But once he returns those two narratives to the original timeline — Freetown, late 2014 — the book swerves back 500 years, all the way to the origins of the trans-Atlantic slave trade. For more than 200 pages, Farmer shifts into historian mode, and the book drops much of its initial focus on disease and public health, turning instead toward the many ways Guinea, Liberia and Sierra Leone, their borders carved out by European overlords, had been crippled by five centuries of what Farmer calls “rapacious extraction — of rubber latex, timber, minerals, gold, diamonds and human chattel.”
This history is as powerfully conveyed as it is tragic. Farmer takes the reader through many fascinating episodes: the early “back to Africa” movement in the 1800s that led to the founding of Freetown and the nation of Liberia itself; the centuries-long obsession with the Human Leopard Society, an underground network of shape-shifting Africans that supposedly practiced cannibalism and ritual murder; Harvey Firestone’s successful attempt to circumvent the British monopoly on rubber that turned Liberia into the United States’ primary supplier of latex. Most tellingly, he traces the origins of the “control-over-care” ideology that emerged around the turn of the 20th century, as European agents emphasized disease containment — quarantines, segregationist building codes — over direct medical care, an approach that would govern much of the initial response to Ebola.
By the time the chronology returns to the events covered in the opening chapters of the book — Operation No Living Thing, Khan’s death, Farmer’s initial encounter with the two brothers dying of Ebola in Monrovia — the facts recounted are, technically speaking, the same, but in the reader’s mind, they have been transformed from isolated symptoms into a much more profound diagnosis, both by the intimate histories of Yabom and Ibrahim, and by the wide-angle view of the region’s ravaged history. The looping structure is not without its flaws: Several sequences are repeated almost verbatim, and a slightly pared-down version of the historical interlude might have made the book even more powerful. But the overall effect is nonetheless illuminating.
Reading “Fevers, Feuds, and Diamonds” in the annus horribilis of 2020 inevitably begs the question of how the Ebola outbreak compares with the coronavirus pandemic. Farmer’s account of the 2014-15 period contains some obvious foreshadowing: Dr. Anthony S. Fauci appears in a supporting role; a television personality named Donald J. Trump rails against President Barack Obama’s handling of the crisis on Twitter. But in a way, the lessons of 2014 are almost the inverse of what we have experienced in 2020. The death toll from Ebola, in Farmer’s account, arose from the medical deserts of upper West Africa, from a longstanding failure to invest in basic health infrastructure and supportive care. Covid-19, by contrast, is a story about how a disease managed to cause such destruction in what should have been a medical oasis: a failure of control, not care.
Farmer begins the final section of “Fevers, Feuds, and Diamonds” with a quote apparently uttered by Louis Pasteur on his deathbed: “Le microbe n’est rien, le terrain est tout.” The microbe is nothing, the terrain is everything. If indeed Pasteur said the line, the reference to “the terrain” was an allusion to the “terrain” of the human body, and to the immune system in particular. But Farmer invokes it to point to a broader landscape, more political than biological: the violent conflict and material inequalities that inevitably play a role in determining whether a virus destroys a human life, or leaves it relatively unscathed. “This was not,” Farmer writes, “a history of inevitable mortality that resulted from ancient evolutionary forces. … It was the contingent history of a population made vulnerable.” For that terrain — and the ravages of history that created it — Farmer has given us an invaluable map.