic, and the health care system that barely existed in western Africa at the time to emphatically show how the legacy of 200 years of colonization is still alive today. The writing may not be perfect, but I highly recommend the book for anyone interested in the region and it's extractive past. Even if you have minimal interest in epidemiology.
March 2, 2021
I am a fan of books about medicine and epidemiology, but this very long book bogged down in the middle for me. The first part, about the Ebola epidemic in Sierra Leone, Guinea, and Liberia in 2014 and thereabouts, was fine. The last part, returning to the epidemic(s) and the author's central premise (more about that in a minute) was great. In the middle part of the book, however, the author gives a detailed history of this part of West Africa, from slavery through colonial times, through the ravages of extractive forces, into the present. These are important topics, but the author doesn't give the reader enough dates to hang the information on. So we'll read about something awful that sounds like it should have happened back in the ignorance and horrors of the colonial era and then there's a clue--even worse, it happened in supposedly enlightened 2007, or the like. I just kept getting lost in the weeds and couldn't keep track of when and where things were happening, and it became a chore to read until the book got past all this and moved on to the final section. Maps, charts, and timelines would have helped.
That said, this is an important book. The author's central premise (told you we'd get back to it) is that global public health workers and others trying to deal with epidemics, from cholera to Lassa fever to Ebola and all tragic points in between, have prioritized (in Africa) containment over care. This means that the major efforts of (mostly white) people trying to help (mostly Black) people suffering from terrible diseases have been directed at keeping the diseases from escaping into Europe or the United States, rather than taking care of the people who are sick and dying as well as trying to contain the outbreak. So the public health people (in older times) would swoop in, tell people that they could no longer take care of people who were sick or bury their dead (because the disease might spread--would you leave your loved one to die without any care?); when people didn't obey these public health orders, the sanitaires would arrest them or burn down their villages, creating internal refugees who would spread the disease anyway, or suffer a lot in other ways.
Another aggravating factor is that Europeans and Americans have been trying to extract from this and other parts of Africa whatever resources were there--people, timber, rubber, diamonds--without giving back to the people of the countries (except sometimes corrupt officials) any of the wealth derived from their resources, and so the people were extremely poor, working under terrible conditions in the extractive industries, and getting caught up in or displaced by wars fought over the extracted resources. Any medical personnel who might have helped with the resulting problems, such as disease outbreaks or even everyday care for childbirth or minor injuries, were fleeing elsewhere. The area is a medical and clinical desert.
When Ebola was noticed, the world's disaster medicine specialists swooped in--and thank heaven they did--and tried to contain the disease, but there were few if any people trying to shore up the countries' failing health infrastructures or understand anything about the people who did not want to take public health orders from those who seemed to care nothing at all about them except as vectors of disease. This is a failure at the policy level, and not a failure of individual caregivers. The author profiles many people, especially healthcare workers, who heroically cared for the suffering until they succumbed and there was sometimes no one or no way to care for them. These areas--and other places where future pandemics will undoubtedly break out--are suffering from a lack of the caregivers, medical supplies, medical spaces, and public health systems that they need, not for lack of money but because their resources have been diverted away from the people to those who are getting rich off their suffering. Unless the richer countries try to take care of--not just contain the germs of--people who have these pandemic and other illnesses, the needed progress in public health care and containment, which can be effected simultaneously, will not occur, but tragedy will, as it has since the European explorers and European and American exploiters arrived.
That said, this is an important book. The author's central premise (told you we'd get back to it) is that global public health workers and others trying to deal with epidemics, from cholera to Lassa fever to Ebola and all tragic points in between, have prioritized (in Africa) containment over care. This means that the major efforts of (mostly white) people trying to help (mostly Black) people suffering from terrible diseases have been directed at keeping the diseases from escaping into Europe or the United States, rather than taking care of the people who are sick and dying as well as trying to contain the outbreak. So the public health people (in older times) would swoop in, tell people that they could no longer take care of people who were sick or bury their dead (because the disease might spread--would you leave your loved one to die without any care?); when people didn't obey these public health orders, the sanitaires would arrest them or burn down their villages, creating internal refugees who would spread the disease anyway, or suffer a lot in other ways.
