There is a quote (in the last chapter) which captures the essence of Dr Paul Farmers work and philosophy: I have fought the long defeat and brought other people on to fight the long defeat, and Im not going to stop because we keep losing. Now I actually think sometimes we may win. I dont dislike victory. By losing, Dr Farmer is referring to the death of patients despite of their best efforts. He continues: You know, people from our background like you, like most PIH (Partners in Health)-ers, like me were used to being on a victory team, and actually whatre really trying to do in PIH is to make common cause with the losers. Those are two very different things. We want to be on the winning team, but at the risk of turning our backs on the losers, no, its not worth it. So you fight the long defeat.
Farmer adds: If we could identify losers like John [who died despite the efforts made by PIH], and not waste our time and energy on them, then wed all be good, as they say in the States. Right? But the point of O for the P [preferential option for the poor] is that you never do that. You never risk that. Because before you turn your back on someone like John you have to be really sure, and the more you learn about Johns family the more you realize that the whole family, their whole I mean, theyre basically extinct. He was the last kid
Tracy Kidder writes, after have walked for seven hours with Dr Farmer to see two families in Casse near Cange (in Haiti):
I am aware of other voices that would praise a trip like this for its good intentions, and yet describe it as an example of what is wrong with Farmers approach. Heres an influential anthropologist, medical diplomat, public health administrator, epidemiologist, who has helped to bring new resolve and hope to some of the worlds most dreadful problems, and hes just spent seven hours making house calls. How many desperate families live in Haiti? Hes made this trip to visit two.
I can imagine Farmer saying he doesnt care if no one is willing to follow [his] example. Hes still going to make these hikes, hed insist, because if you say that seven hours is too long to walk for two families of patients, youre saying that their lives matter less than some others, and the idea that some lives matter less is the root of all thats wrong with the world. I think he undertakes what, earliesr today, he called, journeys to the sick in part because he has to, in order to keep going. Thats when I feel most alive, he told me once, when Im helping people.
Doctoring is the ultimate source of his power, I think. His basic message is simple: This person is sick, and I am a doctor.
How does one person with great talents come to exert a force in the world? I think in Farmers case the answer lies somewhere in the apparent craziness, the sheer impracticality, of half of everything he does, including the hike to Casse.
Tomorrow: Mountains Beyond Mountains (continued)
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