From Field to Plate...
A review of THE COMING PLAGUE: NEWLY EMERGING DISEASES IN A WORLD OUT OF BALANCE by Laurie Garrett, published in 1994. Chapter 5: Yambuku – EBOLA
Sure, he had a fever, but it was undoubtedly just the malaria again
Mabalo Lokela (whom friends called Antoine) was in great mood. Sure, he had a fever, but it was undoubtedly just the malaria again. The important thing was that he was back from a great vacation – one of the few he’d had in his forty-four years. While he waited for one of the Sisters to give him malaria medicine, Mabalo shared with his colleagues at the Yambuku mission stories of his recent travels. When he got back to Yambuku he bought some fresh antelope meat in the market and his wife, Mbuzu Sophie, who was eight months pregnant, made a stew for a family celebration.
He was never seen again
Two days later, on August 28, 1976, a thirty-year-old man came to the Yambuku Mission Hospital complaining of terrible diarrhea. Though nobody at the mission recognized the man, he told the Sisters that he came from the nearby village of Yandongi. The case of the man from Yandongi was odd and Sisters Béata, Edmonda, and Myriam weren’t sure of the source of his illness. They put the man in one of the 120 beds and, for two days, debated his diagnosis. After two days the man left the hospital against the Sisters’ wishes, his diarrhea and epistaxis, or severe nosebleed, still unresolved. He was never seen again, though events days after his disappearance would prompt dozens of investigators from all over the world to scour villages throughout the Bumba Zone in search of the elusive patient.
There was no doctor in Yambuku
Since 1935 the major hospital and dispensary for some 60,000 villagers living in the central Bumba Zone was that operated by Belgian Catholic missionaries in the village of Yambuku. A staff of seventeen ‘nurses’ – so designated, though none of the Sisters had attended a certified nursing school – and medical assistants tended to the health needs of the community. There was no doctor in Yambuku.
His temperature soared over 100°F
Antoine spent days on end at the mission so it was natural that he returned to the Sisters on September 1, 1976 when, despite the quinine injection, his temperature soared over 100°F. They checked his vital signs and told Antoine to rest for a few days, where Sophie tended to him.
Yombe Ngongo, Lizenge Embale, Ekombe Mongwa, Angi Dobola and Sebo Dombe
At the same time as Antoine was awaiting his chloroquinine shot, sixteen-year-old Yombe Ngongo lay in Yambuku Hospital undergoing transfusions to counter her severe anemia. Nearby, twenty-five-year-old Lizenge Embale was recuperating from what seemed to be malaria, tended by her husband, Ekombe Mongwa. Angi Dobola was recovering from hernia surgery, watched closely by his wife, Sebo Dombe, who complained to the Sisters of exhaustion.
On September 5 Antoine returned to the mission critically ill
On September 5 Antoine returned to the mission critically ill. He was vomiting and had acute diarrhea, leaving him so dehydrated that he had ‘ghost eyes’. His chest hurt, he had a terrible headache, fevers continued, he was deeply agitated and confused. His nose bled, his gums bled, and there was blood in his diarrhea and vomitus.
The hypocrisies, cruelties, failings, and inadequacies of humanity’s sacred institutions
At the macro level a sense of global interconnectedness was developing over such issues as economic justice and development, environmental preservation, and, in a few instances, regulation. However, it wasn’t until the emergence of the human immunodeficiency virus, that the limits of, and imperatives for, globalization of health became obvious in a context larger than mass vaccination and diarrhea control programs. Through the AIDS prism it was possible for the world’s public health experts to witness what they considered to be the hypocrisies, cruelties, failings, and inadequacies of humanity’s sacred institutions, including its medical establishment, science, organized religion, systems of justice, the United nations, and individual government systems of all political stripes.
HIV, far from representing a public health aberration, may be a sign of things to come
Over the last five years, scientists – particularly in the United States and France – have voiced concern that HIV, far from representing a public health aberration, may be a sign of things to come. They warn that humanity has learned little about preparedness and response to new microbes, despite the blatant tragedy of AIDS. And they call for recognition of the ways in which changes at the micro level of thee environment of any nation can affect life at the global, macro level.
An ever-changing ecology we cannot see, but, nonetheless, by which we are constantly affected
In this book I explore the recent history of disease emergence, examining in roughly chronological order examples that highlight reasons for microbial epidemics and the ways humans respond, as cultures, scientists, physicians, bureaucrats, politicians, and religious leaders. This book also examines the biology of evolution at microbial level, looking closely at ways in which disease agents and their vectors are adapting to counter defensive weapons used to protect human beings. In addition, The Coming Plague looks at means by which humans are actually aiding and abetting the microbes through ill-planned development schemes, misguided medicine, errant public health, and shortsighted political action/inaction. Finally, some solutions are offered. What is required, overall, is a new paradigm in the way people think about disease. As Harvard University’s Dick Levins puts it, “We must embrace complexity, seek ways to describe and comprehend an ever-changing ecology we cannot see, but, nonetheless, by which we are constantly affected.”