Another aggravating factor is that Europeans and Americans have been trying to extract from this and other parts of Africa whatever resources were there--people, timber, rubber, diamonds--without giving back to the people of the countries (except sometimes corrupt officials) any of the wealth derived from their resources, and so the people were extremely poor, working under terrible conditions in the extractive industries, and getting caught up in or displaced by wars fought over the extracted resources. Any medical personnel who might have helped with the resulting problems, such as disease outbreaks or even everyday care for childbirth or minor injuries, were fleeing elsewhere. The area is a medical and clinical desert.
When Ebola was noticed, the world's disaster medicine specialists swooped in--and thank heaven they did--and tried to contain the disease, but there were few if any people trying to shore up the countries' failing health infrastructures or understand anything about the people who did not want to take public health orders from those who seemed to care nothing at all about them except as vectors of disease. This is a failure at the policy level, and not a failure of individual caregivers. The author profiles many people, especially healthcare workers, who heroically cared for the suffering until they succumbed and there was sometimes no one or no way to care for them. These areas--and other places where future pandemics will undoubtedly break out--are suffering from a lack of the caregivers, medical supplies, medical spaces, and public health systems that they need, not for lack of money but because their resources have been diverted away from the people to those who are getting rich off their suffering. Unless the richer countries try to take care of--not just contain the germs of--people who have these pandemic and other illnesses, the needed progress in public health care and containment, which can be effected simultaneously, will not occur, but tragedy will, as it has since the European explorers and European and American exploiters arrived.
July 26, 2021
Yikes!! So much history! Dr Farmer gives us a great information on why the Ebola outbreak was so devastating to West Africa in 2014. I learned about Liberia and the origin of what the country it is today. Comparisons of why white physicians and health care workers survived but African black physicians did not even though prophylaxis was available a few steps from them. It is important that we know our history. The US is a culprit in why these countries are not able to thrive and so many medical deserts are present in Africa. We have benefited from the pilferage of their natural resources such as diamonds and rubber. Great eye opener. I would have preferred shorter chapters so my attention span could have recovered from so much information.
November 16, 2022
Phew. This book was a beast. An in depth and inclusive analysis of how colonialism, wars, and clinical deserts form the perfect environment for not merely diseases, but fatalities from them when compared to the US or other western countries. A must read for anyone for a complete understanding how viruses proliferate and the systems (or lack of) that allow them to thrive.
February 10, 2025
paul mf farmer is so intuitive and eloquent it actually makes me mad!!!! white men shouldn’t get to be either of those let alone both. what are we (public health practitioners / infectious disease nerds) supposed to do in a world without him? well we are quickly finding out that it is not looking good !
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April 2, 2022It took me 2 days short of 1year to finish this book and it was quite the feat. however, I am so grateful that spent the time to read Dr. Farmer’s final book. Paul Farmer’s commitment to public health has inspired me ever since I read his first book Mountains Beyond Mountains. His death in March is unbelievably tragic but the legacy he has left is unprecedented. Not just healthcare workers, but humans, have so much to learn from the person that he was. He is a reminder that one person can actually change the world.
Thank you Dr. Farmer and Partners in Health for your selflessness.
Thank you Dr. Farmer and Partners in Health for your selflessness.
April 8, 2021
This is a fantastic book, though grim, that addresses some of the relationships between infections, systemic inequality, and capitalism.
January 4, 2021
This entire book is full of Dr. Paul Farmer’s unique brilliance and compassion, as is all of his work. The real surprise for me, though, is the fact that even in the epilogue he reminds me to remain open to those who don’t comply with current scientific recommendations.
I’ve been filled with anger for so many months now, unsure as to how people can care so little (especially when the science is pretty obvious about the right actions to take...), and yet. Here he is, a person who has dedicated his life to serving communities impacted most heavily by viruses like this one, reminding me that people don’t have confidence that they would receive adequate healthcare assistance even if they needed it.
