Laurie Garrett

Photo by Laurie Garrett

“In the newly globalized economy of the twenty-first century no part of the planet is too remote, too exotic, or too forbidding for travelers or business development.” (pg.12)

Photo by Laurie Garrett

“Trucks and a bulldozer were found, applied to the horrible job of creating enormous mass graves on the edge of town, in which the plastic-wrapped bodies of the dead were stacked.” (pg. 81)

Photo by Laurie Garrett

“Muyembe ordered all non-Ebola patients sent away from Kikwit General Hospital, and he decreed that all suspected Ebola cases in any other clinic, or in people’s homes, be collected by the local Red Cross and brought immediately to Pavilion No. 3, the hastily designated isolation ward.” (pg. 79)

Photo by Laurie Garrett

“The patients were in a sorrier state. The staff had no protection and they hadn’t been paid for risking their lives. So we decide to focus on Hospital sanitation and establishment of an isolation ward.” (pg. 79)

Photo by Laurie Garrett

“Two things are clear: Ebola spread in Kikwit because the most basic, essential elements of public health were nonexistent. And…Ebola haunted Zaire because of corruption and political repression.” (pg.59)

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“For decades Georgia’s health care system was based on enormous facilities like Republican State Hospital, located in downtown Tblisi.  The twelve-story, two-thousand-bed concrete facility was so full during the 1980’s, doctors said, that patients often lay upon gurneys lining the hallways.” (pg.247)

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“It could be seen in Georgia, at the Deserter’s Bazaar in Tblisi, where Goga, an economics student with no medical training, sold antibiotics from an open-air booth, advising customers how to use the drugs, and which to take.” (pg.124)

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“’It’s like a genocide,’ Declares Dugarova. ‘A holocaust. We’re dying.’

“Probably for genetic reasons, though no one was sure, ethnic Buryatis and other indigenous peoples of Siberia are especially vulnerable to the tuberculosis mycobacteria.  In 1996 some 211 of every 100,000 Buryatis suffered active, symptomatic tuberculosis.  That’s twice the TB rate seen in their ethnic Russian neighbors.” (pg.191)

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“WHO water engineers discovered that all over the region Soviet urban planners had bundled drinking water and sewage pipes, burying them one atop the other under the region’s densely populated cities…by the 1990s sewer pipes commonly leaked directly into drinking water carriers.” (pg.181-182)

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“Outside the Siberian city of Ulan Ude, a village has been created downwind of the municipal garbage dump.  Fifty-two adults and eight children live in a pine grove that is covered in an artificial forest floor made of trash that blows off the ten-story-high, redolent garbage heaps.”  (pg.133)

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“In September 1994 all of India resonated with plague panic, coupled with a near universal condemnation of a filthy Surat.” (pg.17)

Photo by Laurie Garrett

“But after the collapse of the Soviet Union the situation flipped 180 degrees.  Suddenly fruit, vegetable, and meat markets sprung up in even the remotest parts of Siberia.  But that was all most people could afford to do: look.” (pg.169)

“Gonorrhea, in contrast, could be treated with a single penicillin injection.  So privacy-conscious people sought discreet care for their gonorrhea, leaving the disease woefully underreported.” (pg.227)

“For two hundred years New Yorkers fought off epidemics and pestilence, learning by erring how to create an enormous metropolis that was, from at least a disease perspective, safe.” (pg.2)

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“It’s Patriote Day in Ulan Ude—May Day in the West—and the city’s population is pouring into Ploshehad Sovietov.” (p.191)

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“But unless this collective lurch toward progress is accompanied by a vision of a cleaner and more hygienic life, India will never quite qualify in the eyes of the international community as a modernizing nation.” (pg.18)

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“And there was equally strong anecdotal evidence that the rape of the land in places like Noril’sk and Murmansk, key mining and industrial centers, contributed to rising incidences of cancer, cardiovascular disease, and the like.” (pg.143)

Photo by Viorel Florescu

“Though the numbers of prisoners dying each year of TB in Georgia paled when compared to neighboring Russia, tuberculosis was the leading cause of death in prison.” (pg.186)

Photo by Viorel Florescu

“In Building Number 1, for example, row upon row of industrial freezers housed Ebola, Lassa, smallpox, monkeypox, tick-borne encephalitits, killer influenza strains, Marburg, HIV, hepatitits A, B, C, and E, Japansese encephalitits, and dozens of other human killer viruses.” (pg.505)

