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The Fever (thoughts)

April 5, 2011

I was quite surprised to see so many comments about Sonia Shah’s The Fever: How Malaria Has Ruled Humankind for 500,000 Years on my Library Loot post last week! But I am nothing if not a slave to my reader’s interests (that, and I was quite excited about it myself), so when a nonfiction slot opened up in my rotation, I eagerly grabbed it from the pile. The verdict? It’s a marvelous book, I’ve already put another work of Shah’s on hold at the library, and this shall be a post full of gushing.

While the book is relatively short (two hundred forty pages of text with another fifty pages devoted to notes and a thirteen page index), Shah manages to cover a wide variety of aspects related to malaria, from historical to contemporary, from individual to broader picture, from scientific facts to policy analyses. And she does it all with style; the book never loses its readable, fascinating tone. This is the best kind of popular nonfiction on offer: part science, part history, part social commentary, and completely recommendable. I learned so much, I’m having trouble distilling it into a blog post. I just want to bombard y’all with ‘did you know?’s, which hardly makes for coherent reading.

One of the things I like most is Shah’s balanced presentation; particularly when she’s looking at current campaigns to eradicate malaria, she provides a clear-headed critique of many of the policies but at the end also acknowledges the gains that have been made. And she’s willing to look past what the Western aid community thinks to actually look at what the individuals most affected by malaria think about it. I was fascinated to learn that in most countries with high rates of malaria, it’s perceived the way a cold or flu is by Westerners.

Our outsider’s perspective on malaria strikes those we see to help as incomprehensible. Across the malarious world, medical anthropologist H. Kristian Heggenhougen writes, people profess “puzzlement over the focus on malaria.” People who live in poverty and who face myriad life-and-death issues wonder “why outsiders pay such attention and resources on what they see as a minor concern within the range of problems they face every day.” They “cannot understand why malaria should be selected for elimination,” says Thai social epidemiologist Wijitr Fungladda, “rather than their poor living conditions or any other disease.” (So what do they want? The New York Times Tina Rosenerbg cites a survey that asked rural poor people just that. “The first three items,” Rosenberg notes, “were a radio, a bicycle and, heartbreakingly, a plastic bucket.”) 

This flu/cold parallel extends, from my reading at least, to the almost impossibility of eradicating it. Shah explains why a vaccine, the current focus of most of Western aid money and research, is highly unlikely to ever actually work, and how difficult it is to even use medicines to treat since malaria keeps evolving drug resistance (helped by criminals selling lower-potency drugs, sketchy drug companies advocating a shorter than necessary course, and patients who stop taking the drugs when they feel better instead of when they’re finished). Even the much-lauded mosquito net has problems, both in terms of use, but also because the mosquitoes are evolving resistance to the chemicals the nets are soaked with. I don’t mean to imply that the book is entirely negative or presents a hopeless view; there are ways to cut down on the seriousness of malaria cases, but essentially they require far more subtle, long-reaching, grassroots changes than a one-off vaccine or bed net. In fact, as Shah’s explanation of how malaria disappeared from the US and Europe shows, simply becoming a developed nation can change the environment enough that the mosquitoes who carry malaria end up dying out. I’m simplifying all of this, but suffice it to say I ended up with a lot of food for thought (including how powerful the Gates Foundation, aka one person, has become), and I highly suggest you read the book for yourself if any of this piques your interest.

The magic of The Fever, though, comes from the way Shah includes all of this current commentary with a history of mankind’s relationship with malaria. She starts by tracing the way mosquitoes, malaria, and humans evolved, noting that people from different geographic areas ended up with immunities to different strains of malaria. In fact, this immunity allowed the Bantu-speaking people to conquer the majority of Africa over a few millenia; they were farmers who lived in villages, which exposed them to year-round malaria infections. Thus, many babies and children died, and eventually natural selection saw the strongest immune systems become more widespread. As Shah explains,

The immunological fence that P. falciparum built around the Bantu repelled incursions by outsiders as effectively as a standing army. The Bantu villagers didn’t have to be bigger or stronger to beat back the nomads: a couple bites from their mosquitoes did the trick. 

