Paul Farmer, a physician and anthropologist with twenty years of experience studying diseases in Haiti, Peru, and Russia, argues that promoting the social and economic rights of the world’s poor is the most important human rights struggle of our times. Farmer challenges conventional thinking within human rights circles and exposes the relationships between political and economic injustice, on one hand, and the suffering and illness of the powerless, on the other.

Paul Farmer is a physician, anthropologist & prophet of social justice. He combines an unflinching moral stance - that the poor deserve health care just as much as the rich do - with scientific expertise & boundless dedication.

Pathologies of Power, written before "tè tranble" (the trembling of the earth) provides both global health experts and lay readers alike with gripping first hand accounts of this remarkable doctor's work in Haiti, Africa and the United States. Farmer, an eloquent Harvard Medical School professor, describes his work providing medical care in some of the most neglected and abused populations on earth. Pathologies opens up a broad landscape to navigate regarding possibilities for global health workers and allied professionals. Those interested in alleviating the pain by those who are effected by disease, lack of nutrition, and horrific political and economic circumstances will find Farmers book a useful tool in identifying problems they will encounter in their work. ( )

I bought this book after a discussion here on LT of the aftermath of the Haiti earthquake and Dr. Paul Farmer, the author, who is the founder of Partners in Health as well as the subject of Mountains beyond Mountains.

It is powerful, moving, and difficult-to-read: difficult to read both because of the human suffering depicted in its pages and because parts of it are quite a slog and somewhat repetitive. Dr. Farmer's basic arguments in the book are that health is a human right, but has not been treated as such by traditional human rights organizations; that poor people experience "structural violence" which makes them more likely to be sick, injured, etc., than people with more money; that poor sick people are better able to describe their needs than "experts;" that, following liberation theology, there should be a positive preference towards the poor, rather than the wealthy; and that very often treatments that are known not to work (e.g., anti-TB drugs that don't work on patients with multiple drug-resistant TB) are used for poor people (e.g., in Russian prisons) because the drugs that would work are deemed "not cost-effective."

The first part of the book, in which Farmer uses his experiences in Haiti, Chiapas, Guantanamo (this book was written pre-9/11 and the US prisons for suspected terrorists there, and deals with Haitians with AIDS who were imprisoned there, contrasted with AIDS treatment in Cuba), and Russia is the most compelling because Farmer is able to draw his principles from real experiences. The second part, which is more theoretical -- Farmer is both a doctor and an anthropologist -- is harder to read and for me less interesting.

This book certainly has led me to think differently about traditional foreign aid and the traditional way "donor nations" treat poorer countries. And, another outstanding aspect of the book is the many quotes from poets and other writers.

I've been meaning to read some Farmer for years now and finally got around to it. Gave me a whole new perspective on how the world works, and a new way to think about global inequality. ( )

Tough to get through. I admit that I found the book about Paul Farmer more to my taste than this one by him. ( )

Paul Farmer, perhaps the most famous 'Third World doctor' living today, has written an eloquent and moving plea for a reconsideration of modern approaches toward healthcare in the developing nations in this book, "Pathologies of Power". Based on his personal experiences of care in Haiti, but also his professional visits to Russia, Africa, Central America, Mexico, Cuba and many other places besides, Paul Farmer demonstrates that the problematics of healthcare and those of poverty and inequality are insolubly linked in these nations. Whoever says "heal the sick" must also say "end poverty", for the one is not possible without the other; and whoever says "prevent disease" must also say "destroy socio-economic inequality", for the one is not possible without the other. That is the message of this book.

A large part of the work consists of reflections by Farmer on his experiences in Haiti and elsewhere and on the way in which the current worldwide economic structures engender a genuine and systematic violence against the rights of the poor. Strongly inspired by liberation theology (though not necessarily religious), Farmer eloquently and effectively contrasts the heavy importance attached to individual political and legal rights with the way in which the violations of rights done by structural inequalities and injustices is wholly ignored in the same circles that would complain about the former. Rights issues are the domain of jurists, development issues the domain of (liberal) economists; but the way in which the poor and weak are constantly crushed by the systematic repression that is poverty and inequality, at least as real and at least as much a violation as any torture, that seems to be the domain of nobody at all. As Paul Farmer clearly shows, even in the lately so blossoming domain of medical and bioethics the issue of socio-economic structures is completely swept under the carpet. As he says, this really is the "elephant in the room".

The same also goes for the oft-invoked importance of efficiency. Callous and counterproductive Western, often American, inspired healthcare policies in the developing nations (among which we must now sadly share Russia as well) generally fail at providing effective treatment against simple preventable disease such as TBC, because those medications that would actually help are considered "not cost-effective". This is in fact just a polite way of saying "we don't care about these people", but then phrased in a manner that will lead to less of an uproar in the newspapers. Farmer however is not fooled so easily, and sees this for what it is - a structural repression of the developing nations by the developed ones, in the name of "efficiency", i.e. efficiency in achieving the aims of the Western states.

This book is a very powerful work, and a strong indictment of the prevailing attitude towards healthcare and development issues and the little attention paid to their interrelation. It also demonstrates convincingly how the current worldwide economic system is bad for everybody's health. And what could be a more important thing than that? ( )

2 copies