Dr. Paul Farmer is an inspiration. A physician specializing in infectious disease as well as an anthropologist, he was one of the cofounders of Partners In Health in 1987 and has devoted his career to helping the poor gain access to medical services and treatment in Haiti, Rwanda, Peru, Mexico, Russia and elsewhere. He is the author of many influential books and essays addressing the impact of what he has termed “structural violence” (the embodiment of poverty and entrenched inequalities as violence) on the health of populations against whom it is directed, as well as a history of Haiti. He was the subject of Tracy Kidder’s bestselling biography Mountains beyond Mountains.
Partner to the Poor is a compilation of essays and talks given by Farmer from 1988–2009. They are fascinating, thought-provoking and, despite the fact that some are over 20 years old, relevant to anyone interested in global health and issues related to its disparities. The book’s four sections address the intersections of anthropology and medicine at different points: culture, history, ethics, human rights; gender, racial and political inequalities; and access to health care and/or its denial.
A prime example of the latter, discussed multiple times throughout the book, is the rapid spread of AIDS in Haiti and Africa during the 1980s and 1990s, and the various approaches suggested for halting it. Many opposed supplying affordable retroviral medications to some of the hardest hit (and poorest) parts of the world because it was not cost-effective and because of concern that there was insufficient infrastructure in those places to ensure the necessary adherence to prevent the emergence of resistant strains of HIV. Those organizations preferred to focus their efforts on prevention rather than on treatment.
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University of California Press
Farmer disagreed with this approach, which, in his opinion, ignored the real reasons for the spread of AIDS, namely the socio-economic forces that had led to the collapse of traditional agrarian societies, as well as entrenched poverty and gender inequality, which were all beyond the abilities of any of the organizations to resolve quickly. Farmer and Partners In Health successfully demonstrated that it was possible to achieve real progress in the fight against AIDS when combining prevention with treatment. (Farmer notes that those models that focused only on prevention ultimately proved completely ineffective.)
Farmer also argues that properly framing the conversations on how to improve global health and defining their context is critical to understanding the challenges involved in doing so and being able to overcome them. When people defend a reluctance to introduce antiretroviral medication to rural Haiti and Africa because of the cost, he advocates using that as the “beginning of a conversation … [rather than] the end of one.” Costs can be brought down, after all, and effectiveness improved.
He wonders how one can seriously frame questioning the use of medications not yet approved for use in children by the US Food and Drug Administration to treat multi–drug resistant tuberculosis, which causes 500 000 new cases annually, as an “ethical challenge.” He points out that this is in fact a litigious, not an ethical concern, and that it does not begin to consider the priorities of those so desperately in need of treatment.
Similarly, he refers to “the near invisibility of the poor” when describing the reaction to a talk given at Harvard University by a Rwandan pediatrician who was presenting the inroads Partners In Health had made in treating cancer patients in Rwanda. After concluding his talk, the pediatrician found himself “upbraided repeatedly about ethical concerns regarding the delivery of cancer care by people not trained in oncology,” despite the fact that there were no oncologists in the Rwandan countryside and that the real alternative was simply to provide no care at all.
Farmer concludes one of the essays by writing that “we have no more excuses for ignoring the growing inequality that has left hundreds of millions of people without any hope of surviving preventable and treatable illnesses.” This uncompromising commitment to social justice, as well as the dedication and steadfast resolve to improve the lives of others are clearly evident throughout the book and his work at large. It is precisely these qualities that have made him an inspiration to so many across the world.