{"id":4438,"date":"2021-01-01T13:06:12","date_gmt":"2021-01-01T13:06:12","guid":{"rendered":"https:\/\/www.radiofree.org\/?p=145344"},"modified":"2021-01-01T13:06:12","modified_gmt":"2021-01-01T13:06:12","slug":"colonization-fueled-ebola-dr-paul-farmer-on-fevers-feuds-diamonds-lessons-from-west-africa-2","status":"publish","type":"post","link":"https:\/\/radiofree.asia\/2021\/01\/01\/colonization-fueled-ebola-dr-paul-farmer-on-fevers-feuds-diamonds-lessons-from-west-africa-2\/","title":{"rendered":"Colonization Fueled Ebola: Dr. Paul Farmer on \u201cFevers, Feuds & Diamonds\u201d & Lessons from West Africa"},"content":{"rendered":"
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This is a rush transcript. Copy may not be in its final form.<\/p>\n

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AMY<\/span> GOODMAN<\/span>:<\/strong> This is Democracy Now!<\/em>, democracynow.org, The Quarantine Report<\/em>. I\u2019m Amy Goodman, as we continue our conversation with Dr. Paul Farmer, infectious disease doctor, renowned medical anthropologist, co-founder and chief strategist of Partners in Health, author of the new book Fevers, Feuds, and Diamonds: Ebola and the Ravages of History<\/em>. Between 2014 and \u201916, Ebola killed more than 11,000 people, most in Sierra Leone, Guinea and Liberia. I asked Dr. Farmer to talk about his new book and his work in West Africa during the Ebola crisis.<\/p>\n

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DR. PAUL<\/span> FARMER<\/span>:<\/strong> Well, you know, I wrote the book, a lot of it, in Sierra Leone. And as chance would have it \u2014 and I think we talked about this in 2014 \u2014 I was in Sierra Leone in June of 2014, but for an unrelated matter. I was there for a surgical conference, which I was involved, in part, in organizing. And I remember folks coming to the conference saying, \u201cYou know, there\u2019s already Ebola in the neighboring countries. Should we really have it? Is it a safe venue?\u201d And my response was that you don\u2019t get Ebola through medical conferences, but through caregiving \u2014 that is, nursing the sick and burying the dead \u2014 and that we would be OK.<\/p>\n<\/blockquote>\n

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Shortly after that, I left, went back home to Rwanda. And as you will recall, my colleague, Humarr Khan, Sierra Leone\u2019s leading infectious disease doctor, died of the disease on July 29th. And I began lobbying my own friends and co-workers to join in on the fight. And so, I will add, Amy, that we were very tardy to get there, in my view, and arrived in October. And what I saw then, in both Liberia and Sierra Leone, was just terrifying. It\u2019s not like there\u2019s a terror with a respiratory virus that\u2019s invisible. That terror comes when someone is sickened and fell ill. But there, in the midst of this clinical desert, there were times when we saw people collapse in the street, and knew that it was likely or possibly from Ebola and, with some shame, you know, waited for those fully masked and gowned to come and help people. Now, that was not during the time which would follow in a couple of weeks in the Ebola treatment units and community care centers and abandoned public hospitals. We\u2019re still doing a lot of that work today.<\/p>\n<\/blockquote>\n

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But the reason I wrote the book was I got to know a number of patients quite well. And as they recovered, we became, very often, friends, that initial group that I met in October and some that I met in Ebola treatment units in the course of the worst weeks of the epidemic. And one of them, a young man named Ibrahim, on the night that I met him, told me that he had lost more than 20 members of his family to Ebola, and asked me to interview him. And even though, as you point out, I\u2019m an anthropologist as well as a physician, that was a very unusual kind of experience to have someone who just experienced such loss and was still recovering to make such a request. And that kind of convinced me that these stories from West Africa and the history of the place would be an important thing for me to learn about. And that was the genesis of the book.<\/p>\n<\/blockquote>\n