Photo by Viorel Florescu
 
“At VECTOR in 1990—just one year before the collapse of the Soviet Union—Alibek led a team that figured out how to weaponize smallpox, dispersing the deadly microbes in aerosols…and they manufactured eighty to a hundred tons of the horrible stuff.” (pg.508)

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“Gaspard Menga Kitambala was a forty-three-year-old charcoal maker, Jehovah’s Witness, husband, and father of five small children.  By all accounts, Menga was a hardworking fellow, devout Jehovah’s Witness Christian, and a devoted father.” (pg.59)

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“Based on what they did know at the time, however, the team felt American provisions for universal precautions, modified to include goggles and rubber boots, were probably adequate for the Red Cross and health care workers. For Swanpoel and his tiny group of on-site lab workers full-body space suits were, despite the stifling heat and humidity, deemed wise.” (pg. 91)

Photo by Viorel Florescu

“Every individual found to have tuberculosis in Ulan Ude is brought to the log cabins that currently constitute [the] TB sanatorium.” (pg.191)

Photo by Viorel Florescu

“On the staff of the Moscow-based drug group NAN, which stands for ‘No to Alcoholism and Drug Addiction,’ she said she saw a steady daily stream of young men and women similar to those at Club 888.” (pg.142)

Photo by Viorel Florescu

“The new face of health care in the former USSR could be seen at an AIDS clinic in Kyiv, where a nurse took blood from an HIV-positive man without wearing protective latex gloves, using her bare forefinger to apply pressure to the site of injection.” (pg.123-124)

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“Mirian caught TB in jail in 1993…Arrested for robbery, Mirian served three years in a thirty-square-meter jail cell inhabited by more than a hundred prisoners.” (pg.185)

Photo by Viorel Florescu

“The patient’s respiratory ventilator was hand-pumped by a nurse, his anesthesia was dripped onto a cloth over his face.  The surgeon was working quickly because the generator only provided fifteen minutes of electricity for the lights.” (pg.124)

Photo by Viorel Florescu

“About halfway into the Palermo neighborhood, where there are some ten thousand Gypsies and their ‘slaves’—drug-addicted Ukrainian adolescents who work for nothing more than daily hits of narcotics—the road becomes impassable.” (p.207)

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“From 250 grams of poppy straw, three cups of water, about a liter of solvent, and a few drops of acetic anhydride, this is it—enough opiate extract, called chorny, to get two addicts high.  The cost: about $10 and three hours of dangerous labor.” (p.210)

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“But despicable as Surat’s verminous filth was, the stench, garbage, and rodents of the city played little, in any, role in the start or spread of the nation’s plague epidemic…the plague in Surat had much more to do with horrid housing, human panic, and bereft health care than Ratus ratus.” (p.18)

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“Behind thick isolation doors in two sealed chambers were the most dangerous patients – those who were actively coughing up Yersinia-contaminated blood and sputum.” (pg. 30)

“News reports across India ran the gaumt from the Times of India’s calming headline that day…to the Daily’s claim that more than 250 Suratis were dead, and 10,000 had the plague.” (pg 28)

“No one in India had seen a case of plague in more that thirty years.” (pg. 19)

"So from the first moments of Surat’s epidemic the Indian public was deluged with at least as much misinformation as actual facts…The information schism – between truth and fantasy, accuracy and exaggeration – would prove disastrous for India in coming days.” (pg. 29)

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“Meanwhile, in Surat, poor women, one hand clutching their saris in place, spread white DDT powder with bare hands along Ved Road.”

“By the time Ebola struck Kikwit the dictator and his friends had stolen at least $11 billion from the Zairois people. The national bank had been shut down since 1991, when soldiers looted Kinshasa heaving learned that the currency in which they were paid carried no value. There was no cash in the bank, and no legal exchange of currency.” (pg. 57)

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“He swiftly ruled out Ebola infection in the primates, and set about searching for other possible Ebola-carrying animals. The amiable South African managed to recruit local volunteers who helped snare bats from Kikwit’s trees and church belfries.” (pg. 97)

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“’Someone has died! He was my pap!’ screamed a teenage girl. Surrounded by her six younger, grieving siblings the girl’s face and blouse were drenched in tears. ‘He was my pap,’ she cried again, pushing a photograph of the deceased into the hands of a passing stranger.” (pg. 91)

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“At Narcology Hospital No. 17 in Moscow deputy director Tatiana Lysenko sees addicted boys every day. They come in droves, their bodies sickened by the drugs – and by hepatitis.”  (pg. 215)

