Customer Reviews

Pathologies of Power: Health, Human Rights, and the New War on the Poor, With a New Preface by the Author (California Series in Public Anthropology)

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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?

It's a big world, but we Americans seem to reside in a small one, at least those of us fortunate enough to be insured and able to afford the health care we need. Many fellow US citizens cannot afford to be sick or ill at all, yet their needs may be tended only once they are so ill that emergency room care is required, but maybe not even then. Then there are the desperately poor of other nations and whole regions of the world that have virtually no care at all. This book is about those folks and medicine as it is currently practiced and dispensed here and abroad. Author Doctor Paul Farmer shows that modern medical practice violates the very ethos that spawned the impulse to heal in the first place.

This book has a lot of structural problems that, while off-putting, are easily ignored by the enormous contribution Farmer makes to our understanding of a set of topics that most of us have not thought about at all. This is an important and inspired book, one that is clear and easy to read, although marred by redundancy that a good editor might have helped eliminate. The thesis topic is that the desperately poor deserve more attention, not less as they now are accorded, because they are more vulnerable by definition. Farmer successfully questions the allocation of our resources toward corporate profits rather than treating the poor of the world.

Farmer's case studies based on his experience of working in Boston, Hattie, and the Russian Republic amply illustrate that our health care priorities are backward and unjust at best, pernicious and self defeating at worst. Every medical ethics course in the US ought to require this along with, or in place of, their existing textbooks that grind over the hoary issues of abortion and euthanasia, and a lot of other topics that are luxuries of a rich society that all but ignores those in greatest need.

This book is a collection of several essays that Dr. Farmer wrote while he was on-site in several of the areas where Partners in Health (an org he co-founded, which provides healthcare for the poor, regardless of ability to pay, including case management of complex diseases such as HIV and multidrug resistant TB) operate. From Haiti to Chiapas to the TB colonies in Russia's prisons to Boston's slums, Farmer--ever the anthropologist--is able to see beyond the symptoms he treats and points to a common cause for the poverty, disease, and suffering that he and his colleagues try to alleviate: structural violence. Hence, what one reviewer (who gave an unfavorable review) commented: that what he wrote is repetitive. I think that was the point Farmer was trying to make: these problems all have the same cause.

The book is divided into two parts: in the first part, he describes the situation; in the second part, he provides analysis. Structural violence is the thread that is woven through all of these essays. The overall effect, as you can guess, is unpleasant. After finishing this book, I had the same feeling in my stomach I got when I saw a motorist deliberately run over a slow-moving critter crossing the road late one night. It is a feeling of anger and revulsion, which Farmer--ever the physician--seeks to treat with the very last chapter (Rethinking health and human rights).

I admit his prose sometimes ventures out into the realm of the abstract (he is an academic after all), but concrete stories about people being beaten by soldiers and left for dead make his message loud and clear. He is angry about what he sees and he wants us to be angry too, and rightly so. Why, he asks, in the age of medical advancements and human rights, do we continue to see people dying 'stupid deaths' from preventable causes? It is an important question to ask, given that the fields of medicine and human rights generally think they don't have anything to do with each other. This book should be required reading for anyone who is studying medicine, be it clinical or public health. It should also be required reading for anyone who thinks about studying international human rights law. Finally, concerned citizens of 'donor countries' would be interested to read this book too, if only to urge our lawmakers to make sure that our tax money is not being used to fund dictatorships and dirty proxy wars.

I liked it best for introducing me to the concept of "structural violence" - essentially whenever the way an economy is set up guarantees that people at the bottom will be victims of violence - whether de jure (rape, murder) or de facto (preventable diseases, hunger). And also for introducing me to some excellent liberation theologians who reminded me that not all religious people are despicable hypocrites, and some top, top poets.

Farmer's perspective on countries full of structural violence like Haiti and "shock therapy" Russia is intensely personal, and his entire book comes from one who spends more time curing people than sitting in an office or library and writing. Not to say that is a good or bad thing, but that is the style in which the book is written.

For anyone who is inspired by the remarkable work Paul Farmer has engaged in over the years, this book offers a sound explanation of his guiding doctrine on human rights and healthcare for the poor.

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.

I love this book, as an anthropologist and nurse, I just think this book is so insightful of how to merge disciplines to create positive health outcomes.

This book is a great read and it's good quality too. I bought a used one, and I couldn't even tell if it had been opened before, it looked brand new.

Paul Farmer's Pathologies of Power is a written protest against the structural violence suffered by the poor. The first half of the book is devoted to anecdotes from his time spent in the rural highlands of Haiti, the HIV quarantine facilities of Guantanamo, the autonomous zones of Chiapas, and the prisons of Russia. Through these anecdotes Paul gives voice to the suffering poor in these areas in a way that neither dehumanizes nor romanticizes their suffering, a rare feat in literature about poverty.

As a physician, Paul focuses on the ways in which this suffering is experienced through degradation of health. Particularly shameful in these stories is the extent to which the poor suffer and die from curable diseases. "Li mouri bet," Paul bemoans in Creole at the death of a young man from an infection, "what a stupid death."

The poor live Hobbesian lives--nasty, brutish, and short--partially because of our market-based approach to medicine in which health is the exclusive privilege of those wealthy enough to afford it. Instead, Paul calls for a far different approach to medicine based on human rights, in which the benefits of medical knowledge developed collectively by the human race are made available to all as their birthright. Health, Paul argues is not a privilege of the rich man, but the right of every person.

In particular, Paul rails against the aid and development community obsessed with "cost effectiveness" who mark the price of a Haitian life shockingly low--less than the cost of a round of antibiotics necessary to treat multi-drug resistant tuberculosis. Complacent in the charity model of health care, the global heath community timidly seeks only to provide the low quality care afforded by the castoffs of the rich rather than call into question the structural violence that keeps the poor in poverty.

Drawing heavily from liberation theology, Paul argues for a reorientation of societal values toward the preferential option for the poor. From the diabetes of Americas urban slums to the HIV of sub-Saharan Africa, the poor bear the majority of the disease burden, and so Paul calls especially on physicians to lead this priority shift to the poor by focus their efforts on those that need their care, not just those that can afford it.

More than some nominal increase in the American aid budget, what is called for is the recognition of the inherent rights of every human being regardless of nationality. This entails the coordinated effort to secure those rights not merely through the charity of the rich, but through the profound alteration of those structures which deprive people of these rights in the first place.

It's a bold challenge, to be sure, but one of the first that actually has hope to establish a just global society.

Paul's style of writing is sometimes meandering and disjointed which is why I can't give the book 5 stars, but all in all this book is a must-read for anyone interested in global health or human rights.

How are we all responsible for each other? This book will bring that connection quite clear.