Trust me, I’m botching his message. But you should stick it out for this one. (Or skip to the epilogue if you’re too impatient.)
I’ve been filled with anger for so many months now, unsure as to how people can care so little (especially when the science is pretty obvious about the right actions to take...), and yet. Here he is, a person who has dedicated his life to serving communities impacted most heavily by viruses like this one, reminding me that people don’t have confidence that they would receive adequate healthcare assistance even if they needed it.
Trust me, I’m botching his message. But you should stick it out for this one. (Or skip to the epilogue if you’re too impatient.)
July 5, 2021
P. 442: The critical step in preventing future epidemics will be finding ways of delivering vaccines and therapies to those who need them--and who need them in part because they live in a clinical desert that was created when their predecessors were enslaved and subjugated so that people and nations in other parts of the world could amass great wealth and prosperity.
P. 525: [T]he litmus test for advocating specific prevention and care efforts should be a simple one: Might this help?.... If there's indeed a lesson to be learned from Ebola, it may be this one: for everything we do, or say, in pandemic time, let's keep asking the same question. Might this help?
I would like to assign this book to everyone to read, largely because of the support and explanation that precedes the first quote. I would like to make some family members read it because FFS wearing a mask isn't THAT much of an imposition and it might help (I mean, it does help but let's go with the easier argument here).
It is such a gift to be alive at the same time as Dr. Farmer. How I wish we wouldn't take him for granted.
P. 525: [T]he litmus test for advocating specific prevention and care efforts should be a simple one: Might this help?.... If there's indeed a lesson to be learned from Ebola, it may be this one: for everything we do, or say, in pandemic time, let's keep asking the same question. Might this help?
I would like to assign this book to everyone to read, largely because of the support and explanation that precedes the first quote. I would like to make some family members read it because FFS wearing a mask isn't THAT much of an imposition and it might help (I mean, it does help but let's go with the easier argument here).
It is such a gift to be alive at the same time as Dr. Farmer. How I wish we wouldn't take him for granted.
March 16, 2021
This book may be a bit repetitive in some ways, and is definitely is not aimed at readers with no knowledge of biology or medicine whatsoever, but it is still a phenomenal read. Admittedly, some of it was harder for me to wrap my head around - there are moments when you can tell a deeper knowledge of certain things would make Farmer's perspective on it make more sense; but, overall, I learned a great deal that I wasn't even aware I didn't know. He does a remarkably good job of exposing the links between social and medical inequities and our postcolonial, neoliberal, capitalist ideologies. What Farmer shows playing out in these pages is a deeply, globally systemic problem spurred by racial and financial discrimination, exacerbated further by the culture of commodity. I don't have enough background to give a full critique of this book, but I can say this: It opened my eyes and I will be combing through its resources for a long time.
October 23, 2020
Important messages bogged down in detail
Although I appreciate the importance of the material covered, I did not enjoy this book. I found that the messages got lost in all the detail. I also was not fond of the writing style which I found overly literary.
Disclosure: I received an advance reader copy of this book via Netgalley for review purposes.
Although I appreciate the importance of the material covered, I did not enjoy this book. I found that the messages got lost in all the detail. I also was not fond of the writing style which I found overly literary.
Disclosure: I received an advance reader copy of this book via Netgalley for review purposes.
April 23, 2021
Wow. What a disturbing and devastating book. The brutal legacy of colonialism doesn't end. Paul Farmer shows why the mortality rate of Ebola is really a product of our global disregard for healthcare inequity. Structural Adjustment Programs, resource extraction, and preposterous debts to colonizers are recipes for genocide, from war to pathogens. With supportive care (sometimes just IV fluids and meds, sometimes ICU care), Ebola is rough but largely survivable, as seen by the non-African worker medevaced out and hospitalized. Meanwhile, in the worst areas of spread, the "control over care" model Dr. Farmer talks about means that isolation, culturally blaming policies, and ineffectual oral rehydration salts are what were offered to Ebola stricken communities in West Africa in 2014. No wonder foreign led public health teams were met with resistance and distrust-there was little to offer and the outcomes were needlessly grim. In my opinion, global capitalism, created by white supremacy, which requires an underclass and cheap resources and allows billionaires to hoard wealth at the expense of billions of lives is the root cause. I mean, nice that Bill Gates and Paul Allen decided to assist in the Ebola epidemic, but what if Sierra Leone and Liberia had a fighting chance with actual infrastructure and autonomy instead of being saddled with debts and not being the beneficiaries of their deadly mining operations? Don't those minerals go into the making of the products Gates and Allen so excessively profit from? The whole situation is a disgrace.