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AMY<\/span> GOODMAN<\/span>:<\/strong> And so, talk about Ebola, the outbreak and then how it was contained. You talk about it as the \u201ccaregivers\u2019 disease.\u201d<\/p>\n<\/blockquote>\n

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DR. PAUL<\/span> FARMER<\/span>:<\/strong> Well, Ebola, like the coronavirus, is an RNA<\/span> virus. And also, likely, both are zoonoses. That is, they come from other species, animal species, and then leap into humans. And if you look, stand back and look, a lot of the diseases that cause the highest number of deaths among humans have these zoonotic roots. And Ebola is one of those. Its natural host is still disputed. It may be a bat. You know, that seems plausible. But in the midst of all that, its origins, in what species it came from, was not really the task at hand. The task at hand there was stopping transmission from person to person, because once introduced into the human family, Ebola spreads easily through contact.<\/p>\n<\/blockquote>\n

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And the two main sources of exposure are caregiving \u2014 first, you know, nursing the sick, cleaning up after them, and, second, the last act of caregiving, in most parts of the world and in most religious traditions, is burying the dead. And those were causing the transmission. Now, the problem there, unlike the United States, is that there were not professional caregivers, and there were not professional undertakers or morticians, so, of course, family members and traditional healers had to fill in that gap. And that\u2019s why so many people got sick and so many traditional healers got sick.<\/p>\n<\/blockquote>\n

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And then, of course, the professional caregivers also experienced enormous risk. It wasn\u2019t just Dr. Khan. It was thousands and thousands of nurses, laboratory technicians, ambulance drivers and doctors. And of the thousand or so that got sick during that time, probably more than half of them died. So, that\u2019s, again, another huge loss for any country, but if you\u2019re living in a medical desert and don\u2019t have a lot of physicians and nurses and lab techs and ambulance drivers, it\u2019s really something. Going back to the U.N. secretary-general\u2019s comments about COVID<\/span>, the effects of that will be felt for years and decades, if we don\u2019t step in and work to build those health systems again.<\/p>\n<\/blockquote>\n

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AMY<\/span> GOODMAN<\/span>:<\/strong> Certainly \u2014<\/p>\n<\/blockquote>\n

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DR. PAUL<\/span> FARMER<\/span>:<\/strong> I don\u2019t know if that\u2019s a \u2014 sorry.<\/p>\n<\/blockquote>\n

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AMY<\/span> GOODMAN<\/span>:<\/strong> Certainly, as we\u2019ve learned, dealing with health, with epidemics, with pandemics, if people have any questions about whether altruism is a motivation, we just understand we are all connected. You, Dr. Farmer, talk in your book about colonization, the slave trade, the catastrophic consequences on African nations. Talk about \u2014 though this is not usually talked about in health terms, you put the two together.<\/p>\n<\/blockquote>\n

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DR. PAUL<\/span> FARMER<\/span>:<\/strong> Yeah. Well, let me just start, Amy, by saying that during the epidemic, the great majority of our attention, and certainly mine, was on the clinical response \u2014 that is, trying to make sure that Ebola treatment units, at least the ones with which we were affiliated, were not only places for isolation, but places for care.<\/p>\n<\/blockquote>\n

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And care for Ebola is not rocket science, even without what are called specific therapies, like an antiviral, like remdesivir, for example, for COVID<\/span>. Even without specific therapies, the interventions that are required to save the lives of the majority of Ebola patients are to replace the fluids that they\u2019ve lost through nausea, vomiting, diarrhea, sweating \u2014 right? \u2014 the torrid heat of the area. All those losses of fluids and electrolytes are what really imperil the lives of those sickened with Ebola in the short term. And we have therapies for that. They\u2019ve been around for a hundred years. They\u2019ve been improved over time. You know, these oral rehydration salts, what you probably call Pedialyte, are important. And for those who cannot take oral medications, because they\u2019re nauseated or vomiting or in a coma, there are IV solutions that can save lives in that manner.<\/p>\n<\/blockquote>\n

