by Barbara Miller
Paul Farmer walks on water for a lot of people around the world, from Haitian villagers he has treated in his clinic to my GW students who he has inspired with his writings. So what to think when one of my favorite economists, Bill Easterly, zaps him in an opinion piece in The Financial Times for promoting programs that have helped the middle and upper classes and bypassed the poor?
Answer: Easterly has a point. International “health rights” cannot only be about providing ARDs (anti-retroviral drugs). Especially if, as Easterly claims, international aid-supported programs are giving access to these life-saving and costly drugs differentially to better-off people in Africa.
This is an ugly thought but one worth pondering. It would not be the first time in international aid that benefits bypassed the poor and landed with the better-off.
If you read Farmer’s books, and I do every year since I assign his writings in my undergraduate and graduate medical anthropology classes, you will see the interplay between Farmer the anthropologist and Farmer the doctor. The doctor wins. Farmer the doctor is interested in treating, not preventing, illness. Treatment, through drugs, wins out over more anthropological concerns about social inequality, causes of poverty, and “solutions” such as empowerment, employment and other ways to reduce inequality.
Farmer has walked the walk in the hard scrabble hills of Haiti (to get a sense of Farmer the humanitarian healer, read Tracy Kidder’s docu-ography of him, Mountain Beyond Mountain). He has seen countless AIDS victims living in extreme poverty. He has been in Russian prisons and seen the ravages of XMDRTB. He has seen the work of structural violence. His medical political activism: He prescribes ARDs and lobbies in Washington for more funding for ARDs.
Pills alleviate pain and suffering and can extend life. A health rights position says that access to such pills should be equal for all. But in the end, pills don’t cure the diseases called poverty and inequality. Easterly offers a corrective view.
Photo, “Pills & Container (Landscape)”, from Flickr via Creative Commons.
anthropologyworks 
ok, so this time i do not waste an email. I’ll write here 🙂 I too had the same thougths when reading about Farmer. I had wondered why when he was so close, he turned to the pharmaceutical companies for answers. It disappoints me, though i still have a profound respect for the man. very well said about “farmer the doctor” vs “farmer the anthropologist.”
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