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“Until 1991 healthcare workers simply called in the police and locked up the users. And the patients cold-turkeyed, repented, underwent political re-education, and either learned the error of their ways or were sent  to prison. It was simple.
“But after 1991 and the collapse of Communist rule narcologists had no idea what to do.” (pg. 215)

“’I like Edgar Allan Poe. His poems are about death. Live fast, die young,’ says 27-year-old Aruslan Kurcenko. (pg. 200)

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“Following universal rules of marketing, drug traffickers were creating clienteles in the region by selling everything from raw opium to heroin at rock-bottom prices, more than tenfold lower than equivalent drug sales in New York City.” (pg. 213)

Photo by Viorel Florescu

“Minov and the staff of a small drug addiction clinic called Trusting Spot collected thousands of syringes found in the Odessa shooting field in January 1997: fully a third of them tested positive for HIV.” (pg. 212)

Photo by Viorel Florescu

“’It doesn’t matter anyway,’ he adds. ‘I’m HIV positive. Whether it’s from drugs or AIDS, I will soon die.’” (pg. 210)

Photo by Viorel Florescu

“Those more recently inducted into the opiate world haven’t yet sold winter coats and boots for hryvnya; enough, perhaps, for another hit of chorny.” (pg. 210)

Photo by Viorel Florescu

“By the end of 1998 the Russian Ministry of Health had to acknowledge two things: nearly all new HIV cases were among youthful IV drug users, and the ranks of said narcotics and amphetamine injectors had swelled dramatically.” (pg. 223)

Photo by Viorel Florescu

“’Our main task is to save the younger generation,’ Mogilevsky sternly says. ‘If we can manage to pull them out of the reach of the Mafia structures, we will win this battle.” (pg. 213)

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“Artur puts the tin bowl into the jury-rigged double boiler and cooks it another twenty minutes until nothing remains but a thin dark green film reminiscent of pond algal scum. He grabs the syringe full of acetic anhydride and carefully injects it into the pot, producing yet another vile, vinegarish odor. He stirs slowly, his tattooed wrist rotating round and round, bearing the Russian phrase, GOD BE WITH US.” (pg. 210)

Photo by Viorel Florescu                     

“Konstantin, an emaciated, bedridden thirty nine-year-old former Soviet soldier, lies dying at the Moscow Tuberculosis Research Center. Drug-resistant TB has invaded his lungs, liver, kidneys, and heart.
“Still, he says with a smirk that he appreciates the irony of the situation. ‘It’s like a joke,’ he notes, his soft, ruined voice interrupted frequently by fits of coughing, ‘a particularly Russian joke.’
“’I did it all,’ Konstantin begins. ‘Komsomol, Communist Party, fighting in Afghanistan….’”  (pg. 184)

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“Neurostimulation is a greedy mistress. The brain wants more and more of it: the longer a smoker uses cigarettes, the more the brain actually changes physically, adapting to nicotine stimulation so thoroughly that it cannot readily function without it.” (pg. 354)

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“Later, when the discussion turns to alcohol’s effects on their future, Sergei blurts out a bit of his past. ‘I tried to commit suicide,’ he says, pulling up his black leather sleeve to reveal the scares of slit wrists.
“’Me too!’ Alex says, displaying a similar set of scars, and quickly, all five of the young men in the group roll up their sleeves to the astonishment of a reporter, excitedly comparing suicide methods and scarred reminders.” (pg 141)

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“Eight-year-old Katia, for example, boldly approaches a stranger and responds to a smile with heartbreaking warmth, crawling into the adult’s arms. But she cannot answer when asked about her parents’ names or whereabouts.” (pg. 139)

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“When Vanya was just nine years old, he explains with utter lack of emotion, his parents’ drinking escalated. His father – whom Vanya says he detests – beat the boy and his mother repeatedly. And his mother drowned her sorrows in moonshine purchased at local kiosks. …
“…She dragged little Vanya to the massive Belarus train station, located on the western end of Moscow…And then it happened. As a train was about to leave the station Vanya’s mother let go of his hand and jumped into the departing train, never looking back.” (pg. 140)

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“The Siberian teens of Irkutsk flirt, frolic, and strut, as do adolescents the world over. One draws admiring throngs of girls as he strolls nonchalantly into the bandshell, dressed in a genuine Nike jacket and pants made from an American flag, one leg the stars, the other red and white stripes.” (pg. 143)

