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Title: Pathologies of Power: Health, Human Rights, and the New War on the Poor (California Series in Public Anthropology, 4)
ISBN: 0520243269
Author:
Paul Farmer
Publicate Date: 2004-11-22
Publish: 2004-11-22
List Price: $18.95
Average Customer Rating: 4.5
Format: Paperback
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Amazon Lowest New Price: $12.31
Amazon Lowest Used Price: $11.00
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1: Trailblazing
One of the best books I have ever read. Will Dr Farmer please run for Senate.
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2: Admire Paul Farmer, but not necessarily his book; read Kidder instead
Paul Farmer has long been famous, I take it, within the medical community as a brave lifesaver in some of the world's most destitute places. He's lived in Haiti for 20-some years, tending to the poor and sick. He used his success against tuberculosis there as a springboard into Russia, where he's helped prevent the spread of Multidrug-Resistant Tuberculosis (MDRTB) within and beyond the country's prison population. He is, to put it succinctly, a saint.
His fame spread to a much broader audience with the publication of Tracy Kidder's Mountains Beyond Mountains: Healing the World: The Quest of Dr. Paul Farmer. Mountains Beyond Mountains is a hopeful, awe-inspiring, life-changing book. A couple years after reading it, I picked up Farmer's own Pathologies of Power, expecting great things.
It shouldn't be surprising that Farmer is a true Christian. Reading a lot of economics -- and even a lot of politics inspired by economics -- and then reading Farmer, I'm struck by how arid the former sounds in contrast to the latter. A cold calculus might explain to us why we should treat the poor well. Maybe we can justify redistribution to the poor because their utility from one marginal dollar is higher than that for a wealthy person. Or maybe we should aim to stop MDRTB in prisons because those prisoners will go out into the outside world and infect the nonpoor. Farmer cuts through that: *we should help the poor because they are poor, and it is our obligation as humans to serve the least fortunate*.
Not only that: we should help them because, in most every case, their poverty is a sign that we have failed them. Farmer angrily ticks off case after case, most of them straight from his first-hand experience, where what initially looks like a senseless, random death is seen to be a symptom of a deeper systemic problem. The most haunting of these may be the death of a young Haitian girl named Acephie who contracted HIV from a Haitian soldier. She had sex with him because soldiers are some of the few Haitians with dependable salaries. But what led Acephie into that position of economic dependence to begin with? It didn't help that the Haitian government, with the blessing of Western development agencies, had evicted Acephie's family years before to build a dam; the family had to move to higher, poorer ground because of someone's idea of what was good for them. The road from there leads more or less directly to the AIDS death of a Haitian girl. (James Scott's Seeing Like A State contains a lot more tragedies in this direction.)
Pathologies of Power is filled with stories like that. It is not a hopeful book; it is very, very bitter. This despite Kidder's blurb on the cover to the contrary: Kidder recognized the anger, but saw hopefulness that I didn't.
We won't permanently end the suffering of the poor, says Farmer, until we fix the causes of that suffering. He labels these causes "structural violence." Structural violence is what leads poor Haitians to die of preventable disease ("stupid deaths," to use the Haitians' phrase) because the World Health Organization deems their treatment "cost-ineffective," while pharmaceutical companies get wealthy and we argue over the cost-effectiveness of keeping old Americans alive longer. A world devoted to lifting up the least fortunate would stop the stupid deaths first. Drug companies and governments would help the poor *even if there were no money to be made from them*.
Based purely on its message, I couldn't recommend this book highly enough: everyone should learn to think like a true Christian in the midst of rapacious capitalism. But stylistically it's a chore; Farmer is angry, and is lashing out in all directions. His anger leads him to repeat himself 20 or 30 times throughout the book, and to offer very few actual solutions. Which is surprising: the man himself lives to solve the problems of the destitute.
