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Illness As Illness

BETRAYAL OF TRUST The Collapse of Global Public Health By Laurie Garrett; Hyperion: 624 pp., $30

September 17, 2000|ROY PORTER | Roy Porter is the author most recently of "The Greatest Benefit to Mankind: A Medical History of Humanity."

Back in the 1980s, AIDS loomed as the devil of diseases. Unfailingly fatal, it had seemingly arisen out of nowhere and it leapt immediately to pandemic proportions, threatening perhaps to wipe out the human race. No wonder some saw it as the wrath of God. Over the last decade, however, at least for the wealthy West, it has turned itself, or has been transformed by expensive medical interventions, from a Horseman of the Apocalypse into a somewhat manageable disease.

By way of parallel, books about today's health hazards have changed too. A decade ago, what attracted authors were the new flesh-eating killer viruses--Marburg, Ebola and other hemorrhagic fevers--the ones that within days would reduce your body to pulp, blood spurting from every orifice. Remember works like Richard Preston's sensationalist "The Hot Zone" or its movie version, "Outbreak," with Dustin Hoffman clad in a moon suit defying deadly microbes out of Africa? Nowadays, perhaps because the shock value has been lost, what we are getting are rather more sober--but for that reason perhaps all the more chilling--accounts not of scary invasive pathogens but of daily dangers, like Lyme Disease or tuberculosis, skulking in our midst. That's a change evident in the work of the distinguished New York medical journalist Laurie Garrett. Six years ago, in her rightly acclaimed "The Coming Plague: Newly Emerging Diseases in a World Out of Balance," she dramatized the threat posed by grotesque new diseases. Now she has turned her attention to the failings, both medical and political, in our globalized society that have made us needlessly susceptible to diseases at large, old and new, including ones we once had licked.

Displaying masterly craftsmanship, Garrett explores this predicament with four case studies, each successively more detailed and closer to home--literally for her American readers, but also, if more metaphorically, for me, a British reviewer. More and more it is clear, as the story in this book unfolds, that diseases travel without regard to boundaries, societies or economics.

Surat, India, 1994: pneumonic plague erupted and pandemonium ensued. In a city polarized between rich and poor (a labor force employed in diamond-polishing), responsible public leadership and moral authority proved hopelessly lacking. Responses swung from panic to denial, from cover-ups to victim-blaming. The doctors fled (rather like what happened in London in 1665, as Samuel Pepys recorded in his chronicle of the plague years in his "Diary"); conspiracy theories and anti-Pakistani paranoia mushroomed; overseas governments responded opportunistically, with Islamic states slapping bans and quarantines on Indians; and the World Health Organization sat inactive.

Mercifully few people died, but even those fatalities were unnecessary because plague is a disease readily handled today with routine antibiotic treatments. The experience in Surat serves as a brief curtain-raiser for Garrett's three other studies and her book's key thesis: If, in this day and age, disease gets the better of us, it is entirely our own fault--the product of greed, myopia and lack of collective will. Basic measures, medical and political alike, give us all the weapons we need to hold catastrophe at bay.

Kikwit, Zaire, 1996: Ebola virus broke out in an epidemic that quickly grew more serious than it should have been. Lack of basic equipment in the hospital (goggles, gowns and masks, antiseptic soap and sterilizing gear), coupled with faulty or lax hygiene, spread the virus to nurses and medics and from them to other patients, their families and communities. But this was hardly surprising, concludes Garrett, given that decades of ghastly political corruption under Gen. Sese Seko Mobutu had run down the country's health-care system. In Garrett's telling, the 1997 toppling of Mobutu brought neither reform nor improvement but instead local henchman of Laurent Kabila, who converted the hospital's only ambulance for use as his private chauffeur-driven limousine.

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