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And even that was not happening across the region. And there were reasons for that, right? People were frightened. And anything that involved a sharp \u2014 that is, a needle, to put in an IV, for example, or a blood draw \u2014 poses some risk to healthcare workers, right? But it would have been better just to say, \u201cHey, we\u2019re frightened,\u201d because anyone in their right mind would be frightened. But instead, we started having arguments about what kind of care was the appropriate care. And the arguments, I mean, especially within what are called the international actors \u2014 which doesn\u2019t mean Academy Award-winning actors, but the NGOs and humanitarian groups that had flooded this region after the civil wars that afflicted it for some time, and then returned, obviously sometimes a different cast of characters, including ones that we know well, like the CDC<\/span> \u2014 came back, just a decade after this conflict ended, to be involved in the Ebola response.<\/p>\n<\/blockquote>\n

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And I made the argument in the book that the response was hampered by the fact that the attention was largely to containment, not to care. And, of course, this generated very painful echoes from colonial rule, which in that part of the world was largely a 20th century phenomenon. This is not remote history, as you know. So, in order to improve the quality of containment efforts, we should have focused more on the quality of care. And, you know, we\u2019re going to face that when the next epidemic of Ebola comes along.<\/p>\n<\/blockquote>\n

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AMY<\/span> GOODMAN<\/span>:<\/strong> Your description of people, the life histories of the Ebola survivors, is deeply moving. Can you talk about Ibrahim Kamara and Yabom Koroma, some of the people that you dedicate this book to?<\/p>\n<\/blockquote>\n

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DR. PAUL<\/span> FARMER<\/span>:<\/strong> Well, you know, it\u2019s not always been easy to talk about them, because they endured such losses, and they were not easy to hear about. Of course, having been involved in their care, I thought I knew something about their losses, but it turns out there were many more. And I had an epiphany, which I\u2019m embarrassed to share. But, of course, it wasn\u2019t long before we understood that every adult patient that we cared for who survived Ebola \u2014 or didn\u2019t \u2014 had also survived a brutal civil war.<\/p>\n<\/blockquote>\n

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And when I started talking with Ibrahim, who is the very man I mentioned earlier, who\u2019s the person, really, in a way, who inspired me to write this book, I couldn\u2019t believe the details, and spent many, many months \u2014 and in the case of Yabom, years \u2014 interviewing and learning about them. And, of course, this happens over time. But Yabom\u2019s story was different. If I could just go back and say, Ibrahim was probably 26 when he fell ill with Ebola, and did not have children of his own. His most grievous losses were his mother, his siblings, family members, grandparents, aunts, uncles. Yabom, on the other hand, was 39, and she lost, in addition to her husband, some of her children, her mother also, and other family members.<\/p>\n<\/blockquote>\n

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And what I learned about these two was that they moved between villages and the capital city during the war, after the war and even during the epidemic, because, very often, they were called to perform those caregiving services for afflicted members of their family. And again, in the case of those who perish, who was going to bury them at the time that they fell ill? And this was in August of 2014. So, they faced these impossible choices \u2014 another reason it was difficult and painful to write about them \u2014 choices that I\u2019ve never faced, like: Do we respect our mother\u2019s dying wish to be buried in her home village? And, of course, that was also against the recommendations of public health authorities. But there wasn\u2019t enough in the way of assistance with caregiving or with respectful burial of the dead until later in the epidemic. And so, their compassion led to their own infections and to infections among other members of their families.<\/p>\n<\/blockquote>\n

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Now, I will add, Amy, that, of course, I still am friends with these people, and they\u2019ve recovered, to varying extents. Yabom almost lost her eyesight, as well, because, as I think we discussed when we were together in August of 2014 to talk about Ebola, one of the complications is a blinding inflammation, that can be readily treated with steroids and eyedrops that cost pennies or a dollar to save someone\u2019s vision. So there were lots of complications, to say nothing of grief and psychological and emotional complications. There were lots of complications that endured in the months after the epidemic was declared brought under control.<\/p>\n<\/blockquote>\n

