Recommendation: Do it
Where to read: Don’t take this on holiday
Read with: A margarita
In brief: It’s gloriously empathetic, wonderfully written and profoundly tragic.
Lordy, I cried. I also ploughed through it in about a day. There are worse ways to spend a Sunday, I suppose…
Honestly, it’s not really what I wanted, which was a history of the 2013-2014 epidemic, but I’m not even mad. Focusing largely on Hatch’s personal experiences in a rural ETU in Liberia, it also dives into Liberia’s history and present conditions in search of an explanation for the severity and scale of the epidemic. As he notes, this bafflement is also part of the answer – it was bad because no one thought it could be that bad.
The virus was first observed in Zaire (DRC) and Sudan in the 1970s and while there were outbreaks over the intervening years, some quite serious, authorities and medical professionals in West Africa were far more concerned about Lassa fever, malaria and any number of other diseases. Despite Preston’s graphic description of the disease in The Hot Zone, it turns out that Ebola doesn’t generally liquefy its victims. Heck, it’s not even called a haemorrhagic fever anymore. As Hatch notes, most cases look like fever for the first week and cholera for the second – if doctors are not looking for Ebola, they’d probably treat the fever as malaria. When dealing with a virus notorious for killing medical professionals and family members, that mistake can have dire consequences.
He also delves into the effects of poverty and underinvestment in education and health care. Malnourishment weakens the immune system, poor health care outcomes at the best of times meant that people were unwilling to go to hospitals until deathly ill (and that’s a vicious cycle in and of itself) and traditional practices clashed with public health science and the rudiments of epidemic control.
Liberia’s disastrous civil war also played a part. Hatch describes a country where trust in government is extremely low and belief in conspiracy theories extremely high – there were rumours that ETCs were part of a conspiracy to spread Ebola, as was the disinfectant spray used to sterilise equipment and buildings was liquid Ebola. In one case, a delegation to one village was hacked to death with machetes.
Ultimately, however, the resonance of this work lies not in its treatment of the background but in Hatch’s deeply personal, humanitarian recollections of the trials of working in an ETU in the midst of the epidemic as families, doctors and communities tried to cope. It’s not a history or a journalistic account or an epidemiological study – it’s a book by a doctor about doctoring.