Wednesday, January 3, 2007

Changing the world...

Over the break, I had the opportunity to do something that I hardly ever do: I read a book that was not related to my academic studies! And, I was very lucky that it was one of the best books that I have ever read. The book is called Moutains Beyond Mountains by Tracy Kidder. It is about the pursuit of Paul Farmer, an M.D./Ph.D. medical anthropoligist/infectious disease specialist who started the organization, Partners in Health as a community-based health organization to give a "preferential option to the poor." This book, written by the journalist Tracy Kidder, is absolutely amazing - both in the way it was written and in the story of Dr. Farmer and what he and his colleagues have been able to accomplish.

Quite possibly the most amazing piece of this book is the demonstration that a few people, who are absolutely dedicated to a goal can accomplish that goal no matter how difficult or impossible it may seem. And, the way to accomplish that goal is to never give up the seemingly impossible ideal behind the goal while looking at the very concrete steps for building a plan to accomplish it.

Farmer's first public health accomplishment was the development on the central plain of Haiti a community health infrastructure, named Zanmi Lasante (Creole for "Partners in Health") that was able to bring real medical treatment to the extremely poor country of Haiti. In order to affect change, he realized that it needed to connect with the everday lived experience of the Haitians. Therefore, his community health program established a whole network of community health providers that are in communities, know the people who they are treating and bring back information about the conditions of those who are sick. Accordingly, Farmer advocated that the sick in Haiti be provided with a modest stipend in order to pay for living expenses while participating in treatment. After being criticized for this decision, Farmer points out that infectious diseases tend to spread because of incomplete treatments; however, if a patient cannot provide for his or her family while on treatment, then it is impossible to ask that person to give up work to take the time to complete treatment. In other words, the treatment is always grounded in the lived experience of the infirm and the poor.

What is extraordinary about Farmer is that he also recognizes that the financial resources for the solutions are grounded in the lived experience of the healthy and the wealthy. While being very critical of wealthy nations and wealthy people (a brief look at Farmer's CV will show that his articles have been less than flattering of leaders of "developed" nations), he also finds a way to connect to their lived experience.

Among the amazing things accomplished by Partners in Health is the treatment of Multidrug Resistant (MDR) tuberculosis beginning in Peru and expanding worldwide. Farmer, and his colleague, Dr. Jim Kim, were able to accomplish this by recognizing the need to become partners with members of the World Health Organization and to respect the worldview of the members while insisting they were wrong. In the same way that Farmer developed a community of members in Haiti (and, subsequently--with help from colleages--in Rwanda, Peru, Russia, the United States, Mexico, Guatemala, and Lesotho) by actively listening and responding to the specific concerns of their patients, they developed a community of WHO professionals by not scoffing at their concerns but by directly confronting them. Rather than shout, "YOU ARE WRONG" and refusing to work with the WHO members because of differences in principles, he engaged the vocal concerns surrounding the costs and "efficiency" of treating MDR-TB in poor populations. In other words, he organized the privileged and the wealthy.

While it is often times not as fun, and much more frustrating, it is also a necessary component of the work that many activists are commited to. Instead of turning our noses and finding people morally reprehensible for not understanding the importance of a struggle, we must engage them if they will let us. As difficult as it is, it is one of the only things that will permit us to succeed. This doesn't mean making a deal with the devil, but it does mean trying to empathize with where the privileged are at now and move them to where we want them to be in the future. Indeed, in a later article, published in Notre Dame Magazine (the whole article is well worth the read as well), Farmer spells out this necessity:

The view of many of my academic colleagues seems to be that good scholarship and activism don't mix. The view of many of my human-rights colleagues seems to be that social and economic rights -- those violated by poverty and disease -- are "pie in the sky." They say they're having a hard enough time getting civil and political rights respected. And the view of many in both sectors seemed to be that the victims themselves should be "empowered" to start their own social movements. Yet those gathered in central Haiti had already started their own social movement. The "missing movement" needs to take place among the privileged, and on the grounds of empathy and solidarity.

I am sure that I will have much more to write on the topic in the future, but the short story is: read this book.


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