As a child, I remember walking down city streets with my father and feeling embarrassed when beggars reached out to him for money. My embarrassment came from being in a position of superiority over against the poor people who were begging. The situation stirred in me wonder about the way the world’s resources were distributed, a wonder that has never quite left me, so many decades later.
There seem to me two basic and sharply different attitudes toward the world. The first is to accept it as you find it, an awesome mixture of good and bad, of fortune and misfortune. Then life’s task becomes learning how to adapt to situations posed by this world and to come away with the best for yourself and those in your own circle of family, friends and associates.
The second approach is to be radically dissatisfied with things as they are, to recognize that the world needs fundamental change because some of its inhabitants have so much and others have so little. In this vision, life’s task becomes a sustained effort to transform the way the world is shaped, to try and bring about the erasing of its dividing lines, and to heal its wounds.
A common, but surely not universal, tendency among people in late life is to come to terms with the world, to accept its not being what we would like, and to leave to others the struggle for change. Many of us with who have been involved in changing things now feel tired out by the struggle and, in the name of a peaceful existence, are ready to retire from the field of combat.
I doubt Paul Farmer will ever feel that way. This physician, who travels to Haiti, Rwanda, Peru, Siberia and other places marked by destitution, provides health care to the poor with a zeal that seems never to flag. Given his dynamism in early middle age, it seems unlikely indeed that his later life will feature late sleeps and rocking chais.
Back in 1987, when he was a medical student, he led the way in founding “Partners in Health,” an agency dedicated to providing care to people who cannot get it otherwise. With extensive support from individual benefactors and foundations, Partners reaches out to far-flung places around the world.
This organization also undertakes research and advocacy on behalf of the poor in ill health. Dr. Farmer has challenged the view that good health care cannot be delivered in resource-poor settings.
Haiti, in particular, has provided what he calls a “crash course” about the world. That island country’s entire financial resources, he points out, amount to less than the annual budget of the city of Cambridge.
He believes in the radical reform of social structures rather than mere stopgap measures. Good as food pantries are, food security is much better, as Farmer is fond of reminding everyone. But that approach does not prevent him from attending to the needs of the individual patients whom he encounters.
Besides the distant sites, Dr. Farmer also works in Roxbury, Mattapan, and Dorchester, giving people in those communities access to decent health care. It bothers him to see our country reneging on services to its poor. “It feels to me as if we are backsliding,” he said recently. He was speaking to an audience gathered to celebrate the 40th anniversary of CEOC, my city’s anti-poverty agency.
When Hurricane Katrina struck, he happened to be in Rwanda watching the events in New Orleans with citizens of a country that had gone through a bloodbath of civil slaughter. Still, at that moment he felt ashamed of his own country. “The Rwandans were horrified at us letting poor people and people of color be afflicted,” he reported.
He regards it as urgent to fight for the social and economic rights of our people. As remedy for the current malaise, he calls for a widely-based movement to secure those rights. Realistically, however, he terms such a movement “both remote and utterly necessary.”
Farmer might well have taken inspiration from a statement made by Margaret Mead and posted behind the speaker’s rostrum when he spoke. “Never doubt,” she once wrote, “that a small group of thoughtful committed citizens can change the world: Indeed it is the only thing that ever has.”
A thin, fragile looking man, Farmer has become a culture hero, a person who has committed himself radically to the cause of excellent health care for the poor. His story can be found in the 2003 book Mountains Beyond Mountains, written by Tracy Kidder, now available in paper.
Hearing about his work, I admire him but feel some concern about the impact that being so widely extended will eventually have on him. How can one individual, no matter how charismatic, endure the demands placed upon him by so many people in such widely separated parts of the world?
More practically, how can more people who are talented and committed be persuaded to share in a task whose importance cannot be doubted?
Richard Griffin