Humanitarian Quests

Doctors Without Bordersby Renée C. Fox

Johns Hopkins University Press. 328p $24.95

A century ago, horror descended on cities across the United States. Paralytic polio and pandemic influenza, ancient scourges with poorly understood transmission, began claiming the lives of young, otherwise healthy people. In New York 72,000 cats were killed in the summer of 1916 for fear they were spreading the first major polio epidemic in the United States. Within three years, 850,000 Americans died of influenza. Nearly 40 years passed before an effective vaccine was found for influenza or polio. Now, nearly 30 years after the first (unsuccessful) H.I.V. vaccine trial and following the world’s worst Ebola epidemic, there is new respect for the power of infectious diseases.

Two new biographies address almost saintly efforts to overcome deadly diseases, one of Jonas Salk, M.D., the other a biography of the international medical relief organization often identified by its French name, Médecins Sans Frontières. Each is a tale of success against seemingly insurmountable odds, the widespread admiration that followed and the subsequent envy and even ridicule by their competitors. This history is still being written, and not necessarily by the victors.

Professor Renée Fox is a richly decorated social scientist and author of many books dealing with the intersection of sociology and medicine. She overcame polio as a teenager in New York, graduated summa cum laude from Smith College and completed a Ph.D. at Harvard/Radcliffe in the 1950s. Her book, Doctors Without Borders, resulted from a 20-year involvement with this quixotic organization. She attended assemblies, got to know leaders and interviewed physicians and patients to better understand the growing pains that took M.S.F. from a fledging reaction against the cataclysmic Nigerian Civil War in 1967 to a mammoth effort today that involves 27,000 people in 60 countries.

Fox had made a name for herself studying health care in the Democratic Republic of Congo and its roots in Belgian colonialism. After bumping into M.S.F. over a period of years, she makes no secret of her deep admiration for the organization. She ultimately immersed herself in M.S.F. to understand their motivations and methods. Chronicling travels to at least 11 countries, she plods through 120 pages of blog postings detailing the daily struggles of M.S.F. workers and a collection of internal spats and larger conflicts, like the expulsion of M.S.F. Greece for its rogue approach to Kosovo.

But when she turns to the catastrophe of AIDS in South Africa, the story finally comes alive. After winning the Nobel Peace Prize in 1999, M.S.F. embraced the idea of bringing antiretrovirals to devastated populations. They collaborated with the Nelson Mandela Foundation to initiate a treatment project near his birthplace. By 2005, M.S.F. was treating more than 40,000 infected people in 27 countries. The story takes on a sense of urgency as M.S.F. leaders overcame their own fear of the problem’s immensity and confronted local politics and prejudice to bring therapies to people who previously had no access to health care.

The capstone of the book is an exploration of efforts to address homelessness and tuberculosis in Russia, from which Fox’s own grandparents had emigrated in the early 20th century. If she is to be faulted in her narrative, it would be for giving short shrift to other organizations that do overlapping work. There are only brief mentions of Dr. Paul Farmer’s Partners in Health, Mother Teresa’s Missionaries of Charity and the Global Fund to Fight AIDS, Tuberculosis and Malaria. She shares a mountain of detail about an organization that has been built on the “anti-heroic heroism” of dedicated providers, fieldworkers and philanthropists. Ultimately M.S.F. distinguished itself from organizations like the Red Cross through témoignage—“bearing witness”—against the injustices underlying so much suffering around the world.

Dr. Charlotte Jacobs’s new biography of Jonas Salk tells a similar tale of heroism that unfolds with a dramatic intensity that makes it seem like a much shorter book. She recreates the sense of fear at the beginning of the last century as parents watched their lives unwind with the seemingly random victimization of young people by the polio and influenza viruses. Salk was a child when the two first great epidemics of these diseases went tearing through New York during the First World War. “Early childhood images of amputees, crippled children, and coffins…settled in Salk’s soul,” she writes. Raised in Russian immigrant Jewish society (his mother was from Belarus and his father’s parents were from Lithuania), Salk grew up with a deeply internalized commitment to ma’asim tovim (good deeds) and tikkun olam (repairing the world)—so much so that his two brothers teasingly called him “Little Jesus.”

Jacobs takes the reader through a history of both Salk’s personal exertions and the fight against poliomyelitis in the 20th century. She tells the story of Franklin Roosevelt contracting polio, falling in the lobby of his New York office building and being helped to his feet by Basil O’Connor—who became his law partner and later founder of the National Foundation for Infantile Paralysis (the March of Dimes). Meanwhile a young Salk stumbled into a partnership with Dr. Thomas Francis that led to the creation of the first vaccine against influenza, a disease long thought to be due to the “influence” of the heavens on humanity.

Enlisted by N.F.I.P. to apply his influenza expertise to the puzzle of polio, Salk demonstrated a single-mindedness and endurance that endeared him to O’Connor, whose own daughter had by then contracted polio. With operatic flare, Jacobs describes the announcement in April 1955 of the national Salk vaccine trial results—“the largest medical experiment in human history.” Suddenly Salk was a national hero. He was besieged with honors and offers and tens of thousands of letters, including one to his wife Donna (another summa cum laude graduate of Smith College) that recognized how little time he had spent with his family: “All the world is thinking of your husband as a saint,” wrote a physician’s wife, “but I know that you are the one who had to be a saint.”

To escape the craven jealousy of his rivals, he moved to the shores of La Jolla, Calif., where O’Connor helped him build an “institute of man,” dedicated to wedding two emerging cultures of science and humanism. With an architectural vision that “recalled the peaceful cloisters he had seen at the Convent of St. Francis in Assisi,” Salk hired the idiosyncratic Louis Kahn to design the structure and began assembling a stable of Nobel Prize-winning scholars like the world had never seen in one place.

When I met him at the end of his life, he had weathered mixed success in treating cancer and multiple sclerosis but was full of energy and enthusiasm for an unconventional approach to AIDS. Testing a therapeutic H.I.V. vaccine over the previous eight years, Salk had shown the personal touch of a physician. “The patients in our study adored him,” said his collaborator Dr. Alexandra Levine at the University of Southern California, “and he, in turn, knew each of them, knew their stories and genuinely cared for them and for their families....They were numbers in our study, but they were people to Jonas.” The number of AIDS cases in the United States had topped 400,000, and he felt a sense of urgency about launching a national campaign among H.I.V.-infected people, telling another colleague, “We’ve got to do this before I die.”

His wife, Françoise Gilot, the great French artist, was in New York when he checked into the hospital in June 1995. Suddenly the doctor became the patient. A heart blockage was cleared as he watched a monitor with amazement. Afterward, he held my hand in the I.C.U. and said, “You just won’t believe the sensation that I had when they opened up that blood vessel. It was as if a tide of well-being washed over me. It was supernatural!” But the man who had sacrificed so much for others was dead two days later.

Charlotte Jacobs’s narrative creates a rich appreciation of the highs and lows suffered by an individual crusader and his family, striving to find tikkun olam—healing for a broken world. Renée Fox’s portrayal of Médecins San Frontières paints a picture of similar persistence by its thousands of staff members worldwide. These two books build the case that the very human “anti-heroic heroism” that conquered polio and influenza may eventually overcome the fearsome plagues of H.I.V. and Ebola. Visiting the United States in 1999, Nelson Mandela said, “I’ve made many mistakes in my life and I am not a saint, unless you think of a saint as a sinner who keeps on trying.”

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