Paul Farmer’s Pathologies of Power is a written protest against the structural violence suffered by the poor. The first half of the book is devoted to anecdotes from his time spent in the rural highlands of Haiti, the HIV quarantine facilities of Guantanamo, the autonomous zones of Chiapas, and the prisons of Russia. Through these anecdotes, Paul gives voice to the suffering poor in these areas in a way that neither dehumanizes nor romanticizes their suffering, a rare feat in literature about poverty.
As a physician, Paul focuses on the ways in which this suffering is experienced through degradation of health. Particularly shameful in these stories is the extent to which the poor suffer and die from curable diseases. “Li mouri bet,” Paul bemoans in Creole at the death of a young man from an infection, “what a stupid death.”
The poor live Hobbesian lives–nasty, brutish, and short–partially because of our market-based approach to medicine in which health is the exclusive privilege of those wealthy enough to afford it. Instead, Paul calls for a far different approach to medicine based on human rights, in which the benefits of medical knowledge developed collectively by the human race are made available to all as their birthright. Health, Paul argues is not a privilege of the rich man, but the right of every person.
In particular, Paul rails against the aid and development community obsessed with “cost effectiveness” who mark the price of a Haitian life shockingly low–less than the cost of a round of antibiotics necessary to treat multi-drug resistant tuberculosis. Complacent in the charity model of health care, the global heath community timidly seeks only to provide the low quality care afforded by the castoffs of the rich rather than call into question the structural violence that keeps the poor in poverty.
Drawing heavily from liberation theology, Paul argues for a reorientation of societal values toward the preferential option for the poor. From the diabetes of Americas urban slums to the HIV of sub-Saharan Africa, the poor bear the majority of the disease burden, and so Paul calls especially on physicians to lead this priority shift to the poor by focus their efforts on those that need their care, not just those that can afford it.
More than some nominal increase in the American aid budget, what is called for is the recognition of the inherent rights of every human being regardless of nationality. This entails the coordinated effort to secure those rights not merely through the charity of the rich, but through the profound alteration of those structures which deprive people of these rights in the first place.
It’s a bold challenge, to be sure, but one of the first that actually has hope to establish a just global society.
[Of note, this is a post from an old blog that I’ve moved here to try and consolidate my healthcare related writing.]