A pioneer in global health has battled pandemics and worked to bolster clinical systems from Sierra Leone to Kazakhstan
By Emily Bobrow March 5, 2021 11:48 am ET
Having signed up to help fight an Ebola epidemic, Paul Farmer, an infectious-disease specialist, traveled to the epicenter of the outbreak in West Africa in late 2014. The fast, fatal spread of the disease in places where the sick sought care meant that most of the region’s few hospitals and clinics had shut down and many health workers had died. To learn how to care for the afflicted without becoming a casualty himself, Dr. Farmer visited an Ebola treatment center run by an international humanitarian group in Liberia. The experience, he says, was alarming—and carries important lessons for how the world has dealt with Covid-19.
In a section for “wet” patients exhibiting the virus’s most serious symptoms, he saw two brothers covered in vomit, one of whom collapsed on the floor. This patient, with his “sunken eyes and withered skin,” needed his fluids restored intravenously immediately, but this was “not in the protocol,” Dr. Farmer learned. Neither were lab tests to assess his liver or kidney function. The man, Dr. Farmer learned, was about to die, and little was being done about it because the primary purpose of this center was isolation, not treatment.
“What we saw there was obvious clinical nihilism,” Dr. Farmer, 61, says in a phone interview. Through the Boston-based nonprofit that he co-founded, Partners in Health, which works to strengthen health systems in the poorest parts of the world, Dr. Farmer helped to reopen some of the hospitals and clinics in West Africa, but it was clear to him that, for the international aid effort, containing the epidemic was a higher priority than caring for its victims. In his recent book, “Fevers, Feuds and Diamonds: Ebola and the Ravages of History,” he writes that this strategy proved both inhumane and ineffective. Within months, the outbreak was 10 times as large as any previously recorded, with little end in sight.
“When people don’t trust you to provide care, then containing doesn’t work,” Dr. Farmer says. Because the treatment centers were known as deathtraps, critically ill patients often avoided them. He recalls meeting an Ebola survivor in Sierra Leone who lost more than 20 family members in 2014. “Why did these people have to take care of their own family? Because in the middle of a massive international Ebola response, we didn’t have adequate clinical care,” says Dr. Farmer.