Ancient Rome enjoyed a similar advantage; the Romans avoided the most mosquito-laden areas surrounding their city, which were the very places any invading army would have to camp before an attack. Interesting, right? (Incidentally, the word malaria comes from the Italian ‘mal aria,’ or ‘bad air,’ which they thought was its cause.)

As a lover of British classic literature, I’ve always been aware that the Caribbean was especially dangerous for Europeans; in fact, having to go to Jamaica was viewed as a kind of death sentence. But I never really thought to wonder why. It turns out that the enslaved Africans brought over their native strands of malaria in their blood; so when Caribbean mosquitoes bit them, they became incubators for these species. In turn, when the Europeans were bitten, they had no immunities whatsoever to the African malaria, and thus could not put up much of a defense. I couldn’t help feeling a bit of satisfaction knowing that slave owners got back even a tiny amount of the pain, suffering, and death that they caused (although unfortunately the ‘New World’ natives were similarly defenseless and ended up far more decimated). Malaria is also why Europeans didn’t start sugar plantations in West Africa, which would have made more sense since it would have eliminated the two longest sides of the trade triangle; they couldn’t survive long enough to colonise.

Well, I’m at a thousand words, and I’ve only begun to scratch the surface of all of the information Shah presents (there’s also a lot of science and cultural information, all woven together seamlessly). But I hope I gave you enough of a taste to convince you to go read Fever for yourselves; it’s smart, well-written, and challenging. What more can you ask of nonfiction?

46 Comments leave one →
  1. April 5, 2011 6:10 am

    Thanks for the review, Eva. I think I was one showing interest for this book in your loot and now I want to read it just the more.

  2. April 5, 2011 7:23 am

    The Fever sounds fascinating! I don’t read as much non-fiction as I should, but this one sounds like my favorite kind – readable and informative. I’m glad it wasn’t overly hopeless or depressing. Your quote about those who live with malaria and how they view it the same as an everyday cold was particularly insightful.

    • April 9, 2011 2:34 am

      I think it would definitely appeal to you!

  3. April 5, 2011 8:17 am

    I was one of those who wanted to know about this book. It is always nice to see a book on disease written in an easy to read fashion. I am especially interested in the fact that she includes a lot of social commentary and history. I haven’t read much science in a while and this might be a good one for a foray back into that subject area. Thank you for providing such well developed thoughts on the book!

  4. April 5, 2011 9:27 am

    So glad you liked it. I felt the same way about the book. I thought Shah did a great job of making all those science-y terms and concepts accessible to someone like me who can’t even balance an equation if her life depended on it, haha.

  5. April 5, 2011 10:14 am

    Wow, this really does look good. I missed the first post on it so I’ll have to go back and look through. I’m glad I caught this one, though. Thansk for the review!

    • April 9, 2011 2:39 am

      It wasn’t really a post, just my last Library loot included it. :)

  6. April 5, 2011 10:22 am

    This sounds awesome, I’ll definitely be looking to track down a copy!

    • April 9, 2011 2:39 am

      Oh yay: can’t wait to see what you think of it!

  7. April 5, 2011 12:09 pm

    Ooh, this sounds like a good one! I presume she must talk about DDT too and its role in eradicating malaria?

  8. April 5, 2011 1:09 pm

    I love non-fiction and this is just the sort of book that will fascinate me and send me off to do further research. I’m adding it to the list and grateful for the recommendation.

    • April 9, 2011 2:40 am

      Glad you’re interested in it Kathleen!

  9. April 5, 2011 1:27 pm

    Social implications of disease are truly fascinating. Thanks for the enthusiastic review, Eva – there’s plenty even in your thoughts that I wasn’t previously aware of, so I can only imagine how much I’ll learn if I pick up Shah’s book. :-)

    • April 9, 2011 2:41 am

      I could have marked up every page with fascinating passages; it was packed of information!