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“Little Natasha apparently could not read. Had she been able to she would have known that the book, authored by Edvard Maksimovsky, was subtitled An Anti-Brothel Guidebook. In page after depressing page Maksimovsky  detailed horrors of the lives of Moscow’s sex workers…” (pg. 230)

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“’That’s the Duma across the street. If they can’t do anything how can we,’ asks the tall guard, who says his name is Sash. ‘It’s been like this since 1980 when the Olympics happened. Now it’s more open. People used to be afraid, but now we have democracy.’” (pg. 229)

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“A few blocks away Marina pimps her six girls in front of Russia’s legislative building, the Duma. Duma security guards dressed in combat fatigues watch but do nothing.” (pg. 229)

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“The region’s hospitals and medical clinics outside the hallowed Kremlin walls ranged from appalling to astonishingly horrible. Most were staffed by personnel who rarely – if ever – were paid. Supplies of all kinds were scarce. Physical maintenance had long since been abandoned, and many health structures were poorly built in the first place.” (pg. 245)

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“…the medical community of the former USSR suffered in the 1990s for having been isolated from the rest of the scientific world for seven previous decades. After all, it was well known everywhere else that burn units, neonatal ICUs, and mechanical ventilators were key sources of nosocomial infections. But it was not because something was ‘growing’ there; it was because the patients and equipment in all three sites were subject to a lot of contact with the ungloved hands of doctors, nurses, orderlies, and family.” (pg. 239)

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“The central blood bank system of Georgia fell apart from 1992 to 1995 during its civil war. In its place emerged a chaotic hodgepodge of hospital banks and blood donation clinics, all of which paid donors, thus attracting alcoholics and drug users in need of quick cash.” (pg.  218)

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“Two such donors, Yuri Nevandovski and Viktor Yakolev, reeked of alcohol as they stuck their arms through a portal in a glass wall. On the other side of the barrier a nurse drained their blood.” (pg. 219)

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“The situation only worsened after 1991, as elevators broke down, compelling ailing individuals to scale stairs in order to get from test sites to their hospital beds. Food fell into short supply, with most hospitals stating frankly that families needed to provide rations for their ailing relatives, much as they would in India or Zaire.” (pg. 245)

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“Cancer is genuinely a problem. Though national cancer rates are generally below those seen in the West, cancer hot spots exist all over the former Eastern Bloc and Soviet Union….’There is a real trend upward especially among children.’” (pg. 148)

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“The pollution was undeniable. It assaulted the senses, both physically and aesthetically.” (pg. 148)

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“The Taiga forests around Angarsk were denuded by acid rain. No floor of scrub or greenery formed a protective bed for dying trees, their trunks encrusted with black filth. Weighed down by their pollution burden trees leaned at sad angles, eventually collapsing.” (pg. 153)

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“Welcome to the most polluted place on Earth, Noril’sk. Located 200 kilometers above the Arctic Circle. No sunlight four months out of the year. Population 280,000.” (pg. 155)

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“Next to the requisite stern stature of Lenin was a sign: ‘Angarsk City – Born by Victory!’ From behind the sign American disco music blared. Rows of concrete apartment buildings, each exactly the same as the last, lined the streets of Angarsk, creating a visually numbing landscape.” (pg. 153)

Photo by Rian Horn

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“’What you have is a kind of modern conflagration. It’s the modern equivalent of the great Plague,’ said Larry Gostin, professor of law at Georgetown and expert on AIDS and human rights. ‘And that’s what you’re going to get in all of the developing world. It’s going to be losses of whole generations.’” (pg. 573)

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“Perhaps African leaders who failed to place HIV prevention on their top priority lists would be drummed out of office by millions of grown-up AIDS orphans.” (pg. 583)

“The image of large open hospital wards filled with row-upon-row of the coffin-like devices would become a lasting legacy of American polio.” (pg. 648)

“On April 12, 1955 – a date deliberately selected because it marked the tenth anniversary of the death of polio victim Franklin Delano Roosevelt – Jonas Salk announced that the polio vaccine was safe and effective. The reaction nationwide was jubilant…” (pg. 329)

Photo by Rian Horn

“The new globalization pushed communities against one another, opening old wounds and historic hatreds, often with genocidal results. It would be up to public health to find ways to bridge the hatreds, bringing the world toward a sense of singular community in which the health of each one member rises or falls with the health of all others.” (pg. 585)