The world is a sick place. Diseases that were conquered decades ago in the United States continue to plague millions. Around the world, crowds of people travel miles on foot to hospitals that lack the equipment to conduct simple, life-saving procedures, or the medications that are plentiful, even cheap, here at home. It's easy to remain unaware of that fact, since those people live thousands of miles away. Besides, we have our own health care crisis to worry about. What do those people have to do with us?
The first trip Paul Farmer took to Haiti more than 20 years ago left him unable to forget the tuberculosis patients who sleep in dirt-floored shacks or the young men and women wasting from AIDS. Since then, he has been on a mission to cure the world's poorest and sickest inhabitants of diseases that disproportionately afflict them. His work is chronicled in Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World a narrative nonfiction account of Farmer's life and work by Pulitzer Prize-winner Tracy Kidder, published in 2003. (The book was required reading for Duke's incoming freshmen this year.)
A Duke graduate who went on to get his medical and anthropology degrees from Harvard, Farmer launched an international organization called Partners In Health through his clinical practice in Haiti, where he built a medical complex. Today, PIH serves communities in Peru, the United States and Russia.
Farmer and Kidder will be in the Triangle this month talking about their work, on Wednesday, Sept. 29, at Duke and Thursday, Sept. 30, at a PIH fund-raiser at Binkley Memorial Baptist Church in Chapel Hill.
Reading about Farmer's work--his life, as the two are completely interchangeable--is overwhelming. He's proof that one person can make an enormous difference in the world, yet most mere mortals could hardly imagine following in his footsteps. Kidder probes the personality behind Farmer's altruism, making note of the long-distance relationship Farmer's young daughter has with her father. But beyond his personal sacrifices, there is also something deeply empowering about the connections Farmer has forged between public health and the fight for global economic justice. Anyone whose humanitarian efforts have been stopped by red tape will relish the way he cuts through the petty politics of budgets and regulations, unflinching in his optimism.
Farmer knows that medicine alone won't save people if they don't have clean water to drink or a decent house to live in, so PIH addresses those needs as well. Its workers build houses, provide potable water to the surrounding area, and teach school to hundreds of local children. In the Central Plateau region of Haiti, health spreads out the way disease and poverty once did.
Farmer finds arguments about "cost effectiveness" morally abhorrent when dealing with HIV patients, and in this way he takes the radical stand that health care is a human right. PIH's annual report contains before and after pictures of patients with HIV and/or TB, their ribcages and faces looking hollow. After only months of treatment, they are barely recognizable and beaming with color. Given Farmer's philosophy, the pictures seem to make a defiant statement: We have no right to give up on these people.
This social justice approach has also resulted in major advances in treating those diseases. Consider the tuberculosis patients who live out their days in crowded prison cells in the former Soviet Union. When funding has run low, drugs aren't always available, and the missed doses lead to virulent and rapidly spreading drug-resistant strains of the disease. By refusing to accept a lower standard for poor people, Farmer treats the global problem.
Dr. Adam Goldstein, a professor at UNC-Chapel Hill medical school, will be bringing his class of second-year medical students to hear Farmer speak. Goldstein's class teaches leadership skills and community service. Students are hoping to launch projects of their own--school clinics in rural areas to address obesity and physical activity, for instance, or substance abuse treatment centers. "We're trying to give them the skills they need to be leaders in serving underserved populations," Goldstein says, "including networking, collaboration, facilitation, advocacy, fund-raising and laying out a vision." The course uses Mountains Beyond Mountains as an example of how to undertake a medical practice that requires networking with community groups, churches, donors and other support systems.
Farmer's saintliness, however, is not necessarily prescribed. "It's a path," Goldstein says. "For some people that's overwhelming. It's tough enough to learn the science of medicine, much less to try to solve all the world's problems. I totally respect people who try to just maintain a good practice and take care of their patients." The students in this class have a "core passion," Goldstein says, and they're trying to put it to work. "We talk a lot about balance in our group and how one balances leadership with providing clinical care, with one's own personal health and providing for one's family."
Goldstein says Farmer is adding to a long tradition of social consciousness in the medical profession. "Frequently medicine is the avenue by which people make connections to these things. What Dr. Farmer does very well is, it's not just about recognizing those relationships, it's challenging yourself to do something about that. By looking at something differently, one can have an impact; by not accepting the negative response, one can't have an impact. He has the vision to see things that others can't, and that's an important vision for us to transmit to our students."
Ultimately, Goldstein says, he hopes learning about Farmer's work will make his students good doctors. "If one person comes out a better physician for having met Dr. Farmer and incorporating his vision into their own, our course will have been successful."
Dr. Paul Farmer and Tracy Kidder will be at Duke University's Page Auditorium on Wednesday, Sept. 29, at 8 p.m. Contact Ryan Lombardi at 684-6389 or firstname.lastname@example.org for more information.
They will be at Binkley Memorial Baptist Church in Chapel Hill on Thursday, Sept. 30, at 7:30 p.m. Minimum donation $15. E-mail PIHEvent@aol.com for more information.