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AMY<\/span> GOODMAN<\/span>:<\/strong> Dr. Farmer, you write that every American and most Europeans who fell ill with Ebola in West Africa survived. \u201cDifferent mortality outcomes emerged from the same strain of Ebola, depending on care that was or wasn\u2019t available depending on your country of origin.\u201d If you can explain this, and then expand that to what we are seeing today in this country, for example, also on the issue of racial differentials and disparities?<\/p>\n<\/blockquote>\n

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DR. PAUL<\/span> FARMER<\/span>:<\/strong> Well, you know, this is something that I encourage my students to grapple with or our trainees in clinical medicine, you know, which is case fatality rate, because case fatality rate is a report card on the quality of the medical system, right? And there are many parts to that \u2014 referral to a clinical facility able to manage complications.<\/p>\n<\/blockquote>\n

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And we\u2019re going to be facing the same challenge in the coming weeks. If hospitals become saturated, if we don\u2019t flatten the curve, then they become overwhelmed. And not only do they perform more poorly in terms of caring for those sickened by the pandemic \u2014 or, in the case of Ebola, the epidemic \u2014 they also fail to provide the services that people need for other problems, other illnesses and injuries. And we saw a lot of that during Ebola, but we\u2019ve also seen it in the United States once our hospitals in New England and New York became overwhelmed. And that\u2019s, of course, exactly what happened in West Africa, as well. It just happened earlier and more devastatingly.<\/p>\n<\/blockquote>\n

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But that\u2019s just the first part of the equation. You know, case fatality rate is a marker, a report card, on what happens after you get infected, right? We also have racial disparities and other social disparities, as you\u2019ve noted, in risk of infection. So, all along that noxious path, we have to make interventions that lessen the risk for infection, but also that lessen the risk for a bad outcome once infected. And I think that is the goal before us with COVID<\/span>-19, just as it was a goal during Ebola.<\/p>\n<\/blockquote>\n

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Now, why am I bringing this up as a controversial matter? Because if the report card is only about disease control \u2014 that is, stopping the epidemic \u2014 and not about survival once infected, why is it that people would go to an Ebola treatment unit to be isolated, if they fear they will not receive care? And the answer is, they won\u2019t. Right? And this was not new. Treatment centers and treatment units that were really isolation and quarantine facilities proliferated across the continent of Africa during \u2014 under colonial rule and remained a feature there even after the end of colonial rule. And that pathology of focusing on disease control over care, I think, really weakened the epidemic.<\/p>\n<\/blockquote>\n

AMY<\/span> GOODMAN<\/span>:<\/strong> Dr. Paul Farmer, author of the new book Fevers, Feuds, and Diamonds: Ebola and the Ravages of History<\/em>. He\u2019s chair of global health and social medicine at Harvard Medical School, co-founder and chief strategist of Partners in Health, also featured in the documentary Bending the Arc<\/em>.<\/p>\n

That does it for today\u2019s show. Democracy Now!<\/em> is produced with Ren\u00e9e Feltz, Mike Burke, Deena Guzder, Libby Rainey, Nermeen Shaikh, Mar\u00eda Taracena, Carla Wills, Tami Woronoff, Charina Nadura, Sam Alcoff, Tey-Marie Astudillo, John Hamilton, Robby Karran, Hany Massoud and Adriano Contreras. Our general manager is Julie Crosby. Special thanks to Becca Staley, Miriam Barnard, Paul Powell, Mike DiFilippo, Miguel Nogueira, Hugh Gran, Denis Moynihan, Erin Dooley, David Prude and Dennis McCormick. I\u2019m Amy Goodman. Thanks so much for joining us.<\/p>\n<\/div>\n\n

This post was originally published on Radio Free<\/a>. <\/p>","protected":false},"excerpt":{"rendered":"

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