Crisis in the Red Zone: The Story of the Deadliest Ebola Outbreak in History, and of the Outbreaks to Come in Science and Inquiry

Mar 29, 2020 Anna rated it liked it

The 2014-2016 West African Ebola outbreak devastated three nations and killed thousands. It was especially tragic in how it killed skilled and compassionate caretakers, people who had dedicated their lives to treating terrifying infectious diseases in their home countries. With that knowledge in mind, it is difficult to meld Preston鈥檚 emotionally heightened and hyperbolic writing style with the heartbreaking reality that this outbreak doesn鈥檛 need to be made thrilling or suspenseful to understan The 2014-2016 West African Ebola outbreak devastated three nations and killed thousands. It was especially tragic in how it killed skilled and compassionate caretakers, people who had dedicated their lives to treating terrifying infectious diseases in their home countries. With that knowledge in mind, it is difficult to meld Preston鈥檚 emotionally heightened and hyperbolic writing style with the heartbreaking reality that this outbreak doesn鈥檛 need to be made thrilling or suspenseful to understand its reach and consequences.

First, let me say that this book is gripping. It could easily be read in one setting, and it plays out like a well-paced movie. However, given Preston鈥檚 known penchant for (sometimes inaccurately) hyping up the drama, one must wonder how reliable a narrator he is. He writes as if he knows what now-deceased characters were thinking and experiencing, and while he did do field research and speak with the surviving individuals who were in the thick of it, no documents, communications, or interviews are referenced and indicated within the text. For me, this would have lent some sense of accuracy and transparency. Without a more journalistic or academic form of documentation, the inclusion of such personal details feels exploitative and bordering on fiction. When I finished this book, I did my own research before taking anything presented here as factual.

Preston does paint the scenes of hospitals and treatment facilities in incredible detail. From those figures he did speak to, he recreates a tense chronology of exposures and decisions that influence who lives and who dies. A particularly upsetting and infuriating part of the book begins when beloved staff of the Kenema hospital begin to fall ill and die. This includes a major figure in Sierra Leonean healthcare, Dr. Hummar Khan. Dr. Khan is provided treatment at an MSF facility, where, unbeknownst to him, a course of the new potential Ebola treatment, ZMapp, is being stored. In what seems like an impossible ethics scenario, largely foreign healthcare workers argue about whether Dr. Khan should receive the medication, as he is someone who could understand the risks of being the first human to test the drug, or if to administer it to him is unethical by prioritizing his survival over that of other patients. If the drug were to kill him, would this cause violence to erupt and be yet another example of an African body being used to test a dangerous treatment? Ultimately, Dr. Khan is not provided the opportunity to even consider taking ZMapp. However, shortly thereafter, we are made uncomfortable to learn that two foreign, white healthcare workers are given ZMapp, after what I perceived to be a decision-making process fraught with ethical concerns and an agonizing delay by the physician making the call. The two aid workers survive.

Keeping in mind the great personal risk all the health workers were exposed to and the challenging environs, I do recognize that they were ultimately in a lose-lose situation. The real judgement here should be reserved for the failure on the part of international and national organizations to prepare adequately for this outbreak. Local and foreign healthcare workers were doing the best they could with woefully inadequate supplies and capacity. Another major issue I had with this book is how Preston falls short of explicitly describing the role that colonialism and racism had in this outbreak. Resource-restricted health care systems employed people who were never considered eligible for the top-notch treatment foreign aid workers would receive, and this must be called racist before anything else. I wondered if Preston was hesitant to directly make the connection so as to not appear to cast dispersions on the foreign workers he profiles. Individually, they may not bear responsibility, but their organizations and their governments do. However, Preston did describe local customs and beliefs in overly simplistic and offensively dramatized language, which makes me wonder if this connection never even occurred to him at all. Though this book was published three years after the end of the West Africa outbreak, we receive little information on how systems in the affected countries have been bolstered (if at all) and what actions - beyond the US stockpiling Ebola treatments for itself - have been taken to ensure an outbreak like this one never occurs again.

Reading this during a pandemic further highlights the need for investment in epidemic prevention and the safety and training of healthcare workers around the world. Paul Farmer (of Partners in Health) said in response to this outbreak, 鈥淲hat if the fatality rate isn鈥檛 the virulence of disease but the mediocrity of the medical delivery?鈥� When it comes to infectious disease, we are only as strong as our weakest link.

(Physical Distancing Read #5) ...more

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