Side notes about the book: Dr. Fauci is a gem. EVERY story I hear about him shows his kindness and dedication. Of course he was involved in the PIH Ebola response.
I am definitely guilty of reading too many white travel/history books about the world instead of local ones, and this fits the bill, but it was still valuable. I also think about 100 or so pages probably could have been edited out. Some redundancy there. Also, even though I had some knowledge already about the history of the region, I found the middle section very hard to follow.
Side notes about the book: Dr. Fauci is a gem. EVERY story I hear about him shows his kindness and dedication. Of course he was involved in the PIH Ebola response.
I am definitely guilty of reading too many white travel/history books about the world instead of local ones, and this fits the bill, but it was still valuable. I also think about 100 or so pages probably could have been edited out. Some redundancy there. Also, even though I had some knowledge already about the history of the region, I found the middle section very hard to follow.
December 30, 2022
"The virus is never the only protagonist of the story." Dr. Paul Farmer crafts an allegoric commentary on the international response to the 2014 Ebola Epidemic in West Africa. Marred with fetishizing African culture, moralistic condemnation of contextual strife, and accepting gruesome case-fatality-rates, the international response aided in the spread, not the prevention, of the epidemic. Farmer elucidates about his personal endeavors in West Africa during the epidemic while sharing the personal stories of his patients that miraculously survive; I could not help but tear up reading about the challenges his patients faced, both with the virus and their personal contexts. His main conclusion relies heavily on the extractive history of West Africa from, spanning the Slave Trade, European Colonialism, World Wars, and contemporary Civil Wars plagued by natural resource driven corruption. In eye opening accounts, one cannot help but feel anger towards European and American Hypocrisy and sympathy to the *many* injustices faced in West Africa.
Unfortunately, the history portion of the book (middle 200-250 pages) is also where he lags. It becomes rather obvious that Dr. Farmer is a medical anthropologist, not a historian. While attempting to clarify the intertwined and complex histories of Sierra Leone, Liberia, and Guinea, he muddles them by focusing on irrelevant details, non-consecutive storylines, many rushed characters, and only *occasionally* tying it back to the subject matter of Ebola. There were many times where I forgot the book was about Ebola, and often I would have to make the logical chains on my own rather than through his writing. He should have co-written this part with a historian to make it clear, concise, and logical to the argument at hand.
Nevertheless, I would recommend this book to someone who does not mind rather dense and unclear/incomplete historical development. This book shines in its first 100 pages and last 150 pages, where Dr. Farmer argues for public health that is context driven rather than containment driven. *some* of the history he does site adds to his argument and leads to the ever importance of contextual public healthcare.
Unfortunately, the history portion of the book (middle 200-250 pages) is also where he lags. It becomes rather obvious that Dr. Farmer is a medical anthropologist, not a historian. While attempting to clarify the intertwined and complex histories of Sierra Leone, Liberia, and Guinea, he muddles them by focusing on irrelevant details, non-consecutive storylines, many rushed characters, and only *occasionally* tying it back to the subject matter of Ebola. There were many times where I forgot the book was about Ebola, and often I would have to make the logical chains on my own rather than through his writing. He should have co-written this part with a historian to make it clear, concise, and logical to the argument at hand.
Nevertheless, I would recommend this book to someone who does not mind rather dense and unclear/incomplete historical development. This book shines in its first 100 pages and last 150 pages, where Dr. Farmer argues for public health that is context driven rather than containment driven. *some* of the history he does site adds to his argument and leads to the ever importance of contextual public healthcare.
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