Thoughts on “Mountains Beyond Mountains” & Global Health Care for the Poor.
Let me start by saying that I highly recommend Tracy Kidder’s book Mountains Beyond Mountains The Quest of Dr. Paul Farmer, a Man Who Would Cure The World. Undoubtedly, I will be contemplating Dr. Farmer’s words and beliefs for the rest of my life. His actions as a medical doctor, anthropologist and humanitarian have greatly impacted my philosophy on global health care, especially in regards to the poor, and my hope is that you will find as much inspiration from his story as I have.
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The popular line of thought in regards to medically treating the poor was, for some time, an issue of great moral, social and human tragedy. To treat the poor with the same drugs and medical regimens as one would treat the rich was seen and portrayed by scientists and experts alike, as irresponsible, an undisciplined undertaking bound for failure. The most proactive of health care providers had long failed to discover ways of treating the most impoverished people groups. Never, on a large scale, had a community of poor people, unable to afford the care they needed or the drugs to save their lives, been equally treated, their overall diagnoses for survival reversed from eminent death to thriving perpetuation, until Dr. Paul Farmer went to work in the central plateau of Haiti. Overall, the impoverished, highly vulnerable societies from Haiti to Sub-Saharan Africa to Central Asia, had been left to die by governments and health care systems designed to simply let the poor pass. It may seem strange to say, but throughout the existence of man, those with the power and wealth have been relegating the poor into systems of unseasonable death by withholding treatment, using every excuse to justify their selectiveness. Inequality has long had a strong hold on the culture of medicine, especially in places like Cange, Haiti, which is exactly where Dr. Farmer went to work.
The most often used excuse for not treating the poor as the rich, is that the poor cannot, obviously, afford it; that they are but a burden on an already strained system, therefore unworthy of being treated. The common line of thought has been to ignore the poor by triaging them into the category Not Likely To Survive. In other words, the more likely a patient is to survive post-treatment, the more likely they are to receive treatment in the first place. And thus the poor perish.
However, based upon what Farmer was able to accomplish in places like Cange and Lima and Siberia, money should never be an end-all excuse when it comes to saving lives. Everything should be done to treat and heal the poor, just as much as is done for the wealthy and their children.
If a community is dying of, for example, Tuberculosis or AIDS in central Africa, and the medications to treat them exist, is it the right thing to treat, save their lives, even if they can’t afford it? The old way of thinking would have said No. And that community would have slowly died because of their inability to pay and the belief that they would be very unlikely to follow up and survive post-treatment, anyhow. Dr. Farmer’s work changed this way of thinking by studying the heart of the problems concerning inequality, taking an anthropological stance first then working vigorously to convince world leaders and the rich to consider equality, to adapt a new perspective toward the poor and follow his well designed regimen for providing the poor with all the care they needed, not just medicine or surgery, but housing, clean water, clothes, and food, too. Farmer dedicated his life to changing how health care is delivered to the poor by showing that the world’s most impoverished could and can be treated and cured effectively and holistically, proving with strong evidence and hard data that equal treatment of the poor was neither a waste of resources nor a waste of time. He proved that equality was not only possible, but that equality made sense from a scientific viewpoint and a humanitarian viewpoint, as well.
Poverty multiplies when governments and the rich ignore the issues of the poor. If we continue to allow ourselves, and those who rule, to make decisions that only benefit the rich, even the wealthiest countries could soon see major decline in their own health care systems and economies.
In Mountains Beyond Mountains Tracy Kidder describes Dr. Paul Farmer’s organization, Partners In Health, as
having an article of faith stating “All Suffering Isn’t Equal.” This saying was generated in reaction to the many times when they had tried to raise money and instead had been offered lectures about the universality of suffering, or simply lines like “The rich have problems, too.”
For too long the West has used arguments such as this in retaliation to actually helping the poor while millions barely survive in a state of poverty unlike anything the United States or Europe possesses. There is an extreme difference between poverty levels across the world, but there is no difference between the people who live across borders. Every person, whether rich or poor, should be treated with compassion and the best health care we have to offer. Many will say it’s impossible. A select few, like Dr. Farmer and his team at Partners in Health, will continue to prove that it’s not.
Dr. Farmer says this,
Resources are always limited. In international health, this saying had great force. It lay behind most cost-effectiveness analyses. It often meant, “Be realistic.” But it was usually uttered, Kim and Farmer felt, without any recognition of how, in a given place, resources had come to be limited, as if God had imposed poverty on places like Haiti. Strictly speaking, all resources everywhere were limited, Farmer would say in speeches. Then he’d add, “But they’re less limited now than ever before in human history.” That is, medicine now had the tools for stopping many plagues, and no one could say there wasn’t enough money in the world to pay for them.