Summary:

Lenny's development from childhood to adolescence concurs with India's independence from Britain and the partitioning of India into India and Pakistan. The interwoven plots give each other substantial meaning. Partly because Lenny's family are Parsees, a religious and ethnic minority that remained relatively neutral in post-Partition religious conflicts, she has access to people of all ethnicities and religions, both within Lahore and in other locales. More significantly, she has access to a wide variety of viewpoints both pre-and post-Partition through her Ayah, a beautiful woman whose suitors are ethnically and religiously diverse.

Lenny's passionate love of Ayah and the loss of innocence that accompanies their changing relationship through the Partition is an energetic center to the plot. Lenny's relationships with her mother, her powerful godmother, and her sexually invasive cousin are also important to the novel. Lenny's polio forms a significant early narrative thread. Other minor but compelling subplots include Lenny's parents' changing relationship, the murder of a British official, and the child marriage of the much-abused daughter of one of Lenny's family's servants.

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Tessa Quayle, the young wife of a British civil servant in Kenya, is mysteriously murdered. Tessa, a lawyer, had been an outspoken human rights activist, and something of an embarrassment to her husband. But shaken from his marital and political complacency by her death and the rumors that quickly surround it, Justin Quayle sets out to solve the mystery and in doing so inherits her cause.

Tessa had discovered, as Justin now learns, that a new tuberculosis drug was being prematurely tested on Kenyan patients: clinical trials were effectively being carried out on the African population by the drug's giant pharmaceutical producer without the patients' knowledge or consent, but with the support and cover of a global corporation with African interests and of the British High Commission in Kenya. Lethal side effects and deaths were being concealed, the drug retitrated and retested in preparation for its safer and more lucrative release in the west in time for a predicted rise in incidence of multi-resistant strains of TB.

Justin, now a kind of rogue agent, uncovers the layers of sinister plotting to be expected in one of Le Carré's intelligence thrillers, but in the process we are led to consider, vividly, the interlocking roles of international biomedical research, postcolonial political interests, and global capital in determining the fates of impoverished, uneducated, and deeply vulnerable patients in developing countries--as well as the fates of those who try, often against all odds, to offer them the best available care. The novel also gives us, in Justin Quayle's odyssey, a moving study of desire, loss, regret, and, finally, outraged action.

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Frank Eloff, the novel’s narrator, is a white doctor working at a hospital in the former capital of one of South Africa’s now-defunct independent homelands (rural areas set aside by the apartheid government for black "separate development"). The hospital, in its deserted and decaying city, is understaffed and understocked, and there are hardly any patients. Those who do arrive usually need to be taken elsewhere if they need any significant treatment. The homeland’s former leader, the Brigadier, has returned as a criminal gang leader to loot the place, and a white former army commander, now in the employ of the present government, is trying to capture him.

Frank moved to this place when promised directorship of the hospital (and in flight after his wife left him for his best friend), but the previous director has not left yet, and Frank is in a kind of personal and professional bureaucratic limbo. He has a sexual relationship with a black woman who runs a roadside souvenir stall. It is not quite prostitution, not quite a love affair: she is married, speaks little English, and Frank regularly gives her money.

A new doctor, Laurence Waters, arrives. He is fresh from medical school, sent to the hospital in order to complete the rural community service year required by the government of all new physicians. He and Frank become roommates and begin an uneasy friendship. Laurence is an idealist, planning to make heroic changes, but he misunderstands the complex balance of tolerance, cynicism and patience that characterize survival at the hospital, and his well-intentioned efforts, such as trying to end theft from the hospital and to establish a clinic in a local tribal village, lead to disaster. The novel ends with Frank appointed hospital director at last, and things returning to their depressingly ineffective "normality."

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According to the U.S. Department of Health and Human Services, nearly thirty-one percent of the American public is obese; obesity accounts for 300,000 deaths a year, making it the second-most common preventable cause of death after cigarette smoking; individuals who are obese have a fifty to one-hundred percent increased risk of premature death from all causes.  On the opposite end of the scale, so to speak, is anorexia, which, as one of the deadliest of psychiatric diseases, claims up to fifteen percent of its sufferers who either die of suicide or complications related to starvation; about one-third spend their lives dominated by their obsession with food, and almost half never marry. 

How can we ever understand the psychological, physical, emotional, cultural and spiritual complexity of eating disorders, whether they result in morbid obesity or in a starving body digesting itself?  Ann Pai's memoir opens a window to reveal the inner world of a food obsession, her own, and holds up a mirror to reflect the outer experience of a dying, five hundred fifty pound woman, her sister.

The narrative weaves together three strands:  the sweet but unsentimental history of two sisters growing up in the midwest--Joyce, the elder of the two, and Ann, younger by almost five years; the detailed and horrific account of Joyce's sudden hospitalization on September 11, 2001, and her inexorable decline through multiple, undiagnosable and fatal illnesses as the result of her obesity; and the stream-of-conscious and raw monologue of Ann's own struggle to manage a compulsive eating disorder.

