Paul Farmer (1) (1959–2022)

Paul Farmer writes about the Ebola epidemic in Western Africa in 1014. His emphasis is on the fact that epidemics of contagious diseases do not occur in a vacuum, but instead are result of social, medical, and economic deficits that provide opportunities for a disease to rage out of control.

After an description of the clinical desert that existed in West Africa at the time of the outbreak, he describes the sequences of events, almost as if in real time. Then he turns to the history of the area, including the extractive colonialism by European countries and slave trading. Colonial rule meant that these areas were raided for people and natural resources, often heavily taxed and with forced labor, with little to no investment in infrastructure such as health care, education, or basic sanitation. Even while expat colonials living in the colony might enjoy these things within their own compounds. Upon gaining freedom, these countries were left destitute and vulnerable to any factions that hungered to rob them of any remaining natural resources.

The theme through the book is the lack of: staff, supplies, space, and systems to provide basic health care. And the hold over of a philosophy of containment of disease over one of providing medical care that arose in the colonial era. This goal of containment of ebola was the dominant approach during the 2014 epidemic, resulting in many needless deaths. Yet, western medical providers who were airlifted out of the region and provided with 21st century medical care survived their ordeal with the disease. The result is a deep distrust of medical authorities within the region.

Farmer also emphasizes the understanding of social medicine in the context of local cultures for the successful delivery of medical care, citing the work of social psychologists and anthropologists.

Finally, it becomes clear that these clinical deserts are likely to contribute to further epidemics and pandemics in the future, unless we as a society work to equalize the availability of staff, stuff, space, and systems to provide medical care through out the world.

The writing reminds me of Sebastian Junger and Frank Snowden, whose works are both cited in this book. There are segments where the author's anger clearly comes through...but it is a righteous anger formed from his life's work of dealing with difficult contagious diseases.… (más)

I cannot give this book enough stars. 5 plus stars!!! The author puts the ebola outbreak in historical context. This is important as we need to learn from the history of the material conditions that made this outbreak possible. We can learn much about how to break the chain that leads to pandemics and epidemics and all problems by tracing the chain to what brought us to the point of pandemic. This is not just a history but how to look at history to learn how to go forward and make sure it never happens again. I cannot recommend this very relevant book for today. Dr. Farmer is a scientist, medical doctor and a writer who knows well how to y=use the tools called the written word.… (más)