Fevers, Feuds, and Diamonds: Ebola and the Ravages of History by Paul Farmer

Abstract

In an impressively engaging volume that connects the recent Ebola epidemic in West Africa with the even more immediate context of the Covid-19 pandemic, Farmer offers some critical lessons that can elucidate not only how we arrived at our current state but also how we might chart a path forward. At its core, Feuds, Fevers, and Diamonds is about the tension between disease control and patient care, and the dangers that can emerge when patients are sacrificed to prevent the spread of an epidemic. The book’s epilogue opens with a reference to the plea for “decency” by Dr. Rieux in Albert Camus’ La Peste (Paris, 1947). “Decency” for Farmer (and for Rieux) is the commitment to care alongside containment.Equally central to this book is the contention that history has much to teach about the present. Most traditional students would hardly consider a pandemic that exploded in the 2010s as “history.” Farmer makes a compelling case, however, that the recent Ebola epidemic in Upper West Africa has its origins in the enslavement of Africans from the sixteenth to the nineteenth centuries, extractive colonialism in the nineteenth and twentieth, and the widespread violence that followed the collapse of colonial rule in the 1950s and 1960s.The book is divided into three parts. The first provides both a birds-eye and a ground-level view of the Ebola epidemic in Guinea, Liberia, and Sierra Leone from 2013 to 2016. Farmer details the minutiae of local and international responses, but unlike many who have written about the topic, he also embraces the epidemic as a lived human experience. In Chapters 2 and 3, for example, he recounts in detail the stories of two Ebola survivors, Ibrahim and Yabom. Part II of the volume delves into the longue durée history of West Africa, explaining how centuries of exploitation, colonialism, and postcolonial violence left the region both “a public health desert, which is why Ebola spread, and a clinical desert, which is why Ebola killed” (xxviii). The final part of the book circles back to the epidemic, explaining how Ebola came to take so many lives in the context of these dual deserts and why we should hesitate before declaring the epidemic “over.” Although the spread of the disease has slowed significantly in 2021, the material context that allowed it to emerge in the first place persists.History is a unifying force across the three sections of the book. Only an examination of the history of this region and its global connections can uncover the origins of the fear and mistrust that hampered disease-control efforts during the epidemic. “When people do not expect that they or their loved ones will receive the best treatment available,” Farmer writes, “they’re unlikely to take well to containment measures such as quarantines or contact tracing” (517). Although much was made in the global press about the “cultural” origins of the Ebola epidemic (diet, burial practices, etc.), Farmer points out that the disproportionate impact of the disease on this particular region has much more to do with material realities than with the particular social attributes of the communities that it ravaged. Building on the work of Benton and Dionne, Farmer explains how contemporary media have used historical tropes of African “backwardness” to shift blame to African communities and away from those who historically exploited them.1Part memoir, part biography, and part historical monograph, Fevers, Feuds, and Diamonds is interdisciplinary history at its best. Farmer does not shy away from his own embeddedness in this story: Through his organization Partners in Health, he spent extensive time on the ground in West Africa during the epidemic. Although the book brings together the work and stories of others, as he explains in the preface, it is “a synthesis informed by direct service to the afflicted” (xxv). Farmer’s book will be essential reading for those interested in medicine, public health, and global history, as well as those looking to understand our current global health predicament.