Thought you all might be interested in this since we had Paul Farmer here earlier this year... > > Health Care for the Poorest as a Central Human Right > > March 29, 2003 > > > > > > Paul Farmer, a Harvard Medical School professor and > anthropologist, has helped revolutionize the world's health > establishment's view of health care for desperately poor > people sick with complex diseases like AIDS or > drug-resistant tuberculosis by arguing that they can be > treated. In a new book, "Pathologies of Power" (University > of California), Dr. Farmer, who has worked and lived in > Haiti for the past 20 years, criticizes human rights > advocates and bioethicists for giving short shrift to the > health problems of the poor. Patricia Cohen spoke with him. > > > You argue that the greatest bioethical challenge today is > the lack of health care for the poor, yet bioethicists and > human rights advocates ignore this question. > > The ethical dilemmas that are the primary focus of > conversation in the literature or on hospital rounds are > often about an embarrassment of riches. Making choices that > involve options. How long should we continue life support? > What constitutes brain death? Should we perform liver > transplants for people who are alcoholics? Of course these > are serious problems for families facing grave decisions > for their loved ones. But in Haiti and in other similar > places it's about no options, about lack of access to just > the basics: vaccines, clean water, food, treatment for > tuberculosis or AIDS. > > What changes have resulted from your arguments that the > most destitute can be successfully treated? > > There has certainly been a shift in terms of rhetoric and > even analysis. AIDS is the case in point. It's terrific > that people are questioning the logic that complex care > can't be provided in these dirt-poor communities. The > received wisdom about AIDS is also being challenged because > approaches that did not include care have not worked very > well in settings of great poverty. That said, we're > certainly not at the point where it's conventional wisdom > to say, yes, we very much need to make sure that people > living with both poverty and complex diseases have access > to the care they need. In Africa alone there may be up to > 30 million people living with H.I.V., and it's estimated > that fewer than 1 percent of them are on effective therapy. > > > Of course, I can imagine you're thinking what about Bush's > comments recently, and it would be very shortsighted not to > see that as a major shift. But now we need to see that the > money follows the pledges. > > Why are you so critical of the human rights movement? > > > It's an insider, loyalist critique, since we're part of > that movement. The human rights community has focused very > narrowly on political and civil rights for many decades, > and with reason, but now we have to ask how can we broaden > the view. Civil and political rights are critical, but not > often the real problem for the destitute sick. My patients > in Haiti can now vote but they can't get medical care or > clean water. > > You mention drug-resistant tuberculosis in Russian prisons > as an example of how legal problems are only one aspect of > human rights. > > You have all these young guys dying in prisons, and the > prison doctors and nurses are the ones saying, "We can't > have these young men dying of TB on our watch." I heard > that directly in prisons all over Russia. But the > international human rights community was spending most of > its energy yelling at the Russians for prolonged pretrial > detention. And it turns out that a number of people, > including humanitarian groups from Europe and the United > States, were giving the patient-prisoners the wrong > medicines - cheaper drugs to which these epidemic strains > were resistant. The only way to do the human rights thing > is to do the right thing medically. > > As you often point out, though, even medical care is not > enough. > > I joke around with my friends that after I did my > infectious-disease fellowship, I had to go do my tin roof > fellowship and then my dirt floor fellowship and then my > clean water fellowship and then my girls' tuition > fellowship. > > I went to a little town in rural Haiti a few months ago, > and the village council told me their AIDS prevention > project was to add another year to the local junior high > school in the village because when kids go away to high > school, they get pregnant or acquire H.I.V. Who knew that > you couldn't get involved in H.I.V. prevention without > worrying about whether or not kids had an extra grade in > their village? > > As overwhelming as it is, though, looking back on those 20 > years, our own group, which is very small and underfunded, > has helped build a hospital, open up new clinics and > schools, done many water projects, supported equal access > to schooling for poor girls and even managed to launch a > program to use the most modern AIDS therapies in places > where there are no roads or electricity or ready access to > doctors. > > Does your devotion to the poor sometimes give people a > moral inferiority complex? > > Sometimes, and I actually find it more than a little bit > painful. I'm not an austere person. For me, an area of > moral clarity is: you're in front of someone who's > suffering and you have the tools at your disposal to > alleviate that suffering or even eradicate it, and you act. > I'm not recommending this work for everybody, but it's hard > to turn back once you've seen it, and I've definitely seen > it. > > How did you end up choosing this path? > > My father was not a very orthodox guy. We actually lived in > a tuberculosis bus for 10 years. Back in the 60's, the > public health service did TB screening with mobile X-ray > machines. Then they sold them in public auction, and my > father, then a schoolteacher, bought one and moved in his > eight family members. > > When we were growing up in the campground, we were all sort > of embarrassed by it, but I think all of us now feel > grateful to my parents for having liberated us from > middle-class expectations. This makes my biography sound a > little too neat. I mean we grew up in a TB bus and I became > a TB doctor. We worked picking citrus for about a > nanosecond before my father admitted we could never make > enough for us to live on, and years later I worked with > Haitian migrant farmworkers. But it can be too neat and > still true, right? > > http://www.nytimes.com/2003/03/29/arts/29QNA.html?ex=1050124801&ei=1&en=684 a3 > 304a04c4512 > > > > HOW TO ADVERTISE > --------------------------------- > For information on advertising in e-mail newsletters > or other creative advertising opportunities with The > New York Times on the Web, please contact > [log in to unmask] or visit our online media > kit at http://www.nytimes.com/adinfo > > For general information about NYTimes.com, write to > [log in to unmask] > > Copyright 2003 The New York Times Company > > --- > You are currently subscribed to hhr as: [log in to unmask] > To unsubscribe send a blank email to [log in to unmask] >