Perspectives must be forged that meld many disparate fields
Preparedness demands understanding. To comprehend the interactions between Homo sapiens and the vast and diverse microbial world, perspectives must be forged that meld such disparate fields as medicine, environmentalism, public health, basic ecology, primate biology, human behavior, economic development, cultural anthropology, human rights law, entomology, parasitology, virology, bacteriology, evolutionary biology, and epidemiology.
A review of THE COMING PLAGUE: NEWLY EMERGING DISEASES IN A WORLD OUT OF BALANCE by Laurie Garrett. Part 2
By the time my Uncle Bernard started his medical studies at the University of Chicago in 1932 he had already witnessed the great influenza pandemic of 1918-19. He was seven years old when he counted the funeral hearses that made their way down the streets of Baltimore. Uncle Bernard was introduced to tropical medicine during World War II, when he served in the Army Medical Corps at Guadalcanal and other battlefields in the Pacific. That’s when he learned firsthand about diseases of which he’d heard very little in medical school: malaria, dengue (breakbone fever), and a variety of parasitic diseases.
Something strange was going on in Africa
During the summer of 1976 I had reason reconsider much of my Uncle Bernard’s wisdom. As I tried to make sense of my graduate research project at Stanford University Medical Center, the news seemed overfull of infectious disease stories. The U.S. government was predicting a massive influenza epidemic that some said would surpass that of 1918 – a global horror that would claim over 20 million lives. An American Legion group met in a hotel in Philadelphia and something made 182 of them very sick, killing 29. Something else especially strange was going on in Africa, where, according to garbled press accounts of the day, people were dying from a terrifying new virus.
Will something worse emerge – something that can spread from person to person in the air?
The shock of the AIDS epidemic prompted many more virus experts in the 1980s to ponder the possibility that something new was, indeed, happening. As the epidemic spread from one part of the world to another, scientists asked, “where did this come from? Are there other agents out there? Will something worse emerge – something that can spread from person to person in the air?’
Ill equipped to anticipate or manage new epidemics
By 1988 an impressive group of American scientists, primarily virologists and tropical medicine specialists, had reached the conclusion that it was time to sound the alarm. On May 1, 1989, the scientists gathered in the Hotel Washington and began three days of discussions aimed at providing evidence that the disease-causing microbes of the planet, far from having been defeated, were posing ever-greater threats to humanity. In February 1991 the Institute of Medicine (IOM) convened a special panel with the task of exploring further the questions raised by the 1989 scientific gathering and advising the federal government on two points: the severity of the microbial threats to U.S. citizens and steps that could be taken to improve American disease surveillance and monitoring capabilities. In the fall of 1992 the IOM panel released its report, Emerging Infections: Microbial Threats to Health in the United States, which concluded that the danger of the emergence of infectious diseases in the United States was genuine, and authorities were ill equipped to anticipate or manage new epidemics.
$12 billion annually
After the release of the report, the U.S. Centers for Disease Control and Prevention in Atlanta began a soul-searching process that would, by the spring of 1994, result in a plan for heightened vigilance and rapid response to disease outbreaks. The slow responses to the emergence of HIV in 1981 had allowed the epidemic to expand by 1993 to embrace 1.5 million Americans and cost the federal government more than $12 billion annually in research, drug development, education, and treatment efforts.
Efforts worsened the plight of the average individual in the Third World
By 1990 the world’s major donor institutions would be forced to conclude that modernization efforts seemed only to have worsened the plight of the average individual in the Third World, while enhancing the power, wealth, and corruption of national elites and foreign-owned institutions.
An ambitious global Marshall Plan
In 1992 the United States elected a Vice President who espoused an ambitious global Marshall Plan to protect the environment. Albert Gore warned that nothing short of a massive worldwide shift in human perspective, coupled with elaborate systems of international regulation and economic incentives, would be adequate to ensure that survival of the planet’s ecology. “Those who have a vested interest in the status quo will probably continue to stifle any meaningful change until enough citizens who are concerned about the ecological system are willing to speak out and urge their leaders to bring the earth back into balance.”
