Some Inspiration from Paul Farmer

As a New Jersey transplant in Michigan, the subject of my former home comes up frequently. When people find out I’ve just moved here, they look at me like I have two heads and ask why. Lots of Michiganders are really down in the dumps. Some people hate the dreary cold winters. Some people are demoralized by Michigan’s anemic economy. Mismanagement of the auto industry is a huge part of the reason for this. The result has been massive layoffs, the general demise of manufacturing in the State, and the highest unemployment rate in the U.S. Michigan is also among the top rated states for highest number and rate of foreclosures in the nation. Economists predict more job losses over the next two years or so before things begin to turn around. Most people are getting the hell out of here. Why am I moving to this god-forsaken place to start my practice? Filial piety. My parents are getting older, and I want to enjoy them while they are still in good health. I want to be here for them when they get older and need my help. I think the good people of Michigan need a community acupuncture clinic. Several, actually.

The local negativity can be annoying. I’ve dealt with it by playing a little game I call Things Could Be Worse. For example, I could be living in a cardboard box under an overpass, or I could be blind or deaf, or both, I could be paralyzed, I could have a job cleaning out port-a-johns, or worse yet, I could still have that horrid job at the direct mail marketing firm creating junk mail for a living.

To lift my spirits, I have been reading a really great book about a very special doctor, Paul Farmer, who worked most of the year without pay in Haiti providing medical care to people who lost their land to a hydroelectric dam. Early in his career he worked four months out of the year in Boston at Brigham and Women’s Hospital teaching and treating patients and living in a church rectory. Farmer specialized in infectious disease and became an expert at treating TB and HIV in Haiti, Peru and Russia. Lisa mentioned this book in THE REMEDY in a discourse on peasant medicine and appropriate technology. MOUNTAINS BEYOND MOUNTAINS by Tracy Kidder is the story of a man whose commitment to helping poor people goes well beyond what most individuals would regard as a reasonable effort. He believed in sacrifice and saw value in remorse and even pity. He would make five-hour treks on foot over steep mountain rocks to visit TB patients who couldn’t make it into the clinic for follow-up appointments.

Some of Farmer’s ideas about how to address inequality in healthcare are useful for CAN members starting community supported practices. For example, Farmer is adept at pointing out the gross inequalities of wealth and healthcare distribution that most people have accepted and take for granted. He criticizes even sympathetic liberals for thinking that the world’s problems can be fixed without any cost to themselves. Farmer didn’t believe that. I think it is useful for us to point out inequalities that exist among our own patients. Is it a guilt trip? Maybe. But the fact remains we need to ask people to contribute to our practices however they can. We need our more financially secure patients to pick up some of the slack for those who are not able to pay their own way, and we need the able-bodied ones to help us run our clinics. This book is full of stories about how Farmer and his colleagues appealed to people of means to help out.

Another interesting philosophy of Farmer’s was that patients are not to blame for “noncompliance,” The only noncompliant people are the doctors. If the patient doesn’t get better, it is the doctor’s own fault, and the doctor should fix it. He reasoned that if it takes five-hour treks, or giving patients something they need, like milk, food, or clean water, the doctor needs to find a way to do it. Farmer regarded medicine as a social science and politics as nothing but medicine on a large scale. He thought physicians were “the natural attorneys of the poor,” and that social problems should largely by solved by them. Most Americans are rich by Haitian standards, but low to middle income Americans still need and deserve to have advocates working for accessible healthcare on their behalf. Likewise, it behooves us to make our prices affordable for people so that they can afford to be “compliant.”

Reading this book made me realize that CAN is social medicine in its own right. It also made me appreciate what I have here in Michigan, even with single-digit temperatures and a sluggish economy. Most people are simply not capable of making the kinds of personal sacrifices that Paul Farmer made to help poor people all over the world, and I include myself in that group. The best thing about Paul Farmer is the example he sets of refusing to accept that nothing can be done to help people who need us and that we have an obligation to do something.