"I have fought the long defeat and brought other people on to fight the long defeat, and I'm not going to stop because we keep losing ... you know, people from our background ... we're used to being on a victory team, and actually what we're really trying to do in [Partners in Health] is to make common cause with the losers. Those are two very different things. We want to be on the winning team, but at the risk of turning our backs on the losers, no, it's not worth it. So you fight the long defeat"
-- Paul Farmer
i just finished reading tracy kidder's mountains beyond mountains, which left me alternately inspired and uncomfortable, in admiration and in trepidation. the book in effect serves as a manifesto of the philosophy, life and work of physician, anthropologist, epidemiologist and Partners in Health (PIH) founder paul farmer, who has devoted his life--i mean, really devoted his life--to global health issues and their connection to poverty. in january, the devastating 7.0 earthquake that struck Haiti compelled people globally to contribute to relief efforts, and i kept hearing about PIH's history of amazing work in the country. so i picked up mountains beyond mountains ... and feel richer for the experience.
shaped by liberation theology's preferential option for the poor--the belief that followers of Christ should immerse themselves among and serve in solidarity with the poor and marginalized--farmer has fought for resources to treat global epidemics from tuberculosis to HIV/AIDs in the poorest parts of the world. what struck me most was farmer's dogged pursuit of justice whether that meant donning a suit to persuade world health leaders of the morality and logic of dedicating resources to medical treatment for the poor rather than merely prevention (something that wealthy countries take for granted) or walking seven hours along dusty roads in one day to pay medical house calls to just two families living in rural Haiti.
farmer turns standard perspectives of health approaches for the poor on their head by continually reminding us of the humanity of every person, who unquestionably deserves access to high quality health care, food and shelter. he reminds us that we are so used to notions of scarcity that we forget that scarcity is an assumption and not a given that can be replaced with an ethic of abundance. for example, kidder struggles with farmer's decision to spend $20,000 on a medivac unit to fly a young boy stricken with cancer from Haiti to Boston for treatment. arguably, the money could be used "more effectively" to treat dozens of people. farmer responds that while many would criticize the decision as wasteful, few would pause to consider that the yearly salaries of many young U.S. doctors are quintuple the cost of saving the boy's life. coming from a policy analytic background, notions of cost-effectiveness, efficiencies and equity trade offs are familiar terrain for me. so farmer's work was a welcome reminder that those kinds of constructs have the potential to do violence, and to diminish the humanness and value of every person.
reading kidder's book makes me think again of how my life and work could or should join in the "long defeat" of advocating for the poor and marginalized. the near saintliness of farmer's work and love for the poor easily leads me to discouragement or disengagement because farmer just appears as someone with extraordinary gifts--gifts that most of the rest of us lack. but kidder does an amazing job of basically telling us to get over ourselves because that misplaces the focus. it's not about personal efficacy or personal improvement. farmer's colleague, jim, puts it best when he says in the book:
"Paul is a model of what should be done. He's not a model for how it has to be done. Let's celebrate him. Let's make sure people are inspired by him. But we can't say anybody should or could be just like him ... because if the poor have to wait for a lot of people like Paul to come along before they get good health care, they are totally fucked."
let's hope not. i'm grateful for people like farmer who help call and point us toward the path of long defeat.
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