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Dr. Paul Farmer has worked for decades to bolster public health care around the globe. His new book, “Fevers, Feuds and Diamonds: Ebola and the Ravages of History,” looks at the 2014 Ebola crisis and what we can learn from it during our current pandemic. Jeffrey Brown spoke with Farmer as part of our ongoing arts and culture series, "CANVAS."
In West Africa, there are concerns about a new outbreak of Ebola. The first cases were reported in Guinea a few days ago. Now those countries and the World Health Organization are racing to contain the problem from spreading.
Dr. Paul Farmer is known for his decades of work to bolster public health care around the globe, including in Africa. Jeffrey Brown spoke with farmer about his new book on the 2014 Ebola crisis and what we can learn from it now during the pandemic.
Hazmat suits, overcrowded wards, bodies of the victims, scenes we're all now used to amid pandemic, but these images are from the 2014 Ebola epidemic that swept across Africa, infecting nearly 30,000, killing 11,000.
Doctors from abroad arrived in Guinea, Sierra Leone, and Liberia, the epicenter of the outbreak.
Dr. Paul Farmer:
It was frightening. The streets were closed off. There was — there were ambulances and noises everywhere. There — literally sometimes bodies in the streets.
Paul Farmer is a renowned public health doctor and anthropologist who founded Partners In Health, an organization that seeks to bring health care to the world's most vulnerable populations.
His work has taken him all over the globe, and raised questions along the way: Who is most impacted by disease? How might things have been done differently? What can be done now? In his new book, the 2014 Ebola outbreak becomes a lens to answer some of those questions.
It's titled "Fevers, Feuds, and Diamonds: Ebola and the Ravages of History."
You were a participant to events described in this book, but this goes well beyond it.
Early in the Ebola outbreak, almost all of our attention was turned towards clinical services. But we kept on bumping into things we didn't understand and sometimes even our colleagues from Sierra Leone and Liberia didn't understand. And that just triggered an interest in a deeper understanding of the place, the culture, the history.
And so what I was after in the book was to link those two very different kinds of experience.
One important lesson, it didn't have to happen, at least not to such a deadly extent. In West Africa, lack of medical resources and decades of war paved the way.
I have called the — that part of the world a clinical desert. They just don't have the staff, the stuff, the space, the systems that are required to respond to an epidemic like this.
And I wanted to know why, because every place has its own history. And that — it's important to understand why people are in such dire straits. It's more important to help them get out of those dire straits, but it's important to understand why as well.
Another lesson, diseases reveal the underlying problems and inequities in any society.
There's this confusion that happens at the beginning of many epidemics, the idea that, if it's really a novel pathogen and no one is immune, that it's going to be some sort of great leveler. There really are almost no examples in which that's the case.
These diseases are never levelers in that sense. They always look for weaknesses in society. They invade these cracks and fissures.
Fissures that have become all too clear in the U.S. COVID response, as communities of color and low-wage workers have been disproportionately affected by the virus.
Here we are in a very different situation, with supposedly the most advanced health care systems in the world. And yet our seems to have failed in many ways just as well. What explains that?
Well, I think it failed in a different way from the failure that we saw in West Africa. There, we just lacked completely the staff, the stuff, the space, the systems required to respond.
Here, we have those, but they're so unevenly stockpiled, right? They're — and we have a entirely patchwork response. And we're — I think we're feeling that unevenness a great deal now in the United States.
And since last April, Partners In Health has worked here in the U.S., with an ambitious contact tracing in Massachusetts.
They're now involved in the vaccine rollout there, as well as in Rwanda.
I mentioned that I thought we had failed differently here. And what I meant by that is, in West Africa, what we saw was clinical nihilism, that is, the argument that there is nothing we can do, Ebola was too deadly, it wasn't cost-effective, sustainable, prudent, feasible to spend all this attention on improving the quality of clinical care.
That's a hard sell here in the United States. What I think we see here is not clinical nihilism. It's containment nihilism, in other words, a refusal to do contact tracing, to invest adequately in public health responses. So it's a different kind of failure, but a failure nonetheless.
You write in this book, and perhaps with some sorrow, about how we humans, your phrase is forget pestilence. We forget what's happened to humans through history.
You know, after a cataclysm like the 1918 influenza epidemic, with such massive loss on the — at the tail end of the worst war in human history, I get why people want to forget. I understand that very well.
It just seems to me that we are forgetting some of these lessons at our peril. You have to understand why people wish to forget dreadful events, at the same time that someone is maintaining the memory of them, so that we can do better next time around.
Hard-earned lessons that have new resonance here and in West Africa, now facing a renewed Ebola outbreak.
Farmer told me today the situation there is concerning, but the experience of the past, plus a vaccine developed at the end of the last outbreak, offers reasons for hope. His goal now, implementing a proven strategy of immediately vaccinating anyone in contact with an infected individual. That, he says, can avoid the terrible death toll of the prior epidemic.
For the "PBS NewsHour," I'm Jeffrey Brown.
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