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Anthropologist Paul Farmer's New Book Explores The Failures Of An Ebola Epidemic


It was nearly seven years ago when another deadly epidemic was in the headlines. Ebola terrorized parts of West Africa, and there were fears it would spread beyond the continent. Among the first international responders was acclaimed doctor and medical anthropologist Paul Farmer. In his new book, "Fevers, Feuds, And Diamonds: Ebola And The Ravages Of History," he describes the harrowing race to contain the disease and what it might teach us about defeating COVID-19. Paul Farmer, welcome to the program.

PAUL FARMER: Thank you for having me.

GARCIA-NAVARRO: Remind us what Ebola is and what it does.

FARMER: Well, Ebola is a viral disease characterized by high fevers, delirium and, rarely, by hemorrhagic symptoms. You know, untreated, it has a very high case fatality rate.

GARCIA-NAVARRO: And remind us how devastating it became for the region.

FARMER: Well, it surely became the leading infectious killer of adults in at least three countries - Liberia, Sierra Leone and Guinea. And really, when we hear this talk now facing COVID about flattening the surge, we did not succeed in flattening the surge, which meant that Ebola took out the health care delivery systems of all three countries.

GARCIA-NAVARRO: The way you tackled documenting this outbreak in your book is not solely as a health expert but as a historian. You delve into the histories of Sierra Leone, Guinea, Liberia. You talk a lot about colonialism, foreign conglomerates, wars. Why did they impact how little this part of Africa could contend with the epidemic - the paucity of actual places that they could get care?

FARMER: Well, one of the main reasons is war. Less than a decade before Ebola hit, these countries had been dragged into a brutal decade-plus-long civil war. So the desertification process that leveled the health care system - they had already just survived that when Ebola showed up. That said, it was striking to me, in learning about this history, that after a couple centuries of British rule in Sierra Leone, for example, they hadn't even bothered to found a single medical school or nursing school.

GARCIA-NAVARRO: And I guess this brings us to your central contention in the book about Ebola. And I quote, "when humans stricken by identical strains of the same pathogen have vastly different fates, the most salient variable is the economic and social terrain."

Ebola did not have to be as deadly as it was. You write "those with ready access to prompt and effective interventions did much better than those without them."

FARMER: I believe that's true. And so in this massive press for containment, I think we all too often forgot about the need for a massive press for better clinical services.

GARCIA-NAVARRO: Well, what do you see when you look at this pandemic here? Because the sort of ravages of American history are also at play, one could argue, in the United States. African Americans, immigrants are most at risk of getting sick and dying in this pandemic.

FARMER: One of the points that I've tried to make in this book is to say this is not a different history - that this is the same history. The fates of West Africa and the United States have been bound up for some time. And, you know, it's better to know that history than not to know it.

GARCIA-NAVARRO: The mistrust between villagers, their governments was so extreme in West Africa that there were attacks on health care workers, stoning, riots. We have a mistrust here now in institutions, in doctors. What do you attribute that to - that there are these similarities in two very distinct places with two very different, ostensibly, types of epidemics breaking out?

FARMER: Epidemics and certainly pandemics reveal a lot about a society. They expose all the fissures and cracks of the ravages of history. And so looking back at previous epidemics, whether we're talking about AIDS or yellow fever or other problems in the United States, we've really seen again and again that social disparities shape not only the epidemics, but our responses to them.

GARCIA-NAVARRO: My last question - I mean, we are at a moment in time when the pandemic seems, frankly, out of control here. It is record numbers of infections. We are seeing hospitals overwhelmed in parts of the country again. Do you think we can find a way out?

FARMER: I'm sure we can find a way out. I'm sure that, even though we have performed as a nation uniquely poorly, that doesn't mean we won't pull out of this. So although I'm dismayed by how poorly we've done it, I don't see any reason why we can't turn that around. This is not unfamiliar terrain. You know, we have come through problems like this before when we had far fewer tools at our disposal. So I think a fair amount of optimism is warranted as long as we're willing to buckle down and share the burden of what will be required over the next few months.

GARCIA-NAVARRO: That's Dr. Paul Farmer, the chair of Harvard's Department of Global Health and Social Medicine. His new book is "Fevers, Feuds, And Diamonds: Ebola And The Ravages Of History." Thank you very much.

FARMER: Thank you for having me. Transcript provided by NPR, Copyright NPR.

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