Something I struggled with a lot this summer was the enormous magnitude and amount of problem that exist in our world. Not only in global health, but relating to poverty and inequality as well. I had finished Mountains Beyond Mountains at the very beginning of summer before I left for South Africa. Today I picked it back up for the first time since to glance through the pages and review what I had highlighted. I was amazed at how much I could relate the problems in Haiti to those I had seen in South Africa. It reminded me that issues with global health are truly universal; as Jenna mentioned in her post we sometimes forget that similar problems exist even in the United States. I feel that a lot of people choose to ignore these problems because its easier not to recognize and deny them rather than confront. As I said, I was overwhelmed with the problems I saw in South Africa. Their government is a corrupt mess, the school system a joke, and the healthcare disfunctional. For example, we took two HIV positive children to the clinic to get their blood drawn. Despite appointments, we waited outside in the windy rain for 3 hours. When the nurse practitioner (one doctor comes once a week on Thursdays) took the childrens' blood, not only was she gloveless, but she also simply wiped up spurted blood with a kleenex off the ground. And this is in the most "developed" country in Africa. How do you fix problems like these in countries that we are so unfamiliar with? Especially in areas where cultural myths tell HIV positive men that if they rape a virgin they will no longer be positive? Or where people won't be tested for HIV because of the social stigma? But there's hope. Lou Nanni told me once to focus on people rather than the big issues. Paul Farmer is a great example of this being done. He did not go into Haiti wanting establish an entire hospital, but started going from person to person. By looking at individuals, listening, and aiding with their problems, progress can be made. I think that we can all agree Paul Farmer is wonderful and has done great work in Haiti. There are obviously still a lot of areas in the world with inadequate healthcare. We need more Paul Farmers. Organizations such as Globemed give me hope that more Paul Farmers are on their way. As Globemed focuses on grassroots work, the different partnerships really listen and work with the individuals solving problems on a situational basis. I believe that this approach will work, and the example that people such as Paul Farmer set keeps me from getting caught up in the pessimism that will otherwise take over when looking at some of these global issues.
As I reread these chapters, I was struck by the theme of finding spots of joy in even the darkest situations. Serena sums it up pretty well when she says “you gotta rejoice a little along the way,” even while they were trying to fix the broken down ambulance. Farmer too finds joy in the little things—his fish pond, the walk and visit with Alcante— in the midst of working in an unjustly deprived and dismal environment. He says that he learned to stop getting angry when he transitioned from the US—a world where a major problem is having excess—to poor and needy Haiti; he learned to change the anger into a sense of hope for a dream of equality. I think this is a good lesson for all of us. When we get angry or despairing about the place we are in, be it stressful classes or the MCAT, or a broader sense of anger about the injustices and waste in our world, we too need to find the little things that bring us joy. Though by comparison to those living in Haiti, we have life pretty good, there are still things that can get us down. The best thing we can do is focus on the things that lift us up, and channel that energyinto fixing whatever it is that makes us upset or angry.I was also struck by Farmer’s comments regarding the cost of the Medevac flight; when talking about other ways the $20,000 could have been spent, he points out that even a young doctor often makes about 5 times what the flight cost was—why not talk about other ways that money could be spent? Farmer has a very acute awareness of the disparity in the world, and it seems that he looks at everything through that lens. That raises several questions for us, now and in our futures. When living in a place like Notre Dame, where poverty is not a sight that many of us see every day, I hope that we keep the stories fromMountains Beyond Mountainsin the back of our minds; when we appreciate the nice things around us, I hope that we also recognize what that money could have done. (For instance, I hope that the sight of a sprinkler system calls to mind those can’t even afford clean drinking water.) I hope that we carry this awareness into our futures too; With several of us probably planning on going into the medical field, and all of us coming out of a good school, there’s a good chance some of us will be making a substantial salary. If we find ourselves in that position, I hope that we all remember those struggling simply to survive, and find a balance with our lives. Although it is important to live a life that will make you happy, I hope that we all work in our own ways to promote the cause of global health, and the greater cause of social justice—be it like Farmer working in the field, Tom White financing, or Kidder raising awareness of the disparity and potential for change in the world. I think Kidder’s final quote, the comparison of the sound of drums to the sound of ‘so many heart beating through a single stethoscope,’ accurately sums up the philosophy that ‘the only real nation is humanity,’ and I hope we carry that philosophy with us forever.
