-----Original
Message-----
From: Alice Yang [mailto:ayang@pih.org]
Sent: Monday, August 25, 2003
A review of Dr. Paul Farmer's latest book, Pathologies of Power
Alice
Yang
Partners in Health/Program in Infectious Disease and Social Change
Harvard Medical
School
641 Huntington Avenue
Boston, Massachusetts 02115
tel: 617-432-1928 fax: 617-432-5300
August
12, 2003
By
Maywa Montenegro,
Globe Correspondent
"......
according to Paul Farmer, author of "Pathologies of Power." This
book is Farmer's account of the Acephies of the world - the disenfranchised
poor whose lives so often end in tragic and yet, he contended, wholly
predictable ways. They are victims of "structural violence," falling
prey to treatable illnesses, preventable hunger, and crime, all for the sole
reason of having no money.
In
the first half of the book, Farmer writes through the lens of his own
experience as an infectious disease specialist. Haiti is the country he knows
best and it is from there that he draws most of his examples, but he also has
spent time in Cuba, Russia, Mexico, Peru, and Boston, where he is on staff at
Brigham and Women's Hospital and on the faculty at Harvard Medical School.
From
the hopeful successes of AIDS sanatoriums in Havana to the dismal state of
tuberculosis-racked prisons in Siberia, Farmer documents what he and other
public health workers have encountered in clinics and hospitals, as well as in
prisons and backstreets around the world.
He
contrasts a common ethical dilemma in Boston - whether to continue giving life
support to a brain-dead patient - with an ethical dilemma in Haiti - whether
to begin giving AIDS drugs to someone like Acephie if there is no guarantee of
the clinic having a continuous supply of medications. Money, apparently,
dictates not only the standards of care, but also how we have come to define
the term "medical ethics."
In
the second half of the book, Farmer addresses human-rights issues at length,
offering suggestions for policy measures that might begin to heal the ailing
public-health system. Change, it seems, will not come easy. Farmer argues that
the incidence of disease among the world's poorest people is preordained by
the very structure of today's "free-trade" markets, and that nothing
short of systemic overhaul is needed. Capitalism, by definition, does not
distribute goods or services equally, so ways must be found to allocate health
care, education, and nutrition evenly, and among all people. These things,
Farmer states, are not privileges, but basic human rights.
Farmer's
indictments, especially in the latter half of the book, can be repetitive and
heavy-handed. On the other hand, an unrelenting voice of protest is perhaps
the only way to spur the largely complacent developed world into action.
What
Farmer does most successfully in this book is pull the problem of justice in
health care into unforgiving focus. "Pathologies of Power" is a cry
for those whose own shouts go unheard. It is a bitter dose of medicine doled
out on behalf of the nameless, faceless millions who have no medicines of
their own.
http://www.boston.com:80/ae/books/articles/2003/08/12/a_doctor_cries
_out_for_the_neglected_millions_boston_globe
Copyright
2003 Globe Newspaper Company
The
Boston
Globe
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