So I think it's vital to differentiate Farmer The Man from Farmer The Author. That's also why I'd recommend that you go right out and read Mountains Beyond Mountains instead: it teaches the same powerful lessons, only a lot more concisely and inspiringly.
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3: Pathologies of Power
Buy this book! Paul Farmer is a highly effective individual, and shows how one man can and did make a difference. He opens the window on what's going on in Latin America.
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4: Health and survival as human rights
Paul Farmer, perhaps the most famous 'Third World doctor' living today, has written an eloquent and moving plea for a reconsideration of modern approaches toward healthcare in the developing nations in this book, "Pathologies of Power". Based on his personal experiences of care in Haiti, but also his professional visits to Russia, Africa, Central America, Mexico, Cuba and many other places besides, Paul Farmer demonstrates that the problematics of healthcare and those of poverty and inequality are insolubly linked in these nations. Whoever says "heal the sick" must also say "end poverty", for the one is not possible without the other; and whoever says "prevent disease" must also say "destroy socio-economic inequality", for the one is not possible without the other. That is the message of this book.
A large part of the work consists of reflections by Farmer on his experiences in Haiti and elsewhere and on the way in which the current worldwide economic structures engender a genuine and systematic violence against the rights of the poor. Strongly inspired by liberation theology (though not necessarily religious), Farmer eloquently and effectively contrasts the heavy importance attached to individual political and legal rights with the way in which the violations of rights done by structural inequalities and injustices is wholly ignored in the same circles that would complain about the former. Rights issues are the domain of jurists, development issues the domain of (liberal) economists; but the way in which the poor and weak are constantly crushed by the systematic repression that is poverty and inequality, at least as real and at least as much a violation as any torture, that seems to be the domain of nobody at all. As Paul Farmer clearly shows, even in the lately so blossoming domain of medical and bioethics the issue of socio-economic structures is completely swept under the carpet. As he says, this really is the "elephant in the room".
The same also goes for the oft-invoked importance of efficiency. Callous and counterproductive Western, often American, inspired healthcare policies in the developing nations (among which we must now sadly share Russia as well) generally fail at providing effective treatment against simple preventable disease such as TBC, because those medications that would actually help are considered "not cost-effective". This is in fact just a polite way of saying "we don't care about these people", but then phrased in a manner that will lead to less of an uproar in the newspapers. Farmer however is not fooled so easily, and sees this for what it is - a structural repression of the developing nations by the developed ones, in the name of "efficiency", i.e. efficiency in achieving the aims of the Western states.
This book is a very powerful work, and a strong indictment of the prevailing attitude towards healthcare and development issues and the little attention paid to their interrelation. It also demonstrates convincingly how the current worldwide economic system is bad for everybody's health. And what could be a more important thing than that?
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5: Pathologies of Power
Read this book. Paul Farmer is one of the few who can enlighten us to a more profound understanding of the mechanisms that underlie disease in so many of its forms. He sees farther than most of us and comes to his conclusions with a gigantic intellect and hard hard hands-on work with the poor and ill for over 2 decades in Haiti and elsewhere. He is our Albert Schweitzer. His concept of "structural violence", that set of social and economic intrastructure deficits that set aside "rich" from "poor" and lays open the environment for not only the contagious diseases like TB and HIV, but also allows for the malnourishment and the reduced choices in nutrition, allows for the maintenance of the dearth of available health care resources, sanitation and educational systems, the conflation of which prevents protection against the illnesses of poverty, puts the reader into the realm of being forced to see a hidden and dirty truth. His prose is mutedly angry. His emotions are unmistakably righteous. His undressing of some of the "liberal" NGO mentality is eye opening. He is the real deal. Read his elegant words and get a glimpse at reality. We are sadly blinded to it by some of the "pathologies" of the powers that be. I have been a physician for almost 30 years. I've given this book to my sons who are young physicians. The thoroughness of his presentation of the causes of the societal ills that allow for the illnesses, and the bibiography that supports his theses are encylopedic in scope. Again, he is the real deal.
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