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Transforming Healthcare
Partners In Health celebrates twenty years of treating patients and creating advocates.
By Mara Weiner-Macario
You cannot call yourself humane unless you actually care for (not just care about)
everyone regardless of place, position, or circumstance
Joseph Jeune was weeks away from death, based on the advancement of the
tuberculosis and AIDS infections running rampant through his body; his skeletal
appearance made him look as though he were already dead. Anticipating what they saw
as the inevitable, his family had already bought his coffin. Instead of the coffin, Jeune
visited a Partners In Health (PIH) clinic on Haiti’s Central Plateau.
Six months later, Jeune was not only still alive, he had gained 44 pounds thanks to
a medical regimen that treated his health issues, including HIV/AIDS tuberculosis (TB).
Today, Jeune is an advocate for infectious disease treatment and transformation of the
global healthcare system who speaks out both in his native Haiti as well as at conferences
worldwide. Jeune is an example of both the work of the nonprofit nongovernmental
organization Partners In Health (PIH), and of a changing paradigm in global healthcare.
Until recently, the general consensus among health policy makers was that the difficult
drug regimen required to treat these chronic infectious diseases would not be “cost
effective” for patients in developing countries to follow.
This year (2007), Partners In Health, commemorates the twentieth year of its
founding, and the global work that began with one clinic in Haiti and an effort to treat
one disease, AIDS, among the rural poor. Their initial vision to raise the standard of care
of the poor, has created a collaborative model of working with communities to provide
healthcare and treat infectious diseases by training local educators and advocates and
addressing basic social and economic needs. Their work has taken them outside Haiti by
invitation, to areas including Peru, Rwanda, Lesotho and Boston, Massachusetts.
Dr. Paul Farmer is an infectious disease specialist and one of the co-founders of
PIH, who has dedicated himself to treating infectious diseases, primarily AIDS and TB in
Haiti and poor communities around the world. He is the author of Pathologies of Power
and the subject of Tracy Kidder’s newly released book Mountains Beyond Mountains.
During a speech at Santa Barbara’s Arlington Theatre in October, Dr. Farmer spoke
about Joseph, and how the success of patients like him has broaden the public health
community’s approach to treating the illnesses of the poor. Patients who come to PIH’s
hospitals are suffering from more than just AIDS; the effects of AIDS are made much
worse by poverty and the structural violence inherent in the today’s unequal global
society.
Dr. Farmer’s approach is very simple and his message clear: you cannot call
yourself humane unless you actually care for (not just care about) everyone regardless of
place, position, or circumstance. This idea is at the heart of Pathologies of Power, where
he argues that unequal distribution of power, not just microbes, are part of the pathology
of illness. This is a noble stance, but it comes dangerously close to alienating people who
oppose socialized medicine, or who think the burden of care is relative. Dr. Farmer is no
stranger to opposition, which is why he uses his patients’ stories. It is easier to dismiss
the unseen masses, but much harder to deny the right to live of someone standing in front
of you.
What started out as an effort to treat one disease, AIDS, turned into a mission of
health as well as social justice. Despite PIH’s locally focused model, their approach is
less think globally, act locally and more the global is the local. Everyone deserves the
same care as any one person. Seen from this perspective, it is unacceptable that so many
medical resources are dedicated to prolonging the last few years of life for people living
in developed countries, whilst it is not deemed “cost-effective” to subsidize relatively
cheap generic antiretroviral therapy for millions of people living in developing countries.
If adopted globally, this emphasis on social and economic human rights could lead to a
radical transformation on a scale impossible to achieve by just pushing the political rights
agenda; people cannot press for voting rights when they are confined to a sickbed.
The ideals espoused by Dr. Farmer and Partners In Health may be garnering more
notice. The Council of Science Editors united 237 science and medical journals
worldwide to publish a global theme issue on poverty and human development, released
October 22, 2007. Each one of the 237 journals focused on this theme, simultaneously
publishing more than 750 new articles devoted to this topic. In one of the articles,
published in PLOS Medicine, Dr. Farmer suggested that the single most important
intervention to improve the health those living on less than $1 a day is to hire community
health workers.
As a specialist in infectious diseases working in the poorest country in the
Americas, Dr. Farmer’s work has taken the position of his patients as a point of
departure, “Since the poor are those put at risk of sickness and then denied access to care,
they are in many ways those most affected by codes of medical ethics.” This statement
encompasses two of Dr. Farmer’s points, the first being that there are actual pathologies
of power that result from limitations imposed upon the poor. The second is that these
limitations need not limit the aspirations of those trying to overcome them; they can
instead serve as lessons and inspiration for people dedicated to transforming the lives of
other people, not just treating disease.
Partners in Health: pih.org.
Mara Weiner-Macario is a medical anthropologist who trained at University College
London.