Summary:
Fevers, Feuds, and
Diamonds is Paul Farmer’s
latest work exploring the connection between health and the social and
historical structures that surround it.
Focusing on how and why Ebola spread in West Africa in 2014, the book is
difficult to categorize — it is not only temporally expansive, ranging from
the late 15th century to the present day, but it also combines elements of a
memoir, an anthropological treatise, and an abbreviated historical text with
powerful calls to action in over 500 pages.
Stemming partially from a desire to fulfill a “personal penance for inaction”
during the early days of the outbreak, Farmer chooses to learn about Ebola from
“the personal histories of the Ebola dead, of survivors,
and of their caregivers.” Harking back
to his days as a college anthropology major, many of the book’s themes, embodied in its title, are introduced via
these in-depth interviews. His two main
subjects, Ibrahim and Yabom, are Ebola survivors who, after initially
recovering from their illness, make it their work to support other Ebola survivors. Through their words and narratives, we
witness some of what it was like to experience the civil strife that predated
the outbreak, see how
Ebola expanded from isolated cases to clusters and communities, how
family members sick with the disease were cared for, what it meant to survive
Ebola, and now what it means to live with its sequelae. Translation for Farmer was provided by Dr.
Bailor Barrie, one of his former students, whose story as a medical student in
Sierra Leone during its civil war soon becomes part of the narrative, as
well. Through the words of these three
people, pieced together over many extensive conversations, a narrative is
developed, allowing those most impacted by Ebola to tell its story.
Farmer interweaves his first-person perspective with their
stories, emphasizing his role in 2014 and how Partners in Health became
involved in assisting in the outbreak.
While working in West Africa during the Ebola epidemic, late one night,
Farmer mixes up Liberia and Sierra Leone.
Realizing how different their histories are, he vows to “make amends for my ignorance” and
transitions from storytelling on the personal level to history-telling on the
country level. To ensure that he, and
we, never mix them up again, Farmer traces the histories of Sierra Leone,
Liberia, and Guinea in four chapters.
During this section, he refers back to the book’s title, taking on the
effects of the rise of imperialism, colonization, the use of
sanitation/Pasteurian principles, the impact of resource extraction, and much
more on each of these nation’s stories and relationships with Ebola. As he describes it, “if you want to understand the
magnitude and dynamics of this Ebola epidemic, in other words, think in terms
of fevers, feuds, and diamonds.”
Fevers, Feuds, and Diamonds is bookended with reflections on COVID-19 in the
introduction and epilogue. In the
introduction, he reflects on the book’s “obvious
implications for our
response to COVID-19” and how COVID-19, though different in many
ways, shares certain similarities with Ebola — among them, the speculative
nature of its origins and the fact that it is a zoonosis. Most importantly, according to Farmer,
treating and managing it will require understanding many of the same “cultural
complexities and... challenges” that treating Ebola required. After taking us on a journey through West
Africa and up to 2014, Farmer writes an epilogue reflecting on how the central
crisis of Ebola was the prioritization of “containment over care” whereas COVID-19 has become a crisis
of containment. To him, writing this on
April 10th, 2020, and to the reader reading it a year later, COVID-19 is seen
as partially a disease of healthcare workers’ exposure,
and partially a disease of social inequity, but completely a disease whose management,
treatment, and eventual control will be defined by the “staff and stuff and spaces and
systems” in place and who has access to them.
Even with this pandemic at the forefront of our minds, Farmer reminds us
that Ebola should not be off our radar just because a new disease is on it—
there continue to be outbreaks of Ebola in the Congo. Ultimately, Farmer’s words leave you thinking — about this pandemic, about
the past, and about the connections between them. If only to prompt more thought, one of Farmer’s last comments is
also his most powerful: “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?”
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