THE COMING PLAGUE: NEWLY EMERGING DISEASES IN A WORLD OUT OF BALANCE
About the author
Laurie Garrett is a health and science writer for Newsday and New York Newsday. A contributing author to AIDS in the World, edited by Jonathan Mann, she was formerly a science correspondent for National Public Radio and has written for The Washington Post Magazine, the Los Angeles Times, and Omni, among many other publications. Garrett researched The Coming Plague as a fellow at the Harvard School of Public Health. Unpurified drinking water, improper use of antibiotics, local warfare, massive refugee migration, changing social and environmental conditions around the world have fostered the spread of new and potentially devastating viruses and diseases – HIV, Lassa, Ebola, and others. In The Coming Plague: Newly Emerging Diseases in a World Out of Balance, published in 1994, Laurie Garrett takes you on a fifty-year journey through the world’s battles with microbes and examines the worldwide conditions that have culminated in recurrent outbreaks of newly discovered diseases, epidemics of diseases migrating to new areas, and mutated old diseases that are no longer curable. She argues that it is not too late to take action to prevent the further onslaught of viruses and microbes, and offers possible solutions for a healthier future.
“Like her role model Rachel Carson, whose 1962 Silent Spring woke up society to environmental poisoning, Garrett aims to dispel social and political complacency about the threat of old, new, and yet-unknown microbial catastrophes in a global economy that links Bujumbura, Bangkok, and Boston more closely than almost anyone appreciates.”
Richard A. Knox, The Boston Globe
Preface by Jonathan M. Mann, Harvard AIDS Institute
We always want to believe that history happened only to ‘them’, ‘in the past,’ and that somehow we are outside history, rather than enmeshed within it. Many aspects of history are unanticipated and unforeseen, predictable only in retrospect: the fall of the Berlin Wall is a single recent example. Yet in one vital area, the emergence and spread of new infectious diseases, we can already predict the future – and it is threatening and dangerous to us all.
The history of our time will be marked by recurrent eruptions
The history of our time will be marked by recurrent eruptions of newly discovered diseases (most recently, hantavirus in the American West); epidemics of diseases migrating to new areas (for example, cholera in Latin America); diseases which become important through human technologies (as certain menstrual tampons favored shock syndrome and water cooling towers provided an opportunity for Legionnaires’ Disease); and diseases which spring from insects and animals to humans, through man-made disruptions in local habitats. What is new, however, is the increased potential that at least some of these diseases will generate large-scale, even worldwide epidemics. AIDS does not stand alone; it may well be just the first of the modern, large-scale epidemics of infectious disease.
A person harboring a life-threatening microbe can easily board a jet plane
The world has rapidly become much more vulnerable to the eruption and, most critically, to the widespread and even global spread of both new and old infectious diseases. This new and heightened vulnerability is not mysterious. The dramatic increases in worldwide movement of people, goods, and ideas is the driving force behind the globalization of diseases. A person harboring a life-threatening microbe can easily board a jet plane and be on another continent when the symptoms of illness strike.
A worldwide ‘early warning system’ is needed
AIDS is trying to teach us a lesson that a health problem in any part of the world can rapidly become a health threat to many or all. A worldwide ‘early warning system’ is needed to detect quickly the eruption of new diseases or the unusual spread of old diseases. Without such a system, operating at a truly global level, we are essentially defenseless, relying on good luck to protect us. Laurie Garrett has spelled it out clearly for us. Now we ignore it at our peril.
A NEW HISTORY OF THE WESTERN WORLD
Chapter 18: The Post-War World: From Social Cohesion to Global Marketplace (cont.)
As well as direct military spending, the 1944 GI Bill of Rights gave $13 billion for returning soldiers to enter college, enrol in training programmes or set up in business; while the government eased taxes and most people cashed in their war bonds. There was suddenly an awful lot of money around, and with an industrial sector with huge unfilled capacity, America found itself in a boom economy. The 1950s was a partial repeat of the 1920s. Legislation curtailed workers’ rights, while the revival of consumerism engendered political conservatism. In 1952 Eisenhower immediately signalled the return of big business to politics; Secretary of State John Foster Dulles was a corporate lawyer, his deputy was a former head of Quaker Oats, and the Secretary of Defense, Charles Wilson, was formerly head of General Motors, while Edward Bernays reappeared as a government adviser.
In the post-war decades, discoveries and inventions made in the 1920s, 1930s and during the war itself began to be turned into practical innovations that would alter the lives of western people. Antibiotics, television, jet engines, rocket technology, computers, quantum mechanics, nuclear fission, DNA, electronics, materials, metallurgy and plastics were all, in the short and medium term, to feed into a technological revolution of western life. Organizational refinements proved just as influential as technological changes. Mass production of cars began in America in the 1920s, but in the war years and after economies of scale, organizational efficiency and improved distribution networks combined with changing technology to make American industry and American corporations the economic powerhouse of the world.