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A night on the town with two friends turns into "an attack of nerves" for Vasilyev, a law student. The three students spend the night drinking and visiting houses of prostitution; Vasilyev is horrified and repulsed by the women, who he thinks are "more like animals than human beings." The social problem of prostitution becomes an obsession; he is so fixated on finding a solution that he is in moral agony. His friends, among whom is a medical student, are concerned only with his health; they take him to a psychiatrist who "cures" Vasilyev with bromide and morphine.

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The narrator is a Vietnamese husband who has a beautiful, flirtatious wife. They have been living in the New Orleans area for more than a decade, arriving in America after the fall of South Vietnam. The husband tells a remarkable story about the lengths to which he has gone, both in Vietnam and in America, to intercept and discourage his wife’s extra-marital interests. The narrator is humorously self-deprecating and matter-of-fact.

In Vietnam, he was a spy for the Americans, and able to "bring fire from heaven" in the form of American rocket attacks to scare off his wife’s would-be lovers; in America, he adapts to the local culture by consulting a "low-down papa" voodoo specialist. What follows this consultation is a hilariously told sequence of events that succeeds finally in winning the wife’s loyalty.

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The author tells the story of two Native-American (Chippewa) families whose lives interweave through several generations during the years 1934-1984. The primary setting is a reservation in North Dakota. The main characters, Marie and Nector Kashpaw and Lulu Lamartine, are colorful, sympathetic people caught in a love triangle that endures for most of their adult lives. "Love medicine" represents an attempt by a Kashpaw grandson to assure once and for all that his aging grandfather will love and be true to his wife and cease "hankering after the Lamartine." The plan ends in disaster when corners are cut and the authentic old Indian customs for preparing the "love medicine" are circumvented.

There is a strong sense of the blending of cultures--religion, medicine, commerce, education all take on the distinctive qualities of an evolving mixed culture. Displacement and disenfranchisement are a fact of life, taken almost for granted, with humor, but not without a response. "They gave you worthless land to start with and then they chopped it out from under your feet. They took your kids away and stuffed the English language in their mouth . . . They sold you booze for furs and then told you not to drink. It was time, high past time, the Indians smartened up and started using the only leverage they had-federal law." (p. 326) So begins an initiative to establish a gambling casino; "gambling fit into the old traditions . . . . "

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This short poem contrasts perspectives of the places where two different societal groups live. What the larger (white) society considers the inner city is what the poet and her people call "home." At the same time the inner city view of "uptown" is of a lifeless place that has no particular appeal. The poet would rather stay where she is, in this "no place" and "be alive."

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This absorbing, sad, humorous evocation of an impoverished Irish Catholic childhood describes the first nineteen years of Frank McCourt’s life--from his birth in Brooklyn, New York; through the family’s emigration four years later to his mother’s roots in the slums of Limerick, Ireland--and ends with McCourt’s return migration to America, a young man on his own. McCourt sets the scene in his first lines: "When I look back on my childhood I wonder how I survived at all. It was, of course, a miserable childhood: the happy childhood is hardly worth your while. . . the poverty; the shiftless loquacious alcoholic father; the pious defeated mother moaning by the fire; pompous priests; bullying schoolmasters . . . . "

Born during the Great Depression, the author leads us in lilting present-tense narrative through the struggle and occasional small joys of daily life with siblings, school friends, and the adults who circumscribe his life. He is an alien in his parental homeland, the oldest child of a father whose background in "the North" engenders continual suspicion, and a mother (Angela of the book’s title) who had never known her father and whose own mother is as miserly with her affections as with offers of economic assistance.

The hardships in Limerick are so profound that starvation is a way of life. "Consumption," pneumonia, and typhoid are rampant; children go to school barefoot or in pieces of flopping rubber; stealing is a necessity. Frank’s tiny sister and twin brothers die. Above all, there is "the drink"--the endemic disease of Irish fathers who spend their weeks’ wages in the pub on Friday night.

Frank leaves school to earn money for the family (his father had joined the war-time wave of work in England, but continued to drink his earnings away), and to save for a return to America. Blessed with verbal skills and stamina, through stealth, charm and struggle he manages to save what is needed to book ship’s passage to America. As the Hudson River flows by en route to Albany, the ship’s Wireless Officer says to Frank, "My God, . . . isn’t this a great country altogether?" Answers Frank in the single phrase comprising the last chapter, " ’T. is."

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The speaker is en route by plane from San Antonio to Mexico City to visit Mexican relatives on her father's side of the family. At the airport she had remembered that "in Mexico they don't like hair / under your arms . . . " and is struggling, before landing, to deal with this in the tiny bathroom, with a disposable razor hastily purchased at the airport.

Also before landing she has to negotiate a mix up over declaration forms--"the stewardess . . . has given me the wrong / one assuming I'm Mexican but I am! / and I have to run up the aisle and ask / for a U.S. citizen form instead because / I'm well how do I explain?" When she arrives in Mexico City she is ready for her relatives, "armpits clean as a newborn's soul" and presents herself "like the good girl my father would have them believe I am."

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