Review: 'Fevers, Feuds, and Diamonds,' by Paul Farmer

For most of this year, the talk of the world has been the COVID-19 pandemic, which has killed more than a million people since the novel coronavirus first reared its head in late 2019. For the people of West Africa, the outbreak is all too familiar — it wasn't long ago that an outbreak of Ebola killed more than 11,000 people (and likely more) in the region.

That epidemic is the subject of "Fevers, Feuds, and Diamonds," a fascinating new book from Paul Farmer, the physician and Partners in Health co-founder (and the subject of Tracy Kidder's wonderful 2003 book "Mountains Beyond Mountains"). Farmer's book combines memoir and history to explain how the Ebola virus wreaked so much havoc in the countries of Sierra Leone, Liberia and Guinea between 2013 and 2016.

The first part of Farmer's book chronicles his travels to the region when the virus first hit. He tells the stories of Ibrahim Kamara and Yabom Koroma, two Sierra Leoneans who lost family members to Ebola. Their testimonies are heartbreaking, and Farmer writes about their myriad losses with elegance and sensitivity.

The bulk of the book sees Farmer exploring the history of West Africa, seeking to answer the question, "When an epidemic occurs in a public-health desert, who decides when and where it begins or ends?" Farmer believes that the region was especially vulnerable to the virus because of a long history of colonization, mining and war.

"The precipitate extraction of wealth from earth and forest profoundly disrupted the region's ecology, and in ways that have contributed acutely to the Ebola crisis," he writes.

The case he makes is both depressing and convincing. He blames "a long and sorry chain of events ending in war" for creating "the storied perfect storm" leading to the epidemic, noting that "Giving all the credit to the virus is dubious when we humans have been the architects of the stunning inequalities that characterize our shared world."

"Fevers, Feuds, and Diamonds" is bleak reading, to be sure, but it's also endlessly informative. In the final part of the book, Farmer urges that health authorities abandon the "control-over-care" paradigm, in which preventing spread of a disease is prioritized at the expense of treating those suffering from it. And he strikes a (relatively) hopeful note, writing, "The long history of injury and injustice and extraction in West Africa made the Ebola crisis feel inevitable. What is not inevitable, however, is the cynical notion that misery and privation will continue unabated in the region. … With a modicum of investment, a larger dose of social justice, and attention to the needs of those already sick and injured, the disastrous health conditions of this region can be reversed."

Farmer's book would be valuable reading at any time, but it's even more so in our pandemic times. It's a stunning, sobering book that feels not just important, but actually necessary.

Michael Schaub is a member of the board of the National Book Critics Circle. He lives in Texas.

By: Paul Farmer.
Publisher: Farrar, Straus & Giroux, 688 pages, $40.