The first time I read Mountains Beyond Mountains there was one particular line in the book that made a serious impact on me and is a major reason I wanted to write this reflection. It came when Paul Farmer was describing why he respected Dr. Pérez of Cuba as much as he does. Dr. Farmer says, “He believes in social justice medicine” (207). The reason this struck me is because I believe this description fits Farmer as well as it does Dr. Pérez. In one sentence, this is the essence of Farmer and I believe that if more people could be defined this way there would be far less health inequality in the world. I think this is a profound complement to Dr. Pérez and I certainly hope to be summarized this way some day.
These four chapters to me are some of the most important of the book because they truly show the sacrifices Farmer makes to pursue his “preferential option for the poor” while at the same time highlighting how he does it his own way. I think one of the most important lines to take away from the book comes from Jim Kim when he says, “Paul is a model of what should be done. He’s not a model for how it has to be done” (244). We cannot all be Paul Farmer, however, we can hold similar values and priorities and work in our own way to fight for them.
These chapters describe the intense travel that Farmer has to undergo to juggle the various project’s PIH has taken on and it is difficult not to be overwhelmed just imagining having to take trips like this. The thing that makes Farmer so special, in my opinion, is that his heart is always in Haiti and he is longing to return there. This is the engine that keeps his wheels turning and this seems like one of the key messages of the book. Find a cause you believe in, but more importantly find something you love to push you through the most difficult times. For Farmer this is Haiti and his clinical work, and, as he says to Kidder on page 237, he would be nothing without this. This part of the book highlights how large PIH has become and how that has forced it to evolve, but at its core it is still the organization the Farmer and Ophelia Dahl started so many years back.
Finding something as motivating as Farmer’s work in Haiti may be an impossible goal, but I believe that search is the most important part of being young. This is the best time for us to search out and try to discover what can empower us to accomplish feats as amazing as what Paul Farmer has achieved. This book to me shows just how much is possible when someone truly loves their work and believes in the good one person can create.
Purpose. Young people especially have been attracted to Mountains Beyond Mountains because of the genuine and intense sense of purpose Paul Farmer displays for his work.
Our generation is more socially, environmentally, and politically conscious than ever. We want to know where our food comes from. We want to use recycled products. We find artists that produce independent music. It’s a little simplistic, but I believe all of these little choices are rooted in our desire for authenticity in our lives in a largely profit-driven culture. Many in our generation instead show a motivation to dedicate their lives to work that is purpose-driven.
Paul Farmer and his colleagues have built an organization with a uniquely purpose-driven character. In this section of the book, we see some of the sacrifices Paul Farmer has made for his work. We see him living a hectic life of constant travel and work to build up their MDR-TB program in Peru. We see him in the hospital because of his refusal to address his own health symptoms before they became too severe. We see him struggling with living a life of continually seeing sickness and death. Referring to the health conditions in Haiti, he once says, “Sometimes I get so f*ing sick of it, babies dying….” But amidst all of these trials, we learn more about his spirit.
Ophelia Dahl tells us how Paul has never been depressed. I think the man just has too much faith in what his work can accomplish. He sees what PIH can do amidst all of the challenges and becoming depressed just doesn’t make sense in some way to him.
We also learn more about Jim Kim and his path to PIH. After taking on a few different causes and becoming somewhat disillusioned, he meets Paul Farmer and finds a real passion for health and social justice, eventually co-founding PIH. Among others, his skills in making drugs affordable to treat the poor become extremely valuable. He has since become the President of the World Bank, and judging by this portrait and Farmer’s belief that “you won’t betray the poor” working in policy, he will continue to use his skills well there.
Just like Jim Kim long ago, many people have been inspired by the PIH’s mission of social justice and a preferential option for the poor. This section of the book takes us further into how Farmer and Kim use their sense of purpose to work incredibly hard with their individual skills to expand PIH’s care. GlobeMed was similarly founded with the goal to work for the health of the poor around the world, and I am proud to see this passion and sense of purpose in my fellow GlobeMed’ers at Notre Dame.
By learning from these two men and the founding of Partners in Health, we further our own understanding of global health and social justice and prepare better for our next year of GlobeMed. Does anyone agree? How does a sense of purpose relate to your desire to become involved in GlobeMed? Do you see this in yourself or our generation?