The advertising techniques first introduced in the 1920s, in which consumers were sold happiness rather than goods, came to the fore. The booming economy made people feel that satisfying their own individual desires contributed to national prosperity. The countries that best learned the lessons of American success were Japan and Germany, the defeated nations of 1945. Faced with the urgent need to start anew, they were able to devise distinctive structures in which (in contrast to the United States) their national governments made a priority of strategically guiding investment in manufacturing industry.
The war gave American industry the chance to build a continent-sized infrastructure that pushed it beyond the reach of competition from the devastated continent of Europe. Just as government war spending revitalized American industry in the early 1940s, so federal-funded road schemes gave a huge boost to the automobile, construction and engineering industries in the 1950s and 1960s. By 1950 the United States had 39% of the world’s GDP, and built 80% of the world’s cars, while the Interstate Highway Act of 1956 committed the federal government to spending $35 billion over 14 years to build a national network of roads. The freeways signalled the end of the domination of rail; after the 1950s goods went by truck and people by car and bus. Car numbers increased vastly, making them ever cheaper to buy, while plentiful gasoline made them absurdly cheap to run. Growing prosperity meant that more homes were being built, but now that everyone (except the poor) had cars there was no need for them to be close to factories or offices or schools or shops. Homes and services spread out along highways. America was, after all, a vast country with enough empty space for everyone to have a decent-sized plot. There was no need for offices or shops to be grouped in one place either, so they began to move out of the old downtown areas and relocate on to highways where they were in easy reach of commuters and shoppers. The geographical size of a city was limited only by the distance a car-driver was willing to travel. The newly expanding cities like Los Angeles, Dallas-Fort Worth and Houston became more extensive than anything previously seen on earth, with vast networks of freeways connecting endless suburbs. American culture was no longer centred on settled towns and cities but on cars, trucks and freeways, and on endless movement.
The development of motorized technology produced an enormous effect that began almost invisibly but over the post-war period, brought on the disappearance of a central aspect of western life dating back 5,000 years. By the 1920s and 30s mechanized tractors, harvesters and other machinery were making small farmsteads in the United States redundant. After 1945 the machines got ever bigger, and so the fields and land holdings got bigger too. By the 1950s large machines were being put to work on the agricultural landscape of western Europe first founded in Neolithic times. Ancient landscape features were routinely destroyed as the need for efficient production over-rode the customary relations of people and land.
At the same time agricultural communities, inheritors and custodians of customs that encouraged and celebrated communal working and living, became irrelevant. As George Evans showed in a series of intimate studies, before mechanization a whole village would turn out for hay-making, or harvesting or stone-picking, but afterwards a single tractor could do the work of 50 men, women and children. Farming became a solitary occupation and the meaning of village life was irrevocably altered.
The biggest break with the past was the abandonment of the strident nationalism that had brought catastrophe to the continent of Europe. Both French and German political leaders recognized the cycle of retribution that had marred their countries’ relations, and set about building indissoluble ties. In April 1951 the European Coal and Steel Community, comprising France, Italy, West Germany, the Netherlands, Belgium and Luxembourg, was established and, through the work of French politicians Robert Schuman and Jean Monnet, was turned into an economic community covering all areas of trade, formalized in 1957 by the Treaty of Rome. In Britain’s voluntary absence France and Germany formed an enduring partnership, building a vision of European integration.
Nationalism was subsumed in the formation of other international bodies, including the United Nations in 1948, and NATO in 1949. Even before the end of the war, the Bretton Woods agreement of 1944 tied the economic destinies of western countries together under an American umbrella. Harry Dexter-White and John Maynard Keynes devised an international system of finance based on the dollar, whose value was fixed against gold and against all other major currencies. The agreement, which also set up the International Monetary Fund, World Bank and International Trade Organization, was designed to create stability and growth and open up the world to greater trade. In reality it opened up the world to American capitalism.
Apart from multilateral cooperation and defence against communism, the other great international movement of the immediate post-war years was the retreat from empire. Any possible benefits were now outweighed by the unaffordable costs of policing increasingly assertive local populations, many of whom had fought for their imperial masters during the war. In 1947 India was granted independence from Britain, with Pakistan and Ceylon given status as separate states. Britain managed to extricate itself from the ensuing communal violence but was to become entangled in colonial wars in Malaya, Cyprus, Kenya and Egypt, while avoiding conflict in most of its other African and Caribbean colonies. In retrospect the biggest failure was in the Middle East, where Britain handed the mandate of Palestine to the UN in 1948, after being unable to resolve the claims of European Jews wanting a new homeland with the rights of the indigenous Palestinian population.
