Mankind vs Microbes
By Nizam Damani
Liberty Publishing
ISBN: 978-627-7626-259
237pp.

During the last couple of centuries or so, the healthcare sector has seen many developments, mainly due to the increasing understanding of the causes of many diseases that had previously been the cause of distress and deaths in large numbers. It is worth-mentioning that this has been possible, to a large extent, with the invention of the microscope and the understanding of how microbes affect human health.

While it may sound boring and few would want to read about scientific developments, scientific information is not always just found in boring thick volumes. Mankind vs Microbes by Nizam Damani show how serious and boring subjects can be presented in a plain and engaging way for the layperson.

Dr Damani is one of the world’s leading clinical microbiologists and infection prevention and control experts, whose outstanding contribution has been recognised with many lifetime achievement awards. His first book, The Manual of Infection Control and Prevention, has been translated in many languages. Mankind vs Microbes is part memoir and part history lesson in microbiology and infectious diseases.

Dr Damani takes the reader through his life journey, talking about his childhood, family and his struggles to study, despite the hindrances caused by poverty, and how he beat the odds to achieve his goals. He writes that the book has been written to share his “life experiences as an individual, having been born in a developing country [Pakistan] without running water and sanitation” — conditions that resulted in the spread of many diseases.

A book by one of world’s leading clinical microbiologists is part memoir and part history lesson in infectious diseases and their control

His family suffered from many infectious diseases, which included malaria, amoebiasis, bacillary dysentery, hepatitis A, chicken pox and herpes simplex, to name a few. Perhaps it is these experiences with disease that drew him towards medicine and microbiology.

Alongside his remarkable life journey, the book contains information on some of the major infectious diseases that have afflicted mankind. The origins of each disease are explained in their historical context, along with the microbes that cause them, and captivating accounts of the people who first worked to control the diseases and develop vaccines against them. The book also explains how scientists track disease origins. The book presents complex scientific information regarding scientific achievements and advances in infection prevention in simple, plain language and a conversational tone.

The format of the book is unique in the sense that, while Dr Damani’s personal story moves forward in chronological order — from his childhood on to his days at medical college, to going to Kenya and moving on to the UK — he interrupts the narrative, usually at a place where he has mentioned some disease, to enter into discussion about that disease. Yet the chapters on diseases do not have to be compulsorily read in sequence, and the reader can turn the pages and pick any section to read about a certain disease.

The importance of hand washing has been emphasised for a long time, as it can prevent many diseases and needless mortality and morbidity. Dr Damani notes that “despite the availability of alcohol-based hand rubs in recent years, worldwide compliance with hand hygiene amongst healthcare workers is about 40 percent. This is despite the fact that the importance of hand hygiene in preventing infection in hospitals has been highlighted since the 1800s.”

He further discusses the story behind the large number of maternal deaths in hospitals and the discovery of the reason behind it, and how the simple act of washing hands can prevent mortality.

Anecdotes such as the one where there was problem with cutting a Sikh child’s hair without the parents’ permission, or the one where an elderly Maasai woman drank blood left on her side table in the hospital for transfusion — because she had heard the doctor say that she had lost blood — not only provide interesting reading but give an insight into various cultures and traditions. Sikhs don’t cut hair as part of their five articles of faith, and blood and milk play a considerable role in the traditional Maasai diet.

There’s also interesting information regarding what led to the establishment of the Patient Welfare Society at Karachi’s Civil Hospital and how poverty forces people to make difficult choices, such as even letting some dear ones die for want of resources. At the same time, Dr Damani highlights the empathy and will to help others among medical students and junior doctors, which touches the heart. He also shows the kindness of people in our society who are ready to help others in times of need.

While talking about the origin and treatment of HIV/AIDS, Dr Damani writes: “As Jim Youn Kim, President of the World Bank (2012-19), rightly pointed out, ‘If you look at three diseases, the major killers, HIV, tuberculosis and malaria, the only disease for which we have really good drugs is HIV. And it is very simple: because there’s a market in the United States and Europe.’” The above passage gives readers in developing countries some food for thought and should act as an incentive to reduce our reliance on the West.

While the rich-poor difference is noticeable in the treatment and prevention of almost all diseases, the gap seems to be very wide particularly in the case of rabies. Over 95 percent of human deaths because of rabies occur in Asia, especially in the Subcontinent, and African regions.

Though vaccination of dogs against rabies has substituted the practice of killing stray dogs, “implementing this measure to control rabies is challenging for several reasons,” writes Dr Damani. “Developing countries are having difficulty reaching the childhood vaccination target; unfortunately, the vaccination of dogs is not a priority. As a result, it is estimated that 60,000 deaths from rabies are reported annually from these regions. Rabies vaccine and immunoglobulins which are required for treating rabies, may not be readily available due to poor healthcare infrastructure.”

Conceived during the Covid-19 lockdown, the book is a reminder that, though the invention of the microscope — invented not by a scientist but a draper, who somehow became very interested in lenses and acquired excellent skills in lens grinding — helped in the detection of microbes and finding treatment of many diseases, as Dr Damani writes, “despite human ingenuity, we might win the battle but we will never win the war against microbes.

“Our struggle to fight new and novel microbes will continue until eternity. As Louis Pasteur … concluded, ‘It is the microbes who will have the last word.’”

Reflecting on his life, Dr Damani leaves many lessons for the reader. He writes that he lost the will to live as a child due to his circumstances but, after reading The Myth of Sisyphus by Albert Camus, he learnt that “as individuals we must never give in to despondency. And most importantly, no matter how much we lose in our quest, we must never back down till we fulfil our potential … We must persist in our struggle against life’s essential absurdity and not lose focus on what we want to achieve.”

Overall, it would not be wrong to say that the book reveals fascinating details about Dr Damani, who is truly an inspirational figure; he took chances and, despite facing unimaginable hardships, moved ahead and succeeded.

The references and bibliography at the end of the book add value to this treasure trove of knowledge and will help those who want to further explore the subject.

The reviewer is a freelance journalist. X: @naqviriz

Published in Dawn, Books & Authors, July 28th, 2024