  10. April 5, 2011 1:49 pm

    This sounds amazing! I’ve had your library loot open in a tab for a few days now but haven’t had the time to watch the video yet, so I am really glad you chose to write a full post on this. Sounds like the best kind of non-fiction to me, so I’ve added it immediately to my wishlist.

  11. April 5, 2011 6:26 pm

    Goody! I like books about diseases and their sociological impact — Randy Shilts had this lasting effect on me. :p I’m also verrrry interested in the Gates Foundation and the way they do charity. This isn’t the first time I’ve heard that they have way the hell too much power over their chosen fields of influence.

    • April 9, 2011 2:43 am

      There isn’t a ton about the Gates Foundation, but what’s there is definitely good food for thought!

  12. April 5, 2011 6:49 pm

    You got to a thousand words, but you had me at the first paragraph. This is a wishlist book!

  13. Karenne permalink
    April 5, 2011 6:57 pm

    I recently found out about a book written by Helen Hooven Santmyer. She began writing the book when she was in her twenties and it wasn’t published until she was in her eighties!

    It is called “And the Ladies of the Club” (ISBN 10: 0425174409 ). The book is about 1400 pages long and it is about a ladies’ literary club. To read a little about the author and the book, here is the link to LitLovers post:

    I haven’t gotten my hands on the book yet, but I look forward to reading it.

    Karenne Saylor

    • April 9, 2011 2:45 am

      Ohhh: I remember hearing something about that last year but I’d forgotten abou tit! Thanks for reminding me. :)

  14. April 5, 2011 7:43 pm

    What a coincidence that I literally just watched TED talk video of Bill Gates on Mosquitoes and Malaria! It all sounds fascinating. Here it is if you’re interested

  15. April 5, 2011 8:36 pm

    This sounds excellent! I’ve been on a medical/disease nonfiction kick, and I imagine this would be a good addition :)

  16. She permalink
    April 5, 2011 8:36 pm

    Convinced! I am definitely going to pick this one up. Ten points for the Romans!

  17. April 5, 2011 11:35 pm

    I’m sooooo reading this ! Thanks !

    • April 9, 2011 2:47 am

      No problem Maphead! Can’t wait for your post. :)

  18. April 6, 2011 11:48 am

    This book sounds fantastic! It has so many aspects of what I look for in good nonfiction – the historical, medical and scientific aspects especially. I’ll keep an eye out for this one.

    • April 9, 2011 2:48 am

      Then I think you’d definitely like it Alyce!

  19. April 7, 2011 8:00 am

    This book sounds fascinating! I’m definitely going to add it to the TBR.

    I hope it’s okay if I add a link to your review to the South Asian Review Database.

  20. April 7, 2011 11:08 am

    *very quietly so as not to upset George Clooney or whoever* Insecticide-treated mosquito nets will not do much to help in the so-called fight to eradicate Malaria. This is because in areas most affected by the disease, people don’t even sleep on beds with post. Many reasons why including that it might just be cooler to sleep outside. So if you give a mother a net, she might just lock it in her cabinet or suitcase. But who wants to tell them this and mess the gravy train that includes some of the world’s biggest aid agencies. *moving quietly away now*
    BTW, a wonderful review and thanks for bringing the book to my attention.

    • April 9, 2011 2:50 am

      Yes Kinna! Shah goes into all of those points. And the absurdity of celebrity causes, since they simplify the issues. I would LOVE to see you post on the book.

  21. April 14, 2011 7:37 pm

    Ooohhhhhhh I want I want I want to read :) It’s on the wishlist now. Sounds fascinating. And I would also love to hear more of Kinna’s thoughts :)

  22. April 17, 2011 9:21 pm

    I know this was the book most interesting to me from your Library Loot, and now I’m more intrigued by it than ever from your review. I especially would like to read more regarding how the disease affected the movements of people in history, and how going to the Caribbean was seen as a death sentence.


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