By 1946 French troops were already fighting rebellions in Algeria, Syria, Madagascar and Indo-China. After nine years of guerrilla warfare, the French army was lured into a trap at the remote outpost of Dien Bien Phu, and in 1954 France was forced to surrender North Vietnam to its people. An eight-year war of independence in Algeria came close to bringing down the French government, with independence finally granted in 1962.
The world might have hoped that Europeans would, in the light of the Nazi death camps, be reluctant to use violence for political ends. But torture and brutality were routinely used by the British army against the Mau Mau in Kenya, where detention camps were employed, and by French soldiers against the FLN in Algeria. By the 1970s the remainder of France’s possessions, along with the Dutch, Belgian and, latterly, Portuguese empires, were liberated. Only a handful of small possessions were left from a set of empires that, only 40 years previously, had covered much of the world.
The western powers may have withdrawn from direct political control of the rest of the world but their legacy and influence was felt everywhere. Modern Europeans had no concept of governance beyond the centralized nation state; so as they withdrew from their colonies they created a host of new nations. Some were based on ethnic or religious groupings (India and Pakistan; Ireland); others combined different ethnic or religious groups (Hausa, Ibo, and Yoruba in Nigeria; Kurds, Sunni and Shia Muslims in Iraq); in many, ethnic groups were divided among different states (Kurds in Iran, Iraq and Turkey); and in some the boundaries between states depended on the colonial powers (west Africa) or on the persuasive skills of local leaders (the division of Kuwait from Iraq). But in all cases the political structures were based on the relatively recent western concept of the nation state. This swept away any vestiges of the customary intricate ways of allowing and restraining authority, and instead handed enormous power to whichever individual or small group could control its centre.
- Intimations of change and of challenge to the consensus of the immediate post-war years came first through cultural expression.
- The catastrophe of the conflict and the genocidal murder of six million Jews left European artists with little to say.
- But in America, in the years from 1947 to 1960 Tennessee Williams and Arthur Miller produced a series of plays, including All My Sons, Death of a Salesman, A streetcar Named Desire and Sweet Bird of Youth, that exposed the mismatch between the intricacies of personal and community life on the one hand, and the imperatives of social conformity and economic success on the other.
- When Peggy Guggenheim’s gallery, Art of This Century, opened in New York in 1942, abstract American painters like Jackson Pollock, Mark Rothko and Robert Motherwell were feted in their own land.
- William de Kooning explained that his work, with its slipping planes, visual ambiguities and lack of reference points, was a deliberate analogy of the sense of disorientation of mid-century America and the world.
- The spirit of the outsider who refuses to conform found expression in the work of Norman Mailer, Jack Kerouac and William Burroughs, all of whom stood in frank opposition to the mainstream values of American society; while intimations of rebellion were seen in movies like The Wild One (1953) and Rebel Without a Cause (1955).
- The anti-hero was born.
- The most explosive expression of rebellion against mainstream American life came in popular music.
New electric guitars were coupled with the traditional brass instruments of jazz and swing to produce a new kind of sound, while the lyrics became more sexually explicit, wittier and more self-consciously sophisticated. Joe Turner, Muddy Waters, Wynonie Harris, Julia Lee, Fats Domino and Little Richard, among many others, gave their music an extraordinary, unbelievable energy. This was music for adults who wanted a good time, this was rhythm and blues, or jump jive, or ‘race music’. Whatever you called it, it was the most instantly intoxicating, joyous, infectious, delirious sound anyone had ever heard.
- Through Elvis Presley, a white southerner steeped in gospel and race music, black music hit the heart of white America.
- Rock and roll made everything European seem dreary and old-fashioned; from the 1950s on, ‘modern’ meant American.
- American culture had the ability to speak for those who could not speak, and to articulate the life of the inarticulate. It swept the world precisely because it seemed to speak for everyone.
- While much European culture remained tied to traditional forms – novels, poetry and theatre – European cinema began to find a distinctive voice, principally through Italian and French auteur-directors like Rossellini, de Sica, Antonioni, Fellini, Carné, Truffaut and Chabrol, and the Swedish film-maker Ingmar Bergman.
By the 1960s, citizens of western countries began to shake off their fear of change. The new generation of politicians they elected, such as John Kennedy, Harold Wilson and Willy Brandt, reflected a new optimism; the contrast between the dull but steady Eisenhower and the dynamic, dashing Kennedy, and between the patrician Douglas-Home and the state-educated Wilson could hardly have been greater. Economic recovery in Europe allowed the full spirit of American consumerism to crash into a continent used